OBSTETRICS IX THE PHILIPPINE ISLANDS. 255 



the patient could not be saved. The midwife was tranquil, believing 

 that she had done her duty. 



A little over a year ago I was called to the bedside of a woman in 

 Calle Barbosa, district of Quiapo. This woman had been delivered 

 of a live child at 10 o'clock in the evening. 'When I arrived at 2 o'clock 

 the next morning, the placenta had not been expelled. A copious haemor- 

 rhage had ensued, and while I was attempting to intervene, the patient 

 began to collapse. The family subsequently informed me that a Chinese 

 quack had acted as accoucher in the unfortunate delivery, but that he 

 had disappeared upon my arrival. 



Many other cases might be cited of parturients who have died of 

 haemorrhage, victims of the ignorance of the midwives. It is impossible 

 to estimate the number of infants sacrificed by illegal practitioners who 

 have folded their arms., content with a stupid temporizing in the 

 frequent cases of inertia uteri, with the result that the child has died 

 from prolonged detention in the vaginal canal, when a simple applica- 

 tion of the forceps might have saved it. Among numerous cases of 

 this kind I shall cite only one, which I witnessed in an interior street 

 in the barrio of Santa Mesa at the beginning of the present year (1908). 

 The woman was a multipara, her bladder had not been emptied for more 

 than five hours, and the lack of uterine contractions had detained the 

 child in the canal during the period of expulsion. When I sought to 

 intervene with the forceps, the woman spontaneously gave birth to a 

 beautiful and well-formed child which was born dead because of intra- 

 uterine asphyxia, and which could have been delivered alive if the midwife 

 had had intelligence enough to calk a physician at the proper time. 



A large number of women die every year in the Philippines as a 

 result of puerpal infections, not only because the midwives are ignorant 

 of the most rudimentary conceptions of asepsis and antisepsis, but also 

 because the rooms in which the confinements take place are absolutely 

 lacking in hygienic conditions. In the miserable huts in which the 

 poorer classes live, there are at times neither clean water nor soap with 

 which to wash the hands, the work of attending a birth becoming a 

 veritable sacrifice for the physician who finds himself compelled to labor 

 under such conditions, but even under these circumstances it is as a 

 rule useless to advise the jiatient of the absolute necessity of being 

 taken to a hospital where she can have proper attention, such a proposal 

 being acceded to by herself and her family only with the greatest 

 reluctance. 



The aversion which Filipino women have to entering hospitals is 

 clue principally to their great attachment to their homes, together with 

 an excessive love, sometimes ridiculous and. mistaken, for their families 

 and relatives from whom they are seldom separated. They cling to 

 this notion even at the cost of their lives. It is also certain that the 



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