In place of the applicator we may use the glass pipette or instillation-tube (Fig. 110), as recommended by Skene. This instrument, charged with a few drops of the solution, should be introduced as far as the internal os, and the solution should be expressed as the pipette is slowly withdrawn.
[Illustration: FIG. 110.--Instillation-tube.]
In most cases of cervical catarrh the external os is sufficiently large and the canal sufficiently patulous to permit the applications already described. Sometimes, however, when the external os and the canal are contracted, it is desirable to dilate slightly with the small uterine dilators before making the application. Such dilatation to one-quarter or one-half an inch may be performed without an anesthetic, and may be repeated as often as necessary.
Various solutions are used for application to the cervical canal. Violent caustics should be avoided. The solutions of mild strength are preferable. A solution of 1 or 2 grains to the ounce of chloride of zinc, sulphate of zinc, tannic acid, nitrate of silver (5 to 10 per cent.), or bichloride of mercury (1:1000) is often useful. An application of pure carbolic acid is sometimes followed by good results. Perhaps the most generally useful application is Churchill’s tincture of iodine or a solution of 2 parts of tincture of iodine and 1 part of carbolic acid.
CONGENITAL EROSION AND SPLIT OF THE CERVIX.
In describing the lesions of laceration of the cervix and cervical catarrh, frequent mention has been made of the cervical erosion or the catarrhal patch. The erosion, or red granular area, surrounding the external os seems to be caused by various factors. In laceration it is due to the eversion and exposure of the normal cervical mucous membrane, and perhaps to slight proliferation of the cylindrical cells of this mucous membrane on to the mucous membrane of the vaginal aspect of the cervix. In cervical catarrh it is caused by swelling and prolapse of the mucous membrane of the cervical canal, and extension of the inflammatory process beyond the limits of the external os, with partial desquamation of the squamous cells.
There are other cases, however, in which the erosion appears to be congenital. Such erosions have been observed by Fischel and other investigators surrounding the external os in new-born infants. Erosion of this character has been found, in a more or less marked degree, in 36 per cent. of new-born infants. Microscopically, these erosions appear to be a direct continuation of the mucous membrane of the cervical canal. They are covered with a single layer of cylindrical epithelium, and they possess mucous glands, resembling in these features the cervical mucous membrane, and not the mucous membrane of the vaginal aspect of the cervix, which, it will be remembered, is covered with squamous epithelium and contains no glands. This congenital erosion usually is of very limited extent, but in some cases it covers the greater part of the vaginal aspect of the cervix, and may then give rise to decided symptoms. The condition is due to imperfect development of the external os. In the well-formed woman there is, at the external os, a sharp line of demarcation between the squamous epithelium of the vaginal aspect and the cylindrical epithelium of the cervical canal. In the congenital erosion the epithelium of the canal extends beyond the limits of the external os, and meets the squamous epithelium at a lower level than normal.