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.

    183/468 (page 133)
    CHAPTER IV. • VESICO-VAGINAL FISTULA. This lesion was long considered an opprobrium of surgery, as, with few exceptions, attempts at cure entirely failed. But such is no longer the case; for, thanks to the persevering efforts of several surgeons within the last few years, almost every example may now be successfully treated. By the term vesico-vaginal fistula is understood an un- natural communication between the bladder and the vagina, allowing all or a portion of the urine to escape through it, in- stead of passing away through the urethra. This opening is different from that produced by a rupture of the bladder; for it is not a simple accidental laceration, but the result of a wound, of ulceration, or of sloughing of the coats of the vagina and bladder. Causes.—These may be thus summed up :—1. Wound of the vagina during criminal attempts to procure abortion. 2. Re- tention of a pessary within the vagina, inducing inflammation and subsequent ulceration, or - sloughing. 3. Long impaction of the head of the child in the pelvis during labour, inducing, by pressure, inflammation ending in ulceration and perforation. 4. Careless or improper use of instruments, and the operation of turning to effect delivery, especially if the bladder be not empty. 5. Corroding cancer of the uterus or vagina per- forating the bladder. 6. Stone in the bladder at the time of delivery, the bladder being pressed between the head of the child and the stone. This is a very rare cause. A review of the causes productive of the lesion in the seventy cases of vesico-vaginal fistula, tabulated hereafter, on which I have operated, shows that the third and fourth in the