13.07.2015 Views

History of medical practice in Illinois - Bushnell Historical Society

History of medical practice in Illinois - Bushnell Historical Society

History of medical practice in Illinois - Bushnell Historical Society

SHOW MORE
SHOW LESS

You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

Obstetrics and Gynecology 235pathology <strong>of</strong> obstetric and gynecologic complications. These he freelydissem<strong>in</strong>ated by precept and example to the <strong>medical</strong> men, undergraduateas well as graduate, with whom he came <strong>in</strong> contact. In 1891, he presentedtothe Ill<strong>in</strong>ois State Medical <strong>Society</strong> a masterful description <strong>of</strong> a case <strong>of</strong>advanced abdom<strong>in</strong>al extra-uter<strong>in</strong>e pregnancy. The relationship <strong>of</strong> previousgenital <strong>in</strong>fection and the symptoms <strong>of</strong> early fetal abortion was po<strong>in</strong>tedout, and the pathogenesis <strong>of</strong> the symptoms presented as the pregnancyprogressed <strong>in</strong> its development. The false labor which occurred at or nearterm followed by the death <strong>of</strong> the fetus was described. He po<strong>in</strong>ted out theperiod <strong>of</strong> wait<strong>in</strong>g to allow the placenta to atrophy after death <strong>of</strong> the fetusand the danger <strong>of</strong> too radical attempts to remove the placenta as opposedto marsupializ<strong>in</strong>g the sac and allow<strong>in</strong>g the placental tissue to autolyze andcome away piecemeal. The prognosis, as regards mortality, varied between42 per cent and 88 per cent up to this time, but if only the cases reporteds<strong>in</strong>ce 1886 were <strong>in</strong>cluded, the mortality rate had been reduced to 17 percent by early diagnosis and operation. Failure to operate until some timeafter death <strong>of</strong> the fetus to permit reduction <strong>in</strong> placental circulation resulted<strong>in</strong> secondary <strong>in</strong>fection <strong>of</strong> the sac from the bowel and secondaryperforation <strong>of</strong> the <strong>in</strong>test<strong>in</strong>al wall, with subsequent peritonitis when operationat a very unfavorable time would be imperative as a life-sav<strong>in</strong>g measure.Fenger concluded that, all th<strong>in</strong>gs be<strong>in</strong>g considered, the sooner apatient with ectopic pregnancy was operated upon after the diagnosis wasmade, the better <strong>of</strong>f she would be. The lead<strong>in</strong>g text books on obstetrics today(1954) express the same op<strong>in</strong>ion.In 1892 Dr. Ellen H. Heise <strong>of</strong> Canton described the conduct <strong>of</strong> labor,particularly <strong>in</strong> regard to care <strong>of</strong> the per<strong>in</strong>eum <strong>in</strong> the second stage. Sheemphasized the dangers <strong>of</strong> a too rapid second stage but admitted that <strong>in</strong>desultory labor, gentle manual dilatation might be permissible. Episiotomywas advised <strong>in</strong> rare cases to save tears <strong>in</strong> the marg<strong>in</strong>al <strong>in</strong>tegument <strong>of</strong> thevulva followed by laceration <strong>of</strong> the underly<strong>in</strong>g muscles and fascia.(Thisis the first mention <strong>of</strong> this procedure which I have found.) Dr. Heise believed<strong>in</strong> support<strong>in</strong>g the per<strong>in</strong>eum at the height <strong>of</strong> the pa<strong>in</strong>s, but decriedthe <strong>practice</strong> <strong>of</strong> <strong>in</strong>troduc<strong>in</strong>g the f<strong>in</strong>ger <strong>in</strong>to the rectum to aid this supportas be<strong>in</strong>g "uncleanly and repugnant." Women were just then beg<strong>in</strong>n<strong>in</strong>gto assert themselves <strong>in</strong> the special field <strong>of</strong> obstetrics and were <strong>in</strong>vited topresent papers on the subject before the State Medical <strong>Society</strong>.An idea <strong>of</strong> the prevail<strong>in</strong>g <strong>practice</strong> <strong>of</strong> the time <strong>in</strong> Central Ill<strong>in</strong>ois isga<strong>in</strong>ed from Dr. Thomas J.Whitten's paper on "Management <strong>of</strong> Labor"presented <strong>in</strong> 1892. He stated that, if practicable, the physician should beengaged <strong>in</strong> advance <strong>of</strong> the onset <strong>of</strong> labor and that if there was very markededema <strong>of</strong> the feet and limbs or puff<strong>in</strong>ess about the eyes, the ur<strong>in</strong>e shouldbe exam<strong>in</strong>ed for album<strong>in</strong>. Apparently, otherwise there was no prenatal

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!