The Ethics of Medical Homicide and MutilationO'Malley, Austin
Religion
The Ethics of Medical Homicide and Mutilation
O'Malley, Austin
Medical ethics
If a uterus is flexed it is easy to poke a curette or like instrument
through it at the bend, especially if the uterus is thin or friable
from sepsis. Again, the placental site is raised, it feels rough, and
the furrows in it lead one to think part of the placenta is still
adherent, whereas all has been removed. Repeated scraping, due to
this error, may dig a hole through the uterine wall. Perforation
in a septic case is practically always fatal to the woman. The use
of the curette supposes a special technic, and no physician should
presume to try its use unless he has been carefully and practically
instructed.
In inevitable abortion after the third month it may be very difficult
to get the embryo out. The cervix, in primiparae especially, may be
long, thick, and hard. If the fetus is dead, it may then be removed
by _morcellement_--_i. e._, by cutting and breaking it into pieces,
and then taking out these pieces with an ovum or stone forceps.
Sometimes, though rarely, the operator may find it impossible to get
the entire fetus away. Then the uterus is packed with weak iodine
gauze, and after twenty-four hours the fetal remains are expelled.
In every abortion the presence or absence of extrauterine pregnancy
is to be made out. If there is an extrauterine pregnancy, curettage
will cause rupture of the sac.
When the interior of the aborting uterus has become septic the old
treatment was to empty the uterus at once, but now the treatment is
expectant, because the traumatism of the curetting makes the sepsis
worse. The commonest and worst infections are of the streptococcus
putridus, a pus staphylococcus, and the bacterium coli communis.
Curettage lets these microörganisms enter the circulation. The
cause of this condition is often unskilful attempts at artificial
abortion. When the womb contains decomposing material bleeding
usually obliges tamponing, and thus often the uterine contents come
away in twenty-four hours with the gauze. If there is no hemorrhage
there should be no tamponing: it is then better to get dilatation by
packing and drain the uterus with gauze. The curette should not be
used at all.
Where there is habitual abortion the cause must be found. During
gestation syphilis and displacements of the uterus, as causes,
may be treated. Endometritis can be cured only when the uterus is
empty. Rest in bed at the time when these abortions usually occur,
and at the time when menstruation customarily appears, is required.
Treatment of the husband is often necessary, as he is virtually
always the source of luetic infection.
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Elsewhere in the archive
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account