[Reprinted from the American Gynaecological and Obstetrical Journal 
for May, 1895.] 
THE DRAINAGE-TUBE IN PUERPERAL INFECTION. 
63% Whitehall Street, Atlanta, Ga. 
To the. Editor of the American Gynaecological and Obstetrical Journal: 
Sir : At this opportune time while surgical measures in puerperal 
infection are being so freely discussed I desire to present a plea in 
behalf of the use of the soft-rubber drainage-tube in these conditions. 
Having tried its efficacy in a number of cases extending over a period 
of several years I am fully convinced that its use coupled with cleans- 
ing and disinfection of the uterine cavity is the most efficient plan of 
treatment and method of drainage in cases of infection occurring after 
labor. I am also fully convinced that its timely, persistent, systematic, 
proper use will save more lives than abdominal section or vaginal 
hysterectomy. 
In making this statement I do not wish to decry or obstruct the 
advances of surgery in this line of work-far from it-for treatment 
and surgery each has its field of usefulness in these cases. 
While I advocate heroic surgical measures in these cases, when 
the conditions and circumstances demand it, yet I feel it is our duty 
to save life by the simplest means possible and with least risk to our 
patient. Not only should life be saved but every organ of the body 
should be so preserved as to perform its functions afterward if pos- 
sible. For this reason I strongly urge the proper use of the drainage- 
tube. 
In cases of abortion or infection afterward I use and advise thorough 
emptying of the uterus, irrigation, disinfection and the gauze tampon. 
Here the gauze tampon is most efficient and meets all the require- 
ments because the uterus is small, readily contracts and is easily 
drained of liquid contents, there being little if any solid elements to 
be thrown off. By the use of the gauze drainage and hot vaginal 
douches involution takes place rapidly. 
Infection after labor at or near full term presents different con- 
ditions to deal with, the uterus is large, flabby, relaxed and will not 
drain itself although the os be patulous, does not contract readily 
Copyright, 1895, by J. D. Emmet and A. H. Buckmaster. 2 
R. R. Kime, M. D. 
leaving a large placental site, and large venous channels open favor- 
ing absorption and preventing involution In all these cases whether 
it be putrid, septic or mixed infection the uterus contains material 
which should be eliminated. As to the method of getting rid of 
this material eminent authorities differ. (See April issue of this 
Journal.) 
In these cases it is important we keep in view the variety and 
severity of the infection as well as investigate the contents of the 
uterine cavity. I can not conceive how any physician can object to 
the removal of putrid placental tissue from the uterine cavity when 
we know that it is the ptomaines or putrefactive alkaloids that are 
absorbed and not the germs. 
While this putrefactive material remains in the uterine cavity it is 
constantly adding fuel to the fire. To remove it is to get rid of the 
cause and the only rational method of procedure whether it be by 
irrigation, finger, curette forceps or curette, adapting the method best 
suited to the individual case and dexterity of the operator. 
In septic infection the conditions are different-the entrance, de- 
velopment and absorption of germs with their alkaloidal developments 
are the cause and the curette should be used with extreme caution. 
Yet if the uterus contains placental tissue or blood-clots they form 
hotbeds for germ development and should be removed by the simplest 
method possible, avoiding injury to the endometrium which forms in 
many cases a barrier to the entrance of germs. To empty the uterus 
in all forms of infection, first dilate the cervix and hold it open with 
dilators then wash out all material possible with a disinfectant solu- 
tion, after which remove the contents of the uterus by the method 
best adapted to the individual case irrigating again and follow by dis- 
infection and drainage. 
Drainage is the most essential factor in these cases and should be 
so conducted as to carry off fluids, germs, pus cells and small parti- 
cles of degenerated endometrium, blood-clots or other debris. 
Gauze drain can meet but one of these requirements-drain- 
ing off fluid-while the drainage-tube properly used meets ah and 
drains off the fluid more readily than gauze. It is to these solid ele- 
ments as well as the fluids we wish to give free exit and even the drain- 
age of fluids is obstructed by the gauze if it be packed tightly in the 
cervical canal or near its entrance. A practical test of the drainage- 
tube properly used will certainly convince the most skeptical. I have 
a case of infection now convalescing which I saw ten days after con- 
finement with a temperature of 106.5° F., the drainage-tube having The Drainage- Tube in Puerperal Infection. 
3 
saved her life. The uterus was large, flabby, relaxed, over six inches 
in depth with a patulous os yet filled with a purulent material that 
filled the vagina and speculum, running down into the tub by the side 
of the bed when the cervix was held open with dilators. On three 
different occasions this patient was so improved the tube was re- 
moved, but each time within twelve to twenty-four hours the patient 
grew rapidly worse with elevation of pulse and temperature reaching 
as high as 104° F. 
The other treatment was not changed, the use of the drainage- 
tube resumed and the patient gradually improved each time. 
Gauze drainage was also tried in this case but failed to accomplish 
the desired result. As to the method of using the drainage-tube, in 
eluding other treatment and the surgical measures in puerperal infec- 
tion, see an article in last issue of Medical Progress of Louisville, Ky. 
R. R. Kime, M. 1).