At the outset we are met by the question of vaginal and intra-uterine injections after labor.
It would seem as though the proposal to give vaginal injections to every patient, to make the toilette internally as well as externally, should be ac cepted without discussion by every accoucheur. This is far from being the case, however, and curiously enough many obstetricians who reject them in normal cases (Tarnier and Bailly among others), resort to them in complicated cases, and lay stress on their utility. For our part, we attach the highest possible importance to these vaginal and intrauterine injections. All our patients, indifferently, whether labor has been nor mal or complicated, receive injections by the vagina even the day after delivery. We do not use intra-uterine injections as frequently, not that we are afraid of them, but because they require more disturbance and manipulation of the patient, at a time when she should be kept as quiet as possible. But, if the lochia are foetid, even slightly, and if vaginal injections do not suffice to overcome the icetor at the first or second injection, we resort at once to intra-uterine injections. We reserve, then, these injections strictly for those cases where the woman is in danger of putrid infection.
Let us examine successively this question of vaginal and intra-uterine injections.
In 1873, Rendu studied this question in detail, and he shows that it was really Recolin who first, in 1757, advocated the therapeutic measure of administering intra-uterine injections. But Recolin and those who followed him, Levret, Baudelocque, Mojon, Legras, Deubel, Lachapelle, Dubois, Barbe, Lii.gard, only resorted to them in case of miscarriage, or to expedite the exit of the placenta, or debris of placenta and of mem branes. On the other hand, Pasta, Doudement, de Lignerolles, Dupierris, Wray, Labalbary, Roper, Barnes, Pajot, Norris, Draper, and others, practised such injections in case of hemorrhage, and the solutions Used were cold water, or dilute iodine, or dilute perchloride of iron. Not one of these, gentlemen, however, resorted to them as a prophylactic measure against or in the treatment of puerperal infection, and still to day, in France, a certain number of accoucheurs, and eminent ones, are afraid of intra-uterine injections, and look upon them as more harmful than useful. Although we find in the writings of Chomel, and of Jac
quemier, certain vague indications for resort to these injections as a pos sible means of utility in case of putrid • infection, or where there exists puerperal metritis or retention of clots, these indications are laid down in a cautious spirit, and it is Gensoul who first formally advocated them, and Lize, in 1860, first actually demonstrated their advantages. Since used and advocated by Piorry, 1866, Stoltz, 1869, Ilervieux, 1870, Guyot, 1868, and others, intra-uterine injections have slowly gained their way into French obstetrical practice, until the happy results from their use have been incontestably proved. Abroad, intra-uterine injections met with no such opposition as in France. From 1840 to 1850, Grunewaldt was using them at the St. Petersburg Maternity, in the shape of chlorine water, one teaspoonful to three quarts of water. He resorted to the in jections within the first hours after delivery, in case the temperature rose, and he proved that since the adoption of this practice, the number of serious puerperal cases had notably diminished, and that such injections were not only advantageous, but so inoffensive that he did not fear to use them in case of every and any puerperal within a few hours after her con finement.
In 1878, Winckel, after having employed them in cases of puerperal endometritis, hemorrhage, retention of placental debris, etc., and after having successively used a solution of sulphate of copper (2 or 5 to 200), of tannic acid (2 or 5 to 200), of carbonate of soda (5 to 100), of subsul phate of iron (50 to 100), of permanganate of potass (10 to 200), lie set tled upon the following practice: In case of any labor which has been terminated artificially, administer a vaginal and a uterine injection of a solution of phonic acid (5 to 100) immediately after the delivery of the placenta, and repeat every three Lours in the strength of 1:50. In case the lochia become foetid, in case there exists a sloughing surface of the genitals, in case of retention of the lochia, in addition to intra-uterine injections, uterine drainage as ad vocated by Fritsch and Schede should be resorted to.