Correlation of Data in Cases Seen at the Psychopathic Department and Foxboro State Hospital

Lawson G. Lowrey
1920 Boston Medical and Surgical Journal  
and the pulse may range from 100 to 110. The uterus is big; it is soft; it is somewhat tender. The lochia are very foul. Simple massage of the uterus will oftentimes push out a clot or material at the internal os with the result that drainage from then on is perfectly competent. In such cases the temperature will go to normal and remain so. The routine treatment of such cases' is elevation, ice and ergot and in the case in which we have very foul pads with no rise in temperature there is
more » ... ure there is nothing to do. Nature is doing all that is necessary. Logically the sapraemia case is the only one which offers any argument for intrauterine manipulation. Here if one wishes to use a douche for the purpose of mechanically washing out material and does it for that purpose alone, no one can say but that the treatment is logical, but inasmuch as elevation, ice and ergot will accomplish this same result, perhaps taking a day or so longer to do it and subjecting the patient to no possibility of danger, is it worth while to run any chance of carrying true bacteria into the uterus for the treatment of a condition which can be successfully combated by conservative measures ? I feel strongly that intrauterine manipulation for sepsis is never indicated; often very harmful and has practically nothing to be said in support of itself. There is one sequela of the saprophytic ini'ection besides the possible superimposed infection of pyogenie organisms and that is the suibinvolution of the uterus with its subsequent prolonged bloody discharge. Cases in which material has been left at the time of labor may often show continued, red lochia two or three weeks after delivery, with a uterus which is bigger than normal. This bleeding is due to some foreign substance in the uterus and it will persist until this foreign substance is removed. This complication is not uncommon and it is not common. The treatment in all such oases is rest in bed, ice and ergot, and if the temperature has been normal for a week or ten days and the lochia does not cease under inactive treatment, curettage is indicated and it is in this condition that the curette holds its only rational position in postpartum obstetrics today. Conclusions. Puerperal infection is bacterial infection. Organisms gain entrance, first by vaginal examination; second, by the presence of an abnormal vaginal flora at the time of labor: third, by extension from foci of infection elsewhere in the body. The three types of puerperal infection depending upon the organism are, first, hemolytic streptococcal infection; second, pyogenie infection: third, saprophytic infection. The treatment of each type depends upon the bacterial reaction and the knowledge of its pathology. By and large, leave it alone. The curette is dangerous. The antiseptic douche unintelligent. The conservative treatment rational and harmless. Surgery plays its part only when the infection has produced localized pus, and then the old-time surgical principle of the evacuation of pus obtains. Vaccines and serums have had their try and they have been found wanting. The future holds its hope first in aseptic preparation of the patient, absolute cleanliness of the operator. In this way, to lower the percentage of infection to its lowest possible point. Next, conservative treatment to do no harm rather than to go on the supposition that some good may come from interference and in the specific serum for each individual case based upon the success of the treatment of type four in pneumonia. Theoretically, vaginal smears and cultures of a pregnant woman taken soon before labor may ponit out those which contain harmful bacteria and in consequence, some method of making these harmful bacteria harmless may bo evolved.
doi:10.1056/nejm192009231831302 fatcat:gsyax3g7fnarzdglhbs2pb5f7y