Queries and Minor Notes
Journal of the American Medical Association
To the. Editor:\p=m-\Ithink no article has appeared in The JOURNAL in a year that has done so much good as the one on "The Management of Normal Labor." When I first saw the article, I did not read it, believing it to be a well-selected cull from approved text-books, but when I noticed the subsequent criticisms, I did as thousands of other physicians have done\p=m-\readit all\p=m-\andwas benefited. It is an article that provokes discussion and brings out clinical facts from personal experience.
... rsonal experience. Perhaps the best way to manage normal labor is to let it alone, but you cannot hold down a job and do that; yet, meddling and continually doing something is as dangerous as a safety razor. Shaving genitals is on the border line of malpractice. I wonder if any physician ever did shave the genital organs and put them in even a relatively aseptic condition? How infrequently do we\ see even the pubes and vulva shaved without capillary oozing! If there is no oozing, examination with .a glass shows sebaceous glands torn open, the epithelium scraped off and the papillary layer in the most favorable condition for infection. Then look at the bayonet bristles that result from culling oil' the hair; they will set some patients wild and make all feel uncomfortable, while the constant prickling sets up an ideal dermatitis, favoring infection. I can scarcely imagine a doctor or nurse shaving the hair from the folds and the anus of any nervous woman in labor with a congested vulva, especially if she is fat. 1 would like to see a doctor go into a rural district, or into the factory wards in which there are five or six neighbor women and. perhaps, the mother of the patient-all mothers of huge families of children-and watch the doctor strip his patient and go at her with soap and scrub-brush, la liier and razor. 1 want him to be a doctor that bus "done" me ¡it some time, so that I do not feel too quick a call of professional duty in pulling him from under. It is not the hairy or woolly animals, or women, that have puerperal fever. The majority of healthy mothers are those who would not know a vaginal syringe from an atomizer. 1 feel sure that shaving the genitals of women who are confined would raise the number of infected cases 50 per cent. In twenty-three years' practice in one city of 8,001) inhabitants, with a thickly settled .surrounding country. I have seen but three deaths from infection following normal labor.