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The choice of methods of making labor easy
AK
ASSN.
OBST.,
GYKEC.,
4KD
A.BD.
SURG.
91
perience, have tried to analyze the various papers on pituitrin; and why some few physicians will not use it, calling it a dangerous drug is beyond me. You would not say you would not use cocaine or ether because Once in a while you had a death from it. I consulted Professor Jackson of the Cincinnati University as to the properties and danger of pituitrin, and he said there was no danger at all if a man understood how to use it. That is the ground which I take. The recent books on therapeutics tell you that there is no danger from pituitrin up to 1 KC., but I never give even 1 c.c., but do’ give one-third to one-half of a c.e. and never repeat it but once. I have not had a death of a mother and not a death of a child so far, and cases that were from fourteen to twenty hours! from the beginning of the labor pains, go three, five or six hours. The gratitude of patients is enough to make me continue this method. Within the next few years I will present my results in case reports. All that I ask is, if you have a normal case, not an abnormal one, try this method and when you have tried it and have seen how beautifully it works, and how grateful the patient is, how the hours of pain are done away with, I think you will agree with me that there is merit in it.
11~. ARTHUR
of Methods 65.)
H. BILL, of Cleveland,
of Making
O., read a paper entitled
Labor Easy.
(For original
article
The, Choic’e
see page
DISCUSSION DR. IRVING W. POTTER, BUFFALO, NEW YORK.-I agree with Dr. Bill that there should be no fads or fancies in obstetrics, but I insist that the use of chloroform is not a fad or fancy. My records prove this. There should be no hurry. Not leong ago I kept a woman three days after rupture of the membranes, and then I delivered her of a normal &Id without injury to her whatsoever. The occipitoposterior positions occur, he tells you, in about 27 per cent of the cases. I find them in about 60 per cent. But that does not make any difference. The tissues of the primipara seem to stretch and dilate easier than those of the multipara. In the past year I have delivered 1130 women. My fetal mortality is now about what I have been striving for, 2.3 per cent. We use chloroform; we do versions; we do not use pituitrin until after the baby is out of the uterus. We do not There is no use pituitrin in cesarean sections until after the uterus is closed. occasion for giving it before. Give it after the uterus is closed and you will have no trouble. That is what version does; it obliterates the second stage. Five years ago there was much discussion on this point. There was no shock then to these labors, and many of them lasted a week. Now we hear from many sources about eliminating the shock of the second stage. Five years ago Dr. Schwarz used to go to sleep. He told me himself that as long as the woman was groaning regularly he could snore easily. (Laughter.) Now, all is different, and we are each of us trying to relieve all the shock and suffering possible by shortening the duration of labor without injury to the mother and child. DR. JOHN NORVAL BELL, DETBOIT, MIClsIGAN.-On this subject I am quite in accord with Dr. Bill. I like his attitude in the whole matter, especially when he s:ays that we should individualize, that we must not treat these eases all along a certain way. I believe Dr. I?otter does a version in all of his cases, or in the vast majority of them. I believe that this is messing it up just as much as Dr. Tate messes it up in his way. I think there is a happy medium, and that is thLis: to relieve the woman of suffering and get her through the labor in the easiest manner possible. We can give the patient scopolamin and morphine in the first stage. We can administer just enough to keep her comfortable until the cervix has softened up and
92
THE
,4l%ERlCAN
JOURNAL
OF
OBSTETRICS
SND
GYNECOLOGY
Then, instead of doing as Dr. Tate does, which the patient is ready for delivery. is a ha.rd thing to do, t.hough he speaks of its being easy, but I find it difficult--do as Dr. Bill does, wait until they are dilated and then do a version if you wish. But you can anesthetize the patient, and, I think, Dr. Potter has taught us that in this $5ay you can dilate the vagina very nicely with the gloved hand and green soap, and go ahead and deliver the child. Why do a version and get all tangled up with the cord? That is what the version usually means-not in the hands of Dr. Potter because he knows how. My method is to give the patients seopolamin and morphine up to the time the cervix is softened, then give ether, use the forceps, deliver the baby, and the patient is comfortable and happy. DR. -4RTHUR H. BILL, (closing).--&. Potter says that if I had stayed in Buffalo and seen all those cases, I would have changed my mind. It would not have changed nly mind one iota,. I know that he can do versions. We can all do versions. Version is all right in its place. There are cases in which version is aclvantage3us and others in whic.h other methods have greater advantage. There is no question ill n+y mind but that the head will come down spontaneously, as I have reported in 6.5 or 70 per cent of the eases, in which it will either reach the pelvic floor or pass through the cervix. Thus there will be many eases in which we simply have to lift, the head over the perineum, and this is so much simpler and gives so much less disturbance that it appeals to one. 80 far as the patient's suffering is concerned, there is no difference. The patient is relieved of pain and knows nothing about the birth in either procedure. The question under eonsideration is the method by which we are to deliver the baby. We are aiming at the same thing in regard to saving the patient pain, but I wish to emphasize the fxt that we should choose only those methods of delivery which seem best adapted to the case in hand, I think the obstetrician should familiarize himself with all methods so that he may avail himself of the method that is best suited to the particular case.
ASSN.
OBST.,
GYKEC.,
4KD
A.BD.
SURG.
91
perience, have tried to analyze the various papers on pituitrin; and why some few physicians will not use it, calling it a dangerous drug is beyond me. You would not say you would not use cocaine or ether because Once in a while you had a death from it. I consulted Professor Jackson of the Cincinnati University as to the properties and danger of pituitrin, and he said there was no danger at all if a man understood how to use it. That is the ground which I take. The recent books on therapeutics tell you that there is no danger from pituitrin up to 1 KC., but I never give even 1 c.c., but do’ give one-third to one-half of a c.e. and never repeat it but once. I have not had a death of a mother and not a death of a child so far, and cases that were from fourteen to twenty hours! from the beginning of the labor pains, go three, five or six hours. The gratitude of patients is enough to make me continue this method. Within the next few years I will present my results in case reports. All that I ask is, if you have a normal case, not an abnormal one, try this method and when you have tried it and have seen how beautifully it works, and how grateful the patient is, how the hours of pain are done away with, I think you will agree with me that there is merit in it.
11~. ARTHUR
of Methods 65.)
H. BILL, of Cleveland,
of Making
O., read a paper entitled
Labor Easy.
(For original
article
The, Choic’e
see page
DISCUSSION DR. IRVING W. POTTER, BUFFALO, NEW YORK.-I agree with Dr. Bill that there should be no fads or fancies in obstetrics, but I insist that the use of chloroform is not a fad or fancy. My records prove this. There should be no hurry. Not leong ago I kept a woman three days after rupture of the membranes, and then I delivered her of a normal &Id without injury to her whatsoever. The occipitoposterior positions occur, he tells you, in about 27 per cent of the cases. I find them in about 60 per cent. But that does not make any difference. The tissues of the primipara seem to stretch and dilate easier than those of the multipara. In the past year I have delivered 1130 women. My fetal mortality is now about what I have been striving for, 2.3 per cent. We use chloroform; we do versions; we do not use pituitrin until after the baby is out of the uterus. We do not There is no use pituitrin in cesarean sections until after the uterus is closed. occasion for giving it before. Give it after the uterus is closed and you will have no trouble. That is what version does; it obliterates the second stage. Five years ago there was much discussion on this point. There was no shock then to these labors, and many of them lasted a week. Now we hear from many sources about eliminating the shock of the second stage. Five years ago Dr. Schwarz used to go to sleep. He told me himself that as long as the woman was groaning regularly he could snore easily. (Laughter.) Now, all is different, and we are each of us trying to relieve all the shock and suffering possible by shortening the duration of labor without injury to the mother and child. DR. JOHN NORVAL BELL, DETBOIT, MIClsIGAN.-On this subject I am quite in accord with Dr. Bill. I like his attitude in the whole matter, especially when he s:ays that we should individualize, that we must not treat these eases all along a certain way. I believe Dr. I?otter does a version in all of his cases, or in the vast majority of them. I believe that this is messing it up just as much as Dr. Tate messes it up in his way. I think there is a happy medium, and that is thLis: to relieve the woman of suffering and get her through the labor in the easiest manner possible. We can give the patient scopolamin and morphine in the first stage. We can administer just enough to keep her comfortable until the cervix has softened up and
92
THE
,4l%ERlCAN
JOURNAL
OF
OBSTETRICS
SND
GYNECOLOGY
Then, instead of doing as Dr. Tate does, which the patient is ready for delivery. is a ha.rd thing to do, t.hough he speaks of its being easy, but I find it difficult--do as Dr. Bill does, wait until they are dilated and then do a version if you wish. But you can anesthetize the patient, and, I think, Dr. Potter has taught us that in this $5ay you can dilate the vagina very nicely with the gloved hand and green soap, and go ahead and deliver the child. Why do a version and get all tangled up with the cord? That is what the version usually means-not in the hands of Dr. Potter because he knows how. My method is to give the patients seopolamin and morphine up to the time the cervix is softened, then give ether, use the forceps, deliver the baby, and the patient is comfortable and happy. DR. -4RTHUR H. BILL, (closing).--&. Potter says that if I had stayed in Buffalo and seen all those cases, I would have changed my mind. It would not have changed nly mind one iota,. I know that he can do versions. We can all do versions. Version is all right in its place. There are cases in which version is aclvantage3us and others in whic.h other methods have greater advantage. There is no question ill n+y mind but that the head will come down spontaneously, as I have reported in 6.5 or 70 per cent of the eases, in which it will either reach the pelvic floor or pass through the cervix. Thus there will be many eases in which we simply have to lift, the head over the perineum, and this is so much simpler and gives so much less disturbance that it appeals to one. 80 far as the patient's suffering is concerned, there is no difference. The patient is relieved of pain and knows nothing about the birth in either procedure. The question under eonsideration is the method by which we are to deliver the baby. We are aiming at the same thing in regard to saving the patient pain, but I wish to emphasize the fxt that we should choose only those methods of delivery which seem best adapted to the case in hand, I think the obstetrician should familiarize himself with all methods so that he may avail himself of the method that is best suited to the particular case.