CASES IN SURGICAL PRACTICE

J WIBLIN
1862 The Lancet  
570 some observation of method of treatment adopted by others and by myself in dealing with the peculiar classes of ailments assembled under the generic name of uterine intiammation and ulceration. First, as regards the uses of injections. These may be learned by their failures. They are insufficient for the cure of ulceration, if it has existed for some time, and I have no satisfactory evidence that they can cure this condition effectually under any circumstances. They are not able to cure
more » ... ot able to cure leucorrhcea in the great majority of cases. I have seen it return again and again after the injections have been discontinued. They are useless for the cure of innammatory indnration and hypertrophy of the cervix, and they are equally ineffectual in the sole treatment of the spongy, indolent, patulous, and ulcerated cervix occasionally met with in obstetric practice. I can furnish abundant proof of the correctness of these statements, and it is much to be desired that they were able to win the assent of all who are engaged in this department of our art-for our own credit and for ehe welfare of the sufferers. They are of great use notwithstanding; but it is only in their secondary position as adjuvants to a higher class of remedies. For the relief of pain, for the removal of acrid discharges, for the deodorization of offensive, and for the suppression of ex. hausting fluxes. injections are of value. They are of use for giving tone to a relaxed and weakened organ, and as ts"rin (,ents for the support of the womb having a tendency to prolapse. Conjoined with judicious and appropriate cauterization, they are of the greatest use in hastening the cure of the inflamed and ulcerated womh; and it is of common observation, that patients who are careful in the use of injections, (as in private practice,) get well very much quicker, and with less pain, than those who (as at public institutions) neglect this means. When the cure is complete, injections are still of much ue, but it is most rlifficult to convince the patient on this point. In married life it ought to be easy to induce the patient to persist in this most healthful duty vet the reverse is the fact. The sacbstaizces adapted for injections in commonest use are of the stimulant and astringent kind. Of these, notwithstanding the opinions and practice of others, I consider the sulphate of zinc the most unjustifiable. I think I have seen it the cause of much irritation and mischief, and it is difficult to believe that the constant use of so poisonous a substance over so large a surface of mucous membrane can be other than injurious. The nitrate of silver is another substance most unsuited for injection, yet very frequently ordered for use. The mucus of the vaginal canal instantly decomposes it if used in a weak injection, and if in a stronger form, the excoriation of the external parts, together with the mischief inflicted on the linen, hands, and utensils of the patient, preclude its repeated employment. I have made use of a variety of substances for this purpose, but as simplicity and economy are chiefly of consequence in a daily matter of this sort, the result arrived at is, that a solution of alum, either alone or in decoction of oak-bark, is, after all, the best and most effective injection we can prescribe. A mixture of equal parts of tannin and alum forms a more elegant, but also more costly substance as an astringent. For the anodyne injections, solutions of belladonna and of opium are the only serviceable remedies, and to these may be added the liquor plumbi and hydrocyanic acid with occasional good effect. For emollients, milk and-water, linseed-tea, barley water, and thin starch or gruel, are very valuable. The injection of gases and vapours is a very uncomfortable proceeding, and is not always free from a certain amount of risk, but considerable relief may sometimes be thus obtained when other means are useless. Of those most valuable are the carbonic acid gas and the vapour of Lastly, of the instruments for injection. Gooch's bent-pipe instrument is a cumbrous and dangerous apparatus, very apt to get filthy, and to inflict injury on the cervix. The glass *' female syringe" is a most absurd con'rivance for cleansing a canal so capacious as that for which it is intended. It is also often broken, and sometimes within the canal itself. The ordinary pump, with elastic tube, has the disadvantage of requiting the assistance of a second person for its use. For the use of the poorer classes a simple and excellent instrument was coiitrived by me some years ago ; it consists of a piece of gutta percha tube, five feet long, fitted at its upper end with an inch or two of elastic tubing : this could be slipped over the mouth of a common kettle, and the other end being placed in its proper position, the inversion of the kettle produced a constant stream of water of sufficient force to well wash out the canal. The same object may be also accomplished (and this method is largely used in France) by the use of a long syphon, the uppel end being immersed in a reservoir of water, and the lower re tained in the canal by the patient. The French have an extraordinary variety of instruments for this purpose, amongst the most useful of which is one on the principle of the moderator lamp. Without exception, however, the most commodious and useful of all instruments for uterine injections is the elegant arrangement known as Dr. Kennedy's, and now becoming much used in this country. It may be employed either for gases or for fluids; as a douche or as an enema. An ingenious contrivance, known as the barrel syringe, macle of caoutchouc, is also useful for this purpose; but the action of its valves is less to be relied upon than in the former instrument. For general use the douche just named is the best of all the varied forms of instrument for vaginal injections, and it will probably ultimately replace every other kind. Its valves require occasionally a little looking after and cleansing, but thts is simple enough, as they merely consist of two metallic peas. This article may be truly said to be drawn in " first lines," but experience has long satisfied me of the great importance of these homely remarks. If it be admitted that injections have a remedial value, it is certainly the duty of the medical man to take care-1st, that they be employed for such uses as they will most surely subserve ; 2nd, that only those substances be used which are adapted for those ends ; and lastly, that the instrument for their employment is a simple and efficient arrangement. Instances of failure on all these points are so common as to justify this note on a very commonplace subject. SIoa'ie-street-May. 1862.
doi:10.1016/s0140-6736(02)61025-6 fatcat:xqvolk6uozglzgtmvp3dpwuxni