The best method to adopt to incur little risk for the patient: No inter ference is necessary in ordinary eases except in eases of severe anaemia pro duced by a profuse haemorrhage or by long-continued slighter bleeding, when portions of the ovum are retained, and in cases which have become septic. The most rational method of arresting haemorrhage is to remove the ovum com pletely. If this has left the body of the uterus, and is retained partially or totally in the cervix or vagina, a spec ulum should be introduced, and, if the finger cannot easily complete the re moval, ovum forceps may be used. When the ovum is still in the body of the uterus, one or two fingers should be introduced, and—while counter-pressure is exercised by the other hand from the abdominal wall—the sae separated completely from the uterine wall. Once it has been separated. it can usually be removed by combined action of the j internal finger and expression from without. The whole process can be made more easy if one seizes the an terior lip of the cervix with vulsellum forceps (double-toothed), and admin isters an anaesthetic. The operator
must not be disturbed by the luemor rhage, but must rely on the fact that this will cease on completion of the abortion. If the cervix is not permeable for the finger, thorough plugging of the uterus. cervix, and vagina with sterile iodoform gauze is then indicated. The cervix is brought into view with a Sims speculum by means of a uterine catheter or sound, and the size of the uterus by bimanual examination, and not by the sound. The vagina is to be thor oughly irrigated, cleansed. and dried. and then the strips of gauze introduced with smooth ovum forceps. All one's efforts should be directed toward keep ing the ovum intact. At times it may be necessary to substitute a sound for the forceps in packing the uterus. If the ovum is not cast out after twenty four hours, the plugging is to be re moved, the passage again thoroughly disinfected. and a second packing under taken. Sellheim (Miinchener med. Woch., March II, 1902).