I. PROPHYLACTIC TREATMENT.
It would appear to result from experience, that those women who have resided in maternities a certain length of time before delivery, are less likely to contract puerperal affections than those who enter in labor, or a few days before. The difference is that the first are, so to speak, accli matized. It would thus be advantageous if all women who are going to be confined in a hospital should enter within the first fortnight preceding the expected labor. There they will be under better hygienic surround ings than is possible at home, and many of them might find there moral quietude, a condition which is lacking in many women confined in mater nities.
When the expected time for labor arrives, three conditions should be fulfilled: 1. The woman in labor, and the puerpera, should be so situated that every possible cause of infection may be kept at a distance; 2. Wounds and traumatism should be avoided as far as may be; 2. During Labor.—It is here that the active work of the accoucheur begins, and this is, therefore, the place to insist on the precautionary measures which should be taken.
At the outset, everything should be absolutely clean. Everybody who is going to have anything whatsoever to do with the woman in labor, physician, midwife, student—in a word, whoever is going to conduct the delivery--should have his hands scrupulously clean, his nails short, and each time before examining the woman, in particular before the vaginal touch, he should bathe his hands in a carbolic solution (1-100), and not rest satisfied with simply washing them with soap, but use the nail-brush thoroughly. The physician should never go direct to the woman in labor from a hoSpital ward, or after visiting patients with eruptive or sep tic fevers. In short, the accoucheur should only be am:tate:1r, a pure specialist in obstetrics. All the more should he avoid confinement cases where his duties or studies bring him into contact with cadavers or ana tomical specimens. [This advice, while true in the abstract, is, we believe, both unnecessary and impracticable. We grant that a pathologist had best never attend confinement cases, and we also grant that those physi cians in whose practice, for the time being, there are many contagious diseases or a single case of puerperal fever, will choose the wise part if they do not attend labor cases; but to attempt to make the accoucheur a specialist is leaning towards antisepticism much too far. The general
practitioner, with us at least, obtains a large proportion of the confine ment cases, and he may with perfect impunity accept them, and attend the patients with absolutely no risk to them, provided he takes the proper and self-suggestive precautions in regard to not carrying infection, pro vided he keeps himself clean, insists on the cleanliness of the nurse and the patient and her surroundings, and provided he conducts the labor in accordance with those principles, on which ample stress has been laid, which ensure the patient against putrid infection—that is to say, provided he leaves her with thoroughly emptied and contracted uterus, and with immediate suture of the perineum in case of its laceration.—Ed.] Vaginal examinations should only be made in case of absolute necessity, and the examining finger should be dipped in oil, cerate, or, better, car bolized vaseline. We should, in particular, avoid pressure, irritation, or attempt at dilatation of the cervix. The diagnosis once established, presentation, position, amount of dilatation, the patient need only be exbmined every two hours until dilatation is complete, or the membranes have ruptured. Once the position assured by the touch, this becomes useless except to certify to the occurrence of rotation. In certain in stances, as we have seen, it may be necessary to sustain, to push up the anterior lip of the cervix, and this little act should be performed with the greatest possible gentleness.
Lucas Championniere and Bailly advise keeping on the genitals, during labor, a compress dipped in a phenic acid solution. Tarnier places over the head, as soon as it appears at the vulva, a cloth dipped in carbolic oil, and then the head as it moves up and down in the vagina, keeps the parts moistened with the oil. We prefer, for our part, once the head has reached the pelvic floor, to pour a teaspoonful of oil into the vagina.