Page:The Texas Medical Journal, vol. 18.djvu/341

Rh If the curette is used, denuding the walls of their protective covering, an immediate vaccination takes place with a septic virus, septicemia following in an incredibly short space of time (chemical metamorphosis is marvelously rapid in the circulatory system) and death quickly ensues.

If without using the curette, we can remove the septic matter from the uterus without disturbing the mucus covering, and enable the uterus of itself to exeplexpel [sic] the coating, we shall have taken a long step forward in the treatment of this class of uterine cases.

The uterus, by reason of its congestion may be made to perform a self-cleansing act by exciting the exudation of the serum of the blood into its cavity, thereby washing itself out, and expelling all septic matter instead of absorbing it.

This process of exosmosis is induced by a properly combined alkaline solution at a temperature of 100° and a strict avoidance of bichloride, carbolic acid, formaldehyde, or any antiseptic of an acid reaction or astringent nature, which would coagulate the fibrine and albumen of the blood.

The method of procedure is as follows:

First. The gentle removal of whatever fragments are lying in the uterine cavity, by means of forceps, care being taken not to tear from the walls the adherent piece.

Second. The gentle flushing of the uterine cavity with the alkaline solution (100°), the reserviorreservoir [sic] containing the fluid being not more than two feet above the level of the hips.

If the flushing could be continuously administered for a few hours (say two or three), the conditions would be more speedily reduced to normal, but the discomfort of the position of the patient (on a douche pan) prevents this, and a flushing once every two hours with one quart of solution is about the limit of the treatment.

For flushing the uterus, I use a small dilating uterine douche, and as there is plenty of room for the escape of fluid and fragments, there is no danger of fallopian colic or salpingitis.

The first flushing is frequently followed by contractile pains and expulsion of any previously adherent pieces, together with much of the mucus.

A tablet of extract cannabis indica, gr. $1⁄4$; extract ergotin, gr. $1⁄2$, every hour till desired effect is produced will contract uterus and alleviate pain.

The bowels should be moved freely, both by enema and cathartics.

During the interval between douches, the patient should be kept