Complete laceration of the perineum and part of the recto-vaginal septum, resulting from forceps delivery : primary operation, complicated with traumatic erysipelas / by A.B. Cook.

  • Cook, A.B.
Date:
[1885]
Catalogue details

Licence: Public Domain Mark

Credit: Complete laceration of the perineum and part of the recto-vaginal septum, resulting from forceps delivery : primary operation, complicated with traumatic erysipelas / by A.B. Cook. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    [Compliments OF the Author.] r ■ COMPLETE LACERATION OF THE PERINEuk-AND PART OF THE RECTO-VAGINAL SEPTUM ; RESULTInS'T'ROM FOR- CEPS DELIVERY. PRIMARY OPERATION, COMPLI- CATED WITH TRAUMATIC ERYSIPELAS.* By a. B. cook, A.M., M.D. Formerly Professor of the Surgical Diseases of the Genito-Urinary Organs and Rectum in the University of Louisville, late Professor of the Science and Art of Surgery and Clinical Surgery in the Kentucky School of Medicine, and one of the Visiting Surgeons to the Louisville City Hospital, etc., etc., Louisville, Ky. On the loth of February last, about 8 P. M., I was summoned by a medical friend to visit Mrs. , who married when 22 years old, and had been a widow three years, when, in April, 1884, she married her second husband. The first marriage was without issue. She is a well-developed woman, above the average size, and weighs 140 lbs. On inquiry I ascertained the case to be that of a primapara ; duration of labor, 17}^ hours; second stage, 4^ hours. The waters broke, in the absence of pain, during the first stage, when the os was thin, hard, and dilated to about the size of a silver half-dollar, vaginal out- let small, soft tissues, unyielding, the head large—circumference 14^ inches. The forceps had been used about 7}^ P. M., and the soft tissues suddenly gave away as the head was about to emerge. On my arrival one hour after delivery, a digital examination showed that the laceration commenced high up in the vagina, on the left side of the septum, tearing the tissues obliquely to the right, and exposing the fibrous investment of the rectum almost to the median line. It then passed downward obliquely through the septum and sphincter ani muscles, tearing the latter from the septum, at their junction with it, and then obliquely through the perineum proper, finally reaching the raphe at the verge of the anus. The wound measured in length six inches from the commencement in the vagina to the perineal center. The soft parts were much tumefied, the lochial flow was free, filling up and obscuring the extensive wound. The patient was drawn to the edge of her bed and placed in the position for lithotomy. An£esthesia was readily produced, she having been chloroformed during delivery, while the sensibility of the soft parts had been obtunded by the pressure of a large head. The lacerated wound favored the arrest of hem- orrhage, and hence there was little trouble from this source. The vagina, above the laceration, was plugged with sponges to prevent, as much as possible, the flow of blood into the wound, and a Sims speculum was introduced to expose the cavity, and held by an assistant. I then proceeded carefully and deliberately to operate. The ragged edges of the wound were clipped off with scissors, and then by the light of a lamp I passed the silver wire sutures. Four sutures were first passed, with Fischer’s needle, through the torn septum ; then five in the perineum, the first at the verge of anus. The needle was inserted on the left side, fully one inch from the edge of the wound, and carried downwards and backwards around the circle of the sphincter muscles, ^Reprinted from Gaillard’s Medical Journal.