134: DISEASES OF THE UTERUS. 



our minds to increase the copious loss of blood by applying leeches 

 to the vaginal portion of the uterus every week or two. A more 

 irritating treatment, particularly the continued use of warm douches 

 to the uterus, seems preferable in the later stages of the disease. 

 These douches should be used about ten minutes every day ; the 

 water employed should not be over 99 or 103 F. It is also worth 

 while trying the use of Kreuznach and other saline baths, as well as 

 the baths and waters of Krankenheil. The internal administration 

 of iodide of potassium and of bromide of potassium, as recommended 

 by Simpson, is also beneficial. 



[Acute metritis demands absolute rest in bed, the pelvis being 

 kept somewhat elevated. When, from the tenderness of the belly, 

 we suspect a complication with peritonitis, leeches should be applied 

 to the abdomen and followed by cold compresses. When the inflam- 

 mation seems limited to the womb, local depletion of that organ 

 should be practised by leeching the vaginal portion of the cervix, 

 unless the virgin condition of the patient forbids it. Scarification 

 by means of Mayer's lance-knife has, however, in a great measure 

 supplanted the leech applied to the womb. It has the advantages 

 over leeching that the procedure is quite painless, and that the 

 amount of blood to be drawn can be nicely regulated by making the 

 incisions deeper or shallower. Moreover, many . observers believe 

 that the suction of a leech may set up an irritation which tends 

 rather to augment the fluxion toward the affected part than to check 

 it. According to Schroeder, scarification should be repeated about 

 every third or fourth day, not more than half an ounce of blood 

 being drawn at one operation as a rule ; but if the patient is ple- 

 thoric and the womb enlarged, an ounce may be taken. Syringing 

 the parts with cold water is a practice which should never follow 

 scarification ; for, although the cold produces a momentary con- 

 traction of the vessels, a relaxation quickly follows, which brings 

 with it a renewed congestion and thwarts the purpose of the op- 

 eration. 



The demonstration by Emmet, of New York, that the majority 

 of so-called ulcerations of the womb are really the effect of laceration 

 of the cervix, is an important advance in the pathology and thera- 

 peutics of this subject. He holds that lacerations occur during labor 

 more often than has been hitherto supposed. They occur most fre- 

 quently in the median line, and then heal readily, and generally 

 escape notice. But if the rent is extensive, and runs in a lateral 

 direction, the weight of the womb tends to force the lips of the 

 wound asunder, so that union by first intention cannot take place. 

 When the woman assumes an erect posture, the flaps diverge still 



