THE APPLICATION OF FLUIDS TO THE VAGINA AND UTERUS.
The. douche, as used to-day, was employed in 1450 by Christian Barzizius, and in 1530 by Conrad Gessner. In 1813 Sedillot first described the douche, and in 1825 Dupuy constructed a complicated douche apparatus. From this time forth numbers have been devised—for instance, those of Beige], Blot, C. Braun, Breit, Busch, Btirkner, Davanceaux, Depaul, Graily Hewitt, Kiwis* etc., etc., apparatuses which, with few exceptions, are only of historical interest, and are generally replaced by Ilegar's tube, and Esmarch's irrigation can. Although we describe a number of the above forms, it is only because they are still made and bought, and the physician is sometimes obliged to use them.
The ordinary injection tube, generally constructed of tin, is a good instrument. The rubber hand-syringe is a popular instrument, and on account of its cheapness and small size it is to be recommended, although the stream which it yields is intermittent. Care must be taken to empty it of air before use, and the liability of injecting air is the one great objection to this instrument and to others constructed after a similar pattern. The Eguisier irrigator, and the douche apparatus of Beigel, as also the Scanzoni-Richter, are frequently used.
The most convenient injection apparatus, however, is the ordinary irrigator. (Fig. 74.) It holds from two to four quarts of fluid, and is suspended from any object above the patient, and by means of it a con stant current is obtainable, the force of which may be regulated.
Under the name vaginal irrigator Kisch has devised an instrument, shaped like Arzberger's rectal cooler, which provides for the return stream. The instrument should properly be called a vagina•000ler. and is useful for the topical application of cold. It cannot, however, be used continuously on account of the pain it causes at the introitus. For the purpose of refrigeration or calorification Ileitzmann's regulators are preferable. They consist of smooth, cylindrical, metal capsules for the vagina, and of metal tubes for the uterus, through which water at the desired temperature is allowed to flow, the flow pipe leading to a vessel under the bed, and the inflow being connected with an irrigator.
[In this country the Davidson, or the Alpha syringe—the latter furnishes a continuous stream— takes the place of all complicated apparatus where the desired object is the injection into the vagina of a limited amount of fluid. Where it is desired to use a large quantity of water, or to obtain the well known effects of heat, the ordinary fountain syringe, or a douche can, such as is figured in Vol. IV. of this Cyclopedia, is to be preferred. The comfort of the patient is subserved by the possession of one or another of the forms of self-discharging bed-pans.— ED.].
Accompanying each apparatus is an injection tube, constructed ordinarily of hard rubber or of porcelain, although I use almost entirely straight glass tubes with rounded extremities. (Fig. 77 c.) The pos sibility of injection into the uterus by means of these tubes should be borne in mind by the phy sician and impressed on the patient. Each patient should have her special tube, and after use it should be thoroughly cleansed and disinfected. The ma jority of the tubes have a central perforation. It is better to close this or to use a tube without the cen tral os, seeing that in case of patulous cervix the stream might be thrown directly into the cavity of the uterus and set up uterine colic. To avoid this occurrence Braun (Fig. 77 a.), and Kooks (Fig. 77 b.), have devised tubes in which the stream of fluid is broken and deviated towards the lateral openings.
The patient must be instructed as to the depth to which the tube should be inserted into the vagina, else she may introduce its entire length into the canal and do herself harm. It is advantageous to place a rubber ring around the tube to mark the depth to which it should be inserted.