Bulletin of the Lying-in Hospital

of the City of New York

JUNE, 1916.

No. 4.

Vol. X.

CONSERVATIVE OBSTETRICS; SOME LESSONS LEARNED IN A TWENTY-FIVE YEARS' SERVICE AT THE PHILADELPHIA LYING-IN CHARITY.1

BY

GEORGE M. BOYD, M.D.,

Professor of Obstetrics, Medico-Chirurgical College; Physician to the Philadelphia Lying-In Charity.

MR. PRESIDENT AND MEMBERS OF THE ALUMNI ASSOCIATION OF THE NEW YORK LYING-IN HOSPITAL: I fully appreciate the honor you have conferred on me in asking me to deliver an address to your Association, and I most cordially thank you. The most courageous would hesitate before accepting such an invitation; for what can one bring to such a body of workers in obstetrics?

I wish to take this opportunity to commend the work of your hospital, which redounds to the credit of its founders and its benefactors, who have organized and built up your great teaching maternity. It is an inspiration to all who are interested in midwifery; a blessing to the community, through the scientific administration of obstetric skill; and a school where the student, undergraduate and postgraduate, may fully equip himself for his life-work. To this Mecca of learning, all who are desirous of acquiring knowledge and skill in midwifery come to sit at the feet of the masters.

I come to you this evening after having served the Philadelphia Lying-in Charity for twenty-five years. Our old maternity was founded in 1828, for the purpose of teaching the medical student and training the obstetric nurse; and since that time, we have been conducting, in a modest way, a work similar to your own. I bring to you little-only a few lessons learned under the hard master, our specialty.

The older members of your society have lived with me through an epoch-making period in obstetrics. We remember the days of "laudable pus" and secondary hemorrhage the days when the existence of 1. Read at a meeting of the Alumni Society of the Lying-In Hospital February 9, 1916.

a pus-tube was doubted, when extra-uterine pregnancy was styled "pelvic hematoma." How fragmentary must have been our knowledge of puerperal infection then! For it was not until 1890 that Döderlein, of Munich, differentiated the several pathogenic organisms found as the causative factors.

We remember the days when Cesarean section was seldom done, on account of its high mortality. At that time, the manual operations were popular; whereas, the use of the hand in obstetrics to-day is almost a lost art. With the appreciation of the value of asepsis, obstetric surgery has been revolutionized. Instrumental methods have taken the place of the manual, and operations once condemned have now been resurrected. (Within the last thirty years, the general rules of conduct in obstetrical cases have been so revolutionized that we may truly state that no department of medical knowledge has been so definitely and positively placed in the domain of an exact science and art as has been the case with obstetrics.)

With all the present-day progress in the science of obstetrics, however, there has not been a commensurate progress in its practice. This I believe is due to the fact that there exist two standards of education: one for the midwife, and the other for the general practitioner. It is unfortunate, as it detracts from the dignity of our profession. The layman is apt to weigh us all in the same scales; and it is hard to teach the community to appreciate skilful work, when the midwife is legally recognized. I am convinced that there should be but one standard in obstetrics. As the midwives have been a failure in Germany, where they have probably been best trained, so are they a failure in this country; and they should gradually, (by means of legislation increasing the requirements for the practice of this profession,) be eliminated. The legal recognition of the midwife makes it difficult for the practitioner of obstetrics to take the right interest in his work, and hard for him to ask and receive a proper reward for his services.

I believe that it also explains the trouble the obstetrician encounters in impressing upon the patients the necessity for skilled care. She will become greatly alarmed and hurry to some hospital for a trivial operation; but if one suggests hospital for her confinement, she refuses. At present, as the result of the efforts to educate the public, the hospital is better thought of than in the past; but even yet, for private patients to go to a hospital in such circumstances is the exception, rather than the rule, in Pennsylvania.

We teachers of obstetrics, along with our privileges, have great responsibilities. We must train the student to appreciate more thoroughly the necessity for the early recognition of complications. "There is no branch of medicine in which the man who has had no special training feels so completely competent as in obstetrics; and yet there is probably no branch in which the incompetent practitioner is capable of doing