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.

    91/468 (page 53)
    through the vagina. To close this recto-vaginal opening, I removed all the sutures, and divided the sphincter ani at the posterior part; the united portion of the perinseum was immediately drawn towards the vagina, and the tissure throughout closed most accurately. Half-past 1 p.m. : a very free discharge of a sanguineous character. She is much more free from pain. Towards the evening the discharge became more purulent. Catheterism every five or six hours. 22nd. Half-past 2 a.m. : great pain in the rectum from the matter not escaping freely. During the day this was assuaged, and healthy granulations were visible. 25 th. On this, the tenth day, the patient was allowed to empty her bladder, supporting herself on her hands and knees. 26th. I consulted with Mr. Lane, and determined to pare the edges where mucous membrane existed. To do this, I placed the patient under the influence of chloroform. 27th. I injected some warm water into the rectum, first plugging the vagina, to prevent any escape of feculent matter into it, when the bowels were relieved for the first time since the operation twelve days ago. 31st. Has gone on well. The granulations springing up freely. Sept. 1st—12th. Going on favourably. The catamenia have appeared. 19th. The catamenia having subsided for twenty-four hours, I examined carefully, and was pleased to find the fistulous opening by the side of the anus much less than it was a week since. The mucous membrane, however, had joined the skin on the left side of the opening, thus arresting all granulations there, and preventing union. I therefore determined to pare the edges of the opening, and then to bring them together by a good deep stitch with a double silk-suture. This I did to-day, and completely closed the passage. Two grains of opium were ordered at once, and one grain every two hours, to prevent pain and to arrest the action of the bowels. At 8 p.m. I emptied the bladder by catheter, and watched all night. The new perinseum produced was thick and sound. 20th. At 3 p.m. she was very sick, and vomited freely ; after which she slept at intervals. At 11 a.m., on again using the catheter, several clots of blood came from the vagina. I directed her to pass the urine herself next time, by kneeling on the bed. 6 p.m. : has voided urine as directed, and some more clots have come away. There is no undue swelling of the sutured parts. She has taken some solid nourishment and some wine. 24th. I removed the suture, and found that only partial and slight adhesion had taken place close to the orifice of the anus, and that a sinus existed, the size of a goose-quill, between the vagina and perinaBum. 25th. The bowels have acted by injections of warm water and a Seidlitz- powder. She has now perfect control over the contents of the rectum. I painted the orifice of the sinus with acetum lyttse, to stimulate the granula- tions, and ordered the bowels to be kept gently relaxed. 29th. The sinus is diminishing, and the granulations filling up the space in front of the anus. The acetum lyttse was again applied. Oct. 5th. The process of granulation continuing very tardy, although the acetum lyttse had been brushed several times during the last few days over the surface ; and as the patient, feeling so nearly well, was extremely anxious to get home, I determined to make use of the actual cautery to deprive the surface of the sinus of all mucous membrane. This was done, and attended with success, and in a short time the sinus closed, and my patient was able to return home on the 7th of October, to enjoy a degree of comfort she had not known for years. There was a good strong perinaeum, and the sphincter ani performed its functions accurately.