On surgical diseases of women / by I. Baker Brown.

  • Isaac Baker Brown
Date:
1866
Catalogue details

Licence: Public Domain Mark

Credit: On surgical diseases of women / by I. Baker Brown. Source: Wellcome Collection.

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    successful results, and which affords more speedy relief to the patient. The narration of the following cases will serve in illustration. It is requisite to say that I now remove the deep sutures on the third day, instead of leaving them, as in my early operations, for four or five days :— Case I.—Bectocelc : Cure.—Hannah H., set. 49 ; married. Admitted May 6th, 1853, into Boynton Ward, St. Mary's Hospital. Has had six children, the youngest now twelve years old ; and has been six years under treatment. She complains of violent pain in the loins and side of the belly ; pain when she passes water and when she has a motion; the latter can only be procured by aperients, and its passage is attended with much difficulty. The straining causes the appearance of a lump in the vagina, which she has taken to be the uterus or a tumour from it. The endeavour to walk causes the tumour to prolapse from the vagina, and hence she is obliged almost always to keep in the recumbent posture. She has suffered from considerable leucorrhcea, and from heat and soreness about the vagina. Intercourse with her husband is impeded by the tumour. The urine is thick and ropy. On examination, the tumour was found to be a prolapse of the posterior wall of the vagina. On introducing the finger into the rectum, it passed forwards into the tumour projecting from the vulva. The perimeum had been torn in some previous labour, and was shorter than natural by imperfect reparation. The leucorrhceal discharge was found to come from the upper part of the vagina and os uteri, the surfaces of which were abraded by friction, the uterus having been displaced obliquely forwards, so that its mouth pressed against the posterior wall of the vagina. On the 7th of May, having previously cleansed the rectum by an enema, I proceeded to operate (anesthesia being produced by chloroform) on the same general plan as in cystocele, omitting as unnecessary in this prolapse, the anterior denudation and sutures. This will be at once understood by referring to plate 3. Paring off the mucous membrane, and insertion of the inter- rupted sutures, are the parts of the operation for cystocele omitted in that for rectocele ; since the object of the latter operation is chiefly to contract the posterior wall of the vagina. The denudation should, however, be much deeper than in cystocele ; indeed, it should be carried as far back, if possible, as the protruding walls of the rectum. (See Plate 8.) The patient after the operation was placed as usual in bed, a water-cushion being placed beneath the pelvis, and a grain of opium was ordered to be taken every six hours. On the 13th the pulse was quick and feeble ; there had been some slight sickness, and excitement of manner, with free perspiration. Opium omitted, and a draught with five grains of the citrate of iron and quinine ordered three times a day. In the afternoon there was a forcing of the rectum, when an opium suppository was used. 14th. Feels better generally, but the tissues between the two quills look red and inflamed. This afternoon the quill sutures were removed, as rigors had occurred, with some bleeding : this last was arrested with ice. The wound indicating a tendency to slough, a lotion of liquor sodas chlorinata? was ordered. At 7 p.m. rigors still troubled the patient ; the pulse was 120 ; tongue moist ; skin perspiring ; tenderness over lower part of abdomen, and a forcing of the bowels. To have an enema containing an ounce of castor oil,