Local treatment may be directed to the vaginal aspect of the cervix or directly to the cervical canal. The former treatment should always be tried first, and it will usually be found sufficient. It consists of the administration of hot vaginal douches, the application of Churchill’s tincture of iodine to the vaginal vault, and the use of the glycerin tampon as described under the treatment of laceration of the cervix. Puncture of the cervix in order to produce local depletion, as already mentioned in the preparatory treatment of laceration of the cervix, may also be tried. If any case of cervical catarrh persists after the cure of the primary local or general lesion, in case such a lesion is present, and after the additional local treatment by douches and applications to the vaginal vault, then we may be obliged to make applications directly to the mucous membrane of the cervical canal. These applications should be made as follows, any time in the menstrual interval being appropriate: The cervix should be exposed through the Sims or the bivalve speculum, and should be steadied by seizing it with a tenaculum. The cervical canal should then be wiped out with cotton either in the grasp of long thin forceps or upon an applicator. The cervical mucus should be removed in this way, in order to permit the direct application of the desired solution to the mucous membrane. The applicator or forceps, armed with cotton saturated with the solution, should be introduced in the cervical canal and applied to all portions of the mucous membrane. In place of the applicator we may use the glass pipette or instillation-tube (Fig. 110), as recommended by Skene. This instrument, charged with a few drops of the solution, should be introduced as far as the internal os, and the solution should be expressed as the pipette is slowly withdrawn. [Illustration: FIG. 110.--Instillation-tube.] In most cases of cervical catarrh the external os is sufficiently large and the canal sufficiently patulous to permit the applications already described. Sometimes, however, when the external os and the canal are contracted, it is desirable to dilate slightly with the small uterine dilators before making the application. Such dilatation to one-quarter or one-half an inch may be performed without an anesthetic, and may be repeated as often as necessary. Various solutions are used for application to the cervical canal. Violent caustics should be avoided. The solutions of mild strength are preferable. A solution of 1 or 2 grains to the ounce of chloride of zinc, sulphate of zinc, tannic acid, nitrate of silver (5 to 10 per cent.), or bichloride of mercury (1:1000) is often useful. An application of pure carbolic acid is sometimes followed by good results. Perhaps the most generally useful application is Churchill’s tincture of iodine or a solution of 2 parts of tincture of iodine and 1 part of carbolic acid. CHAPTER XIV. CONGENITAL EROSION AND SPLIT OF THE CERVIX.