Few surgical procedures have more widely and earnestly engaged professional attention of late years than the intrauterine injection of strong ferric solutions. Schreier, of Hamburg, was accustomed to use weak injections (1/2 to 1 dr. in 4 oz. water) for hemorrhage, either before or after delivery (Medical Times, ii., 1855), and still weaker injections (1 dr. to the pint) have long been practised in the Vienna school, if cold and ergot failed. Ford recorded the successful arrest of severe hemorrhage after abortion by intra-uterine injection of ferric sulphate (1 dr. in 4 oz. water), also three other cases (American Journal, April, 1868). Probably other instances might be found, but general interest in the subject was first thoroughly aroused by Dr. Barnes. The mode adopted by him was to mix 1/2 pint of the liq. ferri perchlor. fort., B. P., with water up to 1 quart, and to inject this slowly through a Higginson's syringe, of which the delivery pipe was passed well to the fundus uteri; by this plan he was satisfied that life had been saved several times, and he held it specially applicable to cases when contractile power could not be roused, and the uterus remained dilated and inert after a prolonged labor. The styptic mechanically stayed the hemorrhage by sealing the vessels, and usually induced also uterine contraction (Medical Times, i., 1865; also Lancet, i., 1869, and British Medical Journal, ii., 1873). Dr. Hugh Norris (Somerset) recorded a similar experience about the same time (British Medical Journal, 1869-70). Cases for and against were soon reported from different parts of the country, and it was not long before a vehement controversy arose, tinged, unfortunately, with some personal animus. A case of secondary hemorrhage really dependent upon retained placenta, but in which several injections of perchloride solution (the last one being of the strong and undiluted tincture) had been practised, died ultimately of septicaemia, and furnished the text for a full discussion at the Obstetrical Society. Such a case was not really illustrative of Dr. Barnes' mode of treatment, and, although it proved fatal, the opinion of practical and experienced accoucheurs such as Braxton Hicks, Playfair, Potter, Edis, Murray, etc., was expressed decidedly in favor of such injections in suitable cases (Lancet, i., 1873, pp. 306, 407). On the other hand, Graily Hewitt, Routh, Bantock, and Snow Beck, referred to other instances in which such injections did apparently cause septicaemia and embolism. In Dublin, the favorable experience of Dr. Barnes was amply corroborated by Dr. Lombe Athill, while Dr. E. Kennedy took a much more cautious view, and urged the reservation of the method for a dernier ressort (Dublin Journal of Medical Science, May, 1874).

In Edinburgh, the discussion of an unsuccessful case showed a balance of opinion against the procedure. Dr. Mathews Duncan especially questioned its propriety, though Dr. Alexander Simpson expressed a more favorable view (Edinburgh Medical Journal, February, 1875). In France, if we may judge by the observations of M. Budin, of the Mater-nite, professional opinion is decidedly adverse (Bulletin de Therapeutique, 1876, p. 89). In Germany ferric injections seem to have been scarcely tried, for no account of them is to be found in the Archiv, Zeitschrift, Centralblatt fur Gynoecologie, nor any comments on German cases in Schmidt or Virchow and Hersch Jahrsbericht.

An impartial estimate of English writings on the subject leads to the conclusion that the greater part of the favorable testimony comes from those who have really used the method of Dr. Barnes, while objections are made chiefly by those who have not ventured to try it. The latter urge (1) that the proper object in the treatment of post-partum hemorrhage is to secure uterine contraction (not simply a plugging of the vessels with clot), and that cold, friction, etc., are better and safer agents for the purpose; (2) that there is too great tendency to neglect these measures for the more energetic iron treatment; and (3), which is most important, that such treatment exposes the patient to grave risk from the formation of emboli or the injection of air into veins, or the forcing of fluid through the Fallopian tubes. The first objection as to uterine contraction is met by the statement that highly experienced men have, in some instances, failed to secure uterine contraction by any ordinary means, and have succeeded with the ferric injection, and have thus stayed severe hemorrhage, and probably saved life, without any ill-result; but much weight must be allowed to the other objections. It is within my own experience that iron injections have sometimes been employed far too soon, from over-anxiety to stay what I should consider not excessive hemorrhage, and which would have yielded, I believe, to cold and the judicious use of ergot. I am also cognizant of at least five cases in which death has followed apparently from embolism, and yet I do not blame the principle of the treatment so much as some defect in carrying it out. Thus, sometimes the uterus has not been properly emptied of clot beforehand; sometimes the solution has not been strong enough, and at other times the exit has not been free. The greatest care is required as to all these points. The patient should be on her back, the womb emptied of clot and gently compressed, the uterine tube should be long enough (about 9 in.) to reach to the fundus, the solution should be of about 2 oz. dry perchloride to 12 oz. water, or 2 oz. liquor ferri perchloridi fort. to 10 oz. water, free from air, and injected slowly and steadily, and the os must be patulous, and the exit quite free, so that no undue pressure or distention should force fluid into vessels or through the Fallopian tubes. If these precautions be all adopted, I believe the ferric injections may be used with safety and with the best results, even in most serious cases; they are an important addition to our means of saving life, but of late years the injection of hot water into the uterus has been found to be as efficacious its solution of iron and devoid of its dangers, and promises to entirely replace it in practice.