Playfair used metal probes, Braun hard rubber applicators, grooved at the tip, Fritsch has modified Playfair's probes, and calls them uterine applicators, lleniere has devised an instrument which he calls the " graph idorneter; " in fact each gynecologist has devised an instrument accord ing to his inclination.
For many years I have used wooden and metal applicators. I have a number of pieces of ordinary kindling wood, cut about seven inches long, and wrap the extremities with cotton. These I use in the vagina to wipe up blood and secretion, and after being used they are thrown away. By means of these cotton sticks applications may also be made to the vagina.
For uterine applications I possess the metal applicators either in one piece, or else with the extremity of aluminium or platinum, and they are either grooved or roughened. These applicators may readily be cleansed, and it is not difficult to wrap them with cotton. A piece of cotton is flattened out in the right hand, the applicator is laid upon it and by rotatory movements the cotton is firmly wound around the applicator. After having made the application, the cotton may be readily removed if the applicator is conical in shape. In case of difficulty, the cotton may be burnt off. With a little practice the wrapping is readily accomplished, but if it has not been applied closely enough and slips off in the uterus, this matters not, for the organ will expel it. It is of advantage, of course, to have a number of such applicators ready wrapped at hand.
Fluid medicaments are readily applied to the vagina. Solutions of nitrate of silver, tannin, alum, sulphate of copper or of zinc, acetate of lead, chloroform, collodion, carbolic acid, etc., are used. The cotton
stick, however, is must frequently used for cleansing and disinfecting the vagina. For such purposes, or for the applications of weak solutions of medicinal agents, a large cotton stick is impregnated and the vaginal walls vol. V.-13 are swabbed with it. It is thus possible to penetrate thoroughly into the vaginal folds and rugs& In order to make applications to the cervical and the uterine cavities, we take slender applicators, not wrapped too tightly, else they will not absorb sufficient fluid. The mucous membrane must be thoroughly cleansed before the application. The cervix is steadied in the speculum by a tenaculum, and a dry applicator is inserted in the uterine cavity, in order to cleanse it. Where the mucus is thick, the applicator should be dipped in a 1 to 2 per cent. solution of some alkali. Then the desired agent is applied by means of another applicator. The excess of fluid is wiped away and a vaginal tampon inserted.
It is only exceptionally that it is possible to insert the applicator into the uterus without precedent dilatation. The greater part of the solu tion is deposited on the cervical mucous membrane and at the internal os. In order to medicate the uterine mucous membrane it is, therefore, desirable to use a cervical speculum.
Applications to the cervix may generally be made through any spec ulum; those into the uterus necessitate, ordinarily, a duck-bill speculum and a tenaculum. It goes without saying, that before attempting an intra uterine application, the direction of the canal should be determined by the sound.