LOCAL VENESECTION.
Local venesection, however, from the cervix, the vagina, the labia, the inner surface of the thighs, the neighborhood of the anus, ranks with other gynecological therapeutic means.
Acute and chronic inflammations of the genital apparatus, disturb ances in the balance of the physiological hyperemia or in the circulatory system of the uterus, are indications for local venesection, although purely symptomatic, and naturally enough the result of the operation will be the more precise the nearer to the site of local congestion the blood is drawn. Experience teaches that a few leeches applied to the uterus amply subserve the same end as the removal of a greater amount of blood from the abdominal walls.
Until quite recently local venesection was only performed by the use of leeches on the cervix, as recommended by H. v. Nigrosolo and Guilbert, but now, owing to the numerous disadvantages of this procedure, scarifi cation (Spiegelberg, A. Mayer, Scanzoni, Fenner, Schroder), artificial leeches (Storer, Thomas, Leblond and others), acupuncture (Kristeler, Schroder, Spiegelberg, Fritsch, etc.), are preferred.
The aim of each of these methods is the same, the withdrawal of a greater or less quantity of blood from the uterus, the leech and its artificial substitute, however, bringing suction to bear in addition. By means of this suction, a greater amount of blood may certainly be withdrawn, but at the same time greater congestion is produced, which counterbalances the advantages from the depletion, aside from the fact that the suction acts as an irritant which often reacts in an unpleasant manner on the nervous system. Where it is desired to increase congestion, as in certain forms of amenorrhea, partial anemia of the uterus, etc., leeches are un questionably preferable, and in many instances where scarification is resorted to, especially in case of deep puncture, the same untoward sequelm may follow as from the application of leeches.
Leeches are applied as follows: The patient should occupy the dorm' position, and a cylindrical speculum should he inserted of sufficient size to surround the cervix, and to prevent a leech from attacking the vagina.
Scanzoni recommended the exposure of only one lip of the cervix, but only exceptionally is this possible. Until all the leeches have dropped off pressure on the speculum should not be relaxed. The cervix should be carefully cleansed with cotton, and the external os should be plugged to prevent the leeches from gaining the cavity of the uterus. Even if a leech should enter the uterine cavity, it is hardly likely it will cause severe colic or profuse hemorrhage; still it is essential that the physician should himself watch the application of the leeches, and in case one should enter the uterus that he should kill and remove it, and when the other leeches have fallen off, if one is missing, that he should inject a saline solution into the cervix or the uterine cavity, in order to dislodge it. Tamponing the cervical canal is not a certain safeguard against the entrance of a leech. Weber has advocated passing a thread through each leech before its application, and this is said not to interfere with its suc tion powers.
The leeches aro to be counted, inserted into the speculum, and pressed against the cervix by a tampon. In case it is desired to apply them to the vaginal wall, it is preferable to use a duckbill speculum. and to in sert each leech at the desired spot by means of a glass rod. Generally leeches do not take hold of the vagina readily, except in the cul-de-sac, and they should here be watched carefully lest profuse hemorrhage occur from injury to a large vessel. The greater the amount of blood it is desired to remove, the greater the number of leeches which must be applied. Ordinarily we may count on one leech causing the loss of about three quarters of an ounce of blood, including the after-hemorrhage; still this amount is purely relative, as obviously it will depend on the congestion of the parts.