Thermocautery

THERMOCAUTERY (termocauterisatio), one of the oldest methods of treatment by cauterization, consisting in the local application of very high temperature to the body. At the end of the 18th and in the 19th centuries, thermocautery was used not only for its local destructive or hemostatic effects but also as a counter-irritant method for various inflammatory diseases, mainly of the nervous system (diseases of the spinal cord, radiculitis, neuralgia). As cauterizing agents, the following were used: 1) various smoldering substances (touchwood, flax, sunflower pith, cotton, etc.), from which cylindrical sticks 2-3 cm long were made (moxa), placed on the skin and ignited; moxa burned slowly and caused superficial burns of the skin; it was used mainly for counter-irritation; 2) boiling liquids (oil, turpentine, water), which were applied or injected into the parts of the body to be cauterized (poisoned wounds, vascular tumors); 3) flame, directed by a narrow stream onto the cauterized place, for which Nelaton proposed an apparatus consisting of a rubber balloon filled with illuminating gas with a thin tip and a directing valve; when the gas escaping from the balloon during compression is ignited, a very thin stream of flame with a very high temperature is obtained; 4) hot air, for which Hollander modified the Paquelin apparatus in such a way that the tube of the balloon forcing air into a bottle with benzene is connected by another tube directly to the tip, so that the forced air partly goes into the bottle and partly bypasses it to the tip, where, coming into contact with the heated metal, it itself becomes strongly heated and escapes from there as a hot stream; it is especially applicable for stopping bleeding from parenchymatous organs, removing vascular tumors, and burning out bone cavities; 5) water vapor (see Vaporization); 6) concentrated solar rays, collected with the help of biconvex lenses, and finally 7) heated metals, of which the oldest and most commonly used is heated iron (ferrum candens). For its application, special instruments - thermocauters - existed, which were iron rods bent at the end at a right angle and ending in tips of various shapes (button-shaped, ball- or disk-shaped, cylindrical, conical, etc.); these rods were mostly heated on coals to red or white heat and fixed in a handle. These thermocauters are inconvenient in that they cool quickly, and therefore in recent times they have been completely replaced by the Paquelin thermocautery (see Paquelin apparatus). Thermocautery is applied: 1) at a distance (in distantia), depending on the degree of burn that one wants to obtain, and 2) by contact (per contactum), briefly or more or less long, depending on the desired effect. Previously, sometimes the insertion of heated needles (ignipuncture) into diseased tissue (vascular tumors, chronic lymphadenitis) was used with the aim of destroying it and causing healing by the development of reactive inflammation. For counter-irritant effect, usually a large number of superficial point contacts are made to the skin or a series of strips 5-6 cm long are made at a distance of 2-4 cm from each other. When the thermocauter comes into contact with tissues, water is removed from them, protein coagulates, local necrosis occurs, and a dry eschar of white, yellow, or brown color is formed, with a slight crackling and smell of burning. The depth and degree of tissue destruction depend on the duration of contact of the thermocauter with them and on the degree of its heat: at white heat, cauterization is faster, deeper, and less painful; at red heat, it is slower, more superficial, significantly more painful, and in this case the eschar often sticks to the thermocauter and when it is removed, it is torn away with it from the tissues. L. Molchanov.