Tuttle, Howard K.: The Treatment of Abortions

552

'fHE AMERICAN JOURNAL Oli' OBSTETRICS AND GYNECOWOY

nomic depression. Of these cases, in H the uterus was emptied by the physician before admission, in 137 cases, which wt>re consernt.th·ely handled on account of ~ume complication, the uterus emptied it~ elf spontaurously, and iu l i.'-:7 patients tltl· uterus was cleaned out in the hospital. 1'here were 6G death~ ( 5.2 per cent), tU11l <'omplications aftf'r the eleaning out wen' ree~>rrlril in 66 patients (5.~ per cent). Of the 6(j deaths, only 2;) had had loeal trentment in tlw hospital fa mortnlity nf :!.3 per cent to the credit of active therapy); ::!:l of the 41 others ha<1 periutf'rinr inflammation, il had had the uterus deaned out hefon' admission, 5 were t•ery septic (some of these were moribuncl on admission), 3 lwr1 sen1re prritonitis, 1 had a lung abscess, and 1 had pulmonary tuberculosis. The fehrilt' abortions showed a gross mortality of 10.1 per eent; the case,; of this group in which the uterus Wr. ·u this cannot he done, a laminaria trnt is employed, but not for more than twelve luHll'R, he(•ause of the 1langer from re· t(•ntion. When the eenix is open, the ovular remHanl$ are loosened with the flu ger, removed with Winter's plaeental fol'('eps. then a large blunt cmette is used if necessary to remove fragments not detncherl b;v the finger, and finally a hot intra· uterine douche of salt solution is given. If the uterus iH flabby, an ergot prepa· ration is given hypodermatically. Packing is prl'formed only whfn nt'C<"Ssitated h~' free bleeding. In one ~ase the uterus was perforated by the curette; supra vaginal l1ysterectomy W:t$ at once performei!, with recovery. In impending abortion witl1 complicationH, rouRervativ~ :md supportive measnre~
Tutt1e, Howard K.: The Treatment of Abortions. Surgery, Gynecology and ObRtetrics, 1925, :xi, 8i. The writer reviews 1,164 cases of abortion at the Ancon Hospital, Canal Zone, to compare his results with those of other clinics. His references are, however, limited to two writers of Chicago and one personal communication. Ire is of the opinion that hemorrhage sufficiently severe ·to C!lll for immediate active treatment is seen in approximately :; per rent of nU cases. Ft>brile cas<>s operated upon promptly have a slightly higher !Jxerage number of postoperative febrile days, a lower per cent of morbidity, and fewer average hospital days than those operated upon a number of ·days after the temperature has remained normaL T11e average febrile days, morbidity I)er<•entage, and average hospital days of operative cases are lower than in the Jlonop.;Jrative. Those cases where infection has extended beyond the uterus, and without evidence of retained necrotic placenta or membranes, should be treated expectantly. When tissue remains in the uteru~ it is just as essential to remove it as a sloughing appendix in the abdomen. W!~>!. C. HENSKE.

Gordon! The 1\h:nagement of Abortion. Journal Amerioo.n Medical Assoociation, 1924, l:xx:rii, 1021.

A series of 961 conseeutiye cases of abortion was divided into septic and aseptic. Septic cases are tho-se with temperatures of 101• F. by rectum. In a further classification of a total of 1,640 abortions into threatened, inevitable, anti incomplete, there were 1528 incomplete abortions. The management of the threat· ened case con-sists in preparation as though for labor. No intravaginal cleansing, bedrest, morphine, % grain hypodermically-repeated two or three times, and daily enemas. If the ease passes to the inevitable stage, and bleeding is excessive, by