For the purpose of disinfecting the uterine cavity, the best measure is repeated or permanent irrigation. We have already spoken of the disin fectants which may be used. At the time, however, we were speaking of asepsis, and now we aim at obtaining the antiseptic action, and therefore we use concentrated solutions. We expect our disinfectant to be absorbed, and to work deeply so as to take the place of a caustic. We thus use carbolic (5 per cent.), chlorine water, chloride of zinc (1 per cent), sub limate (1 to 2 per cent.), remembering the risk of toxic effects. I much prefer chlorine water and zinc chloride. The burning resulting from such caustic agents is best prevented, as is my custom, by simultaneously douching the vagina with water. The external parts are protected by smearing with vaseline or glycerine. The technique of the intrauterine douche, and of the permanent vaginal and uterine irrigation will be spoken of in the next chapter.
Obviously, internal medication must also be instituted. Quinine, salicylate of soda, antipyrin, arsenic, ergotin to keep the uterus in a tonic state of contraction and thus to prevent absorption, alcohol and other stimulants, such are the means at our disposal.
Although all of the measures we have referred to require much time and patience for their application, and may in general only be stringently enforced in a hospital, it is still our duty to bear in mind the possibility of the occurrence of virulent infection even after the most simple mani pulation, such as necessitates, and all our methods should be clothed in asepticism.
In the physician's office asepsis is so much the more difficult to obtain the greater the number of patients, and the more quickly they must be disposed of. This is one reason why women suffering from chronic affections, in particular the catarrhal, should not be referred to the special ist, who is unable to pay attention to minutiae. In a previous chapter we have stated that many manipulations must of necessity be performed by the specialist, and the large proportion of diagnoses must be made by him, but the treatment of many affections must in the interest of the laity and of the profession lie with the general practitioner and not with the specialist.
Since in one's office it is impossible to attend to the disinfection of the patient, we must limit ourselves to the cleansing of the parts to be ex amined by cotton dipped in carbolic, etc., and in case of much leucorrhea to injections of 1 to 2 per cent. carbolid solutions.
Before each examination the physician should wash his hands in soap and water, using a nail brush, and then dip them in 5 per cent. carbolic or 1 to 1000 sublimate. The sleeves should be rolled up, as. also the clothing of the patient. The instruments should be disinfected before use in 5 per cent. carbolic, which solution should be ready in every office. In case of a large clientele it is of advantage to possess a number of instru ments of the same kind, in particular specula and sounds, in order to save the time requisite for frequent washing.