The compressed tupelo tent dilates quite rapidly, but to a considerably less degree than the sponge, but then, if carefully prepared, it is not so likely to become foul, and not a single case of sepsis after its use has been reported, where the necessary precautions were taken. The tupelo can not, however, like the laminaria, be impregnated with medicinal sub stances, seeing that when once it has become distended it cannot be caused to return to its original size. Still, it may be covered with iodo form before use, and in all other respects the tupelo has all the advan tages of the sponge and the laminaria without their disadvantages, so that the preference shown for it is certainly justified.
This tent is inserted even as is the laminaria, although it must be re moved oftener, since it distends more quickly.
A consideration of the properties of these different tents teaches us the indications for resort to the one or to the other. The sponge tent dilates much the quickest, but it is far less readily inserted without the speculum, it attaches itself, however, very speedily in the cervix. It dilates to a much greater size than the laminaria, but with far less in tensity; it is less likely to overcome any great obstacle, but then it induces greater softening of the tissues and congests them 'more, which alone secures sufficient dilatability of the cervical canal; it connects itself inti mately with the cervical mucous membrane, however, its superficial radi cles extending into the depressions in the mucous membrane, and thus, while it cleanses the canal far better than the most careful wiping out can do, it still injures the mucous membrane, causes hemorrhages to a greater or less degree. and offers in consequence great facilities for ab sorption of septic material.
The laminaria tent being harder, distending more slowly, having a smooth surface, is readily introduced, and just as readily slips out; it injures the mucous membrane to a less degree, but then it causes fewer of the local alterations in this membrane than does the sponge; seeing that its co-efficient of distension is greater it excites greater contractions, and is not able in a given time to render the canal so patulous as the sponge, in particular since it does not cause so much softening and serous imbibition in the tissues of the cervix; it does not, however, cause such a foul discharge as the sponge.
The tupelo tent ranks between these two: it dilates more quickly than the laminaria, and less so than the sponge, and its surface being smooth it cleanses the cervical mucous membrane less readily than the latter.
For the above reasons, in general, the laminaria and the tupelo should be chosen in cases where there is narrowness of the external or internal orifices, especially in case of flexion, where it frequently is impossible to pass the sponge around the angle, and also where the cervix is rigid and hard.
[The tupelo tent as at present prepared by reliable makers, is in most respects preferable to either the laminaria or the sponge. Its sphere of dilatability is ample for every purpose of exploration and of treatment, and the absolute immunity from sepsis which it brings should render it more popular than it has as yet become. From our experience we can state that the tupelo, while dilating efficiently, never wounds the tissues of the cervix to such an extent as the laminaria and the sponge, and distends as equably as the latter, and much more so than the former. The chief objection indeed to the laminaria is the fact that it is very likely to distend the least at the very point where dilatation is most requisite, that is to say at the level of the internal os, as is well shown in the annexed figures taken from •und(.
The only advantage, indeed, which the laminaria possesses over the tupelo, is the fact that it may be bent to any desired curve, and hence may more readily be passed in case of flexion; the cases, however, are very exceptional where the tupelo cannot be used. Furthermore, it should be a cardinal rule never to insert a second laminaria, above all a second sponge tent, immediately on the withdrawal of the first. The risk of sepsis from disregard of this rule, is great. The tupelo tent is under no such restriction, and this is a decided point in its favor.
As for the sponge tent, popular as it still is with the general prac titioner, we grant but two conditions in which it should be used. The first is a therapeutic indication, where we desire to stimulate the uterus (as in amenorrhwa) and where we desire to soften down the organ, as in hyperplasia. The second is a diagnostic indication, to differentiate be tween the hard variety of cancer, and a high grade of hyperplasia of the cervix. The sponge tent will affect dilatation in the latter instance, and scarcely at all in the former. In each and all of these conditions, the wise and the safe rule is to be content with the amount of dilatation ob tained by the first tent, and not to follow it up with a second.—En.] The use of any variety of tent carries in its train a number of risks, whence it is necessary never to resort to one without bearing in mind the strict indications and contra-indications. The pressure, the ruptures, which follow on the use of the tent, the mechanical or chemical injuries caused by the laminaria, and even by the sponge charged with disinfect ing substances, the damage to the mucous membrane, and above all the risk of infection from the sponge, such are the sources of danger lurking in tents. Inflammations of the mucous membrane, metritis, parametritis, perimetritis, fatal peritonitis, have frequently enough occurred from ab sorption of the decomposed secretion, and there are instances on record of more or less rapid septicxmia with fatal termination.