{Extractfrom The Nezu York Medical Journal^ March 28y 1885 
UTERINE IRRIGATION. 
By J. W. Long, M. D., Randleman, N. C. 
Injections into the cavity of the uterus were practiced more than two thousand 
years ago ; for we learn that Hippocrates practiced intra-uterine injections, to washout 
bits of retained placenta and medicate the endometrium when affected by catarrh, 400 
years B. C. Since his day the operation has always been more or less in vogue. At this 
time it has many friends, but more opponents. And I do not wonder that so jnany 
eminent authorities have arrayed themselves against the operation when I consider the 
imperfect manner in which it is usually perfoimed. I do not say this to the discredit of 
those who have tried and rejected the operation, for I take it that the fault does not 
lie in the (intelligent) operator, but in the means employed. Now, the objections 
urged against, this measure may be briefly stated as follows: Escape of the injected 
fluid through the Fallopian tubes, causing peritonitis ; absorption of retained fluid, 
causing phlebitis ; shock ; uterine colic ; and sudden entrance of air into a vein. The 
first of these is most apt to occur, and perhaps constitutes the chief danger, and the 
reason why this ever happens is because the injected fluid does not find free exit at the 
os internum. And I believed that a large part of all other accidents occurring with 
this operation-when performed under the proper circumstances-are due to the same 
cause. 
Heretofore the profession have depended on a single-tube, canula, or a double tube 
canula. Now, both of these are defective in the highest degree, for in one there is 
no mode df egress, unless the os,happens to be dilated, which is by no means always 
the case ; and in the other the egress can be very little, if any, greater than the ingress. 
And how can retained pieces of placenta, loose morbid growths, blood-clots, shreds 
of mucous membrane, etc., pass out through a canula? Much less efficient is the 
uncertain dilatation of the os. 
Therefore it is imperative that the internal os (of course the cervical canal also) be 
dilated. To this end I have designed an instrument which has for its first and leading 
principle dilatation of the internal os. 
The instrument, as it appears in the accompanying cut, has been manufactured by 
Messrs. G. Tiemann & Co., who kindly gave me many valuable suggestions. It is an 
elegant specimen of workmanship, made of the very best material, and beautifully fin- 
ished. 
It is sufficiently long ahd small to be used through a bivalve speculum. The handle 
and middle part are straight. The part which enters the cervix is curved to suit 
that canal, and, when the blades are closed-:as seen above-represents three sizes of 
the American scale-13, 14, and 15. The bulbous tip is acorn-shaped, and full of 
holes, with reversible current ; there is no hole in the immediate end. The blades, 
when closed, fit snugly around the tube or canula, and, when opened, expand equally in four directions.- They are. elastic and highly polished, being made of tempered 
steel and plated with nickel. They are controlled by the thumb-screw near the 
handle, and can be opened or closed at the will of the operator. The place for attach- 
ing a syringe is also hear the handle. 
The Operation.-The woman should be placed upon her back, with her hips 
brought to the edge of the bed, her legs flexed and shoulders slightly raised. Now in- 
troduce a speculum, gently hook down the anterior lip of the external os with a tenacu- 
lum, and, after carefully ascertaining the direction of the cervical canal by means of a 
blunt-pointed sound, cautiously pass the instrument in until the tips of the blades pass 
through the os internum. Now, while the womb is steadied by the tenaculum, slowly 
turn the thumbscrew till the blades are half open, or fully open, as may be desired. At 
this point the tenaculum may.be removed, and the speculum also, if necessary. Of 
course, before the instrument is introduced, it is well warmed and oiled, the fluid to be 
injected is prepared, and the syringe is attached. Everything is now ready for the 
second step in the operation. Now slowly inject the fluid, taking good care to see 
that the fluid returns freely into the vagina. 
When the irrigation has continued long enough, simply reverse the thumbscrew and 
gently withdraw the instrument. 
As to the kind of syringe used, the fountain-syringe seems best adapted to this 
purpose-because the force of the stream can be regulated by simply raising or lower- 
ing the syringe, and there is less danger of the fluid being thrown or forced through the 
Fallopian tubes. 
The elasticity of the dilating blades is a point which may be objectionable, and I at 
first thought of having them perfectly stiff ; but the instrument as it is was presented to 
a convention of New York physicians, and they specially commended the elasticity of the 
blades, and said that there being four blades was all the better, as it insured equal dila- 
tation in four directions. 
At any rate, I am willing to let it go on trial as it now stands, and, if those who try 
it think it would operate better with stiff blades than elastic ones, it will be a small 
matter to have them changed. 
In conclusion, I wish to say that I offer this instrument-upon which I have "spent 
so much time and labor-to the medical profession, and all I ask is that my profes- 
sional brethren give it an impartial trial. If they find any merit in it I am sure they 
will say so ; if it has no such thing as merit, they will confer a favor on the huinble in- 
ventor by so stating. 
Note.-I notice that Professor Goodell has been washing out the womb by dilating 
the os withan Ellinger's dilator and passing the nozzle of a syringe between the blades 
of the dilator; but I did not see this till after I had invented the above-described in- 
strument and it had been manufactured. 
Parties wishing our instruments, and finding it more convenient to obtain them 
through dealers, are requested to order "Tiemann's manufacture,'' as otherwise 
inferior goods are frequently substituted. 
MANUFACTURED AND FOR SALE BY 
GEORGE TIEMANN & CO. 
Manufacturers of Surgical Instruments, 
67 CHATHAM STREET, NEW YORK.