INDUCTION OF LABOUR BY MEDICINAL MEANS.

1311 ,distinction being drawn between the treatment of the selected for treatment in this way. Such indefinite " blue " and the " white " infants. With regard to reasons as distress and discomfort (48 cases), false massage of the heart and to intracardiac injections pains (16 cases), and fear of precipitate labour (9 cases) are given and seem to suggest that expediency and the as methods of restarting the heart beat Sir Francis showed that subdiaphragmatic massage was rarely convenience of patient and doctor may be influential successful, and that so many different drugs had been factors in determining the adoption of a method that successfully injected intracardially that probably is not regarded as carrying any risk to mother or In child. The procedure adopted at first was to success was not dependent on the drug at all. this he cited of the laboratory administer 3ii. of castor oil and grs. x. of quinine support argument work of Watson who, in 22 out of 60 experiments sulphate followed two hours later by a hot soap enema. on dogs killed by chloroform, restarted the heart When the enema was about to be expelled, a hypobeat by puncture of the heart alone. A. S. Hyman’s dermic injection of Riii. of pituitary extract was clinical work was quoted in further support of the given, and this dose was repeated half hourly till contention that it is the needle puncture of the labour began or 15 injections had been given, after heart, not the injected drug, which is the essential which no more pituitary was injected. Failure was factor in restarting the heart by intracardiac injection. admitted and the induction was stopped if labour Moreover, it was shown that puncture of the auricle pains did not begin within eight hours of the first is better than puncture of the ventricle, for the injection. The dose of quinine was later cut down to auricle is more sensitive to stimulation and also if grs. v. and afterwards given up altogether. It appears fibrillation is set up then it is not incompatible with that 96 per cent. of the cases were successful-about life. Efforts to restart the heart should be made 70 per cent. at the first attempt, 20 per cent. at the not more than five minutes after the beat has ceased, second, and the remainder after 3, 4, or 5 attempts. but the determination of this movement was shown The writers confirm the general experience that the to be extremely difficult. In the case reported by nearer the patient is to term, the greater the proporDr. A. Fakhry in our correspondence columns this tion of immediate and successful inductions. With week, the pulse was still occasionally perceptible, the cervix effaced, the head deeply engaged, and the though the patient’s condition seemed desperate. os admitting a finger, response was readily obtained. The danger of delay lies in the inevitable damage When the head was floating and the cervix not taken to cortical cells of the brain if they are deprived too up, it was often noticed that by the second or third long of their oxygen supply. Illustration of this attempt the head had become engaged and the fact was given in the case of the child collapsing after response to the next attempt was usually rapid. a tonsillectomy, who was revived after the heart had In the 29 cases of spontaneous rupture of the apparently ceased to beat at least 13 minutes. Her membranes, which Mathieu and Sichel regard as an eventual recovery was accompanied by cerebral indication for their method, induction was always symptoms that lasted for two years. Sir Francis successful at the first trial. Apart from the excellent alluded to the danger of adrenalin in the presence of results recorded in this paper, the striking feature .chloroform anaesthesia and did not believe that it was is the small percentage of cases in which natural limited, as A. G. Levy has maintained, to light delivery was attained. Doubtless there was among He insisted on the necessity for prompti- them an undue proportion of abnormal cases, but narcosis. tude in the application of restorative measures when even making ample allowance on this account, the these are needed, and at the close of the meeting proportion of spontaneous deliveries was but 15 per demonstrated several forms of restorative apparatus. cent., and in the birth of 323 children 80 per cent. were Dame Louise McIlroy described her methods for delivered by the forceps, version was performed 12 dealing with newly born infants that required times, and pubiotomy and Caesarean section each once. resuscitation. She uses oil, not baths, and warmth, It is an open question whether women who have undergentle squeezing of the chest, and application of gone this method of induction are in a condition oxygen with 5 per cent. carbon dioxide. The many which favours the best uterine action. Possibly other speakers who followed evinced a certain amount the physical and psychical disturbance occasioned of difference of opinion as to the desirability or not by the medical treatment may interfere with normal of employing endotracheal intubation early in the function, and the large proportion of failures to process of resuscitation. complete labour, necessitating the use of low forceps, suggests that this may be the explanation. If so, a INDUCTION OF LABOUR BY MEDICINAL MEANS. practice suitable for a well-equipped hospital and skilled attendants may have its risks if adopted by Two years ago1 we drew attention to the total all and sundry and in any circumstances ; for in deaths which occasionally follow medicinal induction the long run injuries, morbidity, and mortality vary of labour and are ascribed to the quinine generally directly with the degree of interference in labour. employed. In this regard a paper by A. Mathieu and M. S. Sichel2 is of interest because they review 320 cases seen in private practice during nine years BACTERIOPHAGE IN CHOLERA. and say that quinine was omitted from the last 120 OF late years we have frequently drawn attention without apparently detracting from the effectiveness to the work on bacteriophage which is going on in of the method. By widely extending the indications India. This work became more complex when for non-operative induction they claim to have saved I. Asheshov isolated three types of bacteriophage, much maternal mortality and several foetal lives. and laid it down that for therapeutic purposes all Their results certainly support the claim, for in their Since then a good these at least must be present.l 320 cases there were no maternal deaths, and the deal of intricate research has been undertaken, and number of foetal deaths, seven in all, was well below it is steadily yielding fresh information. The indivithe usual 3 per cent. average rate. But the classificadual types of bacteriophage, when separated, prove tion used and the lack of uetail in their paper makes somewhat unstaple, and in artificial mixtures also it impossible to judge accurately of the type of case they are liable to die. Natural mixtures from patients, 1

2

THE LANCET, 1929, i., 1047.

Surg., Gyn., and Obst., Nov., 1931, p. 676.

See THE LANCET, 1930, ii., 1248.