THE TREATMENT OF PUERPERAL ENDOMETRITIS

BY THE CAROSSA METHOD.

BY EDWARD J. ILL, M.D.,

NEWARK.

THERE appeared a pamphlet early in the winter of 1896, on Eine neue Methode der Behandlung des Kindbett Fieber mit durchshlagenster Wirkung, by K. Carossa.

With all its fantastic theory, there appeared a grain of truth and practicability in it, which led me to its trial in cases of puerperal fever.

Although the method looks much like permanent irrigation, it is by no means such. The author of the method describes it thus: A catheter is introduced into the uterus, and this organ filled with absorbent gauze, in a light but thorough fashion. At the external end of this catheter a funnel is attached. Through this funnel a 20 to 25 volume per cent. of alcohol solution is poured so as to flow into the gauze with which the uterus is filled. The quantity to be used is from 30 to 50 c.cm. every hour, day and night.

Carossa's theory is, that owing to the high temperature, some of the alcohol will evaporate and bedew the whole lining membrane of the organ with an alcohol solution no longer containing 25 per cent. alcohol, but about 53 per cent., thus getting a very appreciable disinfecting quality of the alcohol.

It is upon the production of alcohol dew that Dr. Carossa mainly ascribes the excellent results of the method employed. Of course, if such a thing took place, there would be by constant evaporation a production of high per cent. alcohol, and constant return flow of diluted alcohol from the mucous membrane of the uterus.

Unfortunately, this theory must be relegated to the fantastic, since an evaporation can take place only in a hollow organ filled

with air, and such the uterus is known not to be. What little air is introduced with the gauze or the alcohol solution must soon be carried away through the cervical canal.

It is not the province of this paper to go further into the learned and far-fetched arguments of Dr. Carossa, which he thinks would prove the above-mentioned theory.

There are, however, several things about the method which recommend themselves to our consideration. There is by this method a possibility of keeping the genital tract clean by the use of a nonpoisonous antiseptic, and at the same time removing débris from the uterus, which would otherwise tend to leave material and form a culture-medium for germs.

We all know from our alcohol preparations that they will keep very well in a 25 per cent. solution.

Since the whole uterus is filled with gauze we are sure to have, by diffusion of the alcoholic solution, a penetration into the furthermost recesses of the cavity.

A further reason why I have employed it is the possibility of its use in the houses of the poor, where the most primitive nursing only can be had, and where, unfortunately, the disease is most frequent.

The way I have used it in five cases is thus: I first cleanse the uterus in the usual way by curettage and irrigation, and then introduce into the uterus an ordinary, small-size soft rubber stomachtube with an open end and a funnel attachment. This tube I take of the usual length, as is used for lavage of the stomach. Near the funnel end there should be a clamp screw. The uterus and vagina are loosely but completely filled with iodoform-gauze, the patient lying on her back and the perineum retracted with the speculum.

I now pour a 25 per cent. solution of 95 per cent. alcohol in water to the amount of 60 c.cm. into the funnel, and, by slightly opening the clamp, gradually allow the fluid to flow slowly, so that the smarting of the alcohol will not be felt by the patient too severely. As soon as the last part of the solution reaches the clamp, this should be closed down, and the tube will remain filled, so that a new installment of the solution will not carry too large a quantity of air with it.

The accompanying drawing will show the relation that gauze and tube take within the uterus.

The addition of 60 c.cm. is done once in two hours. It will be easily understood how any attendant may carry out these simple instructions. The The gauze is changed not oftener than once in three days, and may be left six days. This would depend somewhat upon the febrile condition of the patient. I have used the method five times with entire satisfaction. The treatment lasted anywhere from four to twelve days, and the term of pregnancy from six to nine months. No alcohol poisoning was ever observed.

At my suggestion my colleague, Dr. W. E. Carroll, has carried it out twice successfully, once in a case of pelvic abscess, where he had done a posterior colpotomy, and the ordinary means of drainage failed. A single illustration will suffice:

I was asked to see Mrs. M., an Italian, living in the surroundings usual to those people of the lower classes, with Dr. A. K. Baldwin, on the fifth day after her confinement. She had had several chills, high temperature (104° F.), and a correspondingly high pulse. The treatment outlined above was carried out, with the result that her temperature was normal six days afterward, when gauze and tube were removed, the patient having a purulent vaginitis left, which rapidly gave way to the permanganate solution.

I wanted to report my experience with this, because anything that would enhance the simplicity of the treatment of this malady deserves our attention and trial.

DISCUSSION.

DR. ALBERT GOLDSPOHN, of Chicago.-Mr. President: I fail to see the difference between the treatment mentioned by Dr. Ill and permanent irrigation in cases of puerperal endometritis. I do not wish to reflect on the treatment at all, for we know alcohol to be one of the most potent admissible germicides. It is very valuable for systemic use, and when applied locally it is more energetic than when distributed in the system. And, in opposition to the remarks made this morning, by a speaker in favor of the dry method, that water is one of the elements that germs require for their growth, I would say that while this is true, it will avail them nothing if it is frequently or con