The strength of the caustic should depend somewhat upon the thickness of the tissue that separates the cavity from the peritoneum or other important structures. The thickness may be approximately determined by palpation. Usually a 100 per cent. solution of chloride of zinc may be safely employed. If the walls of the cavity appear very thin--less than a quarter of an inch--the caustic may be reduced to a 50 per cent. solution. Small balls of cotton, about half an inch in diameter, should be saturated with the caustic and carefully packed in the cavity. The operator should be careful to remove quickly with the sponge any excess of caustic that may be expressed from the cotton. Much unnecessary pain may be experienced if the caustic comes in contact with the vagina or the vulva.
When the cavity has been filled with the cotton balls carrying the chloride of zinc, a large vaginal tampon of cotton well greased with the alkaline ointment should be placed in the vaginal vault. The packing should be removed from the vagina in forty-eight hours, and vaginal douches of bichloride of mercury, 1:4000, should be administered.
If this operation is carefully performed, the subsequent pain is usually slight. In some cases, however, the action of the caustic may be so painful that morphine is required.
The slough from the caustic may be discharged in one piece or in shreds. It is usually separated in from five to ten days.
The subsequent treatment of the woman consists in the frequent use of cleansing vaginal douches, such as a solution of bichloride of mercury (1:4000), carbolic acid (3 per cent. solution), permanganate of potash (10 grains to the ounce of water), and peroxide of hydrogen (1 part of the commercial peroxide to 3 or 4 parts of water).
The palliative treatment of cancer relieves the pain, the hemorrhage, and the discharge. The relief is usually immediate, and may continue throughout the disease. The hemorrhage is usually arrested for several weeks, or even for months, and the discharge is much diminished with the destruction of the necrotic cancerous mass. The progress of the disease is delayed, and life is somewhat prolonged.
Acute inflammation of the mucous membrane of the body of the uterus is called acute corporeal endometritis. The disease is usually the result of septic infection occurring at a labor or a miscarriage. Occasionally acute gonorrheal endometritis is seen, but this disease usually produces an inflammation of the mucous membrane of the cervix and the body of the uterus that is chronic or subacute from the beginning. Septic infection through operative traumatism, through the use of the uterine sound, or through other gynecological methods of examination may, of course, result in acute endometritis.