In 99 eases (out of 275) requiring operative interference, 55 were treated by digital exploration and removal of fragments, and 44 cases were treated by curetting. In this series of cases 6 deaths occurred. In 2 cases, at the autopsy, a perforation was found at the fundus uteri, with peritonitis. Both cases were already infected before reaching the hos pital. In 1 curettage had been carefully performed; in the other the uterus had merely been packed with gauze. The third fatal result was due to suppurative salpingitis, operated upon after leaving the hospital. The 3 remaining deaths were due to infection, the patients arriving at the hospital with grave sep tic symptoms. Maygrier (L'Obstetrique, July, '97).
Antiseptic douches are important to remove what detritus may remain behind a 3-per-cent. carbolic-acid solution from the endometrium after curetting.
Packing of the uterine cavity with iodoform gauze after curetting is not a safe procedure; it has caused peritonitis.
The too copious use of corrosive-sub limate solution for injection has caused death. If the cervix will not yield to simple measures, Hegar's, Ellinger's, or Barnes's dilator may be used.
New method of treating incomplete abortion: With Bozeman's intrauterine douche, a hot creolin solution is allowed to flow, always watching to see that the return-current remains free. All loose clots and d6bris are removed by the dull curette. The cavity is again washed. until nothing remains but the firm de cidual tissue (which clings to the uterine wall) and the creolin solution returns white. Finally the uterus is packed from the fundus to the external os with iodoform gauze. The first gauze is with drawn, thereby wiping out the cavity, and a second piece is firmly placed so as to stop all haemorrhage. No opiate is allowed.
As a result of this procedure the ine •t uterus is stimulated to contract. The blood, unable to escape, distends the cavity and flows in between the decidua and the uterine wall, dislodging the former. Finally, the internal as dilates, the gauze is expelled, and all the uterine cavity with it. Another creolin intra uterine douche is then given, and, if en dometritis exist, the gentle use of the sharp curette and a gauze drain corn• plete the work. Contraction and invo lution of the uterus go on rapidly. Three illustrative eases. Anna M. Stuart (N. Y. Med. Jour., Sept. 6, '96).
In curetting after incomplete abortion three following points insisted on: 1. Be
fore introducing the curette a sound should he used and the length it pene trates marked on curette. 2. A specu lum should always be used. 3. Iodoform (or, preferably, xeroform) gauze should be introduced into the uterine cavity after curetting in lemorrhage, or the gauze should be packed well in to excite uterine contraction and left there for twenty-four hours; in infection it is in troduced loosely to act as a drain into vagina, into which a plug of cotton wool is placed to absorb discharge. Beuttner (Rev. Med. de In Suisse Rom., Jan. 20, '98).
The following procedure recommended in incomplete abortion: Under chloro form cervical canal is dilated with, first, index finger and then middle finger. Uterus is fixed with hand acting through abdominal wall. Then, with two fingers or one, interior of uterus is thoroughly scraped. To evacuate uterus it is some times sufficient to make traction on pla cental fragments with fingers or with one finger hooked. Usually it is neces sary to employ uterine expression. done by placing two fingers in posterior vagi nal fornix and pressing them forward, while with other hand placed on hypo gastrium pressure is made on anterior fundus uteri. Uterine cavity is then washed out, and mixture of glycerin and creasote applied. Only when there is any and the uterus does not re tract properly it is necessary to plug utero-vaginal canal with iodcform gauze. P. Budin Med., Sept. 17, '93).
Treatment of abortion based upon 100 IP- cases met with in four years. Vaginal plug usually quite useless. If removal of the ovum is indicated, the manual method is always preferable. Expression fatigues the patient very little. and is indicated when the os has a diameter of about four centimetres, and when the ovum is, in great part, detached and in the cervical canal. In 15 cases this plan was followed, and in 12 the ovum was thus delivered, but in 3 only pieces came away, and the rest had to be removed by the finger. If expression fail, two fingers are to be introduced into the uterus, and the ovum or parts of it at once taken away. In abortion, just as in labor, everything should be removed at once. The finger is generally to be preferred to the curette. The use of all kinds of ovum forceps condemned. Ninety-nine women recovered fully. Drejer (Norsk Mag. for Laegevidensk., No. 3, Mar., '99).