That the injected stream may be thrown directly into the uterus the following case, which I observed, proves: I advised a patient, who fre quently suffered from uterine colic after vaginal injections, to close the central aperture of her injection tube. She used a piece of a match for this purpose. A few weeks thereafter she was seized with parenchy matous metntis and parametritis and convalesced only after the lapse of some months. A few days after the onset of the affection I detected a foreign body in the uterus, which on removal proved to be the match. The stream from the douche had dislodged it from the extremity of the tube and had thrown it into the uterus, where it had set up the inflam matory affection.
Vaginal injections are generally taken by the patient sitting astride of vessel into which the water may flow. Often they are taken while the patient is in a bath-tub. As Ricord has stated, however, thorough douch ing of the vagina is only possible when the woman assumes the dorsal position, and this position is essential when the hot douche is taken. The pelvis of the patient must be elevated and a bedpan slipped under her. Since thus the intra-abdominal pressure is lessened or even negatived, only a feeble injection stream is needed in order to balloon out the vagina. Free outflow may be secured by the insertion of a second tube in the vagina, or else by using a double canula.
In general the aim of vaginal injections is to cleanse this canal. Since the patients usually take such injections themselves, it is necessary to give them an apparatus which is readily used and not complicated. The reservoir should hold at least one quart of water, and the stream should be free, constant, and without admixture with air. Although the danger from entrance of air into the genital passages has been exaggerated, still when it occurs it may be accompanied by infection, or unpleasant reac tion. When cleansing is simply aimed at, plain lukewarm water, or with the addition of permanganate of potass, carbolic, sublimate, and the like, may be used. These injections are, however, also of use therapeutically, either to affect the cervix or the vagina medicinally, or else to obtain the effect of heat.
The fluid injected into the vagina remains only a short time in contact with its walls, and it only occasionally penetrates into the cervical canal. The fluid may be medicated in various ways. The common mistake is to use solutions of too great strength. Seeing that the fluid escapes by the
sensitive introitus vaginae, strong astringent solutions cannot be used. In general, phlegmatic women stand stronger medicaments than the more sensitive, although there are many exceptions to this rule.
Of astringents utilized we may mention alum, zinc, nitrate of silver, copper, sesqui-chloride of iron, permanganate of potass, tannin, and in fusions of various kinds containing it, etc.
At the outset alum should be used only in 2 to 1000 solution; lead, zinc, copper, silver, in 1 to 1000; tannin 1 to 3 to 100. It is well to alternate in astringents. They are to be dissolved in warm water, and the vagina should, when possible, be washed out with plain water before the astringent is used.
Less frequently than astringents, demulcent and narcotic agents are used, such as warm milk, and various decoctions to which may be added opium, belladonna, salt, etc. Cataplasms and ointments were used by Astruc, Lair, and others, but at the present day such agents are only resorted to in cases of incurable disease, where it is necessary for palliative purposes to constantly change the remedy. Disinfectant injections are frequently used for cleansing purposes, such as solutions of perman ganate of potties, carbolic and salicylic acids, thymol, soda, acetic acid, chlorine water, etc.
The irritating effect of forcible vaginal injections was utilized by Kiwisch for the purpose of inducing labor. In gynecology this is rarely necessary and may be injurious; it is resorted to, indeed, only where it is desired to stimulate the uterus.
Thermal effects are frequently aimed at. Cold water, although still frequently ordered, unquestionably may do more harm than good. In general the patient should be directed to use water at a pleasant tempera ture, beginning with lukewarm water and increasing the heat until the desired degree has been obtained. Cold injections are only indicated in case of stony of the uterine structure, in hemorrhage and catarrh due to this cause, in torpid, little sensitive individuals, in case of readily bleed ing erosions, ulcerations and new-growths, in displacement and in distor tion of the uterus, which depend on lack of tone in the organ or its ligaments, in subcutaneous inflammatory and congestive affections where they cause hyperesthesia. The colder the water the less forcible should be the stream, and the greater is the risk of damage.