INEVITABLE AnonTioN.—When abor tion cannot be avoided, all the foregoing measures are contra-indicated.
During the first two months but little treatment is necessary other than rest in bed. If no untoward symptoms appear, such as marked hremorrhage, rise of tem perature, etc., expectant measures are sufficient, at least for some days.
During the third month the ovum may be expelled entire.—i.e., without rupture of the membranes. In this ease no active measure is required beyond, perhaps, an antiseptic douche,—a creolin 2-per-cent. solution of a weak carbolic acid one,—employed twice daily.
When, in the course of the third month the sac ruptures and the liquor amnii escapes, the sudden reduction of the pressure exerted by the ovum upon the intra-uterine surfaces causes free Inemorrhages from the utero-placental vessels.
amnorrhage. — The treatment of the hmmorrhage at this period is that for the subsequent one. The patient being placed in the Sims position, all clots are removed and the vagina is packed with iodoform gauze or cotton-wool. If the bleeding persist, vaginal douches of hot alum solution, 1 ounce to the pint, are administered. The packing is then re newed, and 3 drachms of the fluid ex tract of ergot are injected into the rectum. if the bleeding is alarming, the uterine canal may be packed with small pledgets of iodoform cotton or Whenever abortion takes place none of the tissues should be left in the uterus. 1. At 4 weeks best to keep down hmmorrhage and to wait for nature to act; if interference necessary, decidua to be removed, using the curette. 2. At 6 to S weeks chorion causes most trouble; finger or curette used and strip of iodo form gauze introduced to fundus. 3. At 10 to 12 weeks foetus comes first; other tissues apt to need artificial removal; finger best; gauze as before; small doses of ergot for twenty-four hours. Edward Ayers (Medical _Record, Sept. 28, '95).
When fragments of placenta or other adnexa are left in the uterus they rapidly give rise to foul discharge, which may be followed by grave septic symptoms. The
patient should at once be placed in the Sims position and be given an anes thetic, if necessary. The endometrium is then thoroughly cleansed and curetted, then washed out with hot 1 to 5000 corrosive-sublimate solution. No ergot should be administered until the uterus is thoroughly emptied. The external genitals are then carefully cleansed and a compress of carbolized cotton is applied over the vulva. Lysol, in 1-per-cent. solution, is highly recommended for in jections in infectious cases.
When with closed os limmorrhage is profuse, we must no longer speak of "threatened," but of "beginning," abor tion. In cases like this, especially if the es enlarges, we cannot possibly reckon on saving the embryo, although this may unexpectedly occur in rare instances. The third stage is that of complete abor Lion; persistent bleeding usually denotes retention of bits of membrane, and the proof of retention is usually found in the patency of the os to one finger. Ex amination of the ovum is necessary to determine the likelihood of the persist ency of portions within the uterus. In this way, if we find that the integrity of the expelled ovum has not suffered, we need have no fear of retention. If the ovum is incomplete, and haemorrhage continues from the uterus, we have every warrant for emptying the uterus with the curette. If the os uteri closes, we may feel sure that the remains of decidua must be slight. With every evidence of expelled ovum and closed os. persistent bleeding can be due only to atony of the uterus. Lantos (Monats. f. Geburts. u. Gyndk., May, '99).
If haste imperative, the cervix is di lated and a lateral incision is made in the cervix. The uterus is then emptied with a blunt, rounded, fenestrated curette, followed by swabbing. The uterus is thus emptied without haemor rhage. The pain is very slight and no anaesthetic is required. The incision in the cervix is at once sutured. This method is prompt, sure, and safe. Doleris (Semaine Sled., Sept. 5, 1900).