Eisenmenger, in 1853, made successfully intra-uterine injections of water containing pulverized carbon; Bischoff, 1877, used vaginal injec tions of phenic acid (1:50) from the onset of labor; after delivery he re sorted to vaginal and uterine injections with a solution of 1:10, and in serted into the vagina a cotton tampon saturated in the same solution. In case of hemorrhage, the solution for ultra-uterine use was of the strength of 2 or 3 to 100, used twice or three times daily during the first twelve days, and, in addition, every two hours a vaginal douche was administered.
Haase, Beinlich, use the solutions of phenic acid of 1 and 2 per cent.; Egermann, 3 to 5 per cent ; as also Weber, Riegel, Radecke, Spiegelberg, Fasbender; Spiegelberg, however, only recommending them in case of puerperal complication. The vaginal secretions coming from wounds of this tract are in his opinion inoffensive, and he hence rejects intra-uterine injections unless they are strictly indicated and then he strongly advo cates them. This is the practice endorsed by Schroeder, Weisl, Duncan, Hausmann, ourselves, and many others. Fehling has successively used creosote, permanganate of potass, phenic acid, and finally recommends salycilic acid (1:300); during labor washing of the hands with the same solution; after delivery insuffiations of powdered salycilic acid, and the use of salycilized cotton. The insuffiations should be practised once or twice daily in primipar?. In case of fever, intra-uterine injections at once should be administered, and especially vaginal six or eight times daily, with salycilized solutions (1:600 to 1:1000.) Filatoff, Horder, Kolbe, Meissner, Crec16, Leopold, Ahlfeld, Furst, Henning, also use solutions of salycilic acid for intra-uterine injections.
Fritsch advocates lavage of the vagina after every delivery. He reserves intra-uterine injections for those cases where there has been instrumental or manual interference, dead, macerated or putrefied child, foetid lochia, fever. They must also be used in case of grave and advanced septicaemia.
Munster, Richter, are partisans of intra-uterine injections, and after :laving tested phenic acid solutions, express preference for salycilic. They state that phenic acid produces burning sensations, and eczema of the genital organs, and that in certain instances toxic symptoms have been produced.
Chamberlain, Schultz, Schulein recommend intra-uterine injections.
The latter advocates, before and during delivery, disinfection of the hands and arms Of the accoucheur and of the nurses with a carbolic solution of per cent. The examining finger should be washed in a 10 per cent. solution. After delivery he washes out the vagina and uterine cavity with a quart of carbolized water (3 per cent.) At first lie limited his practice to vaginal injections in every labor, but latterly he has used intra-uterine as well. In grave cases, or where the hand has been intro duced into the uterus, or where there is factor or hemorrhage, he washes out the uterus with a 5 per cent. solution of phenic acid. During the puerperium he resorts simply to vaginal injections in case of normal con ditions, reserving intra-uterine injections for cases where there is suspi cion of infection—that is to say, whenever the uterus is tender, or there is peri- or parametritis, or foetid lochia, and finally whenever the tempera ture rises above 101° or, remaining normal, the pulse rate increases in frAuppy. He uses a glass tube, and the ordinary strength of the solution is 4v or 50 per cent. In 26 cases where there existed puerperal infection, he used but one injection and had 26 recoveries; and in 29 women seri ously infected, where the injections were administered a number of times daily, all recovered. Schulein concludes that carefully administered intra uterine injections are harmless, that they diminish notably the number of cases of puerperal infection, that they take off the edge, so to speak, of infection when it occurs, and that after them the temperature is lowered in a few hours.
Schede, Langenbeck, go to greater extremes still, and counsel drainage of the uterus, and Schucking has proposed continuous irrigation of the organ.
Langenbeck proceeds as follows: He inserts two rubber, disinfected, tubes, 4-i inches long, with lateral openings, so that they project about I an inch from the vagina. At first the uterus contracts and endeavors to expel the tubes, but soon the contractions cease. He then injects for three minutes a 3 per cent. solution of phenic acid through one of the tubes. He leaves the tubes in situ during twelve hours, then removes, disinfects, and re-inserts them. The same manoeuvres are performed for two days, and on the third he withdraws one tube, and the other on the fourth day.