The injection of caustic solutions into a carcinoma or its base is a good procedure and worthy of greater popularity. We can often thus reach the deeper parts of the growth better than with cutting instru-, ments. For this purpose, nitrate of silver solutions, caustic potass, chloride of zinc, brom-alcohol (Schroder, Williams), acetic acid in vary ing strength.
Parenchymatous injections into the cervix have often been made by Delore, in case of myoma, using strong solutions, and he has witnessed many untoward sequel and also abscesses. Schiicking considers that these injections act much more quickly and certainly on the growth of fibromas than the subcutaneous injection. In a not very large number of observations I have not, however, seen any striking results. Still I have never, and Fritsch makes the same statement, seen after a paren chymatous injection any untoward sequelte, and therefore I believe that their worth should be still further tested. I can certainly state that in jections into the uterus or into old exudations to cause their absorption, are not dangerous. In particular has Schiicking found that the injec tion of liquor potass. arsen. into the uterus is a good measure in case of sub-involution, which he believes is due in part to the retrograde meta- • morphosis caused by the arsenic, and on the other hand, to the local irritation caused by the injection, which results in consecutive shrinkage of tissue.
In order to make these parenchymatous injections, the ordinary hypo dermic syringe with strong needle is used, or else the syringe is length ened, and rings for three fingers are adapted to it, which assist in the procedure ( Fig. 134).
Careful antisepsis must, of course, be secured, and since it is always possible for the point of the syringe to penetrate into the cervical or the uterine cavity, these cavities should also be disinfected. The cervix is
exposed through the duck-bill speculum, or through the cylindrical, if we do not propose to inject deeply; the organ is steadied by a tenaculum, and the needle of the previously filled syringe is driven deeply (half an inch) into the uterus or into the tumor. The resistance of the cervix is unquestionably greater than that of the body of the uterus, and we must be careful to see that the needle does not bend, and to inject slowly about one-half a syringe full. In case the tissue is too dense the fluid will escape, and the same thing happens when the 'mucous membrane is per forated and the point of the needle has entered the uterine cavity. In order to avoid this, the needle should be inserted parallel to the cervical canal.
In case of deep penetration in the opposite direction, the needle may enter the peritoneum or the parametrium. Although, according to Schiicking, such an accident does not amount to much, still it is un necessary and is readily guarded against.
When the desired amount has been injected, then the needle is drawn out quickly, and the puncture site closed at once by a tampon. I have found it preferable to pass a suture or else to apply a strong serres-fines forceps.
I have, as stated already, never seen any bad results; still a large vessel may be opened by the needle and the resulting hemorrhage will interfere with the injection, and may call for a suture. In case an abscess should form, it will probably empty by the puncture tract, but if it does not, then this must be done artificially. Such an abscess might prove very unfavorable in case the needle is not inserted into the uterus or through the vagina, but, as in Delorc's practice, through the abdominal wall into the tumor, a method which I have never as yet attempted.