Technique of emptying the uterus in inevitable abortion / by Charles P. Noble.

  • Noble, Charles P. (Charles Percy), 1863-1935.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: Technique of emptying the uterus in inevitable abortion / by Charles P. Noble. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    ! daily. In simple non-infected cases the use of the iodoform pencil and the gauze is a matter of precaution rather than of necessity. When infection of the endometrium has already occurred, after the removal of all portions of the ovum and clots by the finger, the uterus should be carefully curetted, in order to take away as much of the maternal decidua as possible. This at once disposes of a large number of germs, and likewise of the culture medium in which they are growing, and unless the infection has spread to the deeper structures of the uterus, it cuts short the infective process. The uterus should be curetted at once, after removing the ovum. It is best done by retracting the perineum with the Edebohls or other speculum, grasping the anterior lip of the cervix with a bullet forceps, upon which gentle traction is made, to steady the uterus. The broad cutting curette is then introduced, and the cavity of the uterus systematically gone over, curetting one lateral wall, then the anterior wall, the other lateral wall, the posterior wall, and finally the fundus. A useful manoeuvre is to use one or two fingers of the left hand for counter pressure, by introducing them well up against the uterus, and changing their location as the curette is used. in one or other part of the uterus. In order to do this it is necessary that the bullet forceps be held by an assistant. When the curettage is completed, the uterus should be douched with sublimate solution, and a 50 grain pencil of iodoform, and also iodoform gauze, should be introduced. In using the curette it must never be forgotten that the soft puerperal uterus can readily be punctured. This has happened in the hands of the most experienced men, even in the non-puerperal uterus, so that the risks of this accident in the hands of the novice, or the practitioner of small surgical y experience, are considerable. This accident is best avoided by using a broad curette, and by systematically and gently going over the surface of the 1 uterine walls. Force, either in introducing the curette, or in scraping the 1 walls, must never be employed. The real nature of this danger is the reason 1 why the curette should not be employed, except in septic cases. The ] maternal decidua is thrown off by the natural processes in non-septic cases, I and this is an integral part of the normal puerperal processes. To remove i the maternal decidua under these circumstances is a work of supererogation. 1 The argument in its favor, that the nidus for septic germs is thus removed,. ) is not convincing, as if the case is not infected at the time the uterus is- emptied, the probabilities of subsequent infection are slight. When con- 1 trasted with the real danger of puncturing the uterus, I believe that judi- cious men will advise that the practitioner avoid the use of the curette, except in infected cases. As this paper deals only with the technique of emptying the uterus in inevitable abortion, a discussion of the cases in which this method should be employed, as distinguished from those which can be left to the unaided forces of nature, is not in order. Suffice it to say, that abortion occurring, before the third month, and non-infected cases in which the ovum is intact: and the hemorrhage trifling, can usualljr be left to the natural forces. Artificial interference is urgently demanded when infection has occurred, (which includes almost all cases of criminal abortion), in cases in which hemorrhage is free, and broadly speaking, cases in which the pregnancy has- advanced beyond the twelfth week, more especially if the ovum be ruptured.