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The actual cautery or Paquelin's thermo-cautery is seldom employed to arrest hæmorrhage, but is frequently useful in preventing it, as, for example, in the removal of piles, or in opening the bowel in colostomy. It is used at a dull-red heat, which sears the divided ends of the vessel and so occludes the lumen. A bright-red or a white heat cuts the vessel across without occluding it.
Very small nævi may be destroyed by a fine pointed Paquelin thermo-cautery, or by escharotics, such as nitric acid. The extensive port-wine stains so often met with on the face are best left alone. The subcutaneous nævus is comparatively rare. It constitutes a well-defined, localised tumour, which may possess a distinct capsule, especially when it has ceased to grow or is retrogressing.
Excision of the primary nodule, followed by the application of the thermo-cautery and sponging with pure carbolic acid, should be carried out, provided the condition is sufficiently limited to render complete removal practicable. When secondary abscesses form in accessible situations, they must be incised, disinfected, and drained.
If any acne pustules or infected sinuses are present, they should be destroyed or purified by means of the thermo-cautery or pure carbolic acid, after the patient is anæsthetised.
Carbon-dioxide snow may be employed in the same manner, but the results are inferior to those obtained by radium. Igni-puncture consists in making a number of punctures at different parts of the nævus with a fine-pointed thermo-cautery, with the object of starting at each point a process of cicatrisation which extends throughout the nævoid tissue and so obliterates the vessels.
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