592 Diseases of the (ie/iital Organs 



The handling of endometritis may be direct or indirect. 

 The direct treatment consists fundamentally of douching 

 the cavity with suitable disinfecting fluids and introducing 

 into the uterus slow-dissolving agents which may serve to 

 repress bacterial growth. In my experience the compound 

 solution of iodine (Lugol's solution) in a strength of one 

 to two per cent, has yielded satisfactory results. The uterus 

 has a high tolerance for the drug (experimentally I have 

 used a ten per cent, solution) and it does not coagulate mu- 

 cus. Its color is such that muco-pus, when douched out in 

 the fluid, is readily observed as are most kinds of exudate 

 occurring within the uterus. Some have advised instead a 

 physiologic salt or soda bicarbonate solution, contending 

 that the mechanical douching out of the infection is prefer- 

 able to the use of a disinfectant. I can not agree with this. 

 Very good authorities claim that, in douching the uterus of 

 a woman, the fluid may force its way through the oviducts 

 to the peritoneal cavity. Possibly anaesthesia favors such 

 penetration. I have no reason to believe that any material 

 peril of forcing the oviducts accompanies the douching of 

 the bovine uterus, but the danger may be far greater than I 

 have suspected. In case of danger a neutral solution has by 

 far the greater peril because of its tendency to push the in- 

 fection undamaged into the oviducts and set up salpingitis. 



There is always present the danger of puncturing the 

 uterus with the catheter. When this occurs, a few ounces 

 of Lugol's solution injected into the peritoneal cavity irri- 

 tate the peritoneum, there is quickly thrown out an abun- 

 dance of serum which dilutes the fluid, and it is soon re- 

 sorbed. If some infection is pushed into the peritoneal 

 cavity, Lugol's solution tends to neutralize it. but when a 

 salt or soda solution is used the infection acts unhindered. 

 I consideT that in all respects it is much safer to use a re- 

 liable disinfectant rather than neutral fluids when douch- 

 ing the post-puerperal uterus. 



I have used other disinfectants, but have not seen my way 

 to adopt them. Dakin'a solution and similar chlorine-bear- 

 ing solutions have been tried but need to be used in very 



