ENDOMETRITIS.
ACUTE ENDOMETRITIS.—This affection may be either puerperal, gonor rhoeal or due to infection by a dirty instrument. There is considerable risk in the early stages of generalising or at least spreading the infection by energetic local measures, and while the temperature and pulse-rate are still in the acme of the initial rise and there is much local pain, tender ness and discharge, it is the physician's best policy to play a waiting game and to restrict his activity to constitutional measures. Rest in bed should be insisted on, with light diet and a free saline purge. I think some benefit may be looked for from quinine, given in 5-gr. doses three times a day. A hot sitz-bath for hour helps to relieve the pain; so do hot-water bags to the abdomen and back. Good effects may be expected from the use of prolonged vaginal injections at a temperature of io° F. io to 15 quarts of normal saline fluid should be used twice daily.
When the temperature and pulse have fallen and the pain and tender ness lessened, the condition may be treated as subacute and other local remedies may he used. The most generally applicable are those which
are intended to relieve congestion and promote the flushing out of the uterine vessels with blood. The vaginal douche should be continued, and if the physician desires he may make it weakly antiseptic (i in 10,000 perchloride, Tr. Lodi F. i dr. to the quart, lysol or cyllin i dr. to the quart, borax or equal parts of boracic acid and soda bicarb. a teaspoonful to the quart), but he should always remember that the most important constituent of the douche is the hot water. A tampon soaked in bore glyceride or in Ichthyol or Subitol (io per cent. in glycerin) may be applied to the cervix every other day for 12 hours at a time. Iodine (1 per cent, in glycerin) may be used in the same way. Direct from the cervix by scarification has been recommended, but is unnecessary if the douche and tampon are thoroughly used. If symptoms persist after some weeks, treat as for chronic endometritis.