cases get well when the endometritis or periuterine inflam mation subsides. In those in which large pieces of placenta remain in the uterus the subinvolution rapidly disappears if these are expelled early and before the uterine walls have become deeply in fected. Long retention and infection of retained particles may result in a chronic subinvolution that will persist until long after the menopause. In long-standing cases in which the uterine walls have be come hard and anminic, treatment has but little effect upon the enlargement of the organ.
Parenchymatous metritis is not so im portant a factor in the etiology of abor tion as is endometritis. That form, how ever, arising from puerperal infection is very prone to induce an abortion should the woman conceive. Syphilitic metritis, also, is a common cause of abortion. In fectious metritis is a most virulent form of the disease, almost invariably result ing in the death of the ovum and its ulti mate discharge, and not infrequently' in maternal death also. Curnston (Boston Med. and Surg. Jour., Aug. 29, '95).
Treatment.—The prophylactic treat ment consists in a complete evacuation of the uterus after labor, the avoidance of laceration of the cervix and of infec tion, and in rest in bed until the uterus and cervix are firmly contracted and greatly reduced in size.
If after a week or ten days the internal os will admit one or two fingers, the vulva and vagina should be thoroughly disinfected, and the uterine cavity com pletely emptied by the finger. In many cases the tenderness makes it necessary to administer an anmsthetic to accom plish this. Firm pressure can then be made over the pubes, and the uterus be retroverted or depressed until the fun dus can be reached. In recent cases with irregular contraction of the uterus the particles should be sought for until the whole organ contracts and expels the finger. The uterine cavity is then douched out with a 1 to 2000 solution of corrosive mercuric chloride, and the pa tient kept in bed for ten days or two weeks.
If the uterine walls are flabby and in filtrated, they will not contract firmly, and more or less limmorrhage takes place. In such a case the uterine cavity, after being douched with the 1 to 2000 solu tion of corrosive mercuric chloride, is packed with sterile nosophen or iodo form gauze. This is removed in twelve or eighteen hours and the vagina douched with the same solution, and twice daily thereafter until after the temperature becomes normal.
Cases of several weeks' duration should be treated by curettage and the repair of the cervix.
Ichthyol recommended in metritis. After vaginal irrigation, a 5- to 10-per cent. solution in glycerin is applied to the neck oi the uterus as a tampon; this is followed with inunction of the abdo men several times a day with ichthyol in vaselin, 20 to 25 parts in 100. Rapid diminution of pain and abundant vaginal secretion soon take place, with cicatriza tion of the ulceration. Calderini (Revue GNI. de Clin. et de Th5r. Jour. des Prat., Dec., '93).
While the chief action of ichthyol is to relieve pain, it also possesses certain resorbent qualities, in some cases rela tively powerful. Its use is not attended with danger or discomfort, the powdered drug being generally more satisfactory and reliable than solutions. Storer (Boston 11-fed. and Surg. Jour., Aug. 2, '94).
Recovery from septic metritis and gen eral peritonitis after treatment with an tistreptococcic serum. Law (Brit. Med. Jour., Jan. 2, '97).
Continued irrigations of the uterus successfully used for acute puerperal sep tic metritis. Under the influence of con tinuous irrigation the uterus contracts well and fast. The fissure heals rapidly. Irrigation must be kept up until such time as it is certain that there is no more internal suppuration; otherwise the ns, now firmly closed, will retain the dis charge, and the temperature will rise again one or two degrees. llorace Man -.ran kS. Y. Med. Jour., July 23, 'OS).
lit chronic cases these operations must sometinits be followed by local treat ment. such as the application of a cent. solution of chloride of zinc every two weeks or by mild galvanocautery.
Review of one hundred and twenty vases of metritis treated by free infra.- . uterine injections. These found valuable in all varieties, acute or chronic, although in exceptional cases it caused uterine colic, serous discharge, menorrhagia, and sometimes peritoneal irritation. These complications denoted the need of care, though they were of little importance. Suppurative inflammatory lesions de mand evacuation of the pus before the injections are begun. Gesna (These de Paris, '99; La Gynee., Dec. 15, '99).