592 Diseases of the Genital Organs 



The handling of endometritis may be direct or indirect. 

 The direct treatment consists fundamentally of douching 

 the cavity with suitable disinfecting fluid's 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 consider 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's solution and similar chlorine-bear- 

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



