Compliments oj the Author. 
THE THERMANTIDOTE 
OR 
ANTITHERMIC SHIELD. 
AN INSTRUMENT FOR PREVENTING THE EVIL EFFECTS 
OF HEAT FROiM PAOUELIN’S THERMO-CAUTERY 
WHEN OPERATING IN DEEP CAVITIES. 
BY 
H. P. C. WILSON, M. D., 
BALTIMORE, MD. 
SURGEON IN CHARGE OF THE WOMAN’S DEPARTMENT OF THE UNION 
PROTESTANT INFIRMARY.—VICE-PRESIDENT OF THE AMERICAN 
GYNAECOLOGICAL SOCIETY, OF THE BALTIMORE ACADEMY 
OF MEDICINE, AND OF THE MEDICAL AND CHI- 
RURGICAL FACULTY OF MARYLAND. 
Reprint from Transactions of Medical and Chirurgica l Faculty of Alary land. 
BALTIMORE: 
Maryland Medical Journal Steam Printing House, 
No. 9 South Charles Sir ' 
1S79. THE THERMANTIDOTE. 
AN INSTRUMENT FOR PREVENTING THE EVIL EFFECTS OF HEAT FROM 
paquelin’s THERMO-CAUTERY, WHEN OPERATING 
IN DEEP CAVITIES. 
BY H. P. C. WILSON, M. D., OF BALTIMORE, MD,, SURGEON IN CHARGE 
OF THE WOMAN’S DEPARTMENT, OF THE UNION PROTESTANT 
INFIRMARY. VICE-PRESIDENT OF THE AMERICAN 
GYNAECOLOGICAL SOCIETY, OF THE BALTIMORE 
ACADEMY OF MEDICINE, AND OF THE 
[&( 
MEDICAL AND CHIRURGICAL FAC- 
ULTY OF MARYLAND. 
Mr. President and Gentlemen : 
My subject to-day is the Thermantidote, an instrument which 
we have devised for preventing the evil effects of heat from 
Paquelin’s thermo-cautery, when operating in deep cavities. 
I read before the Baltimore Academy of Medicine, on October 
the 15th, 1878, an account of my first operation with this instru- 
ment, in amputating the cervix-uteri for epithelioma. I there 
described the difficulties I had in preventing the shaft of the 
knife from burning the vulva and vagina, although I had it en- 
circled with wood. With all my care the wood was charred, 
and became so hot as to burn the above parts to such an extent 
as to give more pain and trouble afterwards than the stump of 
the amputated cervix. The heat was sufficient to nearly burn 
up the wooden sheath about the shaft of the knife; and from this 2 
h. P. C. WILSON. 
experience I was satisfied, that more efficient means, for counter- 
acting the evil effects of heat, than those used in this instance, 
would have to be adopted, or Paquelin’s cautery would be of 
very little use for operations in deep cavities,—such as the vagina 
mouth, rectum and abdomen. 
I had seen this objection to the instrument for operations in 
cavities, before ever using it, and adopted the sheath of wood, 
as the best applicable non-conductor of heat, with which to pro- 
tect the shaft of the knife from burning the soft parts, (both by 
contact and radiation) between the external labia and os uteri. 
In a subsequent operation for amputating the cervix, other 
means were used in addition to the wooden sheath, such as wet 
felt laid around the walls of the vagina, and covering the labia, 
wet cotton, tinfoil, &c., but they were worse than useless; became 
displaced, and in the way of the operator; generated so much 
steam as to obscure the seat of operation; or became so hot, as 
to burn by contact. 
Asbestos was next tried, as one of the best non-conductors of 
heat, by binding it around the shaft of the thermo-cauter. It 
was found to protect the parts very well for about three minutes, 
and then became nearly as hot as the shaft beneath, and of course 
inefficient for any lengthy operation. 
These operations were performed with Sim £ speculum ; and it 
may occur to some present, that if another form of speculum had 
.been used (as a cylindrical, bi-valve, or quadri-valve), the soft 
parts would have been protected, and the operations on the cer- 
vix might have been eventually successful. This is not so. The 
walls of the vagina will fall in between the blades of bi- valve and 
quadri-valve speculums, sufficiently to be burned by the shaft of 
the knife, in the manipulations necessary for amputating the cer- 
vix; or the speculums will become so hot as to blister the whole 
vagina and vulva. 
Moreover, no speculum, which completely surrounds the en- 
trance to the vagina, will allow that free play of the knife in the 
hand of the operator, which is obtained by the use of Sim’s 
speculum; and which is so essential to a thorough excision of THE THERMANTIDOTE. 
3 
the cervix, or polypoid and cessile tumors, about the neck of 
the uterus ,or walls of the vagina. 
For these reasons my mind has been greatly exercised to 
devise some means by which to counteract the evil effects of heat, 
from this most valuable instrument, when operating in deep cav- 
ities, with soft parts liable at any moment to come in contact with 
the shaft of a red hot knife. 
To Mr, Willms, the surgical instrument maker at No. 79 North 
Howard Street. Baltimore, so well known to all physicians of 
this city, for his ingenuity, integrity, and accomodating manners, 
I am greatly indebted for the result which I lay before you to- 
day. 
When we failed to counteract the evil effects of heat from 
Paquelin’s thermo-cautery, by the wooden sheath and asbestos 
around the shaft of the knife, and wet felt, wet cotton, and tin 
foil protecting the walls of the vagina and external labia, my 
mind was for a time directed to devising a speculum, (notwith- 
standing they are already counted by dozens), which would keep 
cool all the external and internal soft parts, except the points on 
which we desired to operate the hot knife. 
Such a speculum could have been easily invented, whose blades 
or cylinder could have been kept cool for any length of time, 
and which, in turn, would have kept cool the soft parts adjacent 
thereto. 
A cylindrical speculum could have been made with a coil of 
metalic tubing, through which we could have kept constantly 
flowing, a stream of cold water. Or a bi-valve or quadri-valve 
speculum could have been planned, with each blade hollow, so 
as to allow a current of cold water, passing through the same, 
to keep speculum and subjacent tissue at any temperature desired. 
The speculum idea of counteracting the evil effects of heat, 
when using this instrument in the vagina, was speedily aban- 
doned, because any speculum which was not a univalve (such as 
Sim sj, would not allow that free play of the knife which is so 
essential to successfully operating within the vagina. The blade 
of a Sim could be made hollow, and kept cool as 
above, but it would then only protect the posterior vaginal wall ; 4 
H. P. C. WILSON. 
while above, below, anteriorly, within and without, the soft parts 
would be subjected to intense heat. 
Thus we were forced to return to our original idea of encasing 
the shaft of the thermo-cauter with a heat protector; and to aban- 
don the thought of guarding the walls of the vagina with a 
speculum. We have succeeded in devising an instrument which 
will thoroughly protect the vagina, and all the soft parts about 
the vulva, from the evil effects of heat in the use of Paquelin’s 
cautery. In operations with this instrument in any deep cavity 
(as the rectum, mouth, and abdomen), all the parts adjacent to 
the point of operation, will be perfectly safe against the injurious 
effects of heat. 
This instrument, for want of a better name, we shall call the 
Thermantidote, in contradistinction to the thermo-cauter. It is 
a hollow cylinder, of sufficient size, to allow the shafts of Paque- 
lin’s knives to slip easily into it. (As may be seen at Plate A. 
No. i). It is made of German silver,— inches in length. On 
Plate A 
its upper surface, for its whole length, is a fenestrum of one- 
fourth of an inch. (As seen at Plate A. No. 2.) This fenestrum 
is necessary to allow the insertion of a curved knife, such as No. THE THERMANTIDOTE. 
5 
9 in Collin & Co’s catalogue of the Thermo-cautery, *In order 
to give sufficient air to the shaft of the knife, we have provided 
fenestra in the Thermantidote, corresponding to the fenestra in 
the shaft of the thermo-cauter. (As seen in Plate A. No. 3.) 
The Thermantidote increases the diameter of the shaft of the 
thermo-cauter, 4 m, m. only. Its near extremity is provided with 
a flat circular spring, 9 m. m. wide, (as seen in Plate A. No. 4), 
for the purpose of manipulating the Thermantidote backward 
and forward, and fixing it at any point on the shaft of the cauter, 
so as to allow the surgeon to use any desirable portion of the 
end of the knife. In order to prevent the thermantidote from 
turning on the shaft of the thermo-cauter (by which the manipu- 
lations 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 35 m. m. in 
length, and 2 m. m. in width, and effectually prevents any rota- 
tion of the antidote on the cauter. (The spring is seen in Plate 
A. No. 4, and the guard in Plate A. No. 5). 
On the right, and under side of the thermantidote, and running 
between its two plates, is a canula five inches in length, and pro- 
jecting an half inch from the external plate, at its near extremity. 
This canula delivers cold water, at the distal extremity of the 
antidote, where it is poured out into its cavity, thereby keeping 
the hottest part of the shaft of the knife perfectly cool; conse- 
quently 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 canula is 
represented 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 thermantidote, it emerges from a canula, one-half inch in 
*Since reading this paper, we have improved the Thermantidote, by enlarging 
it, so as to make it increase the diameter of the shaft of the thermo-cauter 6 m. m.; 
and by placing a bridge 2 m. m. wide on its concave surface, one and a quarter 
inches from its distal extremity. On this bridge rests the shaft of the thermo-cau- 
tery, and allows sufficient space between the cauter and antidote, for free circula- 
tion of air. Thus we are enabled to dispense with the fenestra corresponding to 
to fenestra in the shaft of the knife ; and what is more important, we prevent the 
knife from being too rapidly cooled, by too close contact, with cold water ever 
flowing about it. 6 
H. P. C. WILSON. 
length, with a perforation of one-fifth of a milli-metre, (as seen 
in plate A, No. 9. To this is attached a small gum tube, of suf- 
ficient 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 Thermantidote is kept constantly supplied with a current 
of cold water, by a gum tube attached to the canula at No. 7, in 
plate A, and connecting with an Eguisier’s irrigator. This irri- 
gator, when filled with water, will take twenty-five minutes to 
discharge its contents; and all that is necessary, in a lengthy 
Operation, is 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 Thermanti- 
dote, is one-fifth of a milli-metre in diameter, which allows the 
Water to be discharged sufficiently fast for all cooling purposes; 
and not so fast as to exhaust the irrigator too rapidly. The can- 
ula opening for the same tube is two milli-metres in diameter. 
PLATE B THE THERMANTIDOTE. 
7 
Letter C, in Plate A, represents the thermantidote applied to 
the thermo-cauter. Plate B represents Eiguisier’s irrigator and 
the Thermantidote applied to Paquelin’s thermo-cautery. 
The improvement which I have recently made can be made plain 
by the cuts which are here exhibited. 
Plate C. 
Plate C. No. i, shows one of Paqulin’s short knives, and 
No. 2 is a stem which is screwed on No. i for the purpose of 
lengthening the handle of the knife. This stem is too small to be 
held firmly by the same Thermantidote used with the curved knife. 
To overcome this difficulty I have invented a short cylin. 
der, as seen at No. 3, 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 Paquelin’s short knives of the same 
length and applicable to the same Thermantidote as the curved knife 
in plate A. Owing to the size and diameter of the button like end of the 
long cautery and the ferule around the near end of the shaft of the same, 
it is impossible to slip it through a Thermantidote of the same diameter 
as that a$tTfhe knives, and it is not desirable to increase its diameter, 
as it would occupy too much space when in deep, narrow cavities. 
To correct this I have, devised one with equilateral sides united 
by a hinge joint as represented in plate D., No. 1. These halves 
have each a water supply pipe and waste water pipe, and when brought 
together completely surround the cautery, as shown at No. 2, plate D. 
These halves are secured by a ring slipped over them, as shown at 
No. 3, plate D. The best method of managing this cautery is to 8 
H. P. C WILSON. 
heat it first, and when ready for use lay it in the hinge joint Ther- 
mantidote, and close the halves over it. This hinge joint Thermanti- 
dote may be used to completely enclose all the knives of Paquelin by 
those who prefer it to the fenestrated one. No. 5, plate D. represents 
the two water supply pipes united by gum tubing at the single point 
{ of entrance, and No. 6, the two waste water pipes united at a single 
“ point oF enlrtTTTCe. No, 7 represents the bridge on which rest the 
cautery to prevent the walls of the cylinder from hugging too closely 
the shaft. 
It will be remembered that all the knives of Paquelin are not of the 
same length and that this improvement is designed to render them 
all equally useful. The fenestrated Thermantidote did not admit of 
the use of the short knife represented in plate C., No. 1. 
Plate D. 
At an operation the irrigator sets on a small table near the 
foot of the operating table, and it and the connecting tubing, are 
not at all in the way of the operator. It* should be remarked, 
that the Thermantidote is adapted to all the forms of cautery- 
knife suggested by Paquelin, 
No surgical instrument has come into my hands for some time 
past, with which I have been more pleased, than with Paquelin’s THE THERMANTIDOTE. 
9 
thermo-cautery. Operating as I do so much, in deep and narrow 
cavities, where bleeding vessels are hard to discover,—hard to 
ligate, and unsafe and difficult of torsion, I can realize the com- 
fort to the surgeon and the advantage to the patient, in having 
an instrument, with which he can cut fearlessly along without 
regard to vessels divided, or the amount of hemorrhage. For it 
must not be imagined that all operations with the thermo-cautery 
are bloodless. Far from it. In many, the loss of blood is great, 
but not nearly so great, as would occur in the same operation 
with any other cutting instrument, except the ecraseur, (if this 
can be called a cutting instrument). 
In my operations with the thermo-cauter, I have never found 
is necessary to stop to tic arteries, or check hemorrhage; but by 
cutting steadily on, without regard to blood, to the end of the 
operation, all hemorrhage was found to have ceased, without any 
necessity for haemostatics. 
I have heard it objected to the thermo-cautery, that too much 
blood is lost in some operations. This will be so if the operator 
attempts to arrest the hemorrhage in the middle of the operation. 
To illustrate.—A few weeks ago, 1 was removing a cystic tumor, 
with dense, thick walls, from the anterior portion of the vagina. 
A large portion of its walls were incorporated with the walls of 
the vagina. The old mode of operating, would have required 
careful dissection, with much hemorrhage, ligation of arteries, 
and accurately tamponning the vagina. It would have been a 
tedious and worrying operation. With the thermo-cautery, I 
removed it in a few minutes. When in the middle of the opera- 
tion, a large artery sprang, and in a moment the vagina was 
deluged with blood; but the next cut went entirely through the 
artery, compelling it to shut up, and there was no more bleeding. 
A little glycerine and sub-sulphate of iron, was applied as an an- 
tiseptic, and the operation was completed with a glycerole of 
cotton in the vagina. 
Again.—A few days since, I was removing the neck of the 
uterus for epithelioma. The patient had had terrific hemorrhages 
before she was brought to me from a neighboring city; where 
she had been treated for months, with topical applications, for 10 
H. P, C. WILSON. 
“ ulceration of the womb.” The intra vaginal portion of the 
cervix was so short, that it would have been impossible to operate 
with the ecraseur, with any prospect of benefit to the patient. 
There was little within the vagina that the ecraseur could cut 
away; and the malignant interstitial deposit extended well .up the 
cervix, above the vaginal junction. To this case the thermo- 
cautery was peculiarly applicable. As, with my small bull-dog 
forceps, firmly fixed in the cervix, I swung the neck about, in 
sweeping my knife around its circumference, in the act of ampu- 
tation ; the hemorrhage was profuse, and did not cease till the 
neck below the vaginal junction was completely severed, and the 
neck above the vagina was peeled out, as the core from an apple. 
All bleeding had stopped at the end of the operation, and the 
stump was dressed with a pledget of cotton, soaked in sub-sul- 
phate of iron and glycerine as an antiseptic. 
Profuse hemorrhage then will occur in some operations with 
this instrument; especially in cases of malignant disease. The 
hotter the knife, the greater the hemorrhage; and even with the 
knife at a dull red heat, we cannot always escape it; but in all 
my operations, by cutting steadily on, without regard to blood, 
the hemorrhage had ceased at the close of the operation. I 
have never had secondary hemorrhage to follow the use of the 
thermo-cautery. 
The chief objection to Paquelin’s instrument in gynecological 
surgery, when operating in deep, narrow passages (as the vagina), 
is, that the shaft of the knife burns the parts, up to, and adjacent 
to the point to be operated on. 
In my earlier operations, my patients had an hundred fold more 
pain from the burns about the vulva and lower vagina, than from 
the seat of operation. I observed that burns high up the vagina, 
gave very little trouble to me, or discomfort to the patient; while 
those about the vulva, were a source of great distress for weeks 
after. This exemption from pain in burns in the upper part of 
the vagina, is no doubt chiefly due to the exclusion of air; while 
the parts below, are subjected to atmospheric irritation, and the 
irritant effect of urine, dribbling over the parts, in the act of 
micturition. THE THERMANTIDOTE. 
11 
These evil effects of heat have been entirely counteracted by 
the Thermantidote. The hot shaft of the cauter, is so thoroughly 
protected by this instrument, that any amount of pressure can 
be made on the soft parts for any length of time, without the 
slightest injury to them. The red hot blade can be drawn with- 
in the Thermantidote, and just as much thrust out, where and 
when, as desired. 
It may be remarked here, that the gynecologist cannot well 
separate the diseases of the rectum from those of the uterus and 
vagina. Whatever affects one of these localities, is sure to have 
more or less effect upon the others; and hence, in my every day- 
life, I have had much to do with diseases of the rectum. My 
experience teaches me, that what has been said of the thermo- 
cautery in the surgery of the vagina and uterus, may be said 
with equal propriety in the surgery of the rectum. 
During many /ears, my operation for hemorrhoids was, to 
transfix the base of the tumor with a needle and double ligature; 
tie on either side; cut off the tumor with scissors close up to the 
ligature, and touch the stump with sub-sulphate of iron. I never 
had septicaemia to follow. My patients all got well; but the suf- 
fering for days afterwards, was always great, and sometimes 
intense, even with the liberal use of opium. Now, I always oper- 
ate with the thermo cautery. The lower end of the rectum is 
turned inside out, by passing my finger into the vagina, and pres- 
sing downwards and backwards against its posterior wall ; the 
hemorrhoids are successively grasped at their base with a clamp; 
the tumor is pealed off, by running the thermo-cauter along the 
upper surface of the clamp; the stump is touched with sub-sul- 
phate of iron ; and the clamp is then removed. The patient 
experiences very little inconvenience afterwards. 
In some cases of fistula in ano, the thermo-cauter is preferable 
to the bistoury; as in a case which was brought to me for an oper- 
ation, a few weeks since. Here the external opening was about 
one inch from the anus, and the internal opening unusually high 
up the rectum, and over the fistulous tract, there was an immense 
hemorrhoid, which there was no way of avoiding in dividing the 
fistula. My grooved director was passed from the external to 12 
H. P. C. WILSON. 
the internal opening, and along this director, the thermo-cauter 
cut every thing in its way. Had I used a bistoury instead of the 
cautery, I might have had troublesome hemorrhage from division 
of the hemorrhoid, whereas there was no loss of blood. In 
removing polypi of the rectum, the thermo-cautery will be found 
to be the best instrument. 
The thermo-cauter protected by the Thermantidote, will be 
found to be invaluable in much of the surgery of the abdominal 
cavity. Thus in gastro-elytrotomy, when the surgeon has reached 
that point where it is necessary to make an opening into the 
vagina, preparatory to tearing the same sufficiently for delivery 
of the child. Here the cauter, when heated, can be drawn with- 
in the antidote, and the end of a cool instrument being placed on 
the point to be divided, the hot knife is thrust forward and 
through the vagina, without injury to the surrounding parts and 
without any loss of blood. With the aid of the Thermantidote 
in such a case, there is no necessity, as suggested by Dr. Garri- 
gues in his most able paper, of protecting the surrounding parts 
with wet compresses.” 
Again, in ovariotomy, where we have a very short and thick 
pedicle; I would condense the pedicle with a clamp for a few 
minutes, and then dividing it with the thermo-cauter, and touch- 
ing the stump with sub-sulphate of iron, I would remove the 
clamp and return it to the pelvis. 
Or in the same operation, where there are firm and vascular 
adhesions, it would be better in many cases, to divide them with 
the cauter than to tear as is now done; and where persistent 
hemorrhage occurs at any point, in the separation of such tumors 
from their attachments; the application of the thermo-cautery to 
these surfaces will be found to be of great value. 
The Thermantidote judiciously manipulated over the Thermo- 
cauter, will enable the surgeon to pass the instrument deep down 
into the pelvic and abdominal cavities, without damage to the 
surrounding viscera. 
What has been said for this instrument in operations within 
the vagina, rectum, pelvis and abdomen, may be said with equal 
truth for the mouth and throat. THE THERMANTIDOTE. 
13 
From Considerable experience with Paquelin’s thermo-cautery, 
I may be pardoned for making some suggestions, and giving 
some cautions in its use. 
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 the tube attached to the cauter; 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 bending 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 tem- 
perature. 
4th. 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 the blade. 
5th. 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 accident has once happened to 
me. 
6th. When we are done using a knife, it should be heated a 
little extra hot, and while so, quickly separated from the wooden 
handle. By doing so, no carbon deposit will take place in the 
knife, and it will be in perfect order for future use. 
7th. Because of the injudicious heating of the knife, and de- 
struction of the platinum gauze, or clogging of 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. 14 
H. P. C. WILSON. 
8th. Every case of Paquelin’s Thermo-cautery should contain 
a small metallic brush, with which to cleanse the blade of all 
burning tissue which adheres to it, with each incision. This 
clogging of the blade impedes its proper heating. The duty ot 
an assistant is to remove such tissue as it accumulates. 
9th. 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 hold the knife, 
when the operator desires to be relieved of it, and a fourth to 
hold Sim s* speculum—the only one fit for use in all uterine 
surgery.