The perineum : its anatomy, physiology, and methods of restoration after injury / by Henry O. Marcy.

Date:
1889
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Licence: Public Domain Mark

Credit: The perineum : its anatomy, physiology, and methods of restoration after injury / by Henry O. Marcy. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    coat over the rectocele. When we are through, the denuded surface will be nearly square, or if the rectocele be very large, parallelogram, the greatest length being transverse to the axis of the vagina. All bleeding should be controlled perfectly by pressure and torsion, but if necessary catgut ligatures may be used, and the parts washed thoroughly with some efficient antiseptic.” This method of posterior colporrhaphy is important chiefly in that Dr. Wylie cuts away, by a second paring of the parts, laterally the vaginal muscle. He also emphasizes the stretching of the sphincter ani, in order to relieve tension and discomfort from rectal distention. He uses the interrupted suture, tightening from below upward, being careful that the needle is buried when it passes under the angle of the sulcus. In Germany the first notice I find of the use of animal sutures in perineorrhaphy is by Brdse, in recent lacerations, in 1883.1 He commended catgut treated with a corrosive sublimate solution and preserved in absolute alcohol, rejecting that prepared after Lister’s method.2 Schroeder used, in perineorrhaphy, with much satisfac- tion, catgut soaked eight days in a 1 to 1000 sublimate solution and then preserved in juniper oil. Doleris3 published his experience -and advised knotting the thread from time to time. He states, “the catgut is absorbed in seven or eight days.” Last year, when here at the International Medical Congress, he informed me his experience continued satisfactory. Dr. Martin, of Berlin, reported4 twelve cases in which he used the continued catgut suture with good results; since this time he has continued its use. When the wound surface is very large he coapts in layers, as did Schroeder, and thus buries one line of the sutures. He commends this practice as very satisfactory. He refers to Werth, as having published, in 1879, the advocacy of the use of catgut as a dee]) suture. Dr. Martin’s method of denudation is a modifi- cation of Freund’s operation. Both leave the columna rugarum and resect in a lateral direction, as thought sufficient to restore the normal vaginal lumen. Bisclioff’s method is interesting in that he revives the flap opera- 1 Centralblatt fur Gyniikologie, 1883. 2 Ibid., July 15, 1885. 3 Archives de Tocologie, Feb. 1885. 4 Deutsche med. Wochenschrift, No. 2, 1880.
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