These are chiefly employed in Leucorrha and Menorrhagia,' and in some diseases of the uterus. They frequently fail, however, from the non-observance of a few plain rules, as pointed out by Sir C. Locock:3 -
1. In order to obtain its full effect, the quantity injected should not be under half a pint, three or four times a day; and it should be so employed that the whole of the lining membrane of the vagina is subjected to its action.
* Clin. Lect., p. 392, vol. ii.: from which this and the three following rules are quoted.
Brit. For. Med.-Chir. Rev., July 1851. Cyc. Pract. Med., vol. iii. p. 38.
2. Ascertain as far as possible the cause of the discharge for which you are employing these remedies: if there be heat, excoriation, and any local inflammatory action, sedative injections, particularly the Liq. Plumbi Diacet., are the most applicable; if the discharge be muco-purulent, or simply of a thin mucous character, depending upon a relaxed state of the lining membrane of the vagina, astringent injections, containing Alum, Galls, &c, will be found most beneficial.
3. The vagina should always be washed out with cold water after an astringent injection, particularly one containing Alum; as otherwise the discharge will sometimes become coagulated, and, remaining in the vagina, will keep up the irritation, and aggravate the symptoms. This is a point to which sufficient attention is not paid.
4. Every injection will fail to produce anything beyond temporary relief, when the discharge arises from an overloaded state of the rectum, or from the presence of ascarides in that viscus; consequently the use of an enema, either plain or with Oil of Turpentine, should always precede that of vaginal injections.
•5. Astringent injections into the vagina should not be used, if there be tenderness on pressure, or a sense of weight in the pelvis. They should at once be discontinued if during their use these symptoms arise, as they indicate a degree of uterine congestion. A case illustrative of the danger of their indiscriminate use is related by Mr. W. Cooke.* In this case the vagina was so contracted as hardly to admit the finger; was intensely hot and painful, with much fever. The coagulated albumen adhered so tenaciously to the os and cervix uteri, that it was with difficulty removed.
6. In Menorrhagia, astringent injections should rarely be used during the first few days of the menstrual period, as they often produce uterine spasm; but when coagula are passed, either alone or mixed with the catamenial fluid, the secretory function is either partially or entirely suspended, and injections may then be highly useful. To the above advice Dr. Ashwell adds the following directions: - When the injection is to be administered, the patient should lie down, the pelvis should be raised by a cushion placed under the hips, and the fluid should be retained for ten or fifteen minutes; to insure which a nurse should hold a napkin, accurately applied to the parts.
7. In some organic diseases of the uterus and its appendages, more permanent relief is derived from the introduction of medicated balls containing Opium, &c, into the vagina, than from injections containing the same substances. Foetid discharges often much improve under the use of injections containing the Chloride of Lime or Soda.
* Lancet, May 11, 1850.
On Diseases of Females, p. 139.