DELAYED ABORTION.—When this oc curs prolonged expectant treatment. exposes the patient to dangerous hnm orrhage and septiemmia; hence early active measures are indicated. If the adnexa are not expelled in twenty-four hours, injections of hot carbolized water into the uterus, between its walls and the ovum, every three hours, using a Bozeman catheter, may be employed; or, if the ha norrhage is controlled and the os is sufficiently patent, the finger may be introduced, then hooked, and the uterine contents evacuated.
If the os is not dilated, a piece of iodo form gauze or an iodoform bougie can be inserted: in from twelve to twenty four hours the finger can generally be introduced and the adnexa removed. If this is difficult. a blunt curette may be employed instead of the finger, prefer ably Thomas's large model. Sims's sharp curette is also highly recommended. If used with due care it is an excellent in strument.
"When intervention is necessary, in stead of the curette I simply use my finger, which is a marvelous instrument for one possessed of intelligence, while the curette is a blind instrument which I only use when there is hmmorrhage or infection." For intrauterine injections a solution of permanganate of potassium recommended. Tarnier (L'Union Med. du Can., Nov., '97).
To use the finger as a curette is, in most cases, unsatisfactory, even whin one hand is used for pressing the fundus down. The finger is often arrested at the internal os or does not reach the uppermost part of the cavity, and, at all events, it can only be used to separate the ovum from the uterus, and cannot remove the decidna vera. Henry J. Gar rigues (Med. News, Nov. 6, '97).
Condition indispensable and invariable for the efficient and thorough use of the curette after abortion, — namely: that the uterine canal should be sufficiently dilated to permit the index finger to explore the uterine cavity to the fundus, in order not only to determine the quan tity and location of the retained secun dines, but also to enable the operator to be perfectly sure that the cavity has been entirely emptied when the operation is completed.
An empty uterus after abortion almost always contracts, and all hmmorrhage from its cavity ceases. A failure to con
tract at that time is an exception. If a hot sterilized or carbolized intra-uterirw douche is used after emptying an abort ing uterus, prompt contraction and cess7 tion of bleeding takes place. Only women very much exhausted from lice orrhage might it be advisable to pack the empty uterus after abortion with iodoform gauze, or, better, sterilized gauze, in order to save her even the few drops of blood which would ooze away during the first day or two, until she has rallied. Paul F. Munde (Med. News, Nov. 27, '97).
Case in which patient had been curetted on two occasions to remove remains of incomplete abortion. At second opera tion, failing to remove all placental tis sue with curette, uterine cavity was plugged, and, after forty-eight hours, finger introduced and remaining portions removed. Severe hemorrhage led to ex tirpation of uterus. On microscopical examination, material removed by curette proved presence of muscular tissue. Conclusion that placenta in this case must have been abnormally adherent, and uterine wall abnormally soft, and that the finger is a better instrument than curette in imperfect abortion. Diihrssen (Berl. Med. Soc., May, '93).
This treatment, if applied sufficiently early, causes a reduction of temperature. Within an hour or two a chill may indicate slight absorption of infectious elements through the vessels laid open during the operation; but rapid improve ment usually follows.
When the curette is used the softened condition of the uterine tissue should be borne in mind; death from perfora tion has been reported. (Alberti, Long, Haynes.) Many accidents have been attributed to the curette. Recamier reported three cases from perforation of the uterus by his curette; Dumarquay two; Chamber lain had a case of hysterical tetanus; Peaslee, a death from collapse; Thomas, a narrow escape from the same cause; and Parker, a ease of peritonitis. But in these cases it was not the Sims sharp curette. It should, of course, be handled with ordinary common-sense in order not to cut too deeply and, perhaps, per forate the uterine wall. Personally used 'urge number of cases without acci „ern.. Goldberg (Buffalo Med. Jour., Aug., '97).