Chromic acid, which is recommended in particular by Sims for cau terization of granular erosions of the cervix, may be used in crystalline form, or in concentrated watery solutions. The crystals arc directly applied on the site which we wish to cauterize, but since they dissolve very quickly we must either speedily irrigate the vagina, or else be prepared to wipe off the surrounding parts. The resulting slough is dark brown in color, and very firmly adherent. It is shed with slight hemorrhage on the tenth to the fourteenth day.
After cauterization with chromic acid, we frequently witness a series of very alarming symptoms. The patients suffer severe pain, nausea, vomiting, cold sweats, loss of consciousness, diarrhoea, symptoms which are likely to be laid to the fact that the women are peculiarly sensitive. Latterly, however, the toxic action of chromic acid, to which Gubler, in 18:2, first called attention, has been proved by the experiments of Bruck, Gergens, Jacob. Koeberle, Mayer; and Mosetig has reported a fatal case after the application of the acid to a carcinoma of the breast. It is cus tomary to-day, hence, not to resort frequently to chromic acid except in the treatment of small granulation surfaces and papillary excrescences.
Bromine, on the recommendation of Routh, Wynn Williams, Schro der, Graily *Hewitt and others, is used particularly in the treatment of carcinoma, especially after curetting, and llenneberg has demonstrated its action on the cancer cell. The agent is either used alone, or else, to lessen the danger of explosion, mixed with alcohol (1:5 to 1:10). It is preferably applied by asbestos pencils, or else injected into the growth (Schroder). The solution of bromine in sulphuric acid is not so dan gerous and less unpleasant, but not so active. Tampons soaked in the solution may remain in Nita for twenty-four hours and over, then.should be placed tampons saturated in an alkali to neutralize any excess. After the removal of the tampons Schroder orders vaginal injections of a weak bromine solution and then cauterizes again at the end of eight days.
The great disadvantage of bromine is its objectionable odor, and its effect on the respiratory organs.
Originally advocated by Playfair, carbolic acid, concentrated or mixed with equal parts of tincture of iodine, is used as a caustic. It is painted over the parts.
The technique of the use of the above agents differs according to the case. They are all useful not only to cause the breaking down of new
growths or the eradication of polypoid and papillary excrescences, but also in case of obstinate catarrh and blennorrhea of the cervical canal and body of the uterus, conditions in which the uterus is often wonderfully tolerant. We must be careful not to obtain too deep action of the agent, especially when we are working near the peritoneum.
Of the alkalies, caustic potass, so warmly recommended by Amussat. Barnes, Bennet, 8f carrier, Simpson, 'lilt and others, is scarcely at all used to-day. It may be applied in the form of pencils, or else as the Vienna paste. The pencils are grasped in a dressing-forceps, and held in contact with the diseased surface for a few seconds, or the parts may be rubbed with them. Since caustic potass is so very deliquescent, the surroundings of the cauterized surface must be carefully protected by cotton dipped in vinegar, and injections of slightly acidified water be administered afterwards.
The resulting slough is soft, slimy, tinged with blood, and it separates in from eight to fourteen days, leaving a deep cavity which only at the end of four to six weeks becomes filled up with a strong, constricting cicatrix. There is often hemorrhage on separation of the slough. For this reason, and on account of its great spreading powers, and further, because it frequently causes cicatricial contraction of the cervical canal or orifices, caustic potass is seldom used. As Dupareque pointed out, this agent penetrates deeply, and may easily injure the neighboring organs; its use is very painful, and for this reason a little morphia has been added to the Vienna paste. Tilt has noted sharp depression after its use. In the past the indications for the use of the agent were manifold. Bennet and Tilt were in the habit of applying it in case of chronic metritis and hypertrophy of the cervix, and Tilt removed on one occasion as much as an inch of the cervix in this way. Amussat resorted to the agent in chronic endometritis, and also applied it to the posterior fornix in case of retroversion, in order to cause this site to unite with the cervix, and thus to cure the displacement.
To-day it is no longer the custom to remove an elongated cervix with a caustic agent, and we no longer endeavor to cause cicatricial contrac tion of the vagina, since this canal may be narrowed in other more certain ways.