The method of Credé, briefly restated, is as follows: First apply gentle, painless friction in a circular direction over the anterior wall of the uterus, laying the hand flat upon the abdomen. Bring the axis of the uterus in conformity with the axis of the pelvic inlet. If the placenta is not expelled after three or four pains assist the next contraction, at its acme only, by compressing the upper segment, grasping the fundus with the thumb in front and the fingers behind, at the same time using gentle downward pressure. Use slight friction only but no compression during the intervals between the pains nor even during the contraction except at its height. Success usually attends the eighth or tenth pain.
SCARLET FEVER: ITS RELATION TO PUERPERAL FEVER
Boxall (Br. Gyn. J.) in sixteen cases of scarlet fever in childbed found septic manifestations in but one. In forty lying-in patients exposed to the scarlatinal poison the puerperium was entirely normal. Three hundred patients or more were admitted to the hospital during the epidemic of scarlatina therein, yet a comparison of the morbidity during this time with that which immediately preceded the outbreak showed that the prevalence of scarlet fever in the hospital exerted no appreciable effect upon the course of the puerperium in patients who escaped scarlatina.
Galabin (Br. M. J.) thinks there is strong evidence of the bacterial relation of puerperal sepsis to scarlet fever. Septicæmia does not represent a distinct entity like scarlatina. Cheyne found the common microbes of suppuration in the blood of scarlet fever patients not infrequently.
MITRAL STENOSIS AND THE THIRD STAGE OF LABOR.
Dr. D. B. Hart (E. M. J., Feb. 1888,) reports eight cases of this complication with seven deaths. With reference to the etiology Dr. Hart thinks the progress of the cardiac lesion is greatly accelerated by the increased amount of work imposed upon the crippled heart during pregnancy. At the beginning of labor, therefore, we may get failure of compensation, dilated heart and engorgement of the lungs. At the close of the labor, if free hæmorrhage does not occur, the extra blood before accommodated in the utero-placental sinuses is returned to the right heart. Death is therefore liable to occur in the third stage from over distention of the right heart.
Dr. Ballantyne (E. M. J., March, 1888,) adds two more cases to the above record, both terminating fatally. Sphygmograms obtained in these cases show that the period immediately following the expulsion of the placenta is the one of greatest danger, and they are entirely consistent with Hart’s theory of the cause of death.
TREATMENT OF ABORTION.
Fry (Am. Obs. J., June, 1888,) advocates the use of the galvanic current as a substitute for the curette for the removal of retained fragments of the secundines. He uses a current of sixty to ninety milliamperes with the anode in the uterus. The application is continued from six to ten minutes and repeated on alternate days. The placental tissue, owing to its relatively low vitality, is destroyed without injury to the uterus itself. Separation and expulsion follow. Hæmorrhage is relieved by the well known hæmostatic action of the positive electrode. Dr. Fry also claims antiseptic properties for the positive pole since here are liberated oxygen and chlorine in a nascent state and also acids.
Goodell thinks the curette an inefficient instrument for the evacuation of the uterine cavity and liable to injure the uterus. He advocates polypus forceps. Parrish finds the curette deceptive. He uses the finger. Longaker prefers the finger. [A Sims’ speculum, a dull curette and a strong, straight uterine dressing forceps, with its joint two and a half inches from its distal end need never fail. The finger is awkward, difficult, painful, and sometimes requires preliminary dilation of the cervix. It cannot, moreover, be so easily sterilized, and even though clean primarily is liable to carry septic organisms from the vagina. Injuries to the uterus are for the most part the fault of imperfect asepsis.]