After cauterization the vagina should be irrigated to remove remnants of the agent, and a tampon should be inserted to further protect the vagina Often curing cauterization severe pain sets in, of a bearing-down character; during the following twenty-four hours uterine colic is not in frequent, and we may be obliged to administer narcotics and to order poultices. Where the tolerance of the patient is not known, it is advis able to keep her quiet for one to two days after cauterization. From five to ten days thereafter the slough separates, often with hemorrhage. In general the process should be repeated only once during the intermen strual period.
The caustic-holder after use must be carefully cleansed, preferably by heat. There is risk of a portion breaking off in the uterus, and on one occasion I removed a platinum cup from the cavity.
Lunar caustic is used in the uterus in case of chronic affections of the mucous membrane, where there are soft granulations and new growths in its cavity, often after curetting, in case of hemorrhage, sub involution, etc. Today the procedure is not so frequently resorted to, and the applicator or injection is considered safer and more rational.
Of the caustic preparations of mercury, the liquor Bellostii, recom mended by Recamier, Lisfrauc, Velpeau, Bennet, and others, is frequently used. It is indicated in case of superficial, readily bleeding, fungous and varicose ulcers, and is applied either by the local bath, or by means of an applicator. There results a dirty-grey thin slough, fairly adherent, which separates on the third or fourth day. This agent is more energetic than lunar caustic, and it must be used with caution, especially in view of the risk of absorption and the resulting salivation, etc.
Of the other metallic caustics, arsenic, the hydro-chlorate of gold, Landolf's paste (the chlorides of zinc, of bromine, of antimony, of gold), etc., are indifferently used, although the chloride of zinc is the best of all when we desire energetic, deep cauterization, as, for instance, after curetting a carcinoma: The chloride of zinc is used either in paste form (Canquoin's), consist ing of one part of zinc chloride to three of starch, with the addition of a little water and alcohol, or it may be shaped into pencils, or applied on cotton dipped in a saturated solution. The energetic action of this agent should be borne in mind, and the surrounding parts should be carefully protected. The slough separates in from eight to fourteen days, and a
readily granulating and healing surface is left.
The more active and fluid the caustic agent used, the greater necessity of localizing its action at the desired spot. This is very difficult to do, although the Atthill and Peaslee tubes assist us, but before they can be used the cervical canal must be dilated.
The most frequently used acid caustics are, nitric acid (recommended. by .4.tthill, Bell, Betz, Braithwaite, Churchill, Edis, Rokitansky, Tilt, and others); chromic acid (Boeberle, Sims, Wooster, and others); acetic acid (J. Simpson, Curie); sulphuric acid (Selnow); carbolic acid (Goodell, Playfair); bromic acid (Routh, Schroeder, Wynn Williams); the sea quichloride of iron (Braun); salicylic acid (Grilnewald), etc.
Nitric acid is used either in the concentrated form, or else as fuming, and this is my preference. It causes a soft, yellow slough, which is shed about the eighth day, and leaves a cicatrizing surface with marked ten dency to contraction. The acid is applied by a glass rod, or a platinum applicator wrapped with cotton, and by the latter means its action may be more readily localized, only it is less intense, seeing that contact with the cotton oxidizes it. A slender asbestos rod is the preferable means of applying this acid, unless it is desired to cauterize extensive surfaces when cotton or charpie impregnated with it should be used. In case it is desired to cauterize the uterine cavity with this agent, the cervical speculum should be used, and then either the applicator or small pieces of asbestos saturated in the acid are inserted into the cavity. Rokitansky has devised a syringe, like Braun's, for injecting the acid. The extremity of this syringe is made of platinum.
After cauterization similar precautions as regards injections and tampons are to be observed, as after the use of other agents. The ditfil culty of localizing the action of nitric acid is the main objection to it. Palfrey has recorded a case of tetanus following its use, and Wigleworth an instance of occlusion of the cervical canal. Further, after the con centrated, not the fuming acid, hemorrhage may set in if the parts are very vascular.