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.

    261/468 (page 205)
    fistula perfectly healed. The line of union is so perfect as scarcely to be recognizable except from the position of the sutures. August 5th. I removed the sutures, and found that the cure was quite complete. She can retain and pass her urine at pleasure, but menstruates per urethram. Case LXXI.— Vesico-utero-vaginal fistula: Two operations: Cure.—A. B., set. 44, residing at Lewes, Sussex, recommended by l)r. Henry Bennet. She was admitted into The London Home on the 10th of January, 1859 ; she has had rive children, all of whom were still-born, except the fourth, who is now living ; she was last confined on Oct. 3rd, 1857 ; she has also suffered from severe monorrhagia, followed by the removal of a polypus. (Statement of her medical attendant):—After her last confinement, a piece of bladder sloughed away. Her general health improved gradually ; and as hopes were held out of a cure taking place without operation, she postponed applying for further relief. She is enormously stout. The opening into the bladder can with difficulty be seen. When felt, it appears about two inches and a half across ; the posterior edge being formed entirely by the lip of the os uteri, which is much enlarged, thickened and patulous. The edges of the fistula were inverted. Jan. 17th. She was cautiously put under the influence of chloroform ; but the parts were unable to be brought into view from the rolls of fat about the labia. Nothing, therefore, was done. The difficulties of the case were so great, that I advised her to give up hopes of recovery ; but she begged so hard to have another trial that I determined to try and bring down her fat, and consequently kept her on milk, fish, biscuit, and water. The result was so satisfactory, that on Feb. 14th, I operated, using Bozeman's button and seven sutures. No chloroform was given ; and she was placed on her knees and chest, so that she might assist us in keeping open the vagina. Every suture was passed through the lip of the us uteri. There was profuse hemorrhage, which continued some hours after the operation. Generous diet and wine were allowed. Feb. 15th. She suffered great pain in her right side and leg, and was obliged to be put on her back. 17th. Slight escape. 26th. Button removed ; the parts look sore and unhealthy, but apparently united. In two days it was found that the opening was but little, if any, smaller than before the opera- tion. March 19th. I intended to operate, but finding a band contracting the parts, I thought it better simply to divide it. The parts were then kept di- lated with sponge tents. April 8th. The parts not being sufficiently healed to allow another opera- tion, she was sent into the country for a time. May 3rd. She returned, much improved in general health. 7th. I operated again, using my bar-clamps. I was assisted by Messrs. Nunn, Philip Harper, Wratislaw, and Spencer. The parts were brought into perfect apposition by six sutures with bar-clamps. Opium was given until sleep was induced. 15th. Catheter left out for half an hour : no escape. 16th. Bowels relieved freely after some aperient medicine ; urine passed naturally. 20th. No escape ; healthy and plentiful discharge of granulating pus. 23rd. The clamps were removed, and most perfect union found to have taken place ; not the least appearance of escape. She was discharged perfectly cured, and has since repeatedly reported that she is -quite well. Remarks.—This was the most unpromising case I had met with. The ex- treme fatness of the patient, especially around the thighs and labia, rendered