TI?? Po5t-partu/T) Douefye 
(Showing New Instrumemt) 
By Edu/ii? fry D. 
Member of the American Medical Association; 
Chicago Medico-Legal Society, Chicago 
Medical Society, Ect. 
before Joei^ty 
-jtt), 1891. 
Reprinted from The North American Practitioner, 
October, 1891; The Chicago Medical Recorder, 
October, 1891; The American Gyneaco- 
logical Journal, October, 1891, and 
The Alabama Medical and Sur- 
gical Age, November, 1891. 
Printed at the office of \ \ 
The Alabama medical and Surgical 'Age, 
Anniston, Ala., 1891. THE POST-PARTUM DOUCHE.* 
(showing new instrument.) 
BY EDWIN PYNCHON, M. D. 
My experience in the care of women during parturition 
has caused me to be a firm believer in the practice of 
thorough asepsis and even of antisepsis. With certain 
modifications, hereafter noted, I have practically adopted 
the methods advised by Garrigues. Shortly before the 
expected deliver}' I direct the patient to take a warm 
plunge bath and follow the same by a copious rectal 
enema and an antiseptic vaginal douche of bichloride, one 
to two thousand. When practical, a flushing of the 
colon is far better than simply the rectal enema. Suc- 
ceeding the delivery my practice has been to remove the 
secundines bv Crede’s method, and if there is cause to 
believe that any material portion thereof has been retained 
I approve of the introduction of the aseptic hand into 
the uterus in order to detach and remove the same or 
learn if such condition exists. The next indication is to 
secure the expulsion of any remaining small and detached 
particles or coagulae of blood, which may be either in the 
uterine cavity or vaginal folds, and to thoroughly cleanse 
the same of all debris which would otherwise remain to 
be dissolved and carried away by the lochial discharge. 
The only practical way of securing such result is by 
means of irrigation. Could we always have our patients 
upon an invalid bed, with opening in the center thereof, it 
would not be so troublesome to administer a proper 
douche, but with the limited facilities usuall}' encountered, 
and with the desire to wet and soil the bed as little as 
possible, the task assumes more troublesome proportions, 
particularly if the customary method of turning the 
patient crosswise the bed with buttocks resting upon the 
side board and feet supported by chairs be adopted. To 
*Read before the Chicago Medical Society Sept. 7th, 1891. me it seems reasonable that no thorough cleansing can be 
secured unless the cavity to he washed is tilled to a degree 
of moderate distention so as to separate all apposing 
surfaces and permit the irrigating fluid to freely touch 
every portion of the surface to be cleansed, and in order 
to attain a thorough cleansing such filling and distention 
should be repeated several times at each seance, or until 
the escaping fluid contains no more debris and is only 
tinged with blood. This means the necessity for the use 
of a considerable quantity of the cleansing fluid—gen- 
erally a gallon at least. Owing to the large quantity 
employed, the maximum strength thereof need not exceed 
one to four thousand, and after the first post-partum 
douche, one to six thousand or eight thousand is prefera- 
ble, unless in event of septicaemic manifestations the 
stronger solution may be returned to. I claim that with 
the ordinary vaginal or intra-uterine tube, be it made of 
either hard rubber or glass and used as is commonly done, 
a perfect cleansing cannot be given. W. Gill Wylie says: 
“Imperfect syringing has frequently resulted in leaving a 
fetid upper segment of the vagina entirely unwashed, 
while the antiseptic stream has been limited to the lower 
third of the canal.” (AT. Y. Medical Journal, June 23, 
1883). Dr. T. Gaillard Thomas also recognizes the in- 
efficiency of a too weakly applied douche and says: “A 
syringe with intermitting jet should be used, which will 
wash away with gentle force all blood-clots, and reliance 
should not be placed on the feeble drip of the fountain 
syringe, the advantages of which are, I think, entirely 
theoretical.” (N. Y. Medical Journal, Dec. 15, 1883). 
This latter writer advises the employment of a douche 
every four to eight hours for at least ten days succeeding 
delivery. More enthusiastic disciples of obstetric antisep- 
sis have even recommended continuous irrigation for a 
similar period of time. (Schucking). 
In order to not soil the bedding it is desirable that the 
cleansing solution shall he carried from the vagina outside 
of the bed into a proper receptacle. 
Feeling the need of a device whereby and wherewith 
such irrigation as described could be obtained I devised and had constructed the apparatus I here show (see Fig. 
1), which has proven to be both simple and efficient in the 
Fig. 1. 
superlative degree. It consists of three parts; first, a 
short hard rubber Ferguson speculum of large diameter; 
second, a soft rubber discharge pipe, about thirty inches 
in length and of sufficiently large calibre to slip over the 
flared end of the speculum employed; and third, an ordi- 
nary hard rubber vaginal tip, passing through a small 
hole on the upper side of the soft rubber discharge pipe 
near its attachment to the speculum, and connected by a 
suitable hose with a fountain .syringe of large size con- 
taining the irrigating fluid, which should be suspended 
not more than from eighteen to twenty-four inches above 
the fundus of the uterus. The specula are of three sizes 
nested, the largest being suitable for use immediately after 
delivery at full term. The smaller sizes will answer for 
douches administered when indicated upon any day suc- 
ceeding the delivery or after a premature birth or miscar- 
riage. In the employment of this device, the soft rubber 
discharge pipe is first stretched over the flared end of the 
appropriate speculum, care being taken that the end of 
the discharge pipe is selected which is provided with the 
small opening and through which is next passed the hard 
rubber vaginal tip, which is in turn connected with the 
fountain syringe already filled with the irrigating fluid. 
The speculum is next entered into the vagina and sufficient pressure is exerted so that its flared end will press against 
the vulva and prevent the escape of the fluid employed, 
which, in order to expel the air, is allowed to flow until 
it begins to escape through the discharge pipe, the lower 
end of which leads to a convenient slop jar. Now by 
compressing the soft rubber discharge pipe the solution 
flowing from the fountain syringe into the vagina is 
retained, causing the solution to enter the uterus through 
the dilated os, thoroughly tilling all portions of the com- 
bined cavities and producing some distention thereof, 
which, at the proper time, is recognized by a swelling of 
the discharge pipe between the point compressed and its 
attachment to the speculum. By now removing pressure 
from the discharge pipe the retained fluid will escape with 
a gush carrying with it post-partum debris. This process 
should be repeated until the irrigating fluid comes away 
quite clear and is, I believe, a method of administering a 
vaginal and intra-uterine douche to the parturient patient 
which gives less disturbance than any other known means 
of accomplishing this result with the patient in the re- 
cumbent posture. The fountain syringe has certainly a 
great advantage in points of simplicity and cleanliness 
over any bulb syringe, and even though its streams or- 
dinarily may be a “feeble drip” when employed with the 
device described, with the intermitting overflow, the 
maximum of flushing power is obtained, causing a me- 
chanical as well as a chemical antiseptic action, while the 
larger quantity of the weaker solution employed gives 
equally as good results as can a smaller quantity of a 
stronger solution, for even “pure water, while not destruc- 
tive to, at least weakens the vitality of many of the 
bacteria which may infest the post-parturient cavity.” 
After the delivery and use of the douche I apply the pro- 
tective pad of absorbent cotton, moistened in the 1 to 
2,000 bichloride solution, covered with oiled silk, retained 
in place by suitable bandages and renewed from four to 
six times daily as suggested b\' Garrigues. 
If the occasional employment of a vaginal douche is ad- 
visable at other than parturient times, and I think it is, 
then why should not appropriately administered douches be indicated daily or even more often after a delivery? I 
have frequently advised such practice and have never 
known the patient to make other than favorable criticism 
thereupon, always acknowledging that after the use of 
the douche there was a sense of relief—a sensation of in- 
creased comfort. 
For use during the first few days after delivery I recom- 
mend the flushing apparatus which I have described, 
though as soon as the patient can get up and sit upon the 
commode, I advise her so to do as by such exercise a 
natural drainage is secured and additionally owing to the 
more vertical position of the uterus, a free escape of the 
antiseptic fluid employed is assured. As soon as the 
patient can thus sit up I advise the use of a more simple 
device consisting of an ordinary hard rubber vaginal tip, 
suitably curved and provided with what is known as a 
“nozzle bulb” (see Fig. 2), an article manufactured by G. 
W. Lutz & Co., of Indianapolis, Ind. This bulb is made 
of soft white rubber and so shaped as to serve as a con- 
venient plug for the external vaginal opening. Regarding 
the hard rubber vaginal tips I will sa\r that there are 
several kinds upon the market, one being round from one 
end to the other, gradually increasing in diameter as the 
point is approached. Another st\de, while round at the 
smaller end, assumes a quadrilateral shape with depress- 
ion between the corners as it increases in size towards the 
point. This latter or corrugated form is not suitable for 
use with the nozzle bulb so the former style described 
should always be employed and should be bent bv heat as 
shown. By use of this nozzle bulb tip the same results are 
attained as with the previously described device, to-wit:— 
filling and distention of the vagina and possibly of the 
uterus, in combination with alternating retention and 
free discharge, and it would seem that in no other way 
can the entire internal surface of the vagina be satisfac- 
torily cleansed. With this nozzle bulb tip no air can 
possibly be introduced if the precaution is taken of allow- 
ing the fluid to flow through the tip prior to its introduc- 
tion. Tn the treatment of vaginal leucorrhoea much 
better results can be secured with this tip than when an ordinary vaginal tip is employed, as all of the secretions 
are first thoroughly removed and afterwards the medica- 
ted wash is made to touch all portions of the surface. This 
latter tip I recommend for general use at all times when 
vaginal douches are employed, and it is the tip par excel- 
lence for use when the antiseptic douche is administered 
Fig, 2. 
shortly before delivery, allusion to whieh has been pre- 
viously made. A small point in this.connection worthy of 
notice, is that the most desirable st\de of fountain syringe 
is one, the several tips accompanying which simply slip 
into the rubber hose, and all those more elaborate, com- 
plicated and expensive kinds wherein the tips are attached 
by screw or soft rubber cork should be avoided. In the 
kind I recommend, when the end of the tube becomes too 
much worn a half inch thereof can be cut off' with a 
scissors and thereby a new and perfect union provided. 
One possible point of objection might be raised against 
the devices I have described when used particularly with 
the post-parturient patient, and that is that through the 
forced retention of the irrigating fluid and the disten- 
tion coincident therewith, some of the fluid might be 
forced through the Fallopian tubes into the peritoneal 
cavity. When employed in the method described and 
with the slight fall of fluid not exceeding twenty-four 
inches as recommended I cannot consider such objection 
admissable. 
When engaged to attend a case of confinement, in order 
that everything may be in readiness, it has been my 
custom to furnish the patient with a list of articles to be 
procured, as follows: 1 fountain syringe No. 4, the tips of which slip into 
the hose. 
1 “nozzle bulb,” vaginal tip. 
1 bed pan. 
1 square yard rubber cloth (to protect mattress). 
2 clean quart bottles with corks. 
2 bedroom sets of washbowl, pitcher, etc. 
V2 yard oiled silk (for protective pad). 
6 yards unbleached muslin (to be washed). 
V2 dozen new safety pins of large size. 
1 one-pound roll of absorbent cotton. 
1 small bottle of sweet oil and a liberal supply of 
clean towels. 
I also give prescriptions for a three per cent, solution of 
phenol in glycerine, and for a bottle of antiseptic bichlor- 
ide tablets containing seven and three-tenths grains each 
with seven and seven-tenths grains of muriate of ammo- 
nia. By supplying such a list I avoid the annoyance of 
finding some needed article missing, and the advantages 
attained through furnishing the list have always richly 
repaid for the trouble involved in penning the same. 
703 Chicago Opera House. 
In closing the discussion Dr. Pynchon said : While my 
obstetrical practice has not been large, it has been my 
fortune to meet with my proportion of cases in which the 
perineum was disposed to be tense and unyielding. In 
two or three instances I have put in practice a mode of 
treatment which I do not remember having seen recom- 
mended by any of the authorities, and that is, during the 
interval between the pains, to introduce the finger and 
give a sort of rolling motion with pressure downward, a 
species of massage if you please, using considerable force 
until the tissues relax. I have frequently observed that 
such procedure has a marked tendency toward overcom- 
ing the tenseness of the perineum. 
In regard to moistening the protective pad with an 
antiseptic solution, I will say that one of the principal 
advantages in using a solution instead of a dry powder, 
is the fact that it gives a cooling, soothing sensation to 
the parts, and has been so frequently praised by the pa- 
tient on account of this quality that I am forced to prefer 
the wet to the dry pad. Axis traction forceps have been mentioned : I will say 
that I have employed a procedure, which I do not remem- 
ber having seen described in any medical journal, and 
which has permitted me to secure axis traction with the 
ordinary forceps. Prior to the introduction of either 
blade I pass through the two fenestrae a strong tape, and 
tie it; then, after introducing the forceps and locking 
them properly, I can get an axis traction by pulling down 
upon the tape. 
As regards curetting, I would not think the curette indi- 
cated after full-term delivery, that is, immediately after 
the delivery or at any time when the os is sufficiently di- 
lated so that the hand can be introduced. I have a cu- 
rette, copied from one devised by Dr. Geo. W. Webster, 
with which I have been much pleased. It consists of a 
curved tube for intra-uterine irrigation and has attached 
by screw to its point asmall sized blunt curette somewhat 
in the shape of an inverted saucer, and is a valuable in- 
strument for use after a miscarriage. 
As regards vaginal examinations, if the hand of the ex- 
aminer is soiled, one examination is enough to contami- 
nate the patient, but if the examiner’s hands are perfectlv 
clean and aseptic, twenty examinations will do no more 
harm than one. In protracted cases of child-birth it often 
has a beneficial effect upon the mind of the patient, if 
these examinations are made every thirty minutes. 
I will say that the largest sized speculum which I use is 
barely two inches in diameter, and it certainly could not 
injure a vagina but recently stretched to a diameter of 
about four inches. For use a few days after full-term de- 
livery and after miscarriages I have smaller sizes provided, 
and I have never known of any difficulty in their intro- 
duction. 
As regards the mortality in private practice, which is 
claimed in special cases to be very low, it is not ever thus, 
and there is always the possibility of septic infection, 
hence I think after one has read the careful results given 
by Garrigues, which read like an Arabian Nights enter- 
tainment, one can hardly object to taking every available 
antiseptic precaution in order to avoid the possibility of 
contamination.