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Dr. George B. Wood ; Alvarenga prize commit- tee. Dr. Elliston J. Morris, Dr. John amoxil tablets M. Swan, Dr. amoxil order Strieker Coles, Dr. Alfred Hand, and Dr. Joseph M. Spellissy. February 25, 1905.] HASTINGS: PREPUERPERAL AND PUERPERAL HEMORRHAGES. 377 A BRIEF REVIEW OF THE TREATMENT OF PREPUERPERAL AND PUERPERAL HEMORRHAGES.* By CHARLES J. C. O. HASTINGS, I\I. D. C. M., L. R. C. P. I., L. M. K. Q. C. P. I., TORONTO, CANADA. In view of the fact that a large number of the Fellows of this society are not engaged in obstetrical practice, I presume I should offer some apology for bringing this subject before you. The facts, how- ever, of the cases being, fortunately, of rare occur- rence and the results depending on the judicious and prompt action of the attendant, justify, if they do not in fact make it obligatory on our part, to have an occasional rehearsal as regards the best line of treatment in order that we may amoxil 400 be well equipped for prompt action, as we can only hope successfully to meet an emergency by being prepared for it. Wellington said that his greatest victories were achieved before the battles were fought. Napoleon maintained that he had conquered the greater part of Europe because the enemy didn't know the value of five minutes. Now if we hope to attain similar laurels in the field of labor we must keep our pow- der dry and know how to appreciate the value of every minute, for in these cases we are confronted by a formidable enemy which will promptly conquer if not conquered. My experience in private practice extending over nearly nineteen amoxil buy years amoxil buy online is limited to two cases of unavoidable, two of accidental, and 500mg amoxil one of post partum haemorrhage. From my per- sonal experience and amoxil 500 mg observations, the successful handling of these cheap amoxil cases depends largely on the abil- ity of the physician to properly classify them, as no method of treatment can be suggested that would be suitable for all cases. The advances in treat- ment of these cases, if they are an advancement, have been with the object of diminishing the infant mortality. If this can be accomplished without di- minishing in the slightest amoxil 500 degree the chances of the mother, then amoxil 250mg they may well be considered advance- ments. If the child is viable, or if a severe haemorrhage has occurred, labor should be induced at once. If on the other hand the child is not amoxil price viable and there have been but slight hjemorrhages and the patient can be kept in the recumbent posture in a hospital, or otherwise carefully guarded, I think one is justi- fied in temporizing, providing that the patient's friends, when advised of the nature of the case, are satisfied or desirous that such a course online amoxil should be pursued. Now, assuming that the child is viable or that a severe haemorrhage has occurred, what is the best metliod of inducing labor and emptying the uterus? * Read before the Toronto Clinic.il Society. May 4, 1904. If the patient is a primpara and the cervix will admit only one finger, and the os is rigid, the cervix should amoxil 250 mg be drawn down with a strong tenaculum and held while the cervix and vagina are gently but amoxil generic firmly packed with iodoform gauze. If properly done this will usually stimulate uterine contractions and satis- factorily control the haemorrhage, and when the packing is removed in a few hours, in a vast major- ity of cases the os will be sufficiently dilated to admit of digital dilatation by Harris's method. If, how- ever, the pains have become strong and regular, the haemorrhage is not severe, the head or buttocks are engaged, we may safely watch purchase amoxil and wait, never leav- ing the bedside of the patient. Should there be any increase of haemorrhage the membranes should be ruptured amoxil 875 mg at once, so that the amoxil 875mg placenta may retract amoxil 875 with the uterocervical walls and at the same time allow the presenting part to press down firmly on the bleeding surfaces. If this is amoxil 250 not effectual in controlling the hasmorrhage, no time should be lost in bringing down a foot, but this must always be done very gently so as to disturb the placenta as little as possible and produce the least possible shock to the mother. I would like to emphasize here the fact that there is no means known to the profession to compare with the bringing down of a foot to control haemorrhage in these cases. The means

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