THE USE OF CAUSTICS.
Every cervix was cauterized, and only twenty years ago Rigby claimed that we could speak of a new form of inflammation of the uterus, de pendent on the misuse and frequent resort to caustics.
Latterly the use of caustics has been lessened owing to the more gen eral resort to many bloody operations, such as curetting, the amputation of the cervix, Emmet's operation, the various radical methods of treating carcinoma, etc.; while, on the other hand, we have learned that diseases which were formerly often fruitlessly treated by the repeated use of astringents, will now yield to a few cauterizations, in particular chronic catarrh and its sequelw, so that there are still a number of indications for resort to caustics.
A further use for caustics is to stimulate the tissues and lead to healthy granulations. In the first place we stimulate tissues in order to destroy them, and thus we may remove new growths or remnants after excision, enncleation, curetting; thus further we may cause the subsid ence of hypertrophies, melt down cicatrices, etc.; further, and this is the chief indication, we cauterize the surface or base of wounds, in order to disinfect them, in order to control fungous granulations, and thus lead to union by first intention. We also resort to cauterization in case of fistulae in order to cause their surfaces to unite; or we cauterize in order to make cavities from which we may operate beneath the superficies. We propose, however, to speak here purely of the technique of the use of caustics, a discussion of the principal indications being given in another place.
The variety of caustic agents in use is large, although each operator has preference only for a small number. Both the potential caustic agents and the actual cautery are utilized. The first are either in fluid or solid form, by which it is of course understood that the solid become fluid in action. Only in case of weak caustics, which then act mainly as astringents, are we able to limit the action. In this way we may use
injections into the vagina or the uterus, pencils, suppositories, tampons, etc. Protection to neighboring organs against the extension of the caustic action is only secured by careful oversight, by surrounding them, where possible, with cotton saturated in a neutralizing solution. In case of the cervix it is necessary to protect the vagina, and this is secured by using the tubular speculum. In case this speculum cannot be used, then the vaginal walls should be protected by retractors. It goes without say ing that the speculum must be constructed of a material which can resist the action of the agent or of the heat. Hard rubber possesses this quality to the best degree, since only fuming nitric acid, bromine and chloro form attack it. For further protection it is well to cover the borders of the speculum with cotton or linen, or, if we use a cylindrical speculum, the of the vagina are to be thoroughly tami.oned, the part to be cauterized being alone left uncovered. After cauterization any excess of the caustic agent must be removed, and this is accomplished by injec tions and wiping with cotton. The tampon, which is laid against the cauterized surface, had better be saturated in a solution which will neutral ize the excess of caustic.
After cauterization there results a firm, thick slough, which after a longer or shorter interval separates and is shed either in whole or in part. During the separation of the slough, through irritation of the nerves, there exists considerable pain, not necessarily localized in the cauterized _portion, but reflex in other parts.
Aside from this sequels, the risks from cauterization lie in the excess ively deep action of the agent chosen, or inflammatory reaction in the neighboring organs, usually from the side of the peritoneum; and, further still, there is risk from absorption of the agent, in especial where mer cury, arsenic, and chromic acid are used.