Auvard, writing to the Annals of Gynec., April, 1888, says, while before the days of antiseptics it was better for a woman to be delivered in the street than in a hospital, the hospital ward is now less dangerous than the isolated lying-in chamber of the out-patient obstetric service. He points out the importance of improving the resisting power by use of tonics before the labor, in debilitated patients. In Auvard’s practice every woman takes a thorough bath at the beginning of labor. The whole vulvar and vaginal surfaces and cervical canal are sterilized before expulsion begins, before obstetric wounds are developed. Asepsis before and during the birth is more effectual than the use of antiseptics at the close of labor and renders the latter unnecessary.
Sublimate soap and the sublimate solution, with which this soap makes a lather, are well rubbed into the surfaces to be cleansed by aid of the fingers. The dangers of sublimate poisoning do not obtain while the surfaces are intact.
In the event of septic developments during the puerperal period he thinks sublimate irrigation insufficient for genital antisepsis. The vulva and vagina should be scrubbed by aid of the fingers with the sublimate soap and solution. The uterus should be scraped with the curette. Auvard has devised for this purpose a curette with a hollow stem through which a stream of the antiseptic solution is kept flowing during its use. [The mercurial salts may be replaced with a 1:1000 hydronaphthol solution for use within the passages after labor, though the danger from the former antiseptic may be greatly diminished by washing away the mercurial with a final injection of plain boiled water.]
Ahlfeld (Cent. f. Gyn., No. 52,) shows that it is not always safe to presume upon the impossibility of self-infection, and reports two cases in point. In rare cases infection may arise from organisms primarily present in the genitalia. [This goes to fortify Auvard’s position.]
OCCURRENCE OF GERMS IN THE DISCHARGES FROM THE UTERUS AND VAGINA DURING THE PUERPERAL PERIOD.
Döderlein (Arch. f. Gyn., B. xxxi., H. 3,) finds in a series of carefully conducted observations, that in normal cases the uterine discharges contain no germs, while in the same patients numerous varieties of germ life abound in the vagina. Pathogenic organisms may occur in the vagina apart from any internal examination. These germs may gain access to the uterus of themselves when not carried by intra-uterine instrumentation or manipulation. These conclusions are confirmed by Kaltenbach.