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.

    195/468 (page 139)
    of disgust to her attendants and even to her dearest friends. She lives the life of a recluse without the comforts of it, or even the consolation of its being voluntary. It is scarcely- possible to conceive an object more loudly calling for our pity, and strenuous exertions to mitigate, if not remove, the evils of her melancholy condition. The escape of the urine also produces excoriation of the vagina and external parts. Wherever this sad condition is suspected, a most careful examination should be made by passing a catheter or probe into the bladder, and introducing the forefinger of the other hand into the vagina, when, if there be an opening, the finger will come in contact with the catheter or probe at some point or other. The best position for examination is, for the patient to rest on her hands and knees; then, the vagina being held open by retractors, the surgeon can see as well as feel the size of the fistulous opening. An examination is especially neces- sary, as partial paralysis of the bladder may induce inconti- nence of urine. The examination is easily made when the vagina itself is not cicatrized. The use of a speculum, by dilating the vagina, renders it possible to detect the fistulous opening when the plan just proposed fails to do so : indeed, I always use the speculum so as to satisfy myself of the exact nature, size, and position of the opening. Besides the situation of the lesion, it is important, in regard to the treatment to be pursued, to ascertain its cause and dura- tion. If it has been produced by a sharp cutting instrument, the early application of sutures may occasionally prove suc- cessful; and, in other cases, if sutures be applied as soon as possible after the discovery of the opening—that is, before the edges have become thickened and turned inwards towards the bladder—a favourable result may be anticipated. When the fissure is far back, and there is considerable loss of substance, the success of an operation is difficult to com- pass. The fissure is more easy of cure the more forward its position. History of Operations proposed.—I shall now allude briefly to the different modes of operation that have been tried. Dessault's method consisted in plugging the vagina and