The practice of medicine and surgery : applied to the diseases and accidents incident to women / by W.H. Byford and Henry T. Byford.

  • Byford, W. H. (William Heath), 1817-1890.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: The practice of medicine and surgery : applied to the diseases and accidents incident to women / by W.H. Byford and Henry T. Byford. Source: Wellcome Collection.

    193/852 (page 181)
    laceration, viz., a median line depression and widening and lengthen- ing of the pubic fossa?. A transverse laceration usually produces a transverse depression internal to the commissure or fourchette extending into the pubic fossa on one or both sides. A wide V-shaped laceration produces a similar depression, but it is felt to extend to the bellies of thelevatores ani around the tongue of mucous membrane instead of into the pubic fossae. T-shaped lacerations have a slight transverse depres- sion, a widening of the perineal fossa forward, and the longitudinal depression instead of elevation of the fourchette or commissure. The inverted T (x) has a transverse depression with a normal fourchette, but has the perineal fosses deepened and widened backwards only, and has a cicatricial line or depression that can sometimes be felt over the rectum in the median line, or else allows the finger to feel the folded rectum more easily than natural. Stellate, cross-shaped and other compound lacerations may be partly diagnosticated by the alterations mentioned above, and partly by the large extent of firm cicatricial tissue at their site. Occasionally Ave find a lacerated vulvo-vaginal outlet that is as nar- row or narrower, and perhaps firmer at the sides, than normal, so that the pubic fossa is as difficult or more difficult to detect as in the virgin, yet the fourchette is gone, and its place taken by the sagging urethra and vaginal walls. Below the narrow elongated orifice upon the shortened but firm perineal body is felt a large firm scar with a nar- row extension through the separated carunculae at or a little to one side of the median line. This condition is produced by the contrac- tion of a large cicatrix drawing the ends of the torn muscles and fascia down toward the posterior end of the wound but not toward the median line. All of the perineal tissues may be firm, but they do not close the vulvo-vaginal outlet. The recto-vaginal promontory may also be flattened as far back as the coccyx. Diagnosis by Rectal Palpation. As the perineal body in section is triangular (Figs. 26 to 31), its size and form may be quite accurately estimated (without reference to the superficial or visible tear) by a finger in the rectum on its rectal sur- face, another on the vulvo-vaginal, and the thumb on the cutaneous surface. Among the most common losses of substance in the perineum are those external to the perineal septum and levator fascia. They are due usually to median lacerations which shorten the cutaneous side Of the triangle and enlarge the vulval angle. This shortening of the externa] cutaneous side and enlarging of the angle goes on progres- sively with larger tears, until the sphincter ani occupies the whole