Baglivi, Clarke, Bandeloeque, Velpeau, Championniere, recommend blisters; covering the entire abdomen is Velpeau's advice. Champion niere uses them from the outset to combat the initial symptoms. We believe in vesication, but not at the beginning of the affection. On the fourth or the fifth day, and even later, when the peritonitis is subsiding, this is when we believe them useful. Hervieux, who uses them from the outset, admits that they have disadvantages, such as the production of retention of urine, of cystitis, of ulceration, of diphtheritic patches, gangrene, etc. We prefer leeches to blisters iu case of pain, and it is especially as resolvents that we use the latter, that is to say, at the end of the disease. The blister has seemed to us especially useful when the peritonitis has resulted in the formation of those masses, sometimes enor mous, which fill the hypogastric region and even beyond. It is in such instances that frequently repeated blisters have rendered us real service.
Mercurials have been recommended, and although we reject them in ternally, we approve of them externally. This is the practice of Depaul.
We have been struck by one fact, and this is that the only patients who have recovered, are those who have been salivated. Hervieux has made the same remark, and has noted that as soon as the buccal signs of mer cnrialism have appeared the inflammatory symptoms have decreased.
Mier has advocated applications of ice, but we have tested them with out success, and in a hospital case we witnessed gangrene of the abdomi nal integument as the result of too prolonged application.
Opium is of great utility, either by the mouth or subcutaneously.
As for baths administered during peritonitis, we do not think they should ever be employed until convalescence, and then with great care.
To resume then the treatment we advocate: As soon as the initial symptoms appear, twenty leeches on the abdomen, fifteen grains of sul phate of quinine, opium, and carbolized vaginal injections. After the leeches have fallen and the bleeding has ceased, mercurial ointment should be rubbed over the abdomen, one ounce in the twenty-four hours. Alcohol in the form of punch should be administered. On the third day, an enema of oil and glycerin, and. if called for by obstinate constipation, a purgative. About the fifth day repeated blisters.
Plienic acid internally has not seemed to us useful. In a single case we saw Depaul puncture the intestine without relief to the tympanites.
[The treatment of puerperal peritonitis which is preferred to-day by many authorities, differs essentially from that which is favored by Char pentier. At the outset of inflammatory symptoms in the puerperal state, it is believed to be good practice to administer a sharp saline purgative, in order to produce free derivation from the intestinal canal. This ac complished, opium in sufficient doses to absolutely quiet the pain is indi cated. As long as the temperature remains below 102°, hot poultices, changed frequently, are called for. Just as soon, however, as the tem
perature rises above 102°, the ice coil should be substituted for the poul tice, and kept over the abdomen if need be, for days. It will not cause gangrene of the abdominal walls if the precaution is taken not to apply it directly against them. The ice-coil not only checks the temperature rise, but lessens markedly the tympanites. For the special relief of this condition, enemata of turpentine administered through a long rectal tube are of great service. If the distension becomes so great as to seriously interfere with respiration, puncture, repeated if need be, of the intestine will often give relief. For the fever, aside from the usefulness of the ice-coil, our reliance to-day should be not on quinine, but on antipyrin. This drug should be pushed cautiously but boldly, to the extent even of fifteen or twenty grains every two or three hours. It had best be admin istered in suppository, since we should aim to keep the stomach as quiet as possible. To guard against the depressing effect of antipyrin on the heart, alcohol should be administered freely, and when giving the drug in large doses, an occasional hypodermatic injection of digitalin is useful. As for food, it should be given as freely as possible and predigested. Peptonized milk, raw eggs, brandy, alcohol, these are indicated to the extent which the stomach will stand. In case the stomach refuses every thing, give it absolute rest, and support the patient on stimulants hypo dermatically, and pepton4ed milk per rectum. By washing out the rectum with cold water before giving each nutrient enema, it will not react against them, usually, for some time. As for blisters, we consider them more harmful than useful, as long as the inflammation is at all acute.
The great indications in puerperal peritonitis are: Clean out the pritnce vice at the outset; keep down the temperature; feed the patient. These indications are all fulfilled by the treatment we have outlined, a treatment which requires faithful application and constant watchfulness, true enough, but in case of puerperal peritonitis, it is a bitter fight for our patient's life, and the measures we have recommended will often, if re sorted to in time, save this life.—Ed.] 2. Putrid lufection.—In this affection, whether it results after mis carriage or labor at term, whether it is due to retention of the placenta, membranes, clots, or to the penetration of infectious germs (Pasteur and Doleris), there is one symptom which leads all others, and this is hetor of the lochia. Therefore we place first among therapeutic measures in jections, not only vaginal but intrauterine. Two intra-uterino injections daily of 1-100 phenic acid solution, and five to six vaginal injections in the intervals—such is the treatment, in addition to quinine as much as forty-five grains to one drachm in the twenty-four hours, and alcohol in in one or another form.