Volume 1

A system of surgery / Translated from the German, and accompanied with additional notes and observations, by John F. South.

  • Maximilian Joseph von Chelius
Date:
1847
Catalogue details

Licence: Public Domain Mark

Credit: A system of surgery / Translated from the German, and accompanied with additional notes and observations, by John F. South. Source: Wellcome Collection.

    934/1006 (page 750)
    sponge might have prevented the escape of the air as well also of the blood, and might perhaps be exciting the disposition to bleed, I removed it, and directed that the plug should be removed from the catheter hourly and the water drawn off. He went on tolerably well except being teased with flatulence and a tiresome cough. On the third day the wound began to discharge; he has been passing plenty of clear urine by the catheter, often accompanied with air; but on the day following some was noticed to pass by its side, especially whenever he coughed. On the jifth day a small portion of hard stool was passed, whilst he was emptying his bladder, and a considerable quantity of fluid motion was on the sheet. This was the first relief after the operation, for although he had taken a little confection of senna with the view of expelling the wind, it was thought advisable to keep the bowels as quiet as possible. On the seventh day he was going on well, still passed air with his urine, but in less quantity. An in- jection was given this evening to clear the lower bowel, but it had not any result. One ligature came away. On the following evening he had a plentiful solid motion which gave-him much pain; his cough having become very troublesome, syrup of poppies and mucilage were ordered. On the ninth day the catheter was removed, and having been replaced with ashorter one, four ounces of urine were evacuated without any air, but afterwards both were again passed as usual: On the twelfth day he felt much forcing pain as if the bowels were loaded, though he had a good motion last night, and he has twice this morning passed some stool as well as air by the catheter. In the afternoon the bowels were freely moved, after which no more motion passed by the in- strument. On the seventeenth day a fresh catheter was introduced; and on the twentieth he complained of much irritation in the perineum, which when examined appeared to depend on the shoulder of the catheter having caused a little ulceration in the cleft of the buttocks. As regards the parts operated on, the external wound is healing fast, but the fistulous opening does not seem much altered. The catheter was removed, and an elastic male catheter passed by the penis to encourage the healing of the perineal wound. This did not answer the purpose so far as the relief of the bladder was concerned; for the urine did not pass through it, but some by its side, through the urethra, the greater quantity however escaped by the rectum. On the evening of the twenty-second day, not a drop of urine having passed through the catheter, the dresser thinking it might be stopped up, and that there might be retention, withdrew it, and introduced a silver catheter; but very little water having been obtained, he replaced the elastic catheter, through which, since the urine flowed freely, and on the twenty- fourth only passed into the rectum whilst he evacuated his bowels. On the twenty- ninth day his bowels having become loose, the catheter began to slip into the rectum, and have stool pass by it. This continuing for several days, the catheter was entirely re- moved, after which he began to pass about a table-spoonful of urine. at each watering, by the penis, but the greater part escaped by the rectum. For the first two hours after taking drink, he was making water every two hours, but after that time much less frequently. After two months he began to get up; he now retains his water for an hour and a half or two hours, but voids it both ways. Four days after the water was held for a longer time, did not pass off as he walked about, but after sitting it oozed from the anus when he got up. He still continued slowly and steadily mending, the quantity passed by the wrethra being equal to that from the rectum. In the thirteenth week I examined the parts with a speculum ; the fistulous opening is about three-eighths of an inch in extent, its edges perfectly scarred and puckered. For the purpose of inducing” contraction, lunar caustic was freely applied. During the following week more urine passed by the urethra, and the edges of the wound were again touched with the caustic. Subsequently, at intervals of about a week, the edge of the aperture was continually touched with the nitrate of silver, and at the end of six months, when I again examined the rectum, the fistulous orifice had diminished to the size of a large goose-quill, but he still passed water by it, though varying in quantity. Soon after he left the house much relieved, but not cured by the operation, and I have since lost sight of him.—J. F. 8.] 968. Vesicuo-vaginal Fistula (Fistula vesico-vaginalis) is almost always the consequence of inflammation and sloughing of the vagina in difficult labour with the head long wedged, or of instrumental delivery, in which the fistula may be produced in from twelve hours to fourteen days after the separation of the slough; more rarely it occurs from injury of the front wall of the vagina and of the bladder, by instruments or sharp bones in opéning the head; from operations, as lithotomy and puncture of the