Historical remarks on the operation of obliterating the vagina by uniting its walls (kolpokleisis) for re-establishing continence of urine in cases of incurable vesico-vaginal fistula : together with a statement concerning the present mode of operation on vesico-vaginal fistulae in Germany / being a reply by Gustav Simon to Nathan Bozeman.

  • Simon, Gustav Wilhelm, 1824-1876.
Date:
[1868?]
Catalogue details

Licence: Public Domain Mark

Credit: Historical remarks on the operation of obliterating the vagina by uniting its walls (kolpokleisis) for re-establishing continence of urine in cases of incurable vesico-vaginal fistula : together with a statement concerning the present mode of operation on vesico-vaginal fistulae in Germany / being a reply by Gustav Simon to Nathan Bozeman. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    ever over fine silk threadl), but on the contrary makes the operation more difficult and prolongs it unnecessarily. Therefore I declared the wire suture in my work of the year 1862, (see pag. 88) to be a transient object of fashion notwithstanding the overflowing praise, which the American, English and French authorities bestowed upon it. Considering the difficulty of its application and removal I do not look upon it as a progress. On the con- trary, I view it as a backward step and I entertain no doubt, that, at a time not far distant, the wire will have to yield to the more handy fine silk thread suture, such as I use in the above mentioned plastic operations'2). The only thing I have welcomed as a real progress in the much praised American or Sims' method3), is the introduction of the duck bill speculum, in as much as it facilitates the exactness of the operation more than all previously invented instruments. But even this I soon found to be insufficient in cases of difficult access, (as in the one described above) and I therefore constructed in addition to the above speculum, which I provided with a long handle, flat specula and so-called „vagina holders for the expansion, and at the same time for the shortening of the vagina4). Instead of the knee-elbow or the side posture, which Sims prefers, I make use of the one generally resorted to in the operation for stone in the bladder with the pelvis somewhat more elevated (Steiss-Riickenlage), which admits enlarging and shortening of the vagina and is less fatiguing to the patient (See Fig. I in my work of 1862). Instead of the very large flat- oblique („flach-schrag) freshening of the mucous membrane of the vagina of a width upwards to 2 Centim., I make the excision of the borders more steep-oblique („steil-schrag) and from 1 to l1 /4 Centim. wide and carry ') I use for fistules and similar plastic operations the so-called Chinese silk, which I receive from Mr. Schliemann, instrument-maker at Hamburg. The finest kind, which is finer than the finest silver wire, I use as double thread. a) To prevent my being misunderstood, I wish to say that my statements are not to be interpreted as if I intended to declare silver wire to be less favourable for the cure of fistules than silk thread. ] only hold that fine, well prepared silk thread is in no wise to be considered inferior to it (even when it remains during a long time in the tissues) and deserves preference on account of its being easier to apply. Any one who does not mind the greater trouble, the longer duration of the operation, which increases in pro- portion to the difficulty of the case, may use wiro of metal. ') To this class belong all the modifications which the followers of Sims, as Bozeman, Baker-Brown, Simpson etc. have invented. All these modifications are more com- plicated than the mothod of Sims and therefore can not be considered as improvements. *) Neugebauer in Warsaw, Ulrich in Vienna and Bozeman in New-York have each invented apparatus and specula for the purposo of rendering operations of fistules practical without assistants. The one of Bozeman is handier than the others. In general I do not value thein much, not only because they are not required, but because they are fre- quently quite insufficient and will not serve to expose fistules of difficult access; while on the other side the most inexperienced assistants, male or female, who can always be had, are able to hold the instruments I use. I have triod Bozeinan*s speculum repeatedly and have found that the fistula was always more easily laid open by means of my instru- ments and that fistules of difficult, access could not bo operated on at all by its aid.