GEORGE J. ENGELMANN. 
massage; to secure permanent contraction after expulsion of 
the placenta, the same manipulations should be resorted to, 
and these will be admirably furthered by the hot yaginaj 
douche, in more severe cases by intra-uterine injections, to 
which a disinfectant should be added, such as carbolic acid or 
corrosive sublimate; this cleanses and disinfects, leaves the 
patient comfortable and safe; by removing clots and shreds 
it may even, if repeated, alleviate after-pains. 
In case of bleeding or profuse hemorrhage, nothing can 
compare to this method; and, if safe and reliable in severe 
cases, why not resort to it in the more simple, where ergot is 
now supposed to be alone useful, even indispensable ? 
In abortion, the proper indications for the administration 
of ergot are so difficult to formulate, its use is so restricted, its 
injurious effects so frequent, that the foregoing axiom—that 
the gravid womb contra-indicates the use of ergot—need meet 
with no exception. Such remedies as meet immediate indica¬ 
tions must, of course, be adopted, and beyond these the hand, 
the douche, and the scoop, sharp and dull, will answer all 
purposes. Massage and expression are not so simple and 
direct as in labor at term, but the uterus can be thoroughly 
and safely manipulated, as Schroeder suggests—the ovum 
even expressed—by supporting the organ by two fingers of 
one hand placed to the sides of the cervix, or in the anterior 
and posterior culs-de-sac , while pressure is made upon the 
fundus with the other hand. 
Conclusion .—So much Injury is done, so much suffering 
caused, by the indiscriminate and injudicious use of ergot, 
that it should be entirely abolished in labor, premature and 
at term. External manipulation, friction of the surface, 
massage and expression, and internal manipulations, by the 
hand, the scoop, and the douche, accomplish with safety and 
certainty the objects which it was supposed to serve, so that 
they will soon become popular, and ergot will only be given 
by the obstetrician for its one legitimate purpose—to insure 
contraction when labor is completed, and to act as a guard 
upon the treacherous fibers of the uterine muscle. To avoid 
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