The Treatment of Septicemia after Confinement
F. J. LONGFIELD, M. D., LATHROP, MISSOURI.
By the term septicemia we mean the absorption into the system of ptomains or toxins generated by putrefaction of hypertrophied decidua, blood clots, shreds of membrane, pieces of placenta, or the lochial discharge.
Therefore, in the treatment our first aim would be to rid the uterus of all infecting material, which cannot successfully be done except by the curette and irrigation. I wish to state that I don't believe that it is really necessary to curette every case, as we can tell by the symptoms, such as recurring hemorrhages, which are passing every time the patient moves, with a cadaveric odor, clots and etc. In such a case as this I would curette; but where we are minus the above symptoms I would not think of curetting, would rely upon irrigation, as I am confident that a great many times there is more harm done by curetting than there is without. Whether this be a case for curettment or irrigation, I first prepare my patient as I would in any other surgical operation, irrigate the vagina and cleanse the parts thoroughly with the "Germicidal Disc. P. D. & Co.," 1 to 5,000, sterilize all instruments, hands and everything else which is to be used about the field of operation. The beauty of using the Germicidal Disc is that it does not coagulate fibrin, or cause corroding of the instruments like the bichloride of mercury, which makes it a much better antiseptic, and can use a much weaker solution with the same results.
When it is necessary I always use a Russell scoop curette, and not too much force, being careful not to lacerate the womb, gradually going around until I have thoroughly cleaned the endometrium of all loose membranes, remains of placenta and blood clots.
In all cases I irrigate with a 50 per cent solution of peroxide of hydrogen, which should be gradually injected into the uterus, using care not to cause uterine colic. The amount of peroxide to be used can be governed by the clearness of the return flow. I generally follow this with a solution of permanganate of potassium, cherry red in color, or if the parts have a cadaveric odor I use chlorate of potassium, saline solution, the antiseptic previously mentioned, or whatever antiseptic I deem indicated, using from one to three quarts at a time. If the patient is in a condition of profound septic prostration, with a high temperature and a feeble rapid pulse, I generally paint the endometrium with full strength campho-phenique, or two parts tincture of iodine and one part of 95 per cent carbolic acid, after which the uterus should be irrigated. The irrigations should be repeated according to the conditions of the patient, if the temperature is very high and discharge profuse, I generally have them repeated every two hours, if not so bad every twelve to twenty-four hours. If we succeed in these cases, we must keep the uterus as aseptic as possible.
If the case goes from bad to worse after repeated curettments and irrigations, we are justified in believing that the seat of infection is in the uterine wall or is due to multiple abscesses, and if such be the case there isn't anything to do but operate. This requires great diagnostic skill and judgment on the part of the physician. He should be absolutely certain that the infection has involved the wall of the uterus before resorting to the operation. The systemic symptoms should be met here as in any other disease, which is a very important factor, especially in these cases. The following remedies may be needed according to their special indications as here given.
Sp. Med. Aconite.—Increased temperature, dry hot skin, small frequent pulse, restlessness.
Sp. Med. Veratrum.—Full bounding pulse, sthenic inflammations.
Sp. Med. Belladonna.—Congestion, patient drowsy, dull and sleepy, cold extremities.
Sp. Med. Gelsemium.—Flushed face, bright eyes, pupils contracted, restlessness, increased heat of the head.
Sp. Rhus Tox.—Sharp stroke of pulse, tongue red at end, restlessness, starting in the sleep, typhoid conditions, tympanites.
Sp. Med. Bryonia.—Sharp knife-like pains in abdomen, worse on motion.
Sp. Med. Hyoscyamus.—Delirious, generally excited nervous condition, low muttering, not sleeping, face usually red.
Sp. Med. Apis.—Puffiness of the eyelids, scanty urination, stinging sensations.
Sp. Med. Macrotys.—Muscular sore-ness, decrease in amount of lochia.
Lachesis 6x.—Great prostration, red face, lower jaw dropped, bluish condition of mucous membranes, tongue dry and purplish, heart very weak, abdomen very sensitive to touch, cannot stand the cover pressure.
Sp. Med. Baptisia.—Face and mucous membranes purplish, sweetish breath, pasty fur on the tongue, looks like had been exposed to the cold for a very long time.
Sp. Med. Echinacea.—The tongue is dark and sometimes black, full, besotted appearance, sordes, offensive diarrhea, sweet breath, gangrenous conditions. This is the best general antiseptic in the materia medica, or at least I have found it so.
Quinine Sulph.—Periodicity, pulse soft, skin moist and soft, tongue clean and moist.
Sodium Sulphite.—Broad, pallid, dirty, pasty, moisty white-coated tongue, bad breath.
Potassium Chlorate.—Tongue moist and yellow, cadaveric odor.
Muriatic Acid.—Dry, brown, cracked tongue, sordes, great prostration.
Sulphurous Acid.—Spoiled beef tongue, glutinous fur, bad breath, sepsis.
Nitric Acid.—Violet colored tongue.
If my patient continued to grow worse in spite of all that I could do, I would not hesitate to use antistreptococcic serum. I have never as yet had to resort to this method, but certainly would try it once if my other treatment seemed to be a failure.
To encourage the flagging heart we may need some of the following remedies:
Strychnia, digitalis, cactus, aromatic spirits of ammonia, glonoin, etc., according to the indications.
The bowels should be carefully watched and kept open with whatever remedies seem indicated, but most generally the salines, oil, cascara are about all that will be needed. The diet should be light and of such material as can easily be digested, such as soups, milk, buttermilk, broths, beef extracts, gruels, milk punch, egg nog, albumin water, etc.
The patient must be kept sweet and clean; she should have a sponge bath at least once per day in which we might use either soda or vinegar according to the indications. She should also have plenty of fresh air, light, and be kept in bed at the very least one week after her temperature has been normal, as getting up too soon may be the cause of relapse and deaths from this disease.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.