Abolish the Midwife.

A young woman, a primipara, was recently delivered by a friend of the writer. The labor was normal, there was no laceration of any kind, and everything went along nicely. On the seventh day the woman had a rise of temperature, following a chill, and began to develop symptoms of puerperal septicemia. There was no local cause to be found and the doctor, a very careful man, was at a loss to account for the sudden appearance of the grave disease. Investigation and inquiry finally elicited the fact that on the day previous, the patient's nurse, an ignorant, dirty old woman, who considered herself competent to deliver and treat post-partum cases, had given her a vaginal injection, contrary to the doctor's directions, and the chamber-pot was the vessel which contained the water for the injection. When upbraided for her unwarranted action, she said that the chamber-pot was clean, that she wiped it herself before putting the water in it. Treatment proving unavailing, the patient was sent to Mount Sinai Hospital. where she died in spite of the best modern treatment.

This incident, which would be comical if it were not so intensely tragic, might serve us as the text for a long discourse. We are the most abject slaves of custom. The greatest absurdity, if only consecrated by long usage, seems to us a perfectly normal thing and excites no comment or criticism. And still, if we only give the matter a thought, it is easy to show the absurdness of many a custom or practice. The medical profession is fighting very hard to prevent unqualified ignoramuses from practicing medicine. Should evidence, for instance, be found that an unregistered man (even if he studied medicine, but failed to graduate or pass the State Board) was treating a case of measles or of bronchitis, he would be arrested and fined. And it would be perfectly right. Human health, human life is too precious to allow ignorant pretenders to meddle with it-and for that reason the midwife is an absurdity. Any old woman, no matter how ignorant or filthy, is considered competent and is permitted to handle a confinement. And how much more, immeasurably more, dangerous is a confinement than a case of measles or bronchitis! In one respect a confinement is more dangerous than any other disease; no disease presents such an extensive raw surface ready for infection, for absorption of pathogenic material. What other disease presents so many possibilities of accident and abnormality? Postpartum uterine hemorrhage, placenta previa, hour-glass contraction, laceration of the perineum or cervix, rupture of the uterus, uterine inertia, breech or transverse presentation, contracted pelvis, prolapse of the funis, non-separation of the placenta, eclampsia, etc., are some of the accidents which are likely to confront us in the lying-in chamber. And the battle with those accidents, some of which present the most formidable problems in medicine and surgery and are likely to make the stoutest heart

quake, is left to the resources of a poor, ignorant woman! It is true that the midwife generally sends for a physician when face to face with some danger, but alas, how often does the physician arrive when it is too late-when the woman's powers have been thoroly exhausted, when she is completely exsanguinated or when irremediable infection has taken place? Every physician with some obstetric experience could tell many a harrowing tale, showing the danger of the ignorant midwife or nurse.

Of course, the customary retort might be made that, after all, most cases of confinement under midwives' hands turn out well. First, this is a great question. What do we understand by "well"? The woman did not die, escaped puerperal fever, and is up and about. Yes, but how many of them become chronic invalids on account of a lacerated and unrepaired cervix and perineum; how many go about with a chronic salpingitis as a sequela of an unscientifically handled confinement? The gynecologist could give us some idea of the number of such women, but the idea would be an imperfect one, for thousands upon thousands avoid vaginouterine treatment, and prefer to leave their ailments untreated or have recourse to some patent medicine. Besides, the above retort that "most" cases turn out well, could be applied with equal force to the general practice of medicine. There is no doubt that most cases of measles, bronchitis, whooping-cough, diarrhea, etc., would recover in the hands of the most ignorant. Nature gives us remarkable recuperative powers, and a patient will often recover in spite of the worst neglect and grossest maltreatment. But this is not what we want. We don't want "most" cases to recover (and recover without complications and sequela), but our aim is to have all recover, and this aim is not furthered by allowing ignorance to meddle with human life.

If the mortality in puerperal cases under the midwife is only 5 per cent higher (and we believe the difference is much more than 5 per cent.) than under the physician's treatment, it is sufficient justification for the complete abolition of that barbaric relic -the midwife. In large maternity hospitals the puerperal mortality has been reduced almost to nothing, o.1 to 0.5 per cent. In private medical practice it is somewhat higher, but every year shows an improvement, as the principles of asepsis are getting more assimilated. Only under midwives' treatment, or rather maltreatment, the mortality remains as high as it was a hundred years ago. On investigating the matter, one finds hundreds of physicians who have not had a single case of puerperal septicemia in ten or more years of practice; they only see such cases when they are called in to treat a patient who had been delivered by a midwife. Let us be consistent and logical. If the practice of medicine by ignorants and incompetents is wrong, then the delivery of a woman by an ignorant and incompetent midwife or granny is doubly wrong; for in a delivery two human lives are involved and the opportunities for mischief and mishaps much more numerous than in many or most of the ordinary diseases.

The midwife has been in existence for many years, and her employment at one time may have been a necessity, but that time has gone, and she must and should go! Our enlightened age cannot permit such relics of ancient times, dangerous to the health and life of mother and child, to continue to exist.

Shall The Midwife Be Abolished?

The above editorial was written by us some time ago; it was accidentally seen by an elderly but very intelligent midwife, and she sent in a note, which instead of printing in the Letters to the Editor Department, we print in this conspicuous place, in order to give it the same prominence that we are giving our editorial. The note, written in German and translated by us, is as follows:

"I don't know whether the midwife could be abolished. I suppose if all the doctors combined, and enlisted the aid of the politicians the women have no votes-they would succeed in abolishing the midwife. But might does not make right, and abolishing the midwife now would be very wrong. You must not abolish the midwife until you abolish poverty. You rich doctors don't know what the midwife means to the poor family. Many poor people cannot afford to pay the doctor fifteen or even ten dollars; and of what use is the doctor to them after he delivered the child? Who is going to bathe the baby or prepare some food for the mother or the other children? Do you know what we midwives do for ten, or even for five dollars? Not only do we deliver the baby-and in normal cases we do it as good as any doctor, and we are not in a hurry either, and we don't use instruments, because we have another case waiting for us, which we don't want to lose-but for ten days we act the part of nurse, cook, chambermaid and washerwoman combined. We bathe and dress the baby and wash its diapers, we prepare food for the mother, we often wash the faces and patch the clothes of the little children and send them to school in proper shape. Once in a while we even wash a few pieces for the mother-in short, we often replace the mother during her lying-in period. Who would be willing to do so much for so little? The birth of a child is not a jolly event in a poor person's house. It would be a much more terrible thing without a midwife. That midwives should possess some knowledge and education all will agree, but I repeat, you must not, for the poor's sake, abolish the midwife until you have abolished poverty."

We will make no comment on our respected midwife's comment. We leave it to our readers.

The Editorless New York State Journal of Medicine.

It is with a sense of genuine regret that we learn of the retirement of Dr. Warbasse from the editorship of the New York State Journal of Medicine. Dr. Warbasse had succeeded in im

parting to the journal a distinct individuality and his editorials and "observations" were imbued with a force and charm, which placed them immeasurably above those of any other State journal in the country. And during his editorship the journal was entirely free from the sins that beset most of the State journals, which render them so obnoxious to the independent and honest thinker, namely: cant, hypocrisy, inconsistency and a tyrannical bureaucratic attitude. Let us hope that now the journal will not be converted into a backboneless, vacillating, vague and hazy soporific nonentity. The medical society of the Empire State of the Union should possess a real medical journal-or none at all!

Vasectomy To Restrict The Propagation of the Criminal

and the Unfit.

We give our fullest approval to the Indiana law, which provides for the performance of vasectomy on criminals and imbeciles. This operation in itself trivial and harmless, effectually prevents the mail criminal from propagating his species. The law reads as follows:

"Whereas, Heredity plays a most important part in the transmission of crime, idiocy and imbecility,

"Therefore, be it enacted by the General Assembly of the State of Indiana, that on and after the passage of this act it shall be compulsory for each and every institution in the State entrusted with the care of confirmed criminals, idiots, rapists and imbeciles to appoint upon its staff, in addition to the regular institutional physician, two skilled surgeons of recognized ability, whose duty it shall be, in conjunction with the chief physician of such institution, to examine the mental and physical condition of such inmates as are recommended by the institutional physician and board of managers. If in the judgment of such committee of experts and the board of managers procreation is inadvisable, and there is no probability of improvement of the condition of such inmate, it shall be lawful to perform such operation for the prevention of procreation as shall be deemed safest and most effective."

Within the first year after the law went into effect 296 perfectly successful vasectomies were performed in the State Reformatory. Neither local nor general anesthesia was found necessary and the prisoners did not have to lose one hour's time from their work. It is well to bear in mind that this operation leaves. the man in full possession of his sexuality. He has the libido and orgasm, but is sterile and can not impregnate any woman. Semen is secreted, but it of course can not reach the ejaculatory duct and is reabsorbed. So far women have not been subjected to the operation of the law, tho it is applicable to both sexes.

Copyrighted, 1909, by William J. Robinson.

Letters from the Editor.

DEAR CHILDREN:

Lugano-Paradiso.

LUGANO-PARADISO, July 22d, 1908.

The place we are stopping at now is called Paradiso, and if any place in the world was ever entitled to the name Paradise, this one surely is. The air is mild and soothing, the sky is of the purest azure, and the lake of Lugano (which the Italians call Lago Ceresio), trimmed all around with beautiful gardens and villas, is constantly smiling, as if it felt secure in the knowledge that no harm could come to it so long as it was watched and guarded on all sides by such faithful and powerful mountains as Monte San Salvatore, Monte Generoso, Monte Caprino and Monte Bré. (Can you notice the sweetness of the sounds in the very names of those mountains? You could if you heard the Italians pronounce them.)

We spend very little time in the rooms-only the time we sleep. Even our meals we take in the open-in the garden. And a good deal of the time we walk about in the immense villa attached to the hotel, and pick flowers, pears, etc. There are walnuts, figs and olives in profusion, but they are not ripe yet.

It is nearly seven now and we are sitting out on the balcony; at our feet is the lake of Lugano. The hotel has a lake frontage of three hundred feet and each and every room has a balcony directly over the lake. On the balcony next to us an old German is puffing his long pipe, and seems to be supremely contented. At the harmonious beauty and sweet peacefulness of the scene, a sense of harmony and peace fills my soul, and I feel reconciled with the world. But for only a brief moment. For, unfortunately, I am not possessed of that self-hypnotizing power of the New Thoughters, Christian Scientists and other muddleheads, which could make me imagine for a moment, that everything is nice and lovely in this nice and lovely world, and that we are to be profoundly grateful for the great gifts and blessings which we, unworthy sinners, receive from the hands of the almighty and allmerciful God. For, whatever my personal condition may be, I cannot forget for a moment that this world is full of poverty, full of terrible suffering, of unkindness, uncharitableness, cruelty. I see it even here, in this beautiful Paradiso. And I rebel with every fibre of my soul against the cruel theologic dogma, that suffering is something useful, something necessary, something sent into this world by divine providence to try, to strengthen, to purify and to chasten men's souls.

I admit that a selfish, hard-hearted, thoughtless man or woman may sometimes be brought to his or her senses, may