Diseases of women, including their pathology, causation, symptoms, diagnosis and treatment : a manual for students and practitioners / by Arthur W. Edis.

  • Edis, Arthur W. (Arthur Wellesley), 1840-1893.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of women, including their pathology, causation, symptoms, diagnosis and treatment : a manual for students and practitioners / by Arthur W. Edis. Source: Wellcome Collection.

    84/566 (page 64)
    The operation of Episiorrhophy {^lirKruov, the labium, and pa.<f>r], suture), or closure of the vaginal ovitlet by uniting the posterior three-fourths of the labia majora, has been practised in cases of elderly women, where patency of the vagina is no longer necessary. The edges of the labia majora are pared, the labia minora removed, and the vivified surfaces united by silver sutures. Le Fort recommended making a longitudinal septum by uniting the anterior with the posterior vaginal wall, thus producing an artificial duplex vagina. Choice of operation.—This will depend materially on the nature of the individual case. Before resorting to any plastic operation, it is always advisable to enjoin rest in the recumbent postuie, the foot of the bed being elevated, or the genu-pectoral position assumed from time to time, in order to diminish the bulk of the uterus, allow any ulceration of its surface to heal, and ensure a healthier condition of the vagina. If the perineum be ruptured, the perineal body should first be restored before any further operation be performed. If the cervix be elongated, it will be well to remove a portion of this at the same time that some plastic o]jei'ation be done. If the uterus be prolapsed without marked elongation of the cervix, ruptvire of the perineum, or evident rectocele dragging down the uterus, the better plan is to perform anterior colporrhaphy, after the manner of Sims or Emmet. If I'ectocele exist to any great extent, or the perineum be much dilated or ruptured, posteiior colpoii-haphy, together with perineor- rhaphy, will be indicated. If there be a combination of these several conditions, it may be necessary to perform more than one operation at successive intervals. Various devices have been tried to procure contraction of the vagina without resorting to incisions, by means of the actual cautery, mineral acids, escharotics, ulceration created by galvanic pessaries, and sloughing produced by pressvire by forceps and clamps. They have the disadvantages of proving excessively painful, more tedious and uncertain in their results, as well as being more unmanageable, and are therefore not to be recommended.