But of all substances iodoform is the most useful as well as safest. Iodoform tampons lessen the discharge, and have the additional advantage of being safely left in the vagina for several days.
In all cases the external genitals must. be kept thoroughly clean, and should from the beginning be kept smeared with a bland ointment, in order to prevent the putrid discharge from giving rise to excoriations, which readily assume a bad condition, and also cause the patients much torment in other respects.
If there be much hemorrhage, use injections of tannin or liq. ferri sesquiclilorati dissolved in ice-water, and if these do not suffice, tampons moistened with liq. ferri sesquichl. of full strength.
Pain is on the whole the one symptom of cancer of the uterus which we are least able to control. If it is more of a perimetritic character, due to reactive inflammation in the vicinity of a cancerous ulcer, it can some times be assuaged by covering the abdomen with moist compresses, or poultices. In all other cases, in which we have to do with the true " cancer pains " of various kinds and degrees of intensity, our last re source will always be opium and its preparations, especially morphine. Commence as a rule with the smallest efficient dose, and employ the drug at first as seldom as possible. Having once begun the use of these reme dies, it is almost invariably necessary to continue them in constantly in creasing doses until the death of the patient. It is well also to vary, from time to time, the method of administration of the narcotic, giving it at one time in its different preparations by the mouth, at other times by subcutaneous injection, or in the form of vaginal or rectal suppositories made up with cacao-butter. Small enemata, containing a little aqueous extract of opium or something similar, are sometimes excellent. AU the other procedures that have been recommended, such as the inflation of the vagina with carbonic acid gas, the introduction of bits of ice into the vagina, cutaneous inunctions of chloroform, the administration of chloral in various forms, and so forth, may be suitable and useful at times, but are much inferior to opium and morphine.
Demarquay ' recommends suppositories of a half to one gramme of lode form as having both an anaesthetic and a cauterizing effect. gives ergot in doses of two grammes every six hours, with good results in violent, throbbing pain due to carcinoma of the uterus. The same writer also recommends croton chloral hydrate internally, and carbolic acid locally applied. Wagner also advises the last mentioned. It is not pos
sible to mention here the innumerable remedies that have been recom mended from all parts of the globe, suffice it to say that their very multi plicity but demonstrates how few drugs we possess that can be relied on for overcoming the pain arising from cancer of the uterus, and also shows how great a role the merely subjective opinions of the individual physician play in this regard.
It is as easy to point out the further indications of symptomatic treat ment as it is difficult to accomplish anything with the agents prescribed therefor. In this connection I can only repeat that which I have already written in No. 18 of Volkmann's Clinical Lectures.
Almost all sufferers from cancer of the uterus become dyspeptic at an early date, and take scarcely any nourishment. Whenever this is the case the diet should be appetizing, and at the same time nutritious and easily digestible. In place of regular meals it is often advisable that patients take a small quantity of food every hour, and take most of it cold. It becomes still more difficult for patients to take sufficient nourishment after they have once been attacked by uncontrollable vomiting and chok ing sensations, that so often occur in this disease; whether these symp toms be caused by the foetid odor of a putrid vaginal discharge, or be simply an aggravated condition of previously existing dyspepsia, the vagina should as often as possible be washed out with strong disinfectants, the apartments of the patient should be well aired, or should often be changed, and particular care should be taken to ensure good ventilation at night. I have often seen much benefit accrue in these cases from hav ing the patients covered with a rubber sheet from the false ribs downwards; to a great extent this keeps away the odor from the patient and those around her, if the most scrupulous cleanliness be exercised at the same time.
As useful in controlling the vomiting may be mentioned ice, water-ices, cold champagne, iced punch, cold milk and strong cold tea, but always in very small quantities at a time. The bowels should also be carefully regulated in these cases, even though the patients prefer to have a move ment but once in many days, because of the severe pain attending the act. If the vomiting be uriemic, it may often be checked in an astonishingly short time, even if only temporarily, by stimulating the secretion of the kidneys. For this purpose copious draughts of Vichy or similar mineral waters, and the administration of digitalis, acetate of potash, iodide of potassium. etc., are useful.