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.

    246/468 (page 190)
    On examination, two fistulse were discovered, one a very large one at least three inches long, stretching zig-zag across the base of the bladder, and another very small one close up to the os uteri, which was not found till the first was healed. Operation, January 31st, 1861. Usual operation under chloroform ; thirteen sutures used. February 12th. Sutures removed ; all healed but a small corner. 21st. Operation ; five silver sutures used. March 3rd. Sutures removed, and still a slight escape. 13th. This small corner was finally closed by three silver sutures, and when the sutures were removed on March 21st, the second fistula was discovered : it was closed in the usual manner by three silver sutures. 30th. Sutures removed, the whole perfectly healed. April 4th. Discharged cured. Case XXXV.— Vesico-vaginal fistula, first labour: three months'1 duration: Three operations: Cure.—Mary Ann D., set. 26, married ; admitted into the London Surgical Home April 14th, 1861. Was delivered of her first child three months ago, after being in labour seventy-seven hours. No instruments used. Immediately afterwards, urine came away per vaginam. On examination, a small fistula was discovered close up to the os uteri, the size of a kidney-bean. Operation, April 18th. The usual operation performed ; four silver sutures being used. Operation very difficult, owing to the situation of the fistula, which it was difficult to reach. 30th. Sutures removed ; a very minute orifice still unhealed. May 9th. Operation on hands and knees without chloroform ; four silver sutures being used. 22nd. Still a slight escape ; sutures removed. 29th. Operation as before, with the same number of sutures. June 10th. Sutures removed ; perfect union and complete control over her water. 14th. Discharged cured. Case XXXVI.— Vesico-vaginal fistula, second labour: two years' duration : One operation: Cure.—Mary M., aet. 26, married ; admitted into the London Surgical Home May 2nd, 1861 Was delivered two years ago of her second child, without instruments, after being in labour twelve hours. Her urine was drawn off for ten days, when a slough came away ; and her urine has since always passed without control per vaginam. On examination, a small triangular fistula was seen, the base of the triangle being within a few lines of the os uteri, which was nearly closed. Operation, May 9th. The usual operation under chloroform, four silver sutures being inserted longitudinally. 21st. Sutures removed; fistula perfectly healed. Remark.—This patient was safely delivered of a living child, at the full period, in August, 1862. Case XXXVII.— Very large vesico-vaginal fistula in second labour: six months' duration: Eleven operations.—Marianne L., aet. 30, married ; admitted into the London Surgical Home May 6th, 1861. First labour lasted three days, and was terminated by craniotomy without further accident. In her second, which occurred six months ago, was also three days in labour, and was again terminated by craniotomy. Three days afterwards the urine came away per vaginam, and she has been unable to hold any since. On examination, it was found that the whole base of the bladder had sloughed away, and the internal surface of the anterior wall prolapsed through the fistulous opening. A large calcareous mass had, before her admission, been removed from near the os uteri, and had produced such a deep slough that the sacrum was exposed, and could be felt by tapping with a probe.