THE ACTUAL CAUTERY.
In gynecology heat as a caustic agent is almost uniformly used in a glowing state. Since its recommendation by Jobert, it has found favor with Aran, Becquerel, Chalvat, Chiari, Gallard, Grenet, Greenhalgh, Grfinewald, Hegar and Kaltenbach; Hoppe, Joseph, Lauri's, Olshausen, Scanzoni, Spiegelberg, Veit, and others. Only exceptionally is it used in the flambent state. In comparison with the indications laid down for the use of the potential caustic agents, the actual cautery ranks above them whenever we wish to break down tissue quickly, and to cause speedy separation of the slough, leaving a cleaning surface with tendency towards rapid healing; when further we aim at checking or preventing huller. rhage. A further advantage is that we can limit its action. The action of heat is different according as we use it in white, red, or dull-red form, the former being most intense.
Glowing heat is utilized for amputating tissues without the risk of much hemorrhage. The galvano-cautery wire finds here its peculiar field. Frequent application of white heat, however, does not cause a deep slough, and therefore in case of large tumors, in particular carci nomata and sarcomata, as much as possible is removed by the knife, scissors or the curette, and the base is afterwards cauterized. The actual cautery is also of service in case of papillary erosions of the cervix, and frequently a single energetic application will cure cases which have re sisted other caustic agents, in particular where the erosion is seated on the everted cervical lip. Further still the actual cautery often answers well in chronic catarrh of the cervix, and Spiegelberg was in the habit of using it in case of hemorrhage and bleunorrhea, hvperplasia of the mucous membrane and sub-involution of the uterus, making the applica tion into the cavity of the uterus. In case of parenchymatous hemor rhage from large wounded or ulcerated surfaces, such as exist after curetting for carcinoma, or after amputation of the cervix, the clitoris, the nymphae, the cautery is useful, although ligation of the bleeding vessels and covering the surfaces with mucous membrane is preferable.
Where, however, union by first intention cannot be obtained, the cautery is an excellent hemostatic, provided it be not brought in contact with large vessels, and the cherry-red, not the white heat should be used. The cautery is also useful for cutting through the pellicle of ovarian cysts (Clay, Baker Brown, etc.). Further the cautery has been utilized for causing loss of substance in diseased or sound mucous membrane for its derivative effect, and Dupuytren advocated the central and peripheral cauterization of vesico-vaginal fistula; to cause union, a procedure to which nowadays we resort only where the fistulas are so small as to be covered over by the slough. Filially Eder and Prochownik have recommended ignipuncture, and it has served me well in case of ectropion and great hyperplasia of the cervix, as also for the peripheral cauterization of tumors (Nussbaum).
The great obstacles to the general use of the actual cautery is the fear of the patients, and the difficulty of applying it in cavities, objections which do not hold, however, for the galvano-cautery. Pain is less in tense after the cautery than after the application of any other of the stronger caustics. The patients often only complain of a sensation of heat, and this disappears on irrigation with cold water. The cautery is contra-indicated in the presence of acute inflammatory processes, and also in the neighborhood of sensitive organs, in particular the peritoneum. Inflammatory reaction after the use of the cautery is rare, although in stances of peritonitis, metritis, and parametritis are known, while reflex irritation from or great irritation of the cauterized parts, leading to dysuria or ischuria, is frequently witnessed. Great hyperesthesia of the individual, and old age, contra-indicate resort to the cautery, although we may control the first by chloroform.