In general it may be stated that the more readily a caustic agent unites with the tissue elements, and the more easily it penetrates into the finer lymphatics, the less the resulting pain, and the more intense the action. The stronger the agent and the greater the surface affected, the more care must we take in cauterization and the more quiet must the patient remain afterwards. The reaction which sets in in the tissue does not alone depend on the quality and the quantity of the caustic which is used, but also, and more frequently, on the vitality of the diseased tissues, which varies, of course, with the individual and with the time chosen.
After the slough has separated, there remains a granulation surface which cicatrizes from the periphery towards the centre, and hence result contractions from the shrinkage, which we cannot always limit. In case of cauterization of cavities and fistuhe, we aim at obtaining union N. between the surfaces in order to close them. At times there remain cicatricial bands, as, for instance, are met with in the vagina. In these instances the frequent passages of sounds and application of tampons, will tend to keep the cauterized surfaces apart, and lead to quick epithe lialization of these surfaces. We must aim, usually, not to cauterize too deeply, and, above all, not to entirely destroy the mucous membrane. As
long as the base of the glands in this membrane are unaffected, regenera tion is possible, but if they are destroyed completely, the mucous mem brane is not reformed, but in its stead cicatricial tissue.
Where we apply the fluid caustic by means of the applicator, we may limit the action by the amount of fluid used and the degree of force with which we apply the applicator.
Vaginal injections after cauterization should not be neglected. They cleanse the surfaces of secretion, and they should be ordered a number of times daily, and to the water a disinfectant should be added, or, in case of deep irritation of sensitive parts, a decoction of flax-seed, milk and tincture of opium, etc., may be used.
Many women bear the application of very strong caustics without reaction, while in others the sequels' are severe, such as pain, depression, and the like, especially when we have cauterized near the menstrual period. The menses are ordinarily altered in rhythm and in quantity. It is advisable, hence, to cauterize in the intermenstrual period. Tho general contra-indication to the use of any caustic agent is the presence of an acute inflammatory process.