Selected writings of John M. Scudder.
As cleanliness was a large part of Prof. Scudder's creed, it is not surprising to find him expressing himself as he does in this editorial. It must be remembered that twenty years ago the management of an obstetrical case was far different from that in the practice of to-day. As meddlesome midwifery is bad, so is dirty midwifery, and asepsis should be rigidly practiced to insure freedom from infection. Dr. Scudder was quick to see the value of the teachings of Crede and others in this line, and was one of the pioneers in favor of a less officious obstetricy.—Ed. Gleaner.
OBSTETRIC HYGIENE.—One would suppose that everything has been said that could be profitable in the practice of obstetrics. Years ago I thought so, but now I believe that there are many lessons the practitioner should learn.
We have been taught the evil of "meddlesome midwifery," and yet the lesson has not been fully learned. I doubt if the majority appreciate the ills that come from the uneasy doctor. Too frequent examinations is a very common failing, and some physicians sit with their fingers in the vagina, uneasily feeling for the presenting part for hours.
The rule should be, make a first satisfactory examination, determining the presentation and the stage of labor. This any one can do, and if he determines the position, so much the better. If it is the first stage no further examination should be made until the second stage is announced by a change in the character of the pains. It is not policy in the first stage of labor to have the patient in bed, much less "bearing down to assist her pains."
It is not usually thought necessary for the physician to wash his hands before an examination, and yet if there is any one thing that I should insist upon, it is that the hands be thoroughly washed in hot water with soap, and the nails cleaned. It is not only the removal of dirt, which is reason enough, but the hands are much softer.
As the woman has freedom of movement and change of position, she does not suffer so much, and comes to the second stage fresh and in good spirits. There is no necessity of bed until the head is pressing on the perineum. If the physician is uneasy, or it is necessary to satisfy the patient, a very satisfactory way to determine the progress of the labor is to hold the hand on the perineum during a pain. If it is carried out by the head, the evidence is better than by a finger in the vagina. Toward the end of the labor the hand at the perineum is in the right place to give any help that may be needed, and to receive the child. Let me say that frequent examinations is "meddlesome midwifery."
"Among many German obstetricians absolute non-interference is the rule in the third stage of labor. The command, 'hands off,' is absolute. The teachings of Crede are tending towards the entire letting alone of the genitals during labor, and the days succeeding it. This distinguished obstetrician, unless some abnormality present, does not make a vaginal examination at all. He makes his diagnosis entirely by external palpation and manipulation. He teaches that one should, for eight or nine days after labor, neither examine, wash out, nor do anything to the genitals, unless there are positive indications therefor."
I endorse the teachings of Crede in this respect wholly and fully, but one must not go to the other extreme, and allow the woman to lie in the dirt of the vaginal discharges, and stink. It should be a rule that all soiled clothing, and such material as protected the bed, should be removed, and the perineum sponged with warm (hot) water, to which a small amount of boras or chlorate of potash has been added. Such sponging every day will be grateful to the patient, and by the removal of the dirt must be beneficial.—SCUDDER, Eclectic Medical Journal, 1888.