Without going into the details of treatment in the use of bandages, tents, etc., I may say that a nurse may, in the absence of a physician, use astringent vaginal injections, astringent pessaries (F. 154, 163), and cold soft water; hip baths may also be used. The nurse should know how to tamponade the vagina, because, when this is deemed advisable by the physician, he desires that the process be repeated every day, and in many instances it is not convenient or possible for him to make daily visits. The vaginal tampon is used as a means of retaining the uterus in its normal position, and also to hold medicinal agents applied to the cervix and vagina; besides, in some cases, direct pressure on the pelvic vessels stimulates and thus benefits them when in a state of chronic, passive dilatation, or venous hyperemia. Tampons are also used in cases of hemorrhage from the uterus, and as an absorbent of vaginal or uterine discharges, and for various other purposes.
The nurse may receive instruction from the physician in each case in regard to the material, etc., to be used as tampon. When it is desired to simply support the uterus in its place, fine cotton batting may be used, and this perhaps is, in ordinary cases, as good as any material. But in some cases absorbent cotton, oakum, marine lint, or wool may be preferred. The size of the tampon will, of course, vary; ordinarily one as large as a hen’s egg may be introduced without difficulty; sometimes one nearly as large as a goose egg may be necessary, because a small one would not be retained. Cotton may be rolled tightly into the form of a cylinder, or a small bag may be made of muslin or linen, and cotton or other substance can be enclosed in this and applied.
The knee-pectoral position (Fig. [13]) is the one in which a prolapsed uterus can best be replaced, and the nurse can best tamponade the vagina while the patient is in that position. The proper knee-pectoral or knee-chest position is shown in Fig. [13].
The physician would, with or without the aid of the nurse, use a Sims’ speculum, and first pack four small pledgets of cotton around the neck of the uterus. One string can be tied in the kite-tail manner around each of these pledgets, and there should be an end about ten inches long to be left out from the vagina, so that the whole may be easily removed. The nurse, if alone, however, will usually press in but one tampon, and she may do this while the patient is in the knee-chest position, or, what is nearly as well, on her side or back, having first, by a digital examination, ascertained that the uterus is in its proper position.
Fig. 13. Genu-pectoral position.
Fig. 13—Knee-chest or genu-pectoral position.
| a, | Retroversion of the uterus. |
| b, | Natural position of the uterus. |
Either the nurse or the patient herself may easily press a tampon into its proper position, if she possesses an ordinary amount of boldness and dexterity. She will find it more difficult to properly place it, however, if there is tannin or other astringent substance on the outside of it. This has an astringent effect immediately when it comes in contact with the vagina, and an unusual amount of vaseline is necessary to cover it.
If a solution of tannin, alum, acetate of lead, sulphate of zinc, or carbolic acid be used, it is best to prepare several tampons at the same time; soak all the tampons in the solution, squeeze them out and dry them, then when one is used put it inside a bag and apply it dry.
The patient herself, if she is intelligent, and is not too timid, can introduce the tampon. She should first smear its surface with vaseline, lard, or olive oil. Then lying on her back with thighs separated and flexed, draw the labia apart with the fingers of one hand and steadily crowd the tampon into the vagina with the other, always taking care to have a good, strong cord, one end attached to the tampon and the other hanging down to facilitate removal.