The operation in most cases requires the administration of an anes thetic for its thorough performance, as the requisite dilatation of the cervix is painful. The most careful antiseptic precautions should be taken, the vulva shaved, washed with soap, and douched with a i in 4,000 perchloride or drachm to the pint Lysol or cyllin solution, the vagina•is then douched, the speculum, which with the other instruments has been boiled and placed on a sterilised towel or in a tray or basin filled with antiseptic solution, is passed and the cervix seized with a vulsellum. The uterine sound is passed to make sure of the exact direc tion of the canal, and the dilators, commencing with a 3 or 5 Ilegar, are passed through the canal into the cavity of the uterus. Only a minimal amount of force should be used, and the passage, if there be any obstruc tion at the internal os, should be felt for in the same way as a sound is manipulated through a urethral stricture. After one or two of the smaller dilators been passed, more force may be safely used. When the canal has been dilated up to to or 12 Flegar the sharp curette is passed up to the fundus, and with successive strokes the interior of the uterus is carefully gone over. Only moderate pressure is necessary to remove the endometrium, and too vigorous scraping has been known to result in complete destruction of the membrane with consequent amenor rhoea. After the body has been dealt with the cervical canal should be
carefully curetted, and for this a small curette is advisable. The frag ments of endometrium should he put at once in a bottle of 4 per cent. formalin and submitted to microscopic examination if thought necessary. The uterus may then be washed out with antiseptic solution through a l3ozeman's catheter, and a strip of iodoform gauze introduced as far as the fundus. Some gynecologists swab out the cavity after curetting with phenol or sonic strong antiseptic on a Playfair's probe, hut the oozing after the operation makes such an application very uncertain and partial in its action, and I prefer to postpone it until the membrane has been re-formed, when better results may be expected should such a treat ment be necessary. Should perforation occur, which may be known by the sudden loss of resistance to the instrument, dilator or curette, and by its slipping through the cervix far beyond the limits of the uterine cavity, no harm will be done if strict antisepsis has been observed. The instrument should be withdrawn at once, no further manipulation should be attempted, a small gauze drain should be passed through the internal os, and the patient put to bed.
The patient should remain in bed for a week; the gauze drain may be removed next day, and daily hot douches should be given.—R. J. J.