Grammaticati Method

GRAMMATIATI METHOD, systematic intrauterine injections of a 5% solution of alumnum in iodine tincture, diluted half and half with alcohol (Rp.: Alumnum 5.0, Sp. vini rectif. 95°, Tincturae Iodi aa 50.0). The method has many supporters and opponents. Indications for the G. method: 1) chronic inflammatory processes of the uterus, its appendages, and the peritoneum surrounding them, of any etiology (but especially of gonorrheal origin, particularly with a tendency to bleeding); 2) pre-climacteric bleeding. Under clinical conditions, some diseases for which intrauterine injections are indicated are treated by other methods (e.g., X-ray). - Contraindications for the G. method: 1) acute and subacute inflammatory processes of the female genital sphere, 2) suspicion of pregnancy (uterine and extrauterine), 3) fresh gonorrhea, 4) markedly expressed infantile condition of the sexual apparatus (there may occur a permanent cessation of menstruation - climax praecox). Most authors also consider intrauterine injections contraindicated in myomas (possibility of necrosis of nodes lying close to the uterine mucosa, with subsequent development of sepsis). The mechanism of action: 1) local cauterizing action of the injected mixture (mainly iodine) on the uterine mucosa, and possibly also on the tubes (the mucosa is replaced by new tissue after 1-1½-2 months of necrosis); 2) bactericidal action against microbes present in the uterus, resp. tubes, especially gonococci; 3) action on the follicular apparatus of the ovary (atresia of maturing and mature follicles), as a result of which, according to Grammaticati, there occurs the so-called 'temporary climacterium' (suspension of ovulation and menstruation), and with it the necessary rest for the entire sexual sphere - the best therapeutic agent for inflammatory processes. The temporary climacterium can last 3-4 months (if more than 40 injections are given), but usually this condition does not last more than 1-2 months. Menses as a rule are absent. They first appear after the injections are stopped, before the first menstruation appears. Technique of intrauterine injections. The injections are made with a Brown syringe [see table (Vol. VII, pp. 45-46), Fig. 19]. It is better to use a Luer syringe (2 g), to which is attached a tip from a Brown syringe (metal or of hard rubber, thin, with a thin end and a massive initial expansion). The injections can be done in an outpatient setting with the aid of a Kusko speculum. They are done daily. The usual course is 30-40 full injections (for nulliparous-1 g, for multiparous-2 g) after 4-5 preparatory ones. In individual cases, the number of injections reached 100 or more. Some recommend making pauses of 1-2 days during the course. During injections, to avoid complications, it is necessary: 1) to maintain the strictest asepsis, 2) to have sufficient dilation of the cervical canal, which ensures the necessary good outflow of the injected liquid, 3) to introduce the liquid slowly and carefully, especially during the first 4-5 injections (to introduce it 'drop by drop', at first not even into the uterine cavity, but into the cervix), 4) to inject the liquid somewhat warmed. In nulliparous women, it is necessary beforehand to dilate the cervix with Hegar bougies (up to No. 7-8). The injections are usually combined with treatment with ichthyol tampons, which enhance the therapeutic effect and protect the vagina and vulva from burns by escaping iodine. - Complications. 1. Difficulty in introducing the tip. It is necessary to carefully study beforehand the direction of the cervical canal, if necessary with the aid of a utine sound, as well as skillful straightening of the uterine angle with bullet forceps. With further unsuccessful attempts - dilation with Hegar dilators. 2. Pains, uterine colic, sometimes taking the form of true shock (pallor of the face, small pulse, cold clammy sweat, severe pains), observed mainly in young individuals, especially in nulliparous women, with a narrow cervical canal and poorly passable internal os. The attack can last up to an hour. Treatment: rest, ice on the abdomen, suppositories with opium and belladonna. 3. Penetration of the injected liquid into the tubes and abdominal cavity, which some use to explain the appearance of shock. 4. Penetration of liquid and air into the vessels of the uterus (individual cases have been described). 5. Introduction of infection. Intrauterine injections, besides therapeutic purposes, are also used as a means of preventing conception and as an abortifacient in the initial stages of pregnancy. In both cases, intrauterine injections are by the majority, and quite correctly, considered unquestionably harmful.