PAQUELIN’S THERMO-CAUTERY 
WITH 
Wilson’s Antithermic Shield, 
IN 
EPITHELIOMA OF THE CERVIX UTERI. 
By H. P. C. Wilson, M. D., 
Baltimore, Md, 
<lymecologist to St. Vincent’s Hospital and the Union Protestant Infirmary; Vice Presi- 
dent of the Baltimore Academy of Medicine; of the Medical and Chirurgical 
Faculty of Maryland; and Ex-Vice President of the American 
Gynaecological Society, etc. PAOUELIN’S THERMO-CAUTERY 
WITH 
Wilson’s Antithermic Shield, 
IN 
EPITHELIOMA OF THE CERVIX UTERI. 
By H. P. C. Wilson, M. D., 
Baltimore, Md. 
Gynaecologist to St. Vincent’s Hospital and the Union Protestant Infirmary; Vice Presi- 
dent of the Baltimore Academy of Medicine; of the Medical and Chirurgical 
Faculty of Maryland; and Ex-Vice President of the American 
Gynaecological Society, etc. 
Read before the Medical Society of Virginia, Oct. 23d, 1879.) 
By your courtesy, Mr. President, and the courtesy of this Society, I will 
detain you for a few minutes to-day, with some remarks on the Removal of 
Epithelioma of the Cervix Uteri, by Paquelin’s Thermo-Cautery, with 
Wilson’s Antithermic Shield. 
A little over one year ago, I performed my first operation of this kind 
with Paquelin’s thermo-cautery. When this instrument first came into my 
possession, I recognized in it a most valuable addition to our surgical 
instruments, and one of peculiar merit for extirpating malignant tumors on 
the surface of the body, and where there was liability to excessive hseraor- 
rhage. With the same stroke, it combines so beautifully the bistoury and 
the actual cautery, that the surgeon wields it with a confidence and rapidity 
hitherto unknown; realizing that what would escape the bistoury, will be 
destroyed by the cautery, and what would be required of styptics and 
ligatures, will be done by caloric. 2 
paquelin’s thermo-cautery, 
At the same time, I realized that unless the intense heat emanating from 
the shaft of the knife could he counteracted, the instrument would be of 
'little practical use in the surgery of gynaecology—to which it is peculiarly 
applicable—as we are nearly always operating in deep and narrow cavities, 
where it is difficult, in many cases, to tie or compress arteries, and check 
haemorrhage. 
At this time, I was called by one of our most distinguished obstetricians, 
to see a case of epithelioma of the cervix uteri. It was evidently just the 
case for Paquelin’s cautery; but how to manipulate that red hot knife, with 
a searing hot shaft, up a narrow vagina, so as to amputate the cervix, 
without burning a hole in the bladder or rectum, and blistering the whole 
vulva, I was at a loss to know. 
It was clear, to my mind, that this operation (as most others about the 
vagina and uterus) could only be done skillfully and successfully through 
Sims’ speculum. No bivalve, quadrivalve, or cylindrical speculum, would 
allow sufficient play to the shaft of the knife, to permit the operator to 
swing the blade around the cervix, close up to the vaginal junction, in the 
act of amputation, nor to peel out the supra-vaginal portion of the cervix, 
if infiltrated with malignant deposit. 
I therefore surrounded the shaft of the knife with a sheath of wood as 
the best applicable non-conductor of heat that occurred to me. I hoped to 
remove the cervix so rapidly, that the operation would be over before the 
vagina and vulva could be burned through the wood. In this I was dis- 
appointed, and was horrified to see the wooden sheath blazing in the vagina 
before the operation was completed. This case, after much suffering, made 
a good recovery, and will be reported further on. 
In my next operation for epithelioma of the cervix uteri, I used pledgets 
of wet cotton and wet felt to protect the walls of the vagina; but in manip- 
ulating the knife they became displaced, and their contact with the hot 
shaft generated so much steam as to obscure vision. Asbestos was then 
tried, and although for about three minutes it remained sufficiently cool to 
protect the soft parts, it then became as hot as the shaft, and had no pro- 
tecting power. 
Although thus frustrated in my efforts to protect the soft parts against 
the injurious effects of heat when operating in the vagina with Paquelin’s 
cautery, I was so impressed with the value of this instrument above all 
others, for certain operations in this locality, that I was nothing daunted 
in my efforts to procure a heat protector. The wooden sheath was the very 
thing, if I could only keep it cool; and the idea occurred to me of a light, 
hollow, metal sheath, to be kept cool by a stream of cold water constantly 
circulating through it. This idea was worked into practice by Mr. Charles 
Willms, the most ingenious and practical surgical instrument maker, of with Wilson’s antithermic shield. 
3 
No. 79 North Howard Street, Baltimore. After many alterations as sug- 
gested by operations on the living subject, I show you to-day the therm- 
antidote or antithermic shield—a big name for a little instrument—but a 
name as nearly indicating the work which it most successfully performs, as 
any that I or my friends could devise. It is formed of the two Greek 
words, dso/Aoz, hot; and avudovoz, given as a remedy; or, in other 
words, something used as a remedy against heat. 
It perfectly protects the adjacent parts against the injurious effects of 
heat when operating on a given point in any deep cavity, as the vagina, 
rectum, mouth or abdomen. With the attachment of the antithermic 
shield, Paqueliu’s cautery becomes to the gynaecologist an invaluable instru- 
ment; without it, to him it is worthless. 
From a paper read before the Medical and Chirurgical Faculty of Mary- 
land in May, 1879, I copy a description of this instrument, with the addi- 
tion of more recent improvements. It is a hollow cylinder, of sufficient 
size to allow the shafts of Paquelin’s knives to slip easily into it (as may 
Plate A 
be seen at No. 1, Plate A). It is made of German silver, five and a quaiter 
inches in length. On its upper surface, for its whole length, is a fenestrum 
of one-fourth of an inch. (See No. 2, Plate A.) This tenestrum is neces- 
sary to allow the insertion of a curved knife, such as No. 9, in Collin & Co’s 
catalogue of the thermo-cautery. It is also important to give sufficient air 
to the shaft of the knife, and to prevent too rapid and excessive cooling of 
the shaft, by which it would be difficult to keep the knife properly heated; 
nor does this fenestrum allow the heated shaft to come in contact with the 
soft parts, for in whatever way the knife is turned, the fenestrum is always 
at the distal side from the walls of the cavity The antithermic shield 
increases the diameter of the shaft of the thermo cautery six mm. A 4 
paquelin’s thermo-cautery. 
bridge two mm. wide is placed on its concave surface, one and a quarter 
inches from its distal extremity. On this bridge rests the shaft of the 
thermo cautery, and allows sufficient space between the cautery and shield 
for free circulation of air. In this way, again, we prevent the knife from 
being too rapidly cooled by too close contact with cold water ever flowing 
about it. 
Its near extremity is provided with a flat circular spring, nine mm. wide 
(as seen at No. 4, Plate A), for the purpose of manipulating the therman- 
tidote backward and forward, and fixing it at any point on the shaft of the 
cautery, so as to allow the surgeon to use any desirable portion of the end 
of the knife. 
In order to prevent the antithermic shield from turning on the shaft of 
the thermo-cautery (by which the manipulations of the operator would be 
embarrassed), the upper portion of this spring is left open to receive a guard, 
which is attached to the top of the shaft of the knife. This guard is thirty- 
five mm. in length, and two mm. in width, and effectually prevents any 
rotation of the shield on the cautery. (The spring is seen at No. 4, and the 
guard at No. 5, in Plate A.) 
On the right and underside of the antithermic shield, and running be- 
tween its two plates, is a eanula, five inches in length, and projecting half 
an inch from the external plate, at its near extremity. This eanula deliv- 
ers cold water at the distal extremity of the shield, where it is poured out 
into its cavity, thereby keeping the hottest part of the shaft of the knife 
perfectly cool; consequently the balance of the shaft is even cooler. By 
this method, while the blade of the knife is kept at red heat, its shaft is 
kept nearly as cold as the water which irrigates it. This eanula is repre- 
sented by No. 6, in Plate A. It receives the water at No. 7, and delivers 
it at No. 8. After passing through and around the whole antithermic 
shield, it emerges from a eanula, one-half inch in length, with a perforation 
one-fifth of a mm. (as seen at No. 9, in Plate A). To this is attached a 
small gum tube, of sufficient length to carry the water into a bucket under 
the table. A weight attached, keeps the distal end of the tube securely in 
the bucket. 
The antithermic shield is kept constantly supplied with a current of cold 
water, by a gum tube attached to the eanula at No. 7, in Plate A, and con- 
necting with an Eguisier’s irrigator. This irrigator, when filled with water, 
will take twenty-five minutes to discharge its contents ; and all that is ne- 
cessary in a lengthy operation, i3 to require an assistant to fill it up from 
time to time. I have kept it constantly running for two hours. 
The irrigator opening, delivering the water to the antithermic shield, is 
one-fifth of a mm. in diameter, which allows the water to be discharged 
sufficiently fast for all cooling purposes; and not so fast as to exhaust the WITH WILSON’S ANTITHERMIC SHIELD. 
5 
irrigator too rapidly. The canula opening for the same tube, is two mm. in 
diameter. 
Letter C, in Plate A, represents the antithermic shield appliel to the 
thermo-cautery. 
PLATE B 
Plate B represents Eguisier’s irrigator and the antithermic shield applied 
to Paquelin’s thermo cautery. At an operation, the irrigator sets on a 
small table; and it and the connecting tubing are not at all in the way of 
the operator. It should be remarked that the antithermic shield is adapta- 
ble to all the forms of cautery-knife suggested by Paquelin ; but from the 
fact that the knives and blunt button-like cautery are of different lengths, 
of different diameters, and of different finish, at their extremities, it is ne- 
cessary that different devices should be employed to make the antithermic 
shield applicable to the various knives and cauteries. 
Thus, in Plate C, No. 1 shows one of Paquelin's short knives, and No. 2 
shows the stem for screwing on and lengthening No. 1 ; but this stem is too 
small to be held firmly by the same antithermic shield used with the curved 
knife. To overcome this difficulty, I have invented a short cylinder (As 
seen at No. 3, in Plate C), which slips over stem No 2, and is fixed by a 
thumb screw, as seen at No. 4. This cylinder over the stem renders the 
shafts of all of Paquelin’s short knives of the same length and diameter, 
and applicable to the same antithermic shield as the curved knife in 
Plate A. 
Owing to the size and diameter of the button-like end of the long blunt 6 
paquelin’s thermo-cautery, 
cautery, and the ferule around the near end of the shaft of the same, it is 
impossible to slip it through an antithermic shield of the same diameter as 
Plate C. 
f^ENq. 
that used with the knives; and it is not desirable to increase its diameter, 
as it would occupy too much space, when in deep, narrow cavities. 
Hence w7e have devised one with equilateral sides, united by a hinge 
joint, as seen at No. 1, in Plate I). These halves have each a water supply 
Plate D. 
J5etu~a.m-E.yg’. 
pipe, and water waste pipe, and when brought together, completely sur- 
round the cautery, as seen at No. 2, in Plate D, and are thus secured by a 
ring slipped over them, as seen at No. 3, in Plate D. The best method of 
managing this cautery, is to heat it first, and when ready for use, lay it in 
the hinge joint shield, and close the sides around it. with Wilson’s antithermic shield. 
7 
This hinge-joint shield may be used to completely enclose all the knives 
of Paquelin, by those who prefer it to the fenestrated one; but I prefer the 
latter to the former, for reasons which I will not stop here to give—only 
remarking, that the shaft of the knife within the fenestrum never comes in 
contact with the soft parts when in use. 
No. 5, in Plate D, represents the two water supply pipes, united by gum 
tubing, at the single point of entrance ; and JTo. 6 represents the two water 
waste pipes united at the single point of exit. No. 7, in the same Plate, 
shows the bridge on which rests the cautery, as in the fenestrated shield. 
Its use is to prevent the walls of the cylinder from hugging too closely the 
shaft of the cautery, and thereby cooling the same too rapidly. We would 
thus have difficulty in keeping our knife or cautery at the proper heat. 
When the makers of Paquelin’s thermo-cautery become familiar with the 
antithermic shield, and learn how essential it is to this instrument, when 
operating in deep, narrow cavities, they will, no doubt, so alter the shafts of 
the knives and cauteries, as to make them with plane cylinders, and of uni- 
form length and diameter, and without a ferule at their near extremities; 
so that each one can be easily slipped into the same shield, and at once be 
ready for use; 
The principle for which I contend, and without which, Paquelin’s instru- 
ment would be almost valueless to the gynaecologist, is, keeping the shafts 
of the knives cool, by circulating cool water around them during operations ; 
and this principle is as practical in operation as beautiful in theory. 
Although when guided by a steady hand, and guarded by the antither- 
mic shield, Paquelin’s thermo-cautery is invaluable for many operations in 
deep, narrow cavities, it is especially with reference to the removal of ma- 
lignant disease from the uterus and vagina, that I would commend this in- 
strument above all others. 
Cancer occurs three times as often in women as in men, and nearly three 
times as often in the uterus as in any other organ of the body. Gynaecolo- 
gists in full practice are very seldom without a case of cancer of the uterus 
not only because of its frequency in the sex and organs to which his spe- 
cialty belongs, but because of being the opprobrium of both medicine and 
surgery, and a disease most disgusting to all attendants, the general prac- 
titioner is too thankful to pass it into hands which cannot shrink from its 
treatment. Hence, any therapeutic remedy, whether medical or surgical, 
which can cure or palliate cancer of the uterus—which can save or prolong 
more comfortably the life of the sufferer, or shield her from being loathsome 
to herself and others—is hailed by the gynaecologist with a hearty welcome. 
Of the five forms of cancer*—epithelioma, scirrhus, encephaloid, colloid 
and cauliflower—the first is the one found in the uterus and vagina more 
*Drs. Satterthwaite & Porter, New York Med. Jour., Sept., 1878. 8 
paquelin’s thermo-cautery, 
frequently than all the others combined. The second in frequency in that 
locality, I have found to be cauliflower. I have not seen more than two or 
three cases of scirrhus of the uterus, in a practice of twenty-eight years ; 
and remember only to have occasionally seen colloid cancer, growing from 
the ovaries. 
Practically, then, in my experience, epithelioma is usually the form of 
cancer with which the gynaecologist has to deal ; and all modes of treatment 
have heretofore been found so unsuccessful, that many of our ablest prac- 
titioners are ready to abandon such cases as hopeless so soon as they are 
presented. With an epithelioma well advanced, growing from the neck of 
the uterus, and involving to a greater or less extent the vagina, the diffi- 
culties of examination and of therapeutical applications are so great, that 
it is no wonder so many such cases are turned from in disgust. The slight- 
est manipulation with the finger is apt to produce free haunorrhage; and 
unless a speculum (and that a Sims’) be introduced with great care, and its 
point kept close to the perineum, it enters only to find the vagina filled with 
blood, and all attempts at an ocular examination completely frustrated. 
Notwithstanding all these difficulties, I believe that the day is not far 
distant, when epithelioma of the cervix uteri and vagina will be as much 
under the control or palliative influence of the physician, as any other well 
advanced chronic or incurable disease. 
Epithelioma is the form of cancer, above all others, which, if seen in its 
incipieucy, and thoroughly eradicated by any cutting instrument or caustic 
application, or both combined, is most apt to be radically cured ; but when 
it has existed for any length of time, the malignant deposit extends so rap- 
idly to adjacent parts, or grows so deeply into the parenchyma of the organ, 
that there is great difficulty, if at all possible, to remove the entire malig- 
nant growth ; and hence, it is almost certain to return, 
I cannot urge too strongly all practitioners of medicine, when they 
meet with a woman from thirty-five to fifty years of age, with the 
slightest suspicious symptom of cancer of the uterus, or with any symptoms 
about the uterus or vagina which are not perfectly normal, that they should 
at once make themselves perfectly cognizant of the'real condition of the parts, 
both by digital and speculum examinations ; and if there is the smallest 
epithelioma present, it should at once be removed, with as much of the 
subjacent tissue as would include all possible malignant growth. 
I cannot do better here than quote from a paper which I read before the 
Baltimore Academy of Medicine, Oct. 15th, 1878, where I say, that “if the 
general practitioner was as prompt to examine a woman’s uterus as he is to 
examine any other portion of her body, under the slightest suspicion of dis- 
ease, the maladies of that organ would be universally discovered in their 
acute form ; life would be saved in many cases where it is now lost; drugs with Wilson’s antithermic shield. 
9 
would be kept from stomachs into which they are so uselessly poured ; and 
the struggle of the gynaecologist with chronic disease would not be so long 
and often so fruitless.” 
The opinion has been held for years by some of our most eminent gynae- 
cologists, and is now growing extensively in the minds of many others, that 
no stage of epithelioma of the cervix uteii or vagina should be abandoned as 
beyond hope of cure, prolongation of life, and mitigation of suffering. We are 
growing in the belief that so soon as the cancer is discovered, all that can 
be, should be cut away, and what can’t be cut away, should be sloughed 
away with caustics. This treatment, in the first stage of this disease, will 
save many lives; in the second and third stages, it will prolong life, relieve 
suffering, and nullify much of the disgust which attends it. 
With a red hot knife, such as Paquelin’s, guarded by a shield, such as 
the antithermic, and manipulated through a uni-valve speculum, such as 
Sims’, the surgeon can coolly cut away any malignant growth, from 
the ostium vaginse to the cavity of the uterus, without fear of haemorrhage, 
or fear of burning any of the healthy parts. There is no necessity to tie 
arteries—no necessity to compress them or use styptics. Sometimes, in 
large epitheliomatous growths, when cutting away the whole cervix with 
this instrument, there will be pretty free bleeding; but by cutting steadily 
on, without regard to haemorrhage, it will be found to have entirely ceased 
at the close of the operation. 
Paquelin’s thermo-cautery, protected by Wilson’s antithermic shield, pos- 
sesses many advantages overall other instruments for removing cancer from 
the uterus: 
First, The ecraseur can remove an epitheliomatous cervix close up to the 
vaginal junction without haemorrhage, but cannot go one line above that 
point; but the cervix must be long enough to allow the application of the 
chain or wire around it. which is not always the case; and again, without 
great care on the part of the operator, enough of the vagina, adjacent to 
the cervix, will be sucked into the grasp of the chain or wire, as to make a 
hole into the bladder or peritoneal cavity. To cut away an epithelioma of 
the cervix below the vaginal junction, and leave the portion above that 
junction infiltrated with cancerous deposit, is useless. 
Second. The electro-cautery, in the hands of as skillful an operator as 
my distinguished friend, Dr. Byrne, of Brooklyn, can be made to amputate 
an epitheliomatous cervix, close up to the vaginal junction, without hem- 
orrhage; and with his manipulation, by pulling the cervix more and more 
towards the operator as the amputation advances, a limited portion above 
the vaginal junction can be removed, so as to give to the stump a cup-like 
shape ; but if the cancerous deposit reaches anywhere near the internal os, 
or above, it is out of the reach of the electro-cautery. Besides, it is a 10 
PAQUELIN’S THEltMO-CAUTEIiY, 
“ cumbersome, expensive and uncertain instrument,” working all right 
sometimes, and failing at others. Secondary haemorrhage is said to have 
frequently followed its use in the hands of some operators. I have never 
yet had such an accident to follow the thermo-cautery. 
Third The bistoury and scissors, in the hands of as skillful and self- 
reliant an operator as Dr. J. Marion Sims—who always finds a resource in 
every emergency—may answer well for amputation of the cervix, and ex- 
section of cancerous masses, even in the cavity of the uterus and vagina ; 
but only one Sims is usually found in a generation, and these instruments 
will hardly be brought into general use for removal of a cancerous cervix. 
The haemorrhage, in many operations of this kind with bistoury and 
scissors, is simply terrific; so that no amount of sponging can cleanse this 
deep, dark and narrow cavity, as to give the operator even a momentary 
glimpse of the point of operation. He must cut with his eyes virtually 
shut; which very few surgeons are competent to do where careful dissec- 
tion is necessary. But even if he should be successful in removing the can- 
cerous mass, with all its ramifications, through a vagina always full of 
blood, the utmost rapidity of sponging and packing the uterus with cotton 
and iron, could not fail to leave much blood on the exsected surface for de- 
composition, and thereby greatly increase the liability to septicaemia. 
Moreover, the great amount of haemorrhage by this mode of operation, 
must tell very disastrously on patients already so anaemic from long, and 
much loss of blood. 
Fourth. I am convinced that we must find an instrument with which to 
exsect the epitheliomatous cervix as far as malignancy extends, without 
much loss of blood, and leaving the cut surface free from all decomposing 
matter, before we shall gain all that is expected from this operation 
Such an instrument is presented in Paquelin’s curved thermo cautery 
knife, guarded by Wilson’s antithermic shield. This instrument is inval- 
uable for many operations within the rectum, the vagina, the mouth and 
the abdominal and pelvic cavities. These I will not stop here to enumerate. 
It is particularly in cancerous growths, from their incipiency to their ter- 
mination, located from the ostium vaginae to the os uteri internum, that we 
are especially grateful for this instrument. 
Even where the disease is so far advanced that it is beyond hope, much 
can be done with this instrument to prolong life, mitigate suffering, and 
quell disgust. By fearlessly cutting away the sloughing masses within the 
vagina, we stop haemorrhage, remove decomposing matter, diminish the 
chances of septicaemia, and thus prolong life in comparative comfort. With 
no other instrument, with no other therapeutical means, can we so promptly 
stop bleeding in this disease; with no other agent can we so efficiently re- 
move the decaying tissue that poisons the blood and terminates life. True with Wilson’s antithermic shield. 
11 
the curette is very valuable for this latter purpose, but it does its work with 
much loss of blood, which usually the patient can illy spare, and is devoid 
of the cautery power, which is so invaluable in this instrument—beg in- 
ing, as it does, where the knife ends, in eradicating malignant disease. 
Another great advantage in using the thermo-cautery is, that it effec- 
tually seals up the mouths of all vessels, so that, even if septic poison is in 
contact with the surface, the absorbent power of the same is greatly dimin- 
ished, if not destroyed. 
Again, the actual cautery in this disease, to a great extent, does away 
with the potential cautery, which is so essential after the use of all other 
instruments. 
Dr. J. Marion Sims, in a recent most original and instructive paper* on 
Epithelioma of the Cervix Uteri, speaks of the absolute necessity of using 
some powerful caustic (such as chloride or sulphate of zinc, or bromine), 
after the knife and scissors have done all that they can. In this statement, 
he is certainly correct: but with the thermo-cautery, much, if not all. of the 
necessity for these caustics is prevented, and the patient is spared the pain 
which they occasion, and the demoralizing effects of anodynes which they 
necessitate. 
It may not be out of place to repeat here some cautions for the use of 
the thermo-cautery, which I have heretofore given in a paper entitled “The 
Thermal) tidote.” 
1st. The benzine bottle should never be more than two-thirds full. If 
too full, the slightest tilt of the bottle would cause the benzine to flow down 
th.e tube attached to the cautery ; and patient, operator and assistants might 
be set on fire. Or a little extra air forced into the bottle when too full, 
might lift the benzine into the tube by atmospheric pressure, and cause the 
same accident. 
2d. The benzine bottle should never be hung to the operator’s clothing, 
or placed in his pocket. If so attached to his person, he, in the act of bend- 
ing forward, might tilt the bottle so as to cause a like accident, although 
very little benzine was in use. 
3d. The benzine bottle should be held securely in the left hand of a 
trained assistant, and the rubber bag for heating the knife in the right 
hand of the same assistant. This assistant, under no circumstances, should 
be allowed to leave his post for any other work. His only duty is to take 
care of the benzine, and watch closely the point of the knife, so as to keep 
it at the proper temperature. 
4th. The hard rubber receptacle for benzine, sold with the American 
imitation of this cautery, is recommended by some to obviate all the objec' 
tions to the benzine bottle of Paquelin. I think the objections to the for- 
*American Journal of Obstetrics, July, 1879. “ Epithelioma,” by J. Marion Sims. 12 
paquelin’s thermo-cautery, 
raer are far greater than to the latter. This receptacle is filled with clean 
wool ; and when used, this wool is to be saturated wiih benzine. If there 
is tooiy little benzine, the instrument will not work,or it will giveout in the 
middle of a long operation ; and if there is too much benzine, it runs read- 
ily down the tube to the hot knife, or is forced there by atmospheric 
pressure, and patient and operator are set on fire. This accident oc- 
curred to a friend of mine in Baltimore in this way. The instrument would 
not work with the amount of benzine with which the wool was charged. 
He poured in more, and with the first squeeze of the rubber bag connected 
with the benzine holder, this fluid was forced to the knife, and it, and pa- 
tient and operator were in a blaze. My friend gave up his instrument in 
disgust, and has not used it since. 
This accident could not occur with the glass benzine bottle of Paquelin, 
provided the precautions given above are adhered to, and the instrument 
is in the hands of a competent assistant. No one should operate with 
Paquelin’s thermo cautery without such assistant. With the glass bottle 
benzine-receiver, the whole thing is under our eye, how much is in the bot- 
tle, and how near it comes to running or being forced into the tube. With 
the hard-rubber benzine-receiver, everything is shut off from sight, and we 
cannot tell whether there is too much or too little benzine, or whether the 
wool itself is the obstructing cause of the non-working instrument. 
5th. The blade of the knife should never be heated too hot. A dull, red 
heat is best, and this redness should never extend above one-third of the 
blade. 
6th. If the knife is too hot, we cut no better, lose more blood, and are in 
danger of bending and injuring the blade, and of burning up the platinum 
gauze within the blade, thus rendering the knife worthless. This latter ac- 
cident has once happened to me. 
1th. When we are done using a knife, it should be heated a little extra 
hot; and while so, quickly separated from the gum tube supplying the va- 
por of benzine. It should then be held for a few minutes in the flame of 
the alcohol lamp, and thus be allowed to cool off by degrees. By so doing, 
no carbon deposit will be left within the blade of the knife, and it wiil be 
in perfect order for future use. 
8th, Because of the injudicious heating of the knife, and destruction of 
the platinum gauze, or clogging the same with carbonaceous deposit, we are 
sometimes unable to heat the knife to the operating point. This is very 
embarrassing, and can be avoided by a little care on the part of the 
assistant. 
9th. Every case of Paquelin’s thermo cautery should contain a small 
metalie brush, with which to cleanse the blade of all burning tissue which 
adheres to it with each iucision. This clogging of the blade impedes its with Wilson’s antithermic shield. 
13 
proper heating. The duty of an assistant is to remove such tissue as it ac- 
cumulates. 
10//i. In all operations with the thermo cautery within the vagina, four 
assistants are essential—one to give chloroform, one to work the cautery, 
one to hand instruments and to hold the knife when the operator desires to be 
relieved of it, and a fourth to hold Sims’ speculum—the only one fit for 
use in all uterine surgery. 
The following four cases are reported in the order in which they came to 
me, as illustrative of the use of Paquelin’s cautery with Wilson’s antither- 
mic shield in epithelioma of the cervix uteri: 
Case I.—Mrs. K, jet. 4(5, married and sterile. I was called to see her 
Sept. 19th, 1878. She had been having haemorrhages from her womb for 
eight months previously, and for two months they had been so profuse and 
so exhausting, that she had been confined to bed. An examination re- 
vealed epithelioma of the 'cervix uteri, but the uterus was free, and the 
disease seemed confined to the neck alone. 
I advised cutting away the epitheliomatous cervix with Paquelin’s 
thermo cautery, which proposition was agreed to. I was at a loss to 
know how to accomplish it without burning dreadfully all the soft parts 
from the vulva to the uterus. After exercising all my ingenuity in the 
limited time allowed before the day of operation, I could think of nothing 
better than to encase the shaft of the knife with a sheath of wood—hoping 
to cut so rapidly as to finish the operation before the wood could burn. 
On the 7th of October, 1878, the patient being chloroformed by Dr. 
Miitenberger, assisted by Dr. Griffith, and Sims’ speculum held by my 
nurse, I proceeded to remove the whole cervix up to the internal os ; but 
before this was accomplished, the wooden sheath was on fire, and the pa- 
tient was dreadfully burned about the vagina and vulva. (I here exhibit 
the charred remains of the wood used on that occasion.) 
The patient suffered greatly from that portion of the burn exposed to 
air, but the burn within the vagina and about the uterus gave no inconve- 
nience. 
The stump of the wound presented the appearance of a hollow cone, 
with the little end upwards —showing that the malignant cervix had been 
peeled out with Paquelin’s curved knife, just as we would peel out the core 
from an apple. 
The patient made a good recovery. In four weeks she was up and well, 
and the wound cicatrized. About four months after, I was called to see 
her. She had had a little show of blood, and an examination disclosed 
the fact that the cicatrix had given way, and a raw, hard surface was pre- 
senting. This surface was covered with powdered sulphate of zinc, and has 
continued so to be treated up to this time. The patient has had no hsem- 14 
paquelin’s tiiermo-cautery, 
orrhage, is in in good health, weighs eight and a-half pounds more than she 
has ever done before, attends to all her family duties, and enjoys life and 
society. Still, there remains a small, raw surface at the seat of amputa- 
tion, which thus far I have not compelled to cicatrize. She is now on 
a visit to friends in Virginia for several weeks. When she returns, I shall 
cleanse this ulcerated surface thoroughly with the curette, and then use the 
powdered sulphate of zinc. 
This woman has had more than one year of good health, happiness and 
usefulness, since the 'operation. How long I can guarantee this state of 
things to her is yet to be seen. If I had seen her in the first, instead of the 
ninth month of her disease, the cure might have been complete long before 
this. 
Case II.-—Mrs. M—, of West Virginia, set. 35, married and sterile. I 
was telegraphed for December 20th, 1878, to come to her residence in that 
State to operate “ for cancer of the womb.” She was so feeble from great 
loss of blood, and exhaustive and offensive discharges from the vagina, that 
she was unable to come to me. 
She had been a victim to the above symptoms for about eight months, 
and was a picture of suffering and despair. The cervix uteri was an epi- 
theliomatous mass, extending over the upper part of the vagina. Malig- 
nant deposit occupied the whole peri-uterine cellular tissue, so that uterus 
and vagina were thus firmly fixed in their position. 
So unpromising was the case, that had I not been sent for by her medi- 
cal attendant for no other purpose than to operate, and had not the patient 
and her husband set their hearts on an operation, I should have shrunk 
from the case. 
But on the 21st of December, 1878, with Paquelin’s thermo-cautery, sur- 
rounded by a wooden sheath, and with wet felt and cotton about the vulva 
and lower part of the vagina, the patient under chloroform, and Sims’ 
speculum in the vagina, I proceeded to cut away all ulcerative and slough- 
ing masses about the vagina, and also the cervix uteri up to the internal 
os. The amputated portion was painted with Monsell’s solution and gly- 
cerine as an antiseptic, aod the patient put to bed with a pledget of cotton 
and glycerine in the vagina. 
Notwithstanding my precautions, this patient was badly burned about 
the vulva and lower vagina (as in Case No. I). The wet cotton and felt 
generated so much steam by coming in contact with the hot knife, that 
I was much embarrassed in the operation. 
She was left to the care of her most intelligent physician, and I returned 
to Baltimore the same night. She made a slowr, but good recovery—suffer- 
ing more with the external burns than with the seat of operation. 
Five mouths afterwards, she came to Baltimore to see me, much improved with Wilson’s antithermic shield. 
15 
in health and strength, and I have heard from her through her physician 
four mouths later. The seat of operation has never completely cicatrized. 
She occasionally has some slight bloody flow, but nothing amounting to a 
haemorrhage. She has some disagreeable discharge, and more or less neu- 
ralgic pains about the pelvis and lower abdomen, from time to time, but 
nothing comparable to what she had before the operation. These discharges 
are kept in check by sulphate of zinc. On the other hand, she has now 
had about ten months of comparative comfort, and has been spared to her 
friends. 
She will ultimately die of cancer, if not carried off sooner by some other 
disease, but she has been already repaid for the operation. 
Case III.—Mrs. H—, set. about 35, mother of two children. Epithe- 
lioma of cervix uteri, had existed, when I saw her, about fifteen months. 
The cervix presented the appearance of a cauliflower, occupying nearly the 
whole vagina ; deposit in the whole .peri-uterine tissue, and extending to 
within the internal os. Has been confined to bed six months. Haemor- 
rhages have been terrific, until she was brought to the brink of the grave. 
One more haemorrhage, in my opinion, and the opinion of her attending 
physician, must have been fatal. A dirty, watery, offensive discharge was 
most profuse and exhausting. She was so feeble, that I doubted the pro- 
priety of any active interference; but it seemed to me, that what little blood 
she had left was daily being poisoned by the decomposing masses within 
the vagina ; and she was liable, at any moment, to have a haemorrhage 
which would carr\y her off. She was offensive to her friends. For these 
reasons, I advised cutting away the diseased mass, as far as it could be 
reached, knowing that it could be done without pain, and with very little loss 
of blood. My advice was resisted by friends and physician for several weeks. 
They were satisfied she would die under the operation ; but finally, on the 
3d of February, 1879, with the thermo-cautery, surrounded by the anti- 
thermic shield, I cut away all the diseased matter that could be reached, 
without burning any of the adjacent healthy soft parts, and painted the 
surface with Monsell’s solution and glycerine as an antiseptic. 
On the 11th of March, 1879, five weeks after the operation, she rode six 
miles in a spring wagon to her home in Baltimore county. I heard from 
her on the 2d of May, three months after the operation. She was then 
walking about, and was in every way improved in health. I have heard 
recently that she died the latter part of August, nearly seven months after 
the operation. The amputated surface never healed, but I am sure her life 
was prolonged, and her condition was in every way better after the opera- 
tion than before. 
Case IV.—Mrs. C—, of Pennsylvania, set. 48, mother of eight children. 
Was brought to me March 26th, 1879. She had epithelioma of the cervix paquelin’s thermo-cautery, etc. 
uteri, of about ten months’ standing, and was treated all this time with lo- 
cal applications for “ ulceration of the womb.” She was constantly having 
profuse haemorrhages, and was so exhausted as to be brought to me on a 
bed. She was a confirmed opium-eater, to the extent of destroying appe- 
tite and digestion. She had much peri-uterine, cancerous infiltration. The 
intra-vaginal portion of the cervix was very short—not long enough to be 
grasped by an ecraseur or galvano-cautery ; but the whole infra and supra- 
vaginal portions of the cervix were peeled out with Paquelin’s cautery, 
protected by Wilson’s antithermic shield, on March 29th, 1879. She re- 
turned to her home April 25th, 1879, and I never saw her afterwards; but 
I learned that she did not improve much in health, lived on opium and 
without food, in spite of her physicians and friends, till the day of her 
death—the last day of August, five months after the operation. I am 
convinced that the excessive use of opium was the main cause of no better re- 
sults in this case. With appetite and digestive power all gone, there was 
nothing left to build upon, and everything to exhaust her decaying frame.