Many cases of mild endometritis may be relieved or cured by attention to the general hygiene and habits of the woman and by applications made only to the vaginal aspect of the uterus. The dresses should be worn loose about the waist and supported from the shoulders. Prolonged standing and slow walking should be avoided. Mild purgation with salines should be maintained. Regulated exercise or general massage should be prescribed. In addition, the vaginal douche, iodine applications, and the use of the glycerin tampon, with depletion from puncture of the cervix, should be used, as has already been prescribed for the subinvolution accompanying laceration of the cervix.
If these methods fail after careful trial, direct treatment must be applied to the endometrium.
The present method of treating chronic corporeal endometritis directly is by the uterine curette. Time is wasted by the use of applications to the interior of the uterus, and a great deal of harm has resulted from such applications carelessly made.
The best curette is the Sims sharp curette ([Fig. 120]). The Martin curette ([Fig. 121]) is useful to remove the endometrium from the fundus.
The operation had best be performed in the menstrual interval, though it may safely be performed during the menstrual period. An anesthetic should always be administered. The woman should be placed in the dorso-sacral position, with the feet in the supports. The vulva, vagina, vaginal cervix, and buttocks should be thoroughly sterilized.
Fig. 120.—Sims’s sharp curette.
The anterior lip of the cervix should be grasped with a double tenaculum. The cervical canal should be wiped out with a small sponge or with cotton and irrigated with bichloride, if the external os is sufficiently patulous. The cervical canal and the internal os should then be dilated to about one inch. The position of the uterus should have been previously determined by careful bimanual palpation.
Fig. 121.—Martin’s curette.