598 Diseases of the Genital Organs 



and, while I have not seen the false seal in pyometra, it may 

 occur. 



The cervix is frequently sclerotic and its canal difficult to 

 pass. Great patience is often required. First the dilators 

 should be carefully introduced and the cervix slowly and 

 liberally dilated. The complete dilation is valuable in diag- 

 nosis and essential in handling. 



When the canal has been well dilated, the small uterine 

 catheter (Fig. 39) or far better the soft rubber horse cath- 

 eter or the seven-foot bull-douching catheter is to be intro- 

 duced. In most cases of pyometra the metal uterine cathe- 

 ter suffices for diagnosis, but in rare cases, when the uter- 

 us is unusually paretic, the pus is not douched out with the 

 catheter even though gallons be present. When fluid is in- 

 troduced through the metal catheter, it simply disappears 

 and is irrecoverable with that instrument. This should in- 

 dicate to the practitioner that he has erred in diagnosis and 

 is trying to douche a pregnant uterus, that he has erred in 

 technic and penetrated the peritoneal cavity, or that there 

 is extensive pyometra dragging the uterus far forward and 

 downward, and the douche has been added to the content. 

 Unless one undertakes the imprudent and perilous filling of 

 the flaccid uterus until it literally runs over, the diagnosis 

 must be made with the rubber catheter used as a siphon. 

 The cervix must be well dilated for this purpose, the uter- 

 ine dilators engaged in the fenestrum of the catheter, and, 

 with the cervix drawn well back with the uterine forceps, 

 the catheter introduced carefully through the canal into the 

 uterus. The catheter is held in place, the uterine dilator 

 withdrawn, and the catheter gently pushed onward as far 

 as may be prudent. It is then filled with fluid (salt solu- 

 tion, Lugol's solution) from an irrigator or otherwise by 

 gravity, and some of the fluid may be allowed to pass into 

 the uterus. The distal end of the catheter is to be com- 

 pressed firmly while completely filled with the fluid. It is 

 then lowered and the compression removed, when purulent 

 or other liquid contents siphon out. If the precaution is no1 

 taken to compress the catheter while elevated and tilled with 



