CHRONIC ENDOMETRITIS.—In the majority of these cases the endo metrium of the body of the uterus is free from infection, probably owing to the thorough flushing with blood which it undergoes at each menstrual epoch, and the disease is confined to the canal of the cervix. Very oftcn a cervix thus affected has suffered laceration at childbirth, and a tender cicatrix or a well-marked ectropion of the mucous membrane may be pry sent. Copious: muco-purulent discharge, with pelvic pain, uterine tenderness and usually menorrhagia arc found as symptoms.
The routine treatment of these cases should take this form: Once or twice a week a speculum should be passed and the cervical canal should be swabbed out with an antiseptic applied on a Mayfair's probe coated with cotton-w ool. For this purpose pure carbolic acid liquefied by heat may be used, or 4o per cent. lormalin, iodised phenol or Tr. Lodi F. or a saturated solution of Picric Acid in alcohol may he used. After the application a tampon soaked in one of the glycerin solutions mentioned above is introduced into the vagina, and the patient lies up till the fol lowing morning, when she withdraws the tampon and uses a douche of from 4 to 8 quarts of one of the antiseptic solutions recommended for subacute endometritis. These may be used of double the strength already indicated. This douche is repeated daily until the next visit to the ph) sician. Cases with much ectropion often do well if treated with nitrate of silver solution (zo grs. to the ounce) poured into a tubular Fergusson's speculum and allowed to remain in contact with the cervix for 5 minutes, and followed by daily douches. Bier's hypercemic treat ment has been tried for obstinate cases, the suction being applied through a special glass tube made to enclose the cervix, and each application lasting for from to to 20 minutes. It is worth while in cases which
resist the methods of treatment suggested above to try the " dry " method. The cervix is swabbed out with a caustic such as pure phenol, the vagina is carefully dried with pledgets of cotton-wool, and dry boracic powder or powdered acetate of alum is then insufflated through a tubular speculum so as to cover the vaginal walls thickly. The powder may be left in place for 4 to 7 days, and may be then removed by douching and the treatment repeated. Gonorrhoeal cases have been treated by the application to the cervix of strips of plain gauze soaked in a pure culture of the lactic acid bacillus, with the object of destroying the gonococcus by the acid secretion formed. Ionic medication, carried out by filling the vagina with a solution of copper sulphate and running a continuous current through it, has been tried with good effect. It should not be forgotten that the discharge in many of these cases is pattly due to debility, and that measures for the relief of anaemia and malnutrition may be of benefit.
Cases which resist local drug treatment, or which relapse after ap parent cure, should be subjected to the operation of curdling. This operation should not he undertaken if there is evidence of suppuration in the ovaries, tubes or pelvic connective tissue, as it is dangerous to some extent under such circumstances, and is not likely to have a per manent good effect. It should be combined with the repair of any deep cervical laceration that exists, and if the perineum is torn and the vulva gaping a perineorrhaphy should be done to protect the vagina and cervix against constant exposure to infection from without (see below, Curet tage).