LIST OF CONTRIBUTORS TO VOLUME CIV. Those whose names are marked with an asterisk have contributed editorial articles. ABRAHAMS, ROBERT, M. D. ABRAMOVITZ, M., M. D., Baltimore. AGER, LOUIS C., M. D., Brooklyn. APFEL, HARRY, M. D., Brooklyn. BABCOCK, ROBERT H., M. D., Chicago. BABCOCK, W. Wayne, M. D., Philadelphia. BAILEY, PEARCE, M. D. *BAILEY, WILLIAM S., Jamestown, N. Y. BALLIN, MILTON J., M. D. BARNES, NOBLE P., M. D., Washington, D. C. BARNES, WILLIAM S., M. D., New Haven, Conn. BARUCH, SIMON, M. D. BEEBE, S. P., Ph. D., M. D. BEHAN, R. J., M. D., Pittsburgh. *BISHOP, LOUIS FAUGÈRES, A. M., M. D. BONDURANT, EUGENE D., M. D., Mobile, Ala. BONN, HARRY K., M. D., Indianapolis, BOOGHER, LELAND, M. D., St. Louis, Mo. BOWERS, PAUL E., M. D., Michigan City, BOYD, W. A., B. S., M. D., Baltimore. BRAV, AARON, M. D., Philadelphia. BRISTOL, LEVERETT DALE, B. S., M. D., BRODER, CHARLES B., A. B., M. D. BUERGER, LEO, M. D. BURRY, C. B., M. D., Woonsocket, R. I. BURWELL, HARTFORD R., M. D., Washington, D. C. BUSH, A. D., M. D., Los Angeles, Cal. CARRINGTON, J. ОTIS, M. D., Malden, Mass. CHARBONNEAU, LIONEL C., M. D., Brooklyn. *CLOUTING, CHARLES A., M. D. COOK, GEORGE WYTHE, M. D., LL. D., COTTON, HENRY A., M. D., Philadelphia. CRAIG, C. BURNS, M. D. Geneva, Switzerland. DAVIN, JOHN P., M. D. DECKER, JOHN J., M. D. *DEEKS, W. H. DELPHEY, EDEN V., M. D. DENCH, EDWARD B., M. D., F. A. C. S. DERCUM, FRANCIS X., M. D., Philadelphia. DICKIE, PERRY, M. D. DIEFENDORF, BURKE, M. D., Hillsdale, N. Y. DORÉ, G. R., M. D., Bordeaux, France. DUNCAN, CHARLES H., M. D. EARP, SAMUEL E., M. S., M. D., Indianapolis, Ind. EASTMAN, JOSEPH RILUS, M. D., Indianapolis. *EGGLESTON, CARY, M. D. ELIOT, GUSTAVUS, M. D., New Haven, ELSBERG, CHARLES A., M. D. GALLANT, A. ERNEST, M. D. GANT, SAMUEL GOODWIN, M. D., LL. D. GORDON, ALFRED, M. D., Philadelphia. GREELEY, HORACE, M. D., Brooklyn. GREGORY, WILLIAM M., M. D., Berea, GRIFFITH, J. P. CROZER, M. D., Philadelphia. GRULEE, CLIFFORD G., M. D., Chicago. *GWATHMEY, James Tayloe, M. D. HALL, WILLIS H., M. D., Carina, Cal. HALLOCK, FRANK K., M. D., Cromwell, Conn. HANLEY, LAWRENCE G., M. D., LL. D., Buffalo. HARRIGAN, JOSEPH D., M. D., Carmel, N. Y. HARROWER, HENRY R., M. D., F. R. S. M., Los Angeles, Cal. HARTSHORNE. ISAAC, M. D. HARTZ, H. J., M. D., Philadelphia. HELLMAN, ALFRED M., B. A., M. D., HENIN, CHARLES C., M. D., Springfield, HERB, FERDINAND, M. D., Chicago. HIRSHBERG, L. K., M. D., Baltimore. HOFF, LOUIS L., M. D., Holyoke, Mass. HORN, HENRY, M. D., F. A. C. S., San Francisco. HOWARD, JAMES HAROLD, M. D., York, Pa. HUBER, FRANCIS, M. D. HUBERT, L., M. D. JOERG, OSWALD, M. D., Brooklyn. Jost, W. E., M. D., St. Louis. KAHN, L. MILLER, M. D., F. A. C. S KEILTY, ROBERT A., M. D., Philadelphia. *KEYES, EDWARD L., JR., M. D. KING, CLARENCE, M. D., Franklinville, N. Y. *KING, HOWARD D., M. D., New Orleans, La. KING, JAMES JOSEPH, A. B., M. D. KINNEY, WILLARD H., M. D., Philadel phia. KLEIN, S. R., M. D., Ph. D., Norwich, KNAPP, ROBERTS S., M. D. KOENIG, EDWARD C., M. D., Buffalo N. Y. LADD, JOHN M., M. D., Indianapolis, Ind. LANE, JOHN E., M. D., New Haven, LAPHAM, MARY E., M. D., Highlands, LAUTMAN, MAURICE F., M. D., Hot *LAVINDER, CHARLES H., M. D. LEARY, J. T., M. S., Philadelphia. LEE, EDWARD WALLACE, M. D. LESLIE, R. MURRAY, M. A., B. Sc., M. D., London, England. LEVIN, OSCAR L., M. D. LIKES, SYLVAN H., M. D., Baltimore. LOTHROP, EARL P., M. D., F. A. C. S., LUBMAN, MAX, M. D. MCCASKEY, G. W., M. D., Fort Wayne, *MCCHESNEY, PAUL ELY, A. B., M. D., MCDOWELL, W. M., M. D., Seattle, Wash. McIVER, JOSEPH, M. D., Philadelphia. MACY, MARY SUTTON, M. D. phia. MANDL, NICOL MARTIN, M. D. Philadel- MANKELL, NATHALIE K., M. D., Buffalo. MARKENS, EDWARD W., M. D., Newark, MARTIN, WILLIAM, M. D., Atlantic City, MARTOCCI-PISCULLI, L., M. D. MAY, ARNOLD H., M. D., Buffalo, N. Y. MAYS, THOMAS J., M. D., Philadelphia. MILLER, CHARLES C., M. D., Chicago. MINOR, JAMES CABELL, M. D., Hot MORALES-MACEDO, C., M. D. MORRIS, ROBERT T., M. D., F. A. C. S. MOSHER, ELIZA M., M. D., Brooklyn. F. A. C. S., Brooklyn. *REED, ALFRED C., M. D., San Francisco, REED, CHARLES A. L., M. D., Cincinnati. RICHTER, GEORGE, M. D., St. Louis, Mo. * *ROBERTSON, W. E., M. D., Philadelphia. RODDY, JOHN A., M. D., Philadelphia. ROSENZWEIG, S. Bernard, M. D. SACHS, B., M. D. SAISON, CONSTANT, M. D., Paris, France. *SAJOUS, LOUIS T. DE M., M. D., Phila- SALE, WALTER W., M. D., Covington, SAPHIR, JOSEPH F., M. D. SAYRE, REGINALD H., M. D. *SCARLETT, RUFUS B., M. D., Trenton, SCHACHNER, AUGUST, M. D., Louisville, *SCHAMBERG, JAY F., M. D., Philadelphia. SCHEPPEGRELL, WILLIAM, A. M., M. D., Schneyer, JulIUS, M. D., Philadelphia. SHEEHEY, JOHN J., M. D., Brooklyn. *STEINBUGLER, WILLIAM F. C., M. D. STEWART, DOUGLAS H., M. D., F. A. C. S. STEVENSON, W. W., M. D., Trenton, N. J. STOCKTON, CHARLES G., M. D., Buffalo. *STRICKLER, ALBERT, M. D., Philadelphia.. *TALBOT, WINTHROP, A. B., M. D. TALMEY, MAX, M. D. TAYLOR, A. L., M. D., Fort Worth, *TAYLOR, J. MADISON, A. M., M. D., TAYLOR, JOSEPH C., M. D. THEOBALD, SAMUEL, M. D., Baltimore. TILNEY, FREDERICK, M. D. *TILTON, BENJAMIN T., M. D., F. A. C. S. UBEL, GEORGE B., M. D., Ithaca, N. Y. VANDERVEER, ALBERT, M. D., LL. D., VAUGHAN, J. WALTER, M. D., Detroit, VEDIN, ALMA, M. D. *VEDIN, AUGUSTA, M. D. VICTORS, ERNST ALBRECHT, M. D., San VOORHEES, IRVING WILSON, M. S., M. D. WALSCHEID, A. J., M. D. WEINGRAD, SOLOMON, M. D., Mountain- WEINSTEIN, JOSEPH, M. D. WEISS, SAMUEL, M. D. WENDER, LOUIS, M. D., Washington, WESSON, MILEY B., B. S., M. D., El *WHEELER, CLAUDE L., A. B., M. D. WIENER, SOLOMON, M. D. WIGHT, LUCY OSBORNE, M. D. WILCOX, REYNOLD WEBB, M. D., D. C. L. WILLIAMS, B. G. R., M. D., Paris, Ill. *WILSON, H. AUGUSTUS, M. D., Phila- WISE, FRED, M. D. WOLF, HEINRICH F., M. D. WOOD, ALFRED C., M. D., Philadelphia. WRIGHT, HAROLD W., M. D., San Fran- New York Medical Journal INCORPORATING THE Philadelphia Medical Journal and Medical News VOL. CIV, No. 1. the A Weekly Review of Medicine, Established 1843. NEW YORK, SATURDAY, JULY 1, 1916. Original Communications CONSERVATISM IN OBSTETRICS.* BY EDWIN B. CRAGIN, M. D., New York. The The last few years have witnessed the development of radical surgical obstetrics and brilliant the results have been. Long lists of Cæsarean sections have been published with little if any mortality, and the indications for the operation have been extended by some to include placenta prævia, eclampsia, accidental hemorrhage, etc. The question before us is: Are we in our enthusiasm over radical obstetric surgery neglecting the fundamentals of obstetrics; the routine precautionary methods which may make the resort to radical obstetric surgery unnecessary? The consultant still sees cases of puerperal infection; of ruptured uteri; of undiagnosed posterior positions of the occiput. He sees cases in which forceps have been applied too early, cases in which version has been attempted too late. We can only conclude that, in spite of brilliant results along certain lines, the fundamentals of every day obstetrics are still neglected. It is freely admitted that pelvimetry does not always tell whether a child can be born through the natural passages or not. angle of junction of lumbar spine and sacrum may be such as to prevent the entrance of the fetal head into the pelvis in spite of large pelvic measurements. The writer has several times been obliged to perform a Cæsarean section upon a woman whose pelvic measurements were justo major, and whose dystocia came as a surprise, demonstrated only by hours of test labor. On the other hand, careful pelvimetry tells a great deal, and if a careful pelvimetry of the inlet and the outlet of the pelvis is practised during pregnancy and especially if coupled with it there is a careful comparison of the size of the presenting part and the brim of the pelvis, the surprises will be few and the possibility of dystocia can usually be foretold and provided for. The mouldability of the head and the strength of the uterine contractions are always uncertain factors in the problem, but pelvimetry will usually tell us at least one factor in the problem and should never be neglected. Pelvimetry is a part of conservative obstetrics, as it will disclose a large percentage of cases in which delivery through the natural passages Read before the Eastern Medical Society of the City of New York, Friday evening, May 12, 1916. WHOLE NO. 1961. is impossible, and these are in the women who should not be allowed to lower their vitality or the vitality of the child by labor. Furthermore, it will disclose a certain percentage of cases in which, if premature labor is induced, delivery may be accomplished without resort to radical obstetric surgery, even if forceps or version is necessary. The importance of uranalysis in the care of an obstetric case has long been recognized, but the importance of regular and frequent examinations seems to have been neglected by many. It is freely admitted that a fulminating case of eclampsia in which the urine was normal on ordinary examination a week before, will occasionally occur. is exceptional, however, and the rule is that if the urine is examined every two weeks, danger signals will be disclosed long before the eclamptic seizure, This The value of taking the blood pressure of a pregnant patient has only recently been recognized, yet it is one of the best criteria of the condition of the woman and her avenues of elimination, and the obstetrician who omits it from his routine procedures in the care of his obstetric cases is not doing his duty. With the portable, relatively inexpensive sphygmomanometers on the market, there is little excuse for the neglect of the blood pressure, and the more we study results the more we become impressed with the fact that a pregnant patient with a blood pressure of 140 or over is usually suffering from a serious toxemia. The importance of taking the blood pressure at short intervals during pregnancy and the valuable information to be gained by seeing the patient, noting the presence or absence of edema, makes it necessary that she should visit her obstetrician frequently during pregnancy and that simply sending the urine is not sufficient. Now let us come to the delivery itself. I am writing for general practitioners. What precautions are you taking against puerperal infection, still the nightmare of the lying-in chamber? Do you provide yourselves with a sterile gown and with sterile rubber gloves? The time has passed when it is safe. for a man to deliver a woman without all the precautions which the laity recognize as important in safeguarding a woman against infection. The use of rubber gloves is one of the safeguards known to the laity, and if a physician has not worn sterile rubber gloves and happens to have a case of puerperal infection, his lot is certainly not a happy one, Copyright, 1916, by A. R. Elliott Publishing Company. |