Page:Clinical Lectures on the Diseases of Women.djvu/44

34 of this lecture, the best treatment I know of is by zinc-alum. This caustic has the advantage of requiring generally only one application. It was introduced to my notice by the late Dr. Sköldberg, of Stockholm. Sticks of zinc-alum, from one to one and a-half inches long, are made by fusing together equal parts of sulphate of zinc and sulphate of alum, and running the mixture into moulds of the size of a No. 6 or 7 bougie. The cervix is exposed, and a sound is passed to find if the passage is clear, and to show its direction. Then the stick of zinc-alum is introduced and left in the cervix. A plug of cotton or lint is placed in the upper part of the vagina to keep the stick from coming out, and to receive the dissolving caustic. After three hours the plug is removed, and the vagina well washed with tepid water. The caustic produces a yellowish-white slough, which, after several days, comes off, leaving in successful cases a surface which secretes healthy cervical mucus, and soon assumes its healthy appearance. This has been the history of the case now in Martha ward. The cervix is contracted, the catarrhal condition is nearly healed, and the secretion is healthy, all within a fortnight, from the use of the remedy once.

Zinc-alum is stronger as a caustic than nitrate of silver, as usually applied. It produces a very thin scale of slough, whereas the slough of zinc-alum is as thick as a sixpence.

In the severest cases, when you have hypertrophy and sometimes a nodular condition of the cervix, stronger caustics are of most use. Caustic potash, duly applied so as to produce a slough in the thicker hypertrophied lip, is the best remedy. Sometimes the actual cautery proves very efficacious. Cases of this kind are not cases of simple catarrh, but are complicated by peculiar pathological changes. They are sometimes now called erosion, or erosion with hypertrophy.

Finally, there are many very slight cases in which you