THE TAMPONADE OF THE UTERUS.
This procedure subserves two purposes, either to check hemorrhage or else to bring medicinal agents directly in contact with the mucous membrane.
Kristellor used two instruments for tamponading the uterus: a quad rilateral, blunt-pointed sound, and a small slide to push the cotton off the sound. I have always used for this purpose the ordinary tampon carrier with attached slide.
The point of the instrument is wrapped with a thin layer of cotton, which is dipped in the desired solution, and a string is tied around the cotton. The cervical canal and the internal os must be patent, or else the tampon cannot be inserted. An obstacle to insertion is offered by the internal os, seeing that this reacts against the various medicinal agents, and contracts. The more complete the previous dilatation the more readily is the tampon inserted. The apex of tampon may be greased to advantage, or else the uterine speculum may be used.
The uterus should be steadied by a tenaculum or tenaculum•forceps, the cervix having been exposed through a speculum, and then the appli cator armed with the cotton is pushed boldly through the cervical canal, and the cotton is removed by the slide. In case the uterine cavity is widely dilated as in the presence of myomata, polypi, or after curetting, etc., we can and often mast insert a number of tampons, but we should beware of this in case the uterus reacts readily, else the muscular structure is caused to contract energetically, and very severe colic may result. In case a number of tampons are inserted, then different colored strings should be affixed to them, in order to be able to remove them in the inverse order in which they were inserted. These tampons, frequently they have been soaked in liquor ferri, may remain in the uterine cavity for twenty-four hours, although even then they are a trifle foul, and may, through decomposition of the secretion, be a source of danger. In case they are adherent, then attempts at loosening them are made by injecting lukewarm water. The only material which I have latterly used for the tamponade of the uterus, is iodoform or tannin-iodoform gauze. The cavity may be filled with pieces the breadth of the finger, and may remain for a number of days, in case we are not dealing at the outset with a septic wound.
Hegar and Kaltenbach have devised an instrument for inserting these strips, consisting of a sound with perforated apex. Through the
perforation a string is passed, which serves to fasten the medicated cotton. The sound is inserted into the uterus, one end of the string is pulled upon until the cotton is loosened and then the sound is withdrawn.
Tents are also used as carriers of medicinal agents. Laminaria or gentian root tents are soaked for awhile in the desired solution, or else are impregnated in some other way with the medicinal agent; they are then dried and inserted in the usual way. In case of hemorrhage, in particular, it is likely that the pressure of the distending tent is also of advantage. The sponge tent, used in this way, is not to be recommended, and the tupelo, for reasons which are obvious, cannot be so utilized.
[Latterly Vulliet has advocated the tamponade of the uterus for the purpose of inspection, and of direct application of medicinal agents to the endometrium. His aim is to obtain permanent dilatation of the uterine cavity, and the method is said to be free from danger, although tedious in its technique. When once dilatation has been obtained, it persists for weeks, and may be maintained even for months. The steps of the method are: Tbc patient should by preference occupy the genu-pectoral position, the perineum being retracted by a Sims speculum. If the cervical canal be not at all patent, a moderate amount of dilatation is first obtained by means of a steel-branched dilator. Small tampons of iodoformized cotton, with a string attached to each, are then pressed beyond the internal os. At the first séance three to four are introduced into the uterine cavity, and are left there for about forty-eight hours. They are then removed and replaced by a greater number, the object being to fill the uterine cavity at each application. The uterus shows great tolerance for this tamponade, and beyond slight colic no untoward result has been met with. The cavity of the uterus is thus gradually distended, and at the end of the treatment, the time required varying from three days to one mouth, the uterus and the vagina form a single cavity, when the endometrium may be thoroughly inspected, and treatment may be instituted at what ever point it seems desirable. Vulliet has resorted to the method in a number of instances of carcinoma, sessile polpyi, fibro-myomata, and endometritis.—ED.]