We are then a partisan in favor of vaginal and intra-uterine injections, but, in agreement with the majority of accoucheurs, while we cause vag prohibit in my service, aside from exceptional cases, since I believe them to be the cause of irritation. When it is necessary to tampon I use only carbolized cotton.
" Finally, suppress the use of plain water in maternitios; disinfect all the linen by means of heat and carbolized water; never torment the geni tals of the woman, even to obtain antisepsis; give the woman rest and a proper amount of food; insist on all the surroundings of the woman be ing antiseptic." It is apparent, then, that Championniere's rules are approximately our own, except in regard to injections (vaginal) which he dispenses with, and which we favor.
[Charpentier's general deductions in regard to vaginal and intra uterine douches during the puerperal state, are in accord with the prac tice of the majority of practical accoucheurs in the United States. in certain details, however, many will differ from him.
In studying this subject, it is above all necessary to bear in mind the vast difference which exists between maternity hospitals and private practice. In the one there are present conditions which are never met with in the other, and therefore, rules applicable to and essential in the one are not at all necessary in the other. In maternities we are face to face with the so-called hospital air, with the evil influences which neces sarily follow on the crowding of a number of patients in one ward, with the risks which may result from neglect on the part of a practically ir responsible house or nurse-staff; these and the like conditions call for stringent antiseptic rules, in order to insure what, after all, is at the bottom of the whole matter—cleanliness. In private practice, however, and not purely among the higher classes, but as well among that great middle class, where the women are still able to be confined at home, the conditions are very different. We are dealing with but one puerpera, in one room, and with one attendant. The chances for infection are hence so much the less, the possibility of cleanliness without antiseptics is so much the greater, and therefore it is why we would very sharply demar cate the rules necessary; essential, in the one case, and scarcely at all so in the other. In the hospital, antiseptics are necessary, it would be crim inal not to use them; in private practice, they are unnecessary where the prophylactic measures which we have dwelt upon at sufficient length are strictly attended to. We are speaking now, of course, of the average
year, and not at all of one when puerperal fever is epidemic, when ob viously the rules for private practice should be no less stringent than those for hospital. If these views are granted as sound for city practice, how much the more so for country.
While, therefore, we are as firm an advocate as any one for antisepsis of the strictest possible sort in hospital practice, we believe it not essential to success in ordinary private practice, provided we do obtain strict clean liness, and this can be secured without the use of antiseptic solutions.
The question as to the necessity of administering the vaginal douche as a routine measure after normal labor, and during the normal puerperium, is one on which there is much difference of opinion. It has been proved practically unnecessary at the New York Maternity hospital, whether so on account of the so-called occlusion binder, devised by Garrigues, and which the patients wear, or not, we cannot say; but the moral is that if they may be dispensed with in a hospital, they certainly can be in private practice, and it is not our custom to order them during the first week, unless in the presence of indications. Not that we are afraid to use them, for a carefully administered vaginal douche by means of a fountain syringe (Fig. 190), and through a tube without terminal opening, ought never to injure the patient in the least. The douche is certainly sooth ing to the patient, it is cleansing, and if used, as it should be, hot, 112° F., about, and in sufficient amount (one quart at least), it unquestion ably has a beneficial effect on involution. Our main reason for dispensing with it as a routine measure, is that it is impossible to give the douches ourselves, and we cannot always trust to the skill or absolute cleanliness of the nurse. Patients apparently do as well where the vaginal douches are not given, and therefore, except in the presence of some indication, we do not see any special utility in ordering them. Certain accoucheurs, however, are in the habit of using the douche twice daily as a routine measure, and the question is one which every accoucheur is at liberty to decide for himself.