CHARLES WOODWARD, M. D., CHICAGO, ILL.
In answer to numerous inquiries concerning the intrauterine irrigation method for treating menorrhagia and metrorrhagia, conditions so frequently met in general practice, we should first consider the etiologic factors which predispose the system to these conditions.
- First, anemia.
- Second, retained membranes and decomposed blood following abortion.
- Third, endometritis and uterine atony during the menopause.
- Fourth, polypoid endometritis and overwork.
First, in anemic patients the blood is thin and the vessels relaxed, without sufficient tonicity to prevent hyperaemia and hemorrhages and especially metrorrhagia. These cases should have the uterus cleansed out every third day and specific belladonna and hydrastis should be prescribed.
Second, retained membranes and septic substances result in a determination of blood to the uterus. This condition requires the uterus to be cleansed every 48 hours with a So percent solution of peroxide of hydrogen, alternated with a 5 to 6 percent solution of any good nontoxic antiseptic, and thoroughly swabbed every fourth day with a solution of equal parts of carbolic acid and tincture of iodine and then followed immediately by the above treatment.
Third, the presence of endometritis and atony of the uterus during the menopause has a tendency to ulceration of the endometrium and to induce menorrhagia. These patients usually have deficient elimination from the skin and bowels and a uterine exudation. In this condition the uterus should be swabbed every fourth day and followed immediately with the cleansing treatment every 48 hours as given for controlling hemorrhages occurring after abortion. Then a solution of sulphate of iron, grs. 3 or 4 to the ounce of water, should be thrown into the uterus to contract the vessels and heal ulceration; this finishes a single treatment. The skin and bowels should be stimulated to normal action and these remedies prescribed as follows:
- Specific veratrum, 1/2 dram;
- belladonna, 10 drops;
- dist. ext. hamamelis, 10 drams;
- aqua, q. s., 4 ozs.
Sig: One teaspoonful in water every 2 or 3 hours, as necessary to control the determination of blood.
Fourth, if the diagnosis is definitely clear that the hemorrhage is due to a polypoid endometritis the curette may be used to remove the vegetative growths, then the swabbing and irrigation treatment will comcomplete the cure.
Overwork: Advise less work and treat similarly to the other cases.
These local treatments can be repeated every 24, 48 or 72 hours, and at any time before, during or after the menstrual period and especially whenever the flow continues too long and the loss of blood is greater than normal.
It is scarcely ever necessary to cleanse the uterus oftener than every 48 hours, unless membranes are retained, when they should be removed.
The best solution for restraining menorrhagia, after the uterus has been swabbed and washed out with the peroxide and other antiseptic solutions, is sulphate of iron, grs. 2 to the ounce of water, for women under 40 years of age, and 4 grs. to the ounce for those older. Observing the age, specific hydrastis and colored pinus canadensis form excellent solutions, 10 to 20 minims to the ounce. The dehydrating pack should be omitted until the menorrhagia is under control.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.