Expectant treatment, antisepsis being the only measure resorted to, is preferred by some (Varnicr and Pinard), active procedures being only resorted to in cases of serious haemorrhage or infection.
Study of 4333 cases in Tauffer's clinic tending to demonstrate that even re tained membranes should only be re moved when decided indications are present. Vents (Int. klin. Ruud., Mar. S, '91).
In cases of retention of the placenta after abortion the practice of 'farrier is as follows: 1. Antiseptic preliminary injections either of permanganate of potash, 1 to 2000, or of carbolic-acid water, 20 to 1000, with iodoform or salol dressings to the vulva. 2. In case there is danger of infection through putrefac tion of the placenta, recourse should be had to digital and antiseptic curettage after dilatation. 3. When the physician is called after septieiemia has become generalized, or when the symptoms of infection are very pronounced, it be comes necessary, considering the immi nence of the danger, to resort to curet tage of the uterine cavity, using, at the same time, all antiseptic precautions.
Quinine, in large doses, has recently been recommended.
The expectant treatment of abortion is to be preferred. Packing of the uterus and vagina recommended. Of 292 cases observed only 1 ended fatally. This pa tient was already infected and suffer ing from high fever. Curetting and local treatment were unsuccessful.
It is best to leave, as long as possible, the expulsion of the ovum to the natural forces, which in many cases of abortion are better able to do it than our hands and instruments. When some special danger exists for the mother, however, or when the termination of the abor tion may easily be accomplished, inter ference is permissible.
The fear of packing, which until re cently was prevalent, has disappeared, for, with due precaution, it is without danger. There is not so much danger of infection with it as with manual and instrumental procedures. P. 11-filller (Volkmann's Samml. hlfu. Vort., No. 153, Apr., '96).
Case of severe postpartum infection in which, notwithstanding active measures, the patient seemed to be becoming mori bund. Twenty ounces of sterilized saline solution injected into the cellular tissue at first. Improvement of the symptoms
followed at once. The injections were continued twice daily for six days. Diu resis and a fall in the pulse-rate were marked throughout, the intestinal irri tation stopped, and the temperature be came normal. The patient made a per fect recovery. Ostermayer (Centralb. f. Gynilk., Mar. 12, '99).
Electricity may be used as a substitute for the curette in incomplete abortion. For the immediate removal of retained secundines the faradic current is em ployed, but, for the removal of these after retention for some time, the gal vanic is preferable.
Case in which the galvanic current was used very successfully, the strength being GO milliamperes, and the appli cation continued for eight minutes and repeated three times. The positive pole was introduced into the uterus, the selec tion being made because of the local effect, since this pole promotes coagula tion, and is htemostatic; a fourth reason is added as probable, but not proved,— its antiseptic powers. H. D. Fry (Amer. Jour. of Obst., vol. xxi, p. 593).
Injections of cold water successfully used in retention of the placenta, in a woman who had expelled a fmtus of six months. Immediately after the lavage the uterus contracted and the placenta was also expelled. John Morton (Indian Med. Record, Dec., '91).
Two hundred and seven cases per sonally treated with curette. Sequeli were met with in only 34.4 per cent. compared with 92.4 in those in which it was not employed. In the former, the menses were regularly re-established in 60 per cent., pregnancy to term supervened in 53 per cent., abortion re curred in only 13 per cent., and sterility prevailed in 32.3 per cent. When the curette was not used and fingers were, regular menstruation in 39.4 per cent., pregnancy to term also in 39.4, repeated abortion in 47.3, and sterility in 25.1. The eases were all treated upon the same general principles, and the curette was only employed in the presence of the strongest indications. Schaeffer (Deutsche Praxis, Nos. 1-3 and 5-8, 1901).
Streptococcic serum in the septicTinia of abortion has been used with apparent success.