The vagina and the surrounding parts are best protected, as far as my experience goes, by the double-walled speculum of Matthieu, which I have used to the exclusion of all others since 1867, since which date I have not observed any burns. The speculum is made of metal and con sists of two concentrically arranged cylinders, closed at both ends, and provided on each side with a short projecting tube, to each of which a piece of rubber tubing is attached. Through one of the latter ice-water is conducted into the space between the cylinders, and passes off by the tube on the opposed side.
The operation itself is so insignificant and gives rise to so little pain that anaesthesia is unnecessary, although it is often used to prevent the shock experienced by timid patients at the sight of the incandescent cautery-irons. The galvano-caustic apparatus is not capable of developing the necessary degree of heat. At first it seemed as if Pacquelin's thermo-cautery would prove an excellent substitute for the ferrum candens, but after an extended trial of the former, I have found it best to return to the actual cautery. Charred blood and tissue-fragments quickly adhere to the plate of the thermo-cautery, forming a thick, porous layer, which is constantly be coming covered by fresh deposits of coagulated blood, and thus prevents the heat rays from coming into direct contact with the diseased masses. The same deposit occurs of course on a cautery iron, but when one is ren dered unfit for use, it may be removed at once, the vagina washed out, and a second, already heated, applied. When the thermo-cautery is removed it requires quite a time before the deposit can be burned off by bringing the blade to a white heat, and even this does not always succeed fully; while even when a second instrument is at hand, the heat cannot be so uninterruptedly applied as with a series of cautery-irons.
In those cases in which the actual cautery seems no longer available or suitable, we can improve the condition of the cancerous ulcer, and tem porarily arrest its growth by other caustics, such as I have already referred to. The chief of these are chloride of zinc, Vienna paste, solid caustic potash, and fuming nitric acid. Recently Routh,' Schroder' and others have spoken highly of applications of one part bf bromine in five of alcohol; the parts that it is not intended to cauterize must be protected by linen rags dipped in a solution of bicarbonate of soda.
Marion Sims (An nales de Gynecol. 1880) claims to have seen good results from the following procedure. The diseased masses are removed, and a tampon soaked in liq. ferri sesquichlorati is introduced into the vagina. Four days later tampons saturated with chloride of zinc (1:2 water) are used, the vagina being protected by tampons dipped in bicarb sod. eica trization is said to be developed in from ten to fourteen days.
I have never been able to procure by means of the above or similar agents anything like the results obtainable by the red-hot iron, applied in the manner previously described, and I therefore look upon them, one and all, merely as adjuvants in those cases in which the actual cautery can no longer be resorted to.
The treatment of the individual symptoms in opithelioma of the cervix uteri is as difficult as it is uncertain. Simple astringent vaginal injections often suffice to moderate a discharge which is mostly muco-purulent, or is slightly tinged with blood. We may employ for this purpose cold solution of sulphate of zinc, sulphate of copper, alum, tannin, pyrolignous acid, etc., of different strengths. When the discharge assumes a more fcetid and putrid character, the injections should consist of solutions of substances which possess more pronounced antiseptic properties, such as chloride of lime, chlorine, permanganate of potash, tar, carbolic acid, creosote and salicylic acid.
Powdered charcoal suspended in water makes quite an efficient injec tion, but is rather uncleanly when used for any length of time. It is always advisable to use different solutions from time to time. Substances applied pure, or nearly pure. to a sloughing cancerous ulcer, arrest or diminish a putrid discharge with more certainty. In this respect I have had very excellent results from tampons saturated with absolute alcohol, applied in the manner first introduced in my clinic by Professor Zweifel. They seldom cause any considerable pain, and their disinfectant action upon the ulcer is usually energetic. Stuffing the vagina with small bags filled with powdered charcoal and carbonate of lime is a tedious and un cleanly procedure, although it deprives the discharge to a great extent of its odor.