600 Diseases of the Genital Organs 



tated into the uterus to dilute some of the pus and 

 start the siphon. The distal end is then lowered and 

 as much of the pus as possible siphoned out. More 

 of the solution is then introduced and the siphon again 

 brought into play. The catheter should be pushed cautiously 

 as far into the apex of the horn as is safe. Heavy pus is to 

 be cautiously broken up by massage of the uterus per rec- 

 tum. It should be determined that both horns are being 

 emptied. Sometimes this may be accomplished by massage 

 with the catheter in one horn only. Sometimes it is essen- 

 tial to introduce the catheter into each horn. This may gen- 

 erally be accomplished by directing the catheter to the right 

 or to the left with the dilator when introducing it. The 

 catheter may also be directed into the horn desired by man- 

 ipulation per rectum. The douching should be continued 

 until the fluid siphons out clear. The uterus may then be 

 washed well with j 4 to 2 per cent. Lugol's solution and, 

 after this has been carefully siphoned out, there may be in- 

 troduced into the uterine cavity eight to sixteen ounces of 

 liquid paraffin holding in suspension one-half ounce each of 

 iodoform and bismuth. 



If the pyometra is a direct continuation of infection from 

 the puerperal period, the corpus luteum of pregnancy is quite 

 certainly present and has sunk deeply within the ovary. In 

 most other cases of pyometra, a central retained corpus lu- 

 teum is present. Professor Hess first drew definite atten- 

 tion to the inhibitory action exerted upon the uterus by a re- 

 tained corpus luteum. While repeated douching of the uterus 

 may finally disinfect it, the dislodgment of the corpus lu- 

 teum with destruction of its inhibitory power constitutes a 

 great and essential aid. The dislodgment generally causes 

 cstrum with uterine engorgement and sharp tonic contrac- 

 tions which tend to expel pus and diminish the infection. 

 The technic of pressing out the corpus luteum has already 

 been discussed under "Central or Embedded Corpus Lu- 

 teum". The douching of the uterus should be repeated as 

 frequently as prudent, generally once in two weeks, some- 

 times more often. Coitus should be excluded as long as the 



