Especially to be avoided are alcoholic and aromatic drinks. Sedatives are only indicated occasionally in very sensitive patients. Lukewarm, indifferent or slightly stimulating sitz and general baths do good by les sening the sensibility of the parts, preventing irritation of the skin of the external genitals, adhesion of the labia by dried-up secretion and other consequences of uncleanliness. Chronic cases do not require such strict general treatment, though a careful regimen is undoubtedly useful, and the use of alkaline and stimulating baths are of service in complicated cases. Even in the chronic form it is important to prevent exascerba tions by a careful regulation of exercise, food, cleanliness (especially at the menstrual epoch), and the avoidance of coitus. 'rhe physiological complication of pregnancy requires the same care as does menstruation; while during the puerperal period the necessary regimen is in any case carried out.
lf pathological complications influence the catarrh, they must be com batted at the same time. It may be necessary to treat uterine affec tions; and the case of any chlorotic or chronic amemic condition which nlay be present is an essential condition for the success of the local treatment.
Sometimes the simplest methods suffice to control the catarrhal condi tion, in eases where we know the c,ause, as for instance, the removal of foreign bodies (frequently pessaries), or of stagnant secretion. Ordinarily, however, the treatment must be directed towards overcoming infection, that is nullifying the life and development of the bacteria which are in the secretion, and we must here disinfect without at the same time irri tating. After neutralizing the infectious action on the mucous mem brane, the after-treatment does not amount to much, since the inflam matory swelling, the circulatory disturbances and the abnormal secretion will disappear largely of themselves. Nevertheless we should not too strictly abstain from local treatment, particularly in chronic cases where there exist papillary excrescences, erosions, etc.
In order to disinfect properly it is necessary that: 1. The secretion be rendered harmless, and its stagnation prevented.
2. The entire superficies of the mucous membrane must be brought int,o contact with the disinfectant, and contact of diseased parts with one another must be prevented.
3. The disinfectant should be of the proper strength.
In order to wash away the secretion, it is preferable to use an irrigator holding at least two quarts, and which should be refilled two to three times in succession. The patient should be informed carefully how to use it. In order to avoid unpleasant sequelte, which ordinarily follow on the injected fluid entering the uterus, attention must be paid to a num ber of rules, even as in case of uterine irrigations. The irrigator should
not be hung too high (about three feet above the genitals will suffice); the patient should occupy such a position that the pressure in the pelvis does not become negative, that is to say, she should ordinarily assume the sitting or the half-sitting posture. The injection tube should not be inserted too deeply towards the cervix, and in order to bring the fluid in contact with every part of the canal, it should be moved from side t,o side, and forwards and backwards. The free outflow of the fluid should be assured, and where the introitus is narrow, this is done by lateral pres sure with the injection tube. A simple tube with central opening, of glass or hard rubber, so that it may be readily cleansed, can be used.
The water should be lukewarm (24° to 26°) in order to avoid the irri tating effect of heat, and the irrigation must, according to circumstances, be repeated twice to four times daily.
If it could be expected that simple cleansing by these irrigators would suffice, as they occasionally do in uncomplicated cases, then we might use water or some indifferent fluids, such as were formally used for the pre vention of the irritant action of an acute catarrh. But recent investiga tions have clearly taught us that the irritant effects remain even after the use of disinfectants, although they control directly the most infectious causes of the inflammation. Injections of flax-seed infusions, of althwa, etc., are, therefore, no longer resorted to.
The mechanical effect of the irrigation will, however, be only partially obtained when it is administered in the way we have outlined, since thus the entire mucous membrane is not cleansed. If the injection is admin istered by the physician, there is greater chance of the aim being fulfilled, for the vaginal walls may be held apart by depressors or specula. This separation of the vaginal walls fulfills also the second condition, which is, that the mucous membrane, in its entirety, must be exposed to the action of the disinfectant. It is, therefore, essential after disinfection to insert an antiseptic, slightly absorbent tampon in the vagina, in order to keep the walls separated, and to smooth out the rugaa. We use for this purpose soft dry tampons which may be impregnated with one or an other disinfectant. In case the vagina is not to be thoroughly tamponed, in which event the physician must himself attend to it, the patient should be taught to insert a tampon herself after each injection, and she can do this most readily by means of a siinple tampon carrier, which I use very frequently, for I find that while oiled tampons may be inserted by the finger alone, dry tampons by soaking up the secretion in the introitus are apt to become painful as they are inserted.