Volume 1

Cyclopaedia of obstetrics and gynecology ... / [edited] by Egbert H. Grandin.

Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Cyclopaedia of obstetrics and gynecology ... / [edited] by Egbert H. Grandin. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    At the first visit we should assure ourselves of the height of the fundus' of the uterus. Not uncommonly it is inclined towards one or the other side, usually the right, and reaching to the umbilicus. This elevation of the organ is due entirely to the distension of the bladder. If the woman cannot pass her urine, it must be drawn by the catheter. This retention of the urine usually disappears at the end of twenty-four hours, although it may last much longer; we have seen it last to the fourteenth day. The woman should be catheterized at least every twelve hours. [This we do not believe is often enough. At the end of six hours, at least, vesical dis- tension is great enough to call for artificial aid, if the patient cannot pass her own urine. As a practical point in regard to the catheter, and one not insisted upon suflficiently, we would state that the catheter should always be passed by sight, never by touch, and that prior to its introduc- tion the vestibule should be carefully cleansed. Thus the introduction of lochia into the bladder on the point of the catheter is avoided, and there- fore a possible cause of cystitis.—Ed.] The toilette of the newly delivered woman should be made with the greatest possible care, and every cause of infection kept away from her, and from the lying-in room. Soiled linen, napkins, should be frequently changed, and taken from the room. The air in the room should be often changed;, in summer the window may be left open from nine in the morn- ing to seven in the evening. If the genitals are abraded, they should be- covered by a compress wet in a solution of phenic acid, 1 to 100. For our part, this external toilette is not sufi&cient, and, in accord with the ma- jority of foreign and French accoucheurs, we cause to be given to all our patients, from the day after delivery, vaginal injections of some antiseptic fluid. We are so convinced not only of the innocuousness, but of the advantage as well, of these injections, that if the labor has been longer than usual, or we have been obliged to interfere, or the woman has given birth to a dead, putrified or macerated child, we begin Avitli them imme- diately after labor. One injection, night and morning, is enough for or- dinary cases, but we give them every tw^to three hours, if the lochia be- come foetid. We use phenic acid solutions, 1 to 100, and the injections are administered from Eguisier's irrigator, with a tube with lateral open- ings. The irrigator should first be filled as well as the tube, and the fluid should be allowed to flow gently. In other words we simply aim at washing out the vagina. The water should be of a temperature of 90 to 95° F. In general, we resort simply to vaginal injections, reserving intra- uterine for special cases. (See subject of Puerperal Fever.) [While we would not be understood as condemning the above pi-actice, our belief is exactly the reverse. In the normal puerperium we are satis- fied that vaginal injections are useless, and that women Avill pass through exactly as normal a puerperium without them. This applies with all the greater force to private practice, when we state that at the New York Ma-