As we have said, general treatment consists chiefly in the exhibition of analeptics. Alcohol in small doses may be indicated, and considerable quantities of opiates may be necessary for the pain and restlessness.
There can be not ths slightest doubt that delivery per rim naturalm under all circumstances enlarges the rupture and renders the prospect of recovery very faint. But unfortunately our experience so far does not seem to render it probable that lo,parotomy, which Trask ' has so sturdily advocated for uterine ruptures, will do much better. For we never suc ceed by laparotomy in controlling the rapidly advancing septic infection. Our best prospects lie in putting the wound in such a condition that its secretions can flow off undisturbed. This is to be accomplished by the position of the patient, drainage and local antisepsis, with complete rest, immobilization of the uterus and light compression of the abdomen by means of a suitable bandage, with counteraction of the collapse by wine, etc. Ruptures of the middle and lower segments of the vagina are al ways accessible, and can be sutured if they are not situated behind ste nosed areas. They can be well exposed in the dorsal position, with the hips
elevated, or on the side, with the duck-billed speculum and depressor, aided by sharp hooks. The sutures should be begun at the posterior angle. Many operators employ carbolized silk, or catgut, which need not be removed later. There is no objection, however, to wire su tures; they are to be removed in fourteen days, and though this may be difficult to do, it can always be accomplished. If the rupture is situ ated behind a stenosed tract, and cannot be seen, the hemorrhage must be stopped by injections through the double catheter, or by the introduc tion of small pieces of ice. If we must use tampons, those of iodoform gauze are the best. Liq. ferr. sesquichlor. is occasionally useful, but should only be employed after other methods have failed. For the special considerations in regard to ruptures at the vaginal entrance and peri neum, we must refer the reader to the section upon diseases of the ex ternal genitala