Drainage of the uterus does not irritate it, but, on the ccntrary, quiets and abates the inflammatory process. It facilitates greatly the evacuation of putrid matter, and thus gets rid of the main obstacle in the way of cure. This drainage further assists greatly intra-uterine irrigation.
Schucking proceeds as fellows: A large metallic catheter is cut at its end and bound to a metallic drain tube, pierced by numerous openings and covered with Lister gauze. The gauze lies in the vagina as a thick wad; the drain is at the internal os, and subierves the purpose of allow ing the escape of the secretions. The gauze aims at keeping the disinfect ant solutions in contact with the uterine and the vaginal walls. Immedi ately after labor the apparatus thus prepared is introduced to the fundus.
The uterus is first washed out with a 5 per cent. solution, and then the irrigating fluid is allowed to flow in for a number of hours. This fluid is composed of 10 per cent. sulphate of soda and 5 per cent. of gly cerin. The catheter is withdrawn every twelve hours, disinfected in 5 per cent. carbolic, and wrapped with fresh disinfected gauze. This treatment is to be continued for six to eight days.
To the above more or less pronounced advocates of jections we must add the names of Playfair, Braxton-Hicks, Schroeder, Gusserow, Muller, Dominico, Chiara, Stoltz, Courty, Laroyenne, Boucha court, Delore, Pajot. The great majority of obstetricians, and we think rightly, reserve such injections for those cases where there is fwtor of the lochia,. retention of septic products, in a word, putrid infection. Among those who reject such injections, or at least only resort to them exceptionally, we mention, in France, Jacquemier, Depaul, Blot.
All French obstetricians, however, do not accept even vaginal injec tions, and although Pinard and Budin, pupils of Tarnier, practise both uterine and vaginal injections, Tarnier himself, and Bailly and Gutniot, reject both entirely. Abroad, as we have stated, Fehling and Spiegel berg use intra-uterine injections only exceptionally, and vaginal injections, as a routine measure, are rejected by Runge and Hoffmeier. Frommel, finally, reports a number of cases where accidents have resulted from the use of vaginal injections, such as those recorded by Kfistner, Fritsch, Rich ter, Veit, Olshausen, Fischer, Staude, Tarnier, Bailly, Gueniot.
The opponents of injections, whether vaginal or uterine, make the fol lowing objections to them: 1. They expose the Patient to the risk of entrance of Fluid into the Tubes
and thence into the Peritoneal Cavity. Although llaselberg, Barnes, and others, have cited cases where the solutions of iron have passed by the tubes into the peritoneal cavity, these were instances of hemorrhage where the uterus was relaxed, inert, capable of distension without power of contraction, and such is not the state of the uterus in the instances where intra-uterine injections are recommended, and the experiments of Guyon, Guichard, Danyau, Guerin, Delore, Fontaine, and others, prove that injections, in order to pitss into the tubes, must be given with a cur rent force never used in practice. The first objection is, therefore, not valid.
2. They cause Miinster, Schucking, and Rich ter have noted hemorrhage in certain instances, such cases are very ex ceptional, and the hemorrhage in any event does not amount to much.
3. They expose the Patient to the risk of entrance of Air into the Uter ine Bendu with justice says, the instances recorded by Depaul, Olshausen, Litzmann, Spiegelberg, Scanzoni, Williams, Win kel, and others, concern vaginal injections used for the purpose of induc ing labor. Matthews Duncan has reported a case where the solution en tered the uterine sinuses. But, it is pertinent to ask, what do these few cases prove when compared with the innumerable ones where intrauter ine injections have been not only not harmful, but positively useful? 4. They provoke Chill, Mardis, for metritis and per itonitis, we believe there is an error of observation, for it was not the in jection which in these cases caused these accidents, but, on the contrary, it was because they existed that the injections were administered. As for the chill, it is true enough frequently seen after intra-uterine injec tions. But this chill is not, we think, pathological, for as a rule it is fol lowed by amelioration, and it is constantly followed by notable diminu tion in temperature and pulse. Certainly, in exceptional instances, intra uterine injections may determine accidents, even as vaginal injections have aside from pregnancy or the puerperium; still, even as the majority of obstetricians are not thus deterred from ordering vaginal injections, even so we should not lose sight of the incalculable benefits to be derived from intra-uterine injections, because in a few instances they have seemed to be harmful.