THE TAMPONADE OF THE VAGINA.
1. As a supporting Measure.—The tampon is inserted into the vagina for the purpose of holding instruments in place, as for instance the intrauterine stem, the sponge or the laminaria tent. Further, it is used for limiting the mobility of the uterus, or else to act as a pessary to keep the uterus in good position. Either the cervix or else the are the points where the support is applied, as where, for example, we fill the me towards which the uterus tends to fall with tampons in order to prevent this tendency.
2. As a erosions, ulcerations, or wounds of the cervix exist, irritation is prevented by covering the surfaces with a tampon, and we thereby also prevent the contact of the secretions with the wound, or else absorb it with the cotton. The tampon answers a similar purpose in holding the vaginal walls apart from one another.
3. For the Purpose of tampon is thus used in case of hemorrhage, congenital or acquired stenosis, or cicatrices in the vagina, in the latter instance in place of dilators. Particularly in the presence of hemorrhage should the tampon be firmly pressed against the bleeding site, and where astringents are combined with the tampon, the resulting contraction of the vagina intensifies the pressure. If astringents are not used then a number of tampons must be inserted to obtain effectual com pression.
4. As a Medicinal the tampon, being medicated, the therapeutic agent is kept longer in contact with the vaginal walls or the cervix 5. As a Diagnostic object here is to obtain the secre tion from the uterus, to assist in diagnosis. (Schultze's test. tampon.) The material for the tampons is generally cleaned, absorbent cotton.
A piece as long as a finger and as thick as the thumb is taken and is tied in the centre with a string, by which the patient is able to remove it. Lint, salicylic cotton, carbolized cotton, bags filled with wool, charpie, strips of calico or muslin, iodoform gauze (30 per cent. to 50 per cent.),
may also be used. The iodoform or linen, etc., is inserted in a continu ous strip, one end hanging from the vulva for the purpose of removal. In addition, various articles have been used, such as an animal bladder (Cliet), a linen cylinder packed with cotton (Scanzoni), the colpeurynter, which is particularly useful where greater pressure is desired.
For introducing the tampons either a speculum is used, or else they are inserted by dressing-forceps, or a tampon-currier, the vaginal walls being held apart by means of two fingers of the other hand. In case a tubular speculum is used the tampons must be held in place by means of dressing-forceps or a sound, while the speculum is withdrawn, and where a duck-bill or valvular speculum is utilized, care must be taken to pack the tampons well beyond the blades. It frequently suffices to place the tampon near the cervix and then the finger alone accomplishes this. The advantage of insertion through a speculum is that the generally sensitive introitus vaginae is not thus brought in contact with the medicinal agent in the tampon.
In case the tampon must be inserted without a speculum, then it is best seized in a broad-bladed dressing-forceps, which protects at least a portion of the cotton from contact with the vaginal introitus. The pro cedure is also simplified by smearing the introitus with fat. Strong medicaments are always to be avoided when the tampon is inserted with out a speculum or by the patient herself. For the latter purpose, Sims, Braun, Weisl and others, have devised tampon-carriers. The instrument described by Sims and modified by Braun, consists of a cylindrical tube curved to coincide with the pelvic axis. In this tube slides a rod which pushes out the tampon. Weisl's apparatus is more complicated, and con sists in a combination of the Cusco speculum with a piston.
Many women are able to use a porte-tampon readily, although gen erally they are unable to place the tampon at the desired spot.