If rigors occur they should be met by the administration of warm stimulants and external heat, hot-water bottles, &c. For sleeplessness, give Sulphonal grs. xx. to xl., or Paraldehyde 5j. in Aqua Chlorof. If sickness and vomiting are marked it may be necessary to give nutrient enemata by the rectum in order to keep up the patient's strength. Stimu lants should be reserved for use if the patient's strength is failing and the circulation is beginning to flag. In such a condition half a glass of cham pagne or a tablespoonful of good whiskey or old brandy may be given every three or four hours. There is no drug treatment that can be relied on to influence the inflammatory process. Quinine in 3 to 5 gr. doses every 4 to 6 hours enjoys a certain reputation and sometimes seems to do good. Salicylates and Aspirin promote sweating and have some influence in reducing the temperature, but it should not be forgotten that profuse sweating may give rise to collapse, and measures should be taken to guard against such an effect.
\Vhen the pulse-rate is above I to, Strychnine and Digitalis should be given as in the following mixture (S. Blakely): Tr. Digitalis 3ij.
Tr. Nuc. Vont. 3iij.
Shit. rather. Nit. 8j. Spt. Chlor of ass.
Aquo ad 5viij. Misce.
Fiat mist. Cpt. ass. Otis lions ex avid.
In puerperal cases benefit seems to follow the injection of 20 c.c. of Polyvalent An t streptococcic Serum. I think the best results are obtained by waiting 24 to 48 hours before repeating the injection, and I believe that 1 have seen harm done by neglecting this precaution. It is quite possible that the next few years will see great advances in the treatment of all forms of acute infection through the use of vaccines. At the present time, however, there is so much danger of doing irreparable damage by vaccines during an acute attack that the administration of them should be left entirely in the hands of a specialist in the subject.
Lastly as regards operative measures. Probably the best thing for the practitioner to do is to avoid all operative interference, including even the intrauterine douche. If vaginal examination shows the presence of a foetid fragment of placenta or membrane in a puerperal case it may be removed as gently as possible with a blunt curette and a copious douche of warm saline given afterwards, but if there is no lector I think that interference with the highly absorbent and easily abraded surface of the uterus should be taboo, on account of the grave risk of inoculating the patient with a further and possibly fatal dose of virulent bacteria. In
inflammation there is absolutely no indication for curettage. The one form of surgical interference which has seemed to me to give good results is indicated in early cases of pelvic inflammation, which on examina tion give evidence of the presence of a fluid exudate in Douglas's pouch. In these cases an incision through the posterior immix gives vent to a quantity of sero-pus; drainage is instituted by a loose gauze pack, which is removed every 48 hours, and the result is usually to cut short the attack and to inaugurate a speedy convalescence. The method is most likely to be successful in gonorrhoeal cases.
Subacute Pelvic Inflannation.—When the acute symptoms have sub sided, the patient is left with masses of inflammatory exudate in her pelvis, and very probably with collections of pus in the tubes, in the ovary or confined between adherent pelvic viscera. The indications for treatment are to restore the general health as far as possible, and to promote resolu don of the exudate. When pus is present, an operation for its removal is practically inevitable, but it is seldom a matter of immediate urgency.
The convalescent patient should be encouraged to be in the open air for as much of the day as possible, but rest should be strictly enjoined and all active movements forbidden, as these have a great tendency to keep up the inflammatory process. Light nourishing diet should be given, and general tonics are advisable. There is often a considerable degree of amemia in these patients, so that a combination containing an easily digested form of Iron is of service—e.g. : Ferri el Quin. Cit. 3ij.
Spi. Chlorof. 3ij.
CaluntIme ad 5x.
Fiat mislura. St. 8ss. ler in die ex aqua post cibos.
Locally the administration of prolonged hot douches should be continued, and Boroglyceride or Glycerin of Ichthyol (io per cent.) tampons should be inserted into the vagina every other night and allowed to remain in situ for 8 to 12 hours. It is recommended to paint the vaginal vault with Iodine in order to promote absorption, but this is a measure of doubtful utility. Small doses of Mercury and Iodide of Potassium seem to do good in many cases. I-lot sitz baths or radiant heat baths applied to the lower part of the body are also useful in promoting absorption. Pelvic massage has at different times been recommended, but it is a remedy that is best avoided by the practitioner. There is a strong probability that it will do more harm than good by lighting up the process again, and it is objectionable from other points of view.