THE USE OF MEDICINAL AGENTS IN SOLID FORM.
Since, when we use solid agents, we do not know in what amount and in what time it will be absorbed, it seems rational rather to use the agent as a fluid; nevertheless, solid agents are frequently used, not only on account of greater con venience, but because we thus obtain more protracted action on the mucous membrane. The patients are generally able to make such applications themselves into the vagina, although not into the uterus. For a time the insertion of suppositories into the uterus was advocated because uterine colic was leas likely to occur than after intrauterine injections, but this was in pre-antiseptic times. I am able to affirm that in my experience colic is no less likely to occur after the insertion of pencils than after intra•uterine injections. The great advantage of this procedure is the ease with which it is resorted to. We can insert a suppository into the uterus much more quickly than we can inject the cavity, for less patency of the canal is requisite, and we are more certain of dissemination of the agent over the entire endometrium.
It has been often objected to the procedure that the action of the agent is illusory; that the suppositories become coated with an albu minate. and are not dissolved, and this has been proved by placing a stick of lunar caustic in a solution of albumin, when it only dissolved after the expiration of a long interval, if at all. We should remember, however, that the uterine musculature is in constant action, and that the move ments are very favorable for the solution and the dissemination of the agent inserted into the cavity. I have often found remnants of secun dines, which I did not suspect were in the uterus, coated and impregnated with the iodoform from an inserted penci' Lents and many others have invented syringes and insufflators for applying salves and powders to the vagina, without the tampon, and Didot devised a speculum with connected piston. The simplest way to insert a powder into the vagina, is by means of a spoon or a spatula through a speculum. Various astringents are thus utilized, in particular alum, and latterly Fritsch has recommended salicylic acid. Gougenheim uses muslin bags containing nine parts of alum and one part tannin, for which I substitute by preference sublimate gauze, etc. Aran was in the
habit of using starch powder for the purpose of retaining fluids in the vagina. Simpson used suppositories and boluses, which the patients could themselves insert into the vagina. To-day it is the custom to use salves worked into suppositories of fat or wax (Simpson), ol. theobrom. (Kidd), starch (Tilt), glycerin. It is well to mix a little emollient ointment with the butter of cacao in order to render the suppositories less fragile. Wax is not a good agent, since it is not at all readily soluble.
In 1848 Dorvault first recommended capsules containing the medicinal agent, and to-day they may be readily obtained in any desired shape. Any astringents, alum, zinc, copper, lead, iron, tannin, resorbents, mer cury, iodide of potass, bromide of potass, iodide of lead—narcotics, morphia, atropine, belladonna, cannabis indica, conium—may be placed in these capsules. As a general rule too much of the agent is inserted, with the'result of pain, and such sensibility of the vagina as to render further local treatment impossible. Of alum, acetate of lead, tannin, about fifteen grains should be used in suppository or capsule; of zinc, copper, iron, about seven grains, with the addition of some narcotic agent. Alkaloids are not to be recommended, since they are too irritating.
The absorption powers of the vagina are but little known, and they certainly vary according to the thickness of its epithelial coating, and the nature of its secretion. In case of many drugs, for instance the iodide of potass, absorption has been proved by Hamburger, and we witness salivation after the use of mercury, and patients frequently taste the drugs. As regards narcotics, however, the rectum absorbs more quickly.
These suppositories and capsules are inserted, after previous cleansing of the canal, with the patient occupying the dorsal or the lateral position, and remaining quiet for a number of hours. In case suppositories com posed of fat are used, it is necessary to order copious vaginal injections in order to remove the masses of fat which remain in the canal, and in this case weak soap-and-water injections are useful.