If light gauze packing is used it might with advantage take the form of a " saline pack" in which tablets of sodium chloride and citrate are buried in the folds of the gauze, and by gradually dissolving in the secretions provide a hypertonic saline solution which will increase the amount of discharge.
The curettage should be preceded by digital exploration. If there are masses of debris adherent to the uterine wall, and not removable by the finger, there is an indication for curettage. When the uterine cavity is smooth, it is highly improbable that scraping it will do any good.
A similar form of treatment is ecoupillonage, in which the debris is removed by successive scrubbings with a set of bristles mounted on wire somewhat like a lamp-brush.
It may be mentioned that the intro-uterine douche must he looked on as an operative measure on account of the impossibility of giving it with out abrading the uterine mucous membrane. Clinical experience bears out this view, for its use is often followed by a rigor, showing that it has caused an inoculation. I think it a useful adjunct to treatment at the commencement of an attack, but its continued use is likely to cause more harm than good in a case of septic infection. It is in its proper place in a case of septic absorption.
Another simple operation is that of opening the posterior fornix and draining the pouch of Douglas. It is very useful where a peritoneal
exudate of sero-pus or lymph has formed. The operation may be done without an anzesthetic. The cervix is seized with volsella and held upwards. A transverse snip with scissors is made inch behind it through the vaginal wall. The peritoneum presents in the wound, and may he cut or torn through and a gauze drain inserted into the pouch of Douglas.
The major operations have an appalling mortality, and are truly desperate operations. Incision of the Abdomen, lavage and drainage for peritonitis has been carried out, but the results are in no way superior to those obtained by posterior vaginal incision, though of course most of the cases operated on were already desperately ill. Removal of the Uterus has been practised. It should be confined to cases in which a local cause—sloughing fibroid, abscess of the uterine wall or ruptured uterus— is present, and it seems wiser to wait until the first burst of the infection has blown over, unless one removes the uterus as a prophylactic measure before infection has become established. Ligature or Resection of the Pelvic Veins has a comparatively small sphere of usefulness, as it is only indicated in pytomic cases, in which the primary focus is evidently situated in the uterus.—R. J. J.