Quinquennium of medicine and surgery : being the first supplementary volume to Green's Encyclopedia and dictionary of medicine and surgery / edited by J.W. Ballantyne.

Date:: 1911

Credit: Quinquennium of medicine and surgery : being the first supplementary volume to Green's Encyclopedia and dictionary of medicine and surgery / edited by J.W. Ballantyne. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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$Atmocausis. — Definition. — Vapor- isation or atmocausis of the uterus is the application of steam to the interior of that organ for the purposes of arresting haemorrhage and of modifying the mucous membrane; it is cauterisation of the endometrium by means of steam; and the steam may be applied either by means of a double catheter, whose central tube cariies in the steam, which comes in con- tact with the mucosa, and escapes again thi'ough the outer tube, which has a number of fenestra- tions in its intra-uterine extremity (atwocausix proper, from Gr. ar/xos, smoke or vapour, and Kawts, a burning); or by a non - fenestrated catheter, which becomes steam-hot, the heat being applied to the uterus through the wall of the outer tube, while the steam itself does not escape into the cavity of the organ (zestocausis, from Gr. ^eo-rds, boiling, hot, and Kaucris, a burning). History.—Although atmocausis was intro- duced into gynaecological practice during the closing years of the nineteenth century, Sneguireff having used it in Moscow in 1894 (Zentralb. f. Gymlk., xix. pp. 74, 870, 1895) and demonstrated it at the International Medical Congress held there in 1897 {Zmfralb. f. Gyndk., xxi. p. 1161, 1897), yet its establishment as a recognised operative procedure in the treat- ment of the diseases of women belongs to the twentieth century. Sir Alexander Simpson reported (in May 1900) the results of fourteen cases in which he had used the atmocautery in Edinburgh (Trans. Edin. Ohstet. Soc, xxv. p. 131, 1900), and described and demonstrated its method of application; in this way it was brought under the notice of British gynae- cologists. But, befoi'e this date. Dr. Ludwig Pincus of Danzig had done much to introduce the procedure into Germany (Zentralb. f. Gyniik., xix. p. 284, 1895; xxi. p. 190, 1897 ;' xxii. pp. 256, 582, 1019, 1898; xxiii. 113, 352, 1008, 1010, 1899), and other workers in that country had reported favourably or unfavourably upon the matter (e.g. Panecki, Zentralb. /. Gyndk., xx. p. 463, 1896; Kahn, ibid., xx. p. 1233, 1896; Pit'ha, ihid., xxi. p. 652, 1897; Schick, ibid., xxi. p. 695, 1897; Baruch, ibid., xxii. p. 113, 1898; Kahn, ibid., xxii. p. 618, 1898; Otto von Weiss, ibid., xxii. p. 636, 1898; T. H. van de Velde, ibid., xxii. p. 1409, 1898; Duhrssen, ibid., xxiii. p. 292, 1899; Gerich, ibid., xxiii. p. 557, 1899; Beuttner, ibid., xxiii. p. 993, 1899 ; Stapler, ibid., xxiii. p. 1000, 1899 ; Pit'ha, ibid., xxiii. p. 1011, 1899; H. A. V. Gu(5rard, ibid., xxiii. p. 1081, 1899). Since the beginning of the present century Pincus has continued to advocate atmocausis strongly, and has brought together in his book (Atmo- kavsif; und Zestokauais (Wiesbaden), 1903, 1906), and in a number of monographs (e.g. Samml. hlin. Vartr., Nos. 238, 261, 262, 1899, and No. 417, 1906), all the evidence in favour of it and all the details regarding its indications and mode of employment. There have been others in Germany, however, who have pointed out that the procedure is not free from danger and that it has disadvantages, and among these writei's may be named Pfannenstiel (Ferhandl. d. deuisch. Gesellsch. f. Gyndk. (Leipzig), p. 463, 1906), P. Meyer (Zentralb. f. Gyndk., xxxi. p. 174, 1907), and H. Cramer (Monat.sschr. f. Gebarish. u. Gyndk., xxvii. p. 346, 1908). In Great Britain there has been comparatively little enthusiasm evinced for the operation of atmocausis. Simpson (loc. cit.), indeed, was appreciative, and Macnaughton Jones spoke with some favour of the procedure ; but Campbell (Brit. Med. Journ., ii. for 1901, p. 964) was critical, and Blacker (Journ. Obstet. and Gyncec. Brit. Emp., i. p. 488, 1902; iii. p. 444, 1903) urged greater discrimination in the selection of suitable cases. Pincus, indeed, still holds (Zentralb. /. Gyndk., xxx. p. 379, 1906) that if the method be cautiously em- ployed in carefully chosen cases it is safe, pain- less, and efficacious ( ungefahrlich, schmerz- los und wirksam); but it may be said with some confidence that atmocausis has not, and will not, supplant, although it may, in rare cases, supplement the use of the curette. In British gynaecological practice, at any rate, curettage maintains its place as one of the most commonly employed and generally successful operations in diseased conditions of the endo- metrium ; atmocausis is occasionally used in hospitals or nursing homes and in special cases. Description of the Operation. — The requisites are (1) a Pincus's kettle or boiler for generating the steam, strong enough to resist a pressure of three atmospheres, fitted with a thermometer, dynamometer, and safety-valve, provided with an exit tube for the steam, and heated by means of a spirit-lamp or Bunsen burner; (2) an intra-uterine two-way metal cannula or catheter (with a protected handle fitted to it at an angle) with openings in it to allow the steam to escape in atmocausis proper, or entirely closed (non-fenestrated) in zestocausis, and with a protective covering (of wood or indiarubber) for the part which comes in contact with the cervical canal; (3) two volsellae to fix or pull down the cervix; (4) specula for protecting the vaginal walls; and (5) cervical dilators (e.g. Hegar's). It is best to have a return tube to bring the steam away from the uterine interior, and not to allow it to escape into the vagina. Zestocausis is now scarcely ever employed, and may be neglected in the description of the operative procedure. The patient is prepared as for a curettage, and an anaesthetic is usually given, although it has been claimed that the opei'ation is pain- less and can be performed without chloroform. The actual application of the steam to the$