 A hundred and fifty. Sixth, number forty. Yeah, half CC, but run a little bit. Get the scope. Good evening, Dr. O'Donnell. Oh, she is dead. Now her striving body that brought her life into the world is cold and empty. Now her blood that was bringing heat and life to them is turning from red to purple. A well-developed white female of thirty. There was no indication of cardiac trouble during labor. Following a spontaneous delivery, her pulse became rapid and her blood pressure dropped suddenly. Cause of death is certified to have been acute heart failure. Contributing cause, mitral stenosis and pregnancy. But there were seven of us. Was there one balanced second when we could have held the life flowing from her? Maybe the record was filled in in advance. She was born and lived and created a life. And tonight she's dead in a hospital basement. But when? At what sudden signal did the complex organism of her life start to fail? Maybe there's a design. An eye for an eye. A tooth for a tooth. A life for a life. Perhaps there's a design. Eye for an eye. Tooth for a tooth. A life for a life. Perhaps there is a design, but we don't know it. We stumble and search and sometimes think we see light. Then it's dark again. As biologists, we know that death is not the inevitable consequence of life. The stuff of life has never died since it began. Now that's cold comfort to a husband in a waiting room or a child who has lost the love of flesh and blood. No, I can't disclose a pattern of life and death for you, Donald. But I know this. That we cannot learn too much about the business of bringing life into the world. The night that you lost a patient, perhaps she could have been saved. Perhaps she couldn't. Of all, Aisman's heart disease is the one that blows out the candle most often. But if you want to learn and if you want to be sure, there's nothing in all medicine and surgery that requires broader knowledge than obstetrics. Too many have thought too long that having children is a normal process. It should be. In modern times it isn't. Of course, among insects, it's normal for the female to die after reproduction. Some die spawning. Floods and erosion are normal in nature. Perhaps human erosion is normal. Too many still think so. The damnable thing is, where are you youngsters to learn? Right now, for all these grand clinics, 90% of our babies are brought by men with 5% training. We don't open up our science to enough men. Only four out of 50 of your class will get a residency in a hospital. There is a place for Donald. There in the slums, where two young doctors are bringing modern science to the poor women of the city. If you want to start over and work as you've never worked before, if you want to learn and teach as you learn, there is a place. Trinity Center. Has she had a baby or is she having a baby? Please. Moran. M-O-R-A-N. Your address please. 4056 Fulton. Has your wife been coming to the center? Fine. Is she having pains? When did the pain start? How often are they coming? Has she had any children before? Now you collect some newspapers, stacks of newspapers. Get two clean kettles and put some water on to boil. Be sure the kettles have covers. Do you have any oil cloth in the house? All of oil? Now don't you worry, the doctor will be right over. It's south of Lincoln Park, doctor. Trinity Center. Trinity Center. Has she had a baby or is she having a baby? What is the name please? Address? 1251 Monroe Avenue. Is your wife having pains? How often are the pains coming? Has she had any children before? Now you collect some newspapers, stacks of newspapers. Get two clean kettles and put some water on to boil. Has there been any sickness in your family? Yes. Any cancer? No. What floor? Do you have a telephone? What is the name of your closest relative? About how many months pregnant would you say she is, doctor? About seven months. Could you hear the baby's heart beats? Teeth, throat, heart, lungs, blood pressure 140 over 90. Mrs. Olson has been having headaches every day. Almost every morning. Is your husband working, Mrs. Olson? Two days a week. Have you someone to help you with the housework? My sister comes in once in a while, but it's hard for her to get away. Do you feel sick at your stomach or dizzy sometimes? No, sir. You can dress now. We're ready in here now, Dr. Hansen. Coming right away. I'm glad you called me. You were right. I thought you'd want to see her below. Mark and Red Ink, patient is toxic. And to watch for preeclampsia. Make sure that she comes in once a week for a blood pressure. If she doesn't come in, send for her. Now, Doctor, what were her symptoms? She was a few pounds overweight. Her test showed a slight trace of albumin. She had a rise in blood pressure. She had a sudden rise in blood pressure. And then there were the headaches. But, Doctor, wouldn't that mean just as well that she might have kidney trouble, a bad diet, or that she might be a hypothyroid? If it were kidney trouble, she likely would have had high blood pressure from the very beginning. If she were a hypothyroid, we would find many symptoms besides high blood pressure. We don't know much about these toxin mires of pregnancy, Doctor. We know that men don't have eclampsia and that women who aren't pregnant never have it. We do know that 25% of the women who die having children or in pregnancy die from eclampsia. And they could be saved. If we didn't heed the danger signals we found, at any time our patient might have an eclaptic seizure, stabs of light before the eyes, convulsions, and then it's a little late for diagnosis. Here is one of the three killers. Remember them. Eclampsia, infection, hemorrhage. Do you notice anything unusual in this case? Her blood pressure is normal. She has no cardiac trouble. She complains of shortness of breath. Note that she's to come in every two weeks for a checkup. Hemoglobin, 50%. Count 3,200,000 red blood cells. Our patient is anemic. Probably overworked and undefeated. We'll give her 60 grains of iron pills daily. Try to get her some fresh vegetables. You must watch this patient carefully. Remember your Bible, doctor. The blood is the life. Hemorrhage in these cases often proves fatal. Purity center. Maternity center. Oh yes, Dr. Craig. Dr. Buller is busy right now. I'll give him the message. Yes, Dr. Hansen is busy too. You came to the maternity center, tree. Because you wish to learn more about obstetrics. Your experience for the most part has been limited to a few months' training in a general hospital. But even in that short time, you've seen tragic accidents resulting in death or injury to mothers and babies. You know some of them could have been avoided. And that's why many of you are here. We have two objectives here at the center. To bring modern obstetrical care to the poor women of the city. And to teach you the art and science of obstetrics as practiced by the best institutions in the country. As doctors, we have to face this fact. Today, almost as many women die bringing children into the world as did 25 years ago. With all the new science and medicine we have in this country, we lose more human lives from childbearing than we do from cancer. The deaths of mothers and infants under one month rank second only to heart disease in the total mortality figures. You know the three things that kill mothers. Eclampsia, infection, hemorrhage. And of these, childbed fever, infection at birth, is still the chief killer. 35 out of 100 women who die, die from infection. And most of them could have been saved. All right, Dan. This washing and scrubbing up may seem like old stuff to you. But we're fanatics here on the subject. Remember, infection most always comes from outside. A clean pair of hands is your guard against invisible death. When you arrive at your home, keep everything above table level at least. Newspapers are the cleanest coverings we find in these poor houses. Spread them on the kitchen table and on chairs. You're carrying those bags and wearing your clothes from home to home. And you must guard against carrying infection with you. Put the large bag on the right and the small one on the left. Get used to making every operation systematic. You may have to find those bags in the dark some night. In a hurry. Here we don't have sterile sheets and sterile surgical tables and the white aseptic looking furnishings of a hospital room. They too often make a doctor careless because he feels secure. You can see the dirt where you're going. Only the insides of the basins, the instruments, your hands and the obstetrical area are sterile. You scrub carefully for 10 minutes, but there's still danger of contamination. Your gloves are specially folded so they can be slipped on without the outside of the glove ever touching the skin. You wear two pairs of gloves at the beginning of delivery. The outer pair is removed following the preparation of the patient. And if your sterile gloves get within afford of anything, you can just assume they're contaminated. Of course, we don't recommend the complete return to deliveries in the home. The isolated, well-equipped maternity hospital is the ideal place for a mother to have a baby. But we're not dealing with ideal conditions. The facts are that over half the women who had babies last year had them at home. A quarter of a million of them had only a midwife to attend them. And thousands of mothers went to hospitals where there was inadequate equipment for men without obstrical training. We want to give you a technique that will enable you to go into a hospital or into private practice, able to meet any condition you may find there. You have one broad plan on a case to bring a live baby to a live, uninjured mother. You have created an island of safety against death from infection. You will remain with your patient until at least two hours after the baby is born and until you've filled in carefully a complete record of your case. In three years, our doctors and students here delivered 9,000 mothers without losing one from infection. You have to maintain that high standard. Since we've been in this room, two mothers have had babies somewhere in this country and died. One of them might have been saved. Remember, gentlemen, it is not only pathological knowledge and a skill with your hands which makes the great obstetrician. It is vigilance, vigilance, eternal vigilance. One that does not let you forget for one tragic moment that during pregnancy and labor you have in your hands the lives of two people. Dismissed. I had a call from Dr. Craig. I think I'd better get over there right away. Fine. Doctor, I can't understand why you don't include standards low reserve kidney in your toxemia classification. I'd like to have seen that cesarean you did with Dr. Johnson. We were out on a case. I'll try to remember to call you next time. Coming upstairs or down? No, I think I've got a couple of calls. Finished with your books, eh, Doctor? Yeah. We'll see. Eternity Center. Eternity Center. Has she had a baby or is she having a baby? What is your name, please? Mendez and BND. Address, please. Is she having pains? When did the pain start? How often are they coming? Have you had any children before? Now, you collect some newspapers, stacks of newspapers. Get two clean kettles and put some water on the boil. Be sure the kettles have covers. Do you have any olive oil in the house? Olive oil? Now, don't you worry. The doctor will be right over. It's 127 East Jay Street. The entrance is in the rear, Doctor. Now, Doctor, do you have your stethoscope? Yes, sir. Record? Yes, sir. Flashlight? Yes, sir. All right. Let's go. I have a little pain. Have you been sick since we saw you last? Have any members of your family been sick? Give her a physical examination. Yes, sir. 124 over 80. They are 150. The plan of delivery here is simple, Doctor. We have a normal pelvis, but her pains are weak, so we may have to help her. She shouldn't have any trouble. Fill out the record. Yes, sir. Comfortable, Mother? Yes, I am. Maternity Center. Maternity Center. Yes, Doctor O'Donnell. Fetal heart beat, 150. Station minus one. Pain's moderate, every 10 minutes. Maternity Center. Maternity Center. Has she had a baby or is she having a baby? Maternity Center. Maternity Center. Has she had a baby or is she having a baby? Maternity Center. Maternity Center. Has she had a baby or is she having a baby? Maternity Center. Maternity Center. Bay Toxemia. We'll have to watch her kidneys closely. Yes, sir. Why do we bring them into the world? They were clean, decent people. Did you notice the flower boxes they had? That was a fine baby, but what will happen to him now? We can bring their babies safely, but how can they keep them well? We tell our mothers, give them plenty of milk to drink. We say, feed them cod liver oil and orange juice and green vegetables. We say, keep them clean and dress them warmly to fight off influenza and pneumonia. We teach them, the sun will make them strong against rickets and help fight TB. But where do we tell them to go for the green vegetables? Where do we tell them to move for the sunshine? We say, guard against measles and hopping cough and scarlet fever and diphtheria. We tell them, there is science to keep your children from being deaf or blind or crippled for life. But where can we tell them to go for the doctors in the science? The house in America. All our great cities from the hills and fields to build their machines and roll their steel and left them in these shacks. There are ruined teeth and tainted blood and infected lungs. Here are damaged kidneys and cracked hearts and twisted legs. But here are men who want decent clothes and homes and medical care for their women and children. How can they keep alive in these places? These markets and warehouses are millions of pounds of surplus food. Yet there are children in this city who never in their lifetime have eaten a decent meal. We tell them, eat liver and mark anemia on the record. We tell them, rest in bed and mark cardiac trouble on the record. We tell them, eat fresh vegetables and mark malnutrition on the record. Why don't we just mark on the record? They're hungry. It's a time of sadness and trouble. Of worn-out ideas and weary people to heal the sick wherever and however he found them. No matter what doubts you have, if you doubt this purpose, you doubt medicine itself. Attorney's Center, Avenue A and 90th Street. Yes, Mrs. Arturo Tannetti, T-O-N-E-T-T-I. Yes, officer. We'll send a doctor over right away, officer. There's an emergency call. Bring the emergency kit, O'Donnell. It's a police call. It just came in. The officer says she's losing her eyesight. Is the car back? Yes. You're not up. Do you want to come? Sure. Buy the steel mills, doctor. Attorney's Center. Yes, Dr. Balloon. Hypertension. You're hospitalizing her at Memorial. Yes, I'll have Dr. Hanson with you there. Yes, sir. Dr. Balloon's case. Yes, Mrs. Tannetti. Puzzle's name. Arturo. Andreas. Avenue A and 90th Street. And who is paying for her doctor? She's on relief. It's a maternity center case. Have you ever had your blood pressure taken before? No, sir. How long have you felt sick? I just felt awfully sick today. Then tonight my eyes went bad. And you felt dizzy and you had spots before your eyes? Yes, sir. Have you been to see a doctor at all during the last few months? No, sir. Take these specimens to the lab at once. I've already telephoned. Life or death, written in the chemistry of her blood, is in the hands of 10,000 ghosts. Here she is neither rich nor poor, young nor old. Here she inherits a legacy freely given. All the knowledge of the legions of unknown men of science. In a basement room running a routine test. But he's not alone. He's working with Domson and Minkowski. Failing and bright. Bold heart and far. Benedict and Van Slyke. Working with the unbroken line of men against death. Who's labored to make life sureer and easier. And now Newman II plus. She's got Hyland and granular casts. We want you to rest and not worry. We're going to keep you here for a little while so that you can be quiet. There's no reason why we shouldn't have a fine baby. Thank you, doctor. Good night. Good night. Here's what we're up against when we have no prenatal record of our patient. There's no way for us to tell how suddenly that blood pressure hit the ceiling. Until we got those tests, there's no way to tell whether she's in a true pre-eclantic state. Or whether she was nephritic due to a past sickness that damaged her kidneys. Which we found to be the case. Suppose she'd been in a true pre-eclactic condition. Well then she'd have been really blinded. Or threatening convulsions by the time we got there. These are the orders from Mrs. Tornetti. She must be kept quiet. No visitors. Restrict her fluids to 800 cc. Put her on a salt-free diet and record intake and output. Get a quantitative albumin daily. And take a blood pressure every four hours. What have we got? Nephritic. Please notify me of any change in her condition. I'll be in in the morning to see her. Yes, doctor. She's pretty sick. But we're going to carry her for a while and I think she'll be all right. She's afraid she's going to lose her baby when I saw the call. You two look all in. How about a cup of coffee? Yeah, I could use one. You can drop me a Presbyterian. There's a post-partum patient there I'm worried about. Almost midwinter. We had shrimps for supper, I remember. My husband said they came from New Orleans. They fly them in now, he said. He told me the second one would be easier. But she seemed harder than Daniel. Perhaps girls are harder. Maybe we'll have a boy this time. We always have a picture full. I forgot tonight. He went to Detroit two weeks ago. He said there was work there. Things have changed since my day. A man was home at a time like this. Too much sugar just makes your heart again, my husband says. You raised your children in a house where there was room. Is there more work, do you think? He said it was better in Detroit. I think it's better. We don't know, we haven't much time to find out what's going on. I didn't bring one for him. He's sound asleep, isn't he? He studies when he's not out on the case. That's why it's so sleepy. They're quiet tonight. Careful with those hands. Remember, the island of safety. What's going on in here? Just a woman having a baby. Eight pounds. I was off a quarter of a pound. You can take him in now. Now, we checked our seven points. Yes, sir. Baby in good condition. Mother uninjured. Blood pressure 110 over 70. Temperature 98.4. All's normal. That's fine. You see, our plan of delivery was very simple here, doctor. Our patient is a young woman. She'd already had two children. She has a normal pelvis. The position of the baby was normal. We had a spontaneous delivery. Now you can fill out the birth certificate. Yes, sir. You want anything? No, I'm fine. Petuitron. The center immediately. Rush this specimen over to the blood bank. Yes, sir. Hurry. Collect all the jars and bottles in the place. Put lots of water on the boil. Yes, sir. I will, yeah, doctor. Downstairs at once. This is on his way over. Give me the blood bank. This is the maternity center. We have a patient in shock. A Dr. Harris is on his way with blood specimen now. Thank you. What have we got? Pembridge. Or Donald case. What about blood? Harris is on his way now. Let's go. 60. Blood pressure 60 over zero. Fix the operating setup. What have you done? I've given up. Petuitron. Irgant. Morphean. Adjusted minister to gentlemen. Massager. Get me an ironing board, mother. Have the glucose and saline. Maternity center. Maternity center. Oh, I am glad, doctor.