Cauterization

CAUTERIZATION (cauterisatio), a method of treatment that aims to have a destructive local effect on tissues. C. is used: 1) for destroying various pathological tissue growths - granulations, condylomas, warts, calluses; 2) for removing neoplasms: papillomas, polyps, epitheliomas, angiomas; 3) for eliminating local infectious foci - in anthrax, glanders, lupus, trachoma, tuberculous and other ulcers and fistulas; 4) for destroying toxic substances - in snake bites, bites from rabid animals, in contamination with putrefactive poison; 5) for limiting hyperplastic inflammatory processes in hypertrophic catarrhs of mucous membranes; 6) as a hemostatic method. - C. is performed either by thermal (cauterium actuale) or chemical (cauterium potentiale) means. In the first case, C. is performed by touching the tissues with some heated object; at present, various apparatus are used for this, the corresponding parts of which are heated, or by flame (see Lacellene apparatus) or by electricity (see Galvanocautery and Diathermocoagulation). As chemical cauterizing substances, various caustic medicinal agents are used, namely many acids, caustic alkalis, and some mineral salts. In this case, liquid cauterizing substances are applied to the cauterized place with the help of glass or wooden sticks or asbestos brushes, while solid ones are used in the form of pointed sticks (pencils) or pieces, which are grasped with forceps or dressing forceps or inserted into goose quills or special holders (porte-caustique). One can attach a small amount of cauterizing substance to a probe by dipping the heated end of the probe into a piece of cauterizing substance or, conversely, by dipping the cold end of the probe into molten cauterizing substance. In any case, the cauterizing substance must be firmly fixed in the holder and should not protrude too much from it, otherwise it may fall out or break off and cause unnecessary damage to the tissues. Due to the great brittleness of some solid cauterizing substances, they are alloyed with other substances that give them greater strength. - Depending on the nature of the tissue to be destroyed and the properties of the substance used for C., either the cauterizing substance is quickly touched to the tissue, or it is drawn relatively slowly over its surface, or it is pressed to it for a longer or shorter time. To protect the surrounding tissues, a piece of adhesive plaster with an opening for the cauterized area can be applied to them, and only then the cauterizing substance is applied. When performing C. in cavities, in order to avoid burning the walls, the cauterizing substance is introduced through tubular mirrors. In some cases after C., the residues of the cauterizing substance are removed by washing them out or syringing them out with neutralizing solutions. When cauterizing substances come into contact with tissues, sharp changes occur in them, accompanied by their necrosis with the formation of a scab, around which a demarcation zone develops. With time, the scab falls off, forming a defect that is filled with granulation tissue and heals with a scar. In this case, acids, destroying tissues, quickly remove water from them, make them dry and form a dense scab (dry necrosis). Alkalis, on the contrary, soften the tissues, make them viscous and give a loose, sometimes pasty scab (colliquative necrosis). In addition, they saponify fats and dissolve keratin of the epidermis, which contributes to their deeper and faster action compared to acids. The action of salts is more superficial and less intense than that of alkalis and acids. On mucous membranes, all cauterizing substances act more strongly than on the skin. The presence of mucus, blood, pus on the cauterized area can weaken the action of cauterizing substances and therefore they should be removed before cauterization. Some of the cauterizing substances can be absorbed and show harmful resorptive action. The most commonly used cauterizing substances are the following: 1) ACIDS. Ac. sulfur. concentr. is used in its pure form or in combination with charcoal (Ac. sulfur, solidefactum); Ac. nitric, pur. and Ac. nitr. fumans are used in their pure form, with the fuming one acting more strongly than the pure one; Ac. chromicum is used in 10-15% aqueous solutions, can cause poisoning; Ac. trichloraceticum is used in 1% solution; Ac. lacticum is used in 10-80% solutions. 2) ALKALIS. Kali causticum and Natr. caust. are most often used in their pure form in the form of sticks; Pasta caustica viennensis (Vienna paste) consists of 5 parts Kali caust. and 4 parts Calcar. ustae; before use, this powdery mixture is diluted with a small amount of water to the consistency of a thick porridge or paste. ^Mineral salts. Argent, nitricum, s. Lapis infernalis is used either in its pure form in the form of sticks or in 5-10% solution; Lapis mitigatus, an alloy of equal parts Arg. nitr. and Kal. nitr., is used in the same way as the previous one, but has less brittleness and a milder action; when using lapis, the surface to be cauterized should be moist; to neutralize lapis, a 0.9% NaCl solution is used; Zincum chloratum is used in the form of a pencil alloyed with an equal amount of saltpeter; Pasta Canquoin's consists of 1 part Zinc, chlor. and 1-3 parts Amyli trit. or flour; Cuprum sulfur is used in its pure form in the form of a pencil; Lapis divinus, s. ophthalmicus, an alloy of equal parts copper sulfate, alum, and saltpeter, is used in the form of a pencil; Hydrarg. bichlorat. corros. is used in 1-10% solutions; Kalium hypermanganicum is used in 1-5% solutions.