When the process is at an end, the patient should remain quiet for awhile, and it is a good plan not to inject dispensary patients until we have determined the tolerance of the uterus.
The indications for injection of the uterus are, in general, the presence of a chronic catarrh of and hemorrhage from the body of the uterus, which do not yield to other measures, and here astringents and styptics are useful; further, the presence of vegetations, polypoid or fungous growths or remnants in the endometrium; further still, and most impor tant of all, the necessity of disinfection of the uterine cavity or of its contents, frequently associated with the removal of such contents (coagula, portions of new growths, etc.). Very seldom is the injection of narcotics called for.
At the beginning, in order to test the tolerance of the organ, either lukewarm water, or a weak solution of the requisite medicament, is to be used, and afterwards concentrated solutions, which are always requisite where we aim at cauterization (bromine, tincture of iodine, Lugol's solu tion, nitric acid, liquor forri sesquichlorati, etc.). G. Braun has advo cated the use of a neutral solution of the sesquichloride of iron, in order to diminish its irritant properties.
In order to cleanse the uterine cavity of mucus, which is in the way of the direct action of the medicinal agent, it may be washed out with weak alkaline solutions or else removed by a cotton stick, etc.
The Braun's syringe may also be utilized for the procedure of artificial impregnation.
Aside from the purpose of medicating the uterine cavity, injections are also resorted to for cleansing and disinfecting it, and such irrigation is also useful in case of chronic endometritis. The indications for disin fecting irrigation of the uterus have already been referred to. It remains only to speak of certain points in regard to the technique.
A pre-requisite to the use of these injections is the securing of a free outlet for the fluid. In case the cervical canal is wide enough open to permit the passage of coagula, etc., by the side of the tube, then any open tube, such as the glass vaginal or a catheter, may be used. Such patency, however, is rarely met with, and generally it must be obtained by means of tents or dilators. In case the requisite patency is not obtain able, then we must use double current tubes.
Schultze, Fritsch, Schroder, Freund, To‘porski, and others, have de vised catheters, some of which act on the principle of Cloquet's double current, and others are like Bozeman's. I use, ordinarily, one of three forms : A straight or slightly curved glass or metal tube, with a terminal opening, a double current catheter, and by preference Fritsch's modified Bozeman's catheter. This latter consists of an injection tube with a guard at its upper third, a large oval window at its lower extremity, a longitudinal lateral slit at its upper portion. By means of this catheter, the outflow of coagula, etc., is secured, not by its side, but through the openings in it, which are in the uterine cavity.
Four years ago I modified the Fritsch-Bozeman instrument by mak ing the guard conical (Fig. 81, a) , and I now use this instrument not only for injections, but also for dilating where this is not requisite to any great extent. The process is analogous to the use of conical dilators, with the difference that during dilatation with the catheter the uterine cavity is being irrigated. The instrument has an S-curve, and this facilitates its introduction. A number of these catheters of varying dimensions and curvatures are requisite. The catheter is connected with the reservoir by means of rubber tubing, and the tubing should be fur nished with a clamp so that the stream may be checked at any minute.
For disinfectant irrigation, water, at the temperature of the body, and with the addition of carbolic, sublimate, or any other disinfecting agent, should be used. We may allow any amount of fluid to pass through the uterine cavity, but the force of the current must be regulated and the proper temperature maintained.
To administer the injections the cervix is exposed by means of a Cusco or a tubular speculum. The dorsal position is to be preferred, since thus the fluid will discharge to better advantage. The nates are elevated on a bed-pan. Welponer has had triangular bed-pans constructed. The cervix is steadied by a tenaculum, wiped off with cotton, and the catheter filled with water is inserted into the uterine cavity, after precedent dila tation in case this is requisite. In case the catheter becomes occluded, it must be removed and cleansed.