that I consider the general treatment, as I have endeavored to sketch it, of secondary importance, and the local as the essential treatment; but wishing to be perfectly clear on this point, I will reiterate what I have already said in regard to the objects of general treatment. They are-1st, To palliate the general condition of the patient before and during local treatment; 2dly, To aid local treatment in effecting the cure; and 3dly, To cure the effects which may remain after the local disease has been removed. I do not believe that a cure is ever effected by general treatment alone.

CHAPTER XVIII.

LOCAL TREATMENT.

BATHS-HIP BATHS OR SITZ BATHS-TEMPERATURE OF BATHS SHOWER BATHS -SPONGE BATHS-INJECTIONS-MANNER OF USING THEM-KIND OF SYRINGE QUANTITY-MEDICATED INJECTIONS-ASTRINGENT INJECTIONSMODUS OPERANDI-FREQUENCY WITH WHICH THEY SHOULD BE USED-ALTERNATION OF DIFFERENT ASTRINGENTS-TEMPERATURE OF INJECTIONS— ACCIDENTS SOMETIMES IN TAKING INJECTIONS-SHOULD INJECTION BE USED DURING PREGNANCY-PRINCIPLES THAT SHOULD GOVERN US IN CHOICE OF LOCAL TREATMENT.

Baths.-The local treatment of inflammation of the cervix uteri is made up of several therapeutic items, varying according to the intensity, quality, and seat of disease. Of these there are, however, a few that are applicable to almost all cases; hence their description, modes of use, &c., may be considered before going farther. Baths, injections, and some minor remedies are of this kind. Water, when applied to the surface, is purely sedative in its effects if it is of the temperature of the part on which it is used. If the bath is partial, the sedative influence is for the most part confined or limited to the part to which the application is made. So with injections per rectum or vaginam. They soothe the parts contained in the pelvis. If the water is warmer than the part of the surface bathed, the effect is stimulant; if it is colder, by virtue of the physiological action brought into play, it is first sedative and then stimulant. The circulation and nervous influence of the vagina, for instance, when the cold water is first thrown into it, are depressed, but very soon after its evacuation, or withdrawal, the vessels become excited to increased circulation of blood, and increased heat takes place and the nerves become more sensitive. In all these respects baths and injections act alike. The injections are internal baths; the uterus is bathed through the vagina by injections. But the effects of baths and injections may be modified by containing medicinal substances. They may be rendered more stimulant or more sedative, or be even made to

possess other qualities by impregnation with medicines: one of which in very common use is astringent in character. Another mode of using water and applying it, either simple or impregnated with medicine, is, to wet a cloth or a sponge with it and bind it to the surface, or introduce it into the vagina. Several thicknesses of cotton cloth applied to the abdomen and impregnated with water is what is called the water compress; and often when allowed to remain in contact with the skin for several hours it produces considerable excitement, and if persisted in for days, will cause first a vesicular, next a pustular, and finally a phlegmonous eruption. The way to render it effective is, after applying the wet cloth compress to cover it over with oil silk, and then confine the whole with a bandage or roller, with a view to prevent evaporation. Sponge introduced into the vagina impregnated with water holding some medicine in solution is a common way of affecting the uterus. I do not design giving an extended view of baths or their application and modus operandi, but so much aid is occasionally obtained by the use of baths, that I cannot refrain from speaking of the application of some forms of them to diseases of the uterus. The bath most applicable in inflammation of the cervix uteri and most commonly used is the sitz or hip bath. It is intended to allay the inflammatory irritation and pain. It is often the case that there is a great deal of suffering from pain without much inflammatory action in the parts; in these cases a sitz bath will often give great relief. In many instances the efficacy of the bath may be enhanced by having the patient introduce a speculum while in the water, so that it may pass up the vagina to the neck of the uterus, and thus directly affect the part diseased. In cases of medicated sitz baths the organ may thus receive the full benefit of the saline, anodyne, or other medicinal impregnation. The common glass tube will do very well for this use, where we wish only to bathe the neck of the uterus; but if we wish the fluid to come in contact with the vaginal walls and remain there for a considerable time, the wire speculum is the best. While speaking of the use of the speculum in this way, I may mention that a very efficacious mode of applying medicated washes without the bath to the cervix uteri or vaginal walls, is to have the patient lie upon her back, introduce the speculum, and then pour the fluid into it.

By remaining in that position she can retain the contact of the medicated solution as long as desirable. Ice water, ice, astringent powders, or almost any form of substance may be applied and retained in contact with the os and cervix uteri with great advantage in this way. This mode of using remedies is particularly useful in bleeding fungus or vascular tumor of any sort.

Hip Bath. The sitz bath, when a patient is suffering with the pain and heat of uterine disease, may be used as often as necessary, twice a day at least; but three, four, or even a greater number of times will not be too often, when they are found to be soothing and useful. We may extemporize a hip or sitz bath, by putting water in a common washing tub; but the cheap vessels made for the purpose are within the command of almost all persons. There should be so much water that when the patient sits down in it, the whole pelvis will be covered.

Temperature of the Bath.-What should be the temperature of the bath? The patient's sense of comfort, or discomfort, from its use, should be our guide in this respect. We should seek a temperature that is comfortable and soothing to the patient, while in the water, and that leaves no sense of discomfort. The baths are intended for, and should add to the comfort of the patient; when they do not do this, they should at once be discontinued. As a general rule, I advise my patient to take tepid water for her first bath, and then gradually use them cooler until they are cold, unless they become disagreeable in some respect; if they do so, to continue them tepid. The colder a bath is, the more good it does, provided it be comfortable. The time for taking it may be regulated by the convenience of the patient, and the necessity for it, with the view of allaying pain, heat, &c.; probably in the majority of instances, the most advisable times for taking it are upon rising and retiring. The length of time the patient remains in the bath. should also be regulated somewhat by their effects. If the patient remain too long in the water, it will debilitate her, particularly if there is considerable water and the bath is frequently repeated; on the other hand, if she does not remain long enough, she will not derive any benefit from it. She may try remaining in it fifteen minutes, if she does not find herself very much relieved before that time, and she ought to be governed in her use of subsequent baths in this particular by the effects of the first few trials. While in

the bath, the intended temperature of the water may be kept up by adding hot water from time to time. The hip bath is used almost wholly with reference to the local disease, but when general baths are required, it is usually for the relief of some attendant general symptom.

Shower Bath.-The shower bath may be used as a roborant excitor of the circulation, if upon trial it can be borne, and produce a good effect. Some patients think they are very much benefited

by the shower bath, and say they cannot do without it.

Sponge Bath.-The sponge bath is useful in causing a tonic and soothing reaction upon the surface. Neither of these can be tolerated by very feeble patients. The cold or tepid sponge bath, administered at bedtime, not unfrequently soothes nervous irritability, and enables restless persons to sleep soundly. I have not used baths in any other form than these, but when used as I have here indicated, I have seen such pleasant results from them, that I cannot refrain from recommending them.

Injections.-Another remedy applicable to almost all cases of inflammation of the cervix uteri, and which does a great deal of good, and is believed to be sufficient to cure some cases is injections. As I have before said, they may be used as internal baths, to get the influence of water and temperature on the vagina and uterus, the medium for the application to the mucous surface of this cavity and viscus, medicinal substances, and also as detergents, to wash the vagina of all substances that should be removed from it for purposes of cleanliness. In some one of these forms injections may be used in nearly every sort of cervical inflammation. The simple injection of water may, and ought to be used, by all females who have inflammation of the uterine neck. The medicated injections can be useful only in cases where the inflammation is within reach of them, as when inflammation affects the mucous membrane of the vagina, or the membrane covering the external surface of the vaginal portion of the cervix. For obvious reasons, injections containing medicines can hardly do any good, by virtue of the solution, when the inflammation is situated inside the cervical cavity. Vaginal injections cannot reach the seat of disease. I have not used intra-uterine injections, as I think there are less hazardous modes of conveying medicines into the cavity of that organ. The efficacy of injections depends very much upon