On the treatment of the laceration of the perineum in parturition / by Thomas Alcock.

  • Alcock, Thomas, 1784-1833.
Date:
[1820]
Catalogue details

Licence: Public Domain Mark

Credit: On the treatment of the laceration of the perineum in parturition / by Thomas Alcock. 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.

    3/6 (page 195)
    I On Laceration of the Perineum in Parturition. i<>5 ch, if it be not productive of immediate illness, seldom fails >roduce injury at a more distant period. Jnder the circumstances above mentioned, and in the first ;e of the complaint, the uterus falls down into tbe vagina, ing upon the posterior part of the latter, and supported by perineum; a state which, although attended by leueorrhoea pain and weakness in tbe loins, is often submitted to with- complaint. But if, in addition to the causes above enume- d, the perineum be lacerated, so as to be incapable of rding its usual support, the uterus does not remain within vagina, but gradually descends beyond the external parts, in extreme cases inverts the vagina, which thus serves as an ;rnal covering. The want of support from the perineum prevents the use of pessaries, except those of sponge, ch will not in all cases afford the palliation required. A case of this nature came under my observation in the year ]Sl I, in which the uterus was pendulous, and enlarged to the size of a child’s head, hanging entirely beyond the external parts. The os uteri was the most depending point, and the in- verted vagina formed the external covering of the tumor. The greater part of the inverted vagina had acquired much of the appearance of the common integument; but the lower part, or that attached to the os uteri, was ulcerated to the extent of se- veral fingers’ breadth, taking a lateral direction* The ulcerated surface was red and glassy, and had not for years shown any ! disposition to heal, probably owing to the constant friction and irritation occasioned by the patient’s clothes. She had la- boured under the disease during the last fourteen years ; in the early part of which she had first noticed the obstruction in the vagina, which increased after delivery, particularly when she was employed in carrying heavy weights; and the external tu- mor gradually succeeded and increased in bulk, till it had at- tained the size before stated. She had been a patient of various hospitals and dispensaries, but without relief. She could not, from the friction on the ulcerated surface, wear a bandage ; neither had the use of pessaries, lotions, &c. improved her loathsome condition. There was a copious and offensive dis- charge, but whether from the ulcerated surface or from the mouth of the womb, she could not determine, probably from both ; and the frequent and urgent call to pass urine, with the almost constant presence of diarrhoea, rendered her miserable. She could return the tumor within the pelvis without difficulty when in the recumbent posture, (for the opening was sufficiently ■ large,) or, by considerable effort, by bending tbe body for- ' wards, and pressing the tumor upwards, but it descended again as soon as she resumed the erect position. < She stated that, five years before this period, the tumor had