360 MATEEXAL DY ST OKI A 



In order to set the water flowing, the tube must be exhausted of air 

 by suction with the mouth, and the end provided with the syringe pipe 

 carried into the vagina and directed towards the cervix uteri. Each 

 douche should continue for about ten or fifteen minutes, or longer ; 

 and it may be repeated every two or three hours, or even at shorter 

 intervals, according to circumstances, until the desired effect has been 

 produced. 



Cazeaux speaks highly of this method of dilating the cervix in 

 woman, and for the following reasons : 



1. The uterine douche prepares the act of premature birth with the 

 greatest possible gentleness, by means of the softening and the necessary 

 dilatation of the inferior segment of the uterus. 



2. By this means all preparatory treatment is needless. 



3. This procedure is easily employed, and not at all disagreeable to 

 the woman, as the injection of warm water does not produce any 

 discomfort. 



4. It does not require much time. 



5. Its action can be graduated at the will of the obstetrist, who may, 

 according to requirements, increase or diminish the duration of the 

 douche and the temperature of the water, as well as vary the parts of 

 the cervix on which he directs it. 



6. Finally, it can never occasion lesions of the genital organs, nor 

 yet injure the foetal membranes or the foetus. 



This uterine douche is well worthy of notice, and though there are 

 only, so far as we can ascertain, three cases on record in which it has 

 been tried with animals, yet as these were most successfully treated 

 by it, it may be assumed that it will be found a most valuable means 

 of not only dilating the os uteri, but also of controlling the action, or 

 relieving certain morbid conditions, of the uterus itself. 



Eougher treatment for the dilatation of the cervix than that which 

 has been described, is sometimes resorted to, either through impatience, 

 ignorance, or in cases which demand prompt action ; as the other 

 measures require a certain amount of time, from the slowness of their 

 operation — though perhaps this is rather an advantage than otherwise. 



Forcible dilatation of the os uteri has been practised in human 

 obstetrics, and special instruments have been devised with this object. 

 Such dilators have been constructed by Osiander, Busch, Mende, and 

 Krause, but they have not been much used, as milder measures are 

 preferable. The same remark is applicable to veterinary obstetricy, 

 in which there is only too often a tendency to imagine that because 

 the patient is an animal, so all the more force and brusqueness can be 

 resorted to. 



Forcible dilatation of the cervix, which is not to be recommended, 

 except perhaps in very exceptional instances, has its advocates, and 

 two cases reported by Oschner, a Swiss veterinary surgeon, prove that 

 it may be successful, notwithstanding its disadvantages. In these 

 cases, every other known means had failed ; so Oschner procured a pair 

 of large fire-tongs used by blacksmiths, and wrapping their jaws round 

 with tow which was smeared with grease, he introduced them, closed, 

 through the os ; then an assistant gradually opened the shanks or 

 handles of the tongs, and so produced the desired widening of the 

 passage. The inflammation set up by this manoeuvre was dissipated 

 by the employment of soothing remedies, after fifteen days' treatment. 



It is obvious that such a mode of dilatation should not be practised. 



