CATARRH OF THE UTERUS. 129 



above, I only intended to show that one indication should not be 

 followed to the neglect of the others. In all cases where the cause 

 of the catarrh cannot be discovered, as is most frequently the case, 

 local treatment must be used ; and where it has existed for a l6ng 

 time, and is complicated with ulcers, particularly granulating ulcers, 

 local treatment should be used with that for fulfilling the causal 

 indications. Among the local remedies we shall first mention in- 

 jections into the vagina. It is not long since these constituted the 

 only local treatment for " leucorrhoea," no matter whether it came 

 from the uterus or vagina. They aid the treatment and are re- 

 quired for cleanliness, although they are of far less use than the 

 procedures to be hereafter mentioned. In acute catarrh we inject 

 lukewarm water ; in chronic catarrh, at first lukewarm, and after- 

 ward cold water, or solutions of sulphate of zinc, tannin, or alum. 

 [Thomas, Emmet, and other eminent gynecologists of America 

 prefer to employ vaginal injections of water, of as high a temper- 

 ature as .the patient can comfortably bear, the action of heat upon 

 the tissues being more enduring than that of cold.] Instead of 

 using an enema syringe with a uterine nozzle, it is well to employ 

 a clysopompe (Davison's syringe), so that we may throw in a large 

 amount of liquid without irritating the vagina by frequent intro- 

 duction of the nozzle. The application of leeches to the os uteri 

 in acute catarrh is indicated when it begins with great severity, and 

 in chronic catarrh when the substance of the uterus participates in 

 the inflammation, or when there is acute exacerbation of the disease 

 with symptoms of severe congestion in the pelvis. Scanzoni also 

 recommends them when there are granulating ulcers on the os 

 uteri. We should apply leeches to the os uteri ourselves, or have 

 it done by a nurse skilled in the operation. Gynecologists of the 

 present day are refraining more and more from the use of leeches 

 in the treatment of catarrh of the uterus and ulcers of the os, while 

 formerly they were used far too often. The local application of 

 nitrate of silver, in substance or in strong solution, is by far the 

 most effective treatment of chronic uterine catarrh, and particu- 

 larly for catarrhal erosions and follicular ulcers of the vaginal por- 

 tion of the uterus. To prevent the caustic from breaking off in the 

 cervical canal, we should employ sticks of double-annealed nitrate 

 of silver, or have, it hardened by the addition of a few grains of 

 nitrate of potash. When thus prepared, we may push it boldly 

 into the cervical canal. If cauterizations with solid nitrate of sil- 

 ver cause hemorrhage, which is often the case even in simple ulcer, 

 we should use in its place concentrated solutions (one part to two 

 or four of water), which should be poured in through the speculum 



