File:Diseases of women. A clinical guide to their diagnosis and treatment (1899) (14581558559).jpg

Identifier: diseasesofwomenc00herm (find matches)
Title: Diseases of women. A clinical guide to their diagnosis and treatment
Year: 1899 (1890s)
Authors: Herman, G. Ernest (George Ernest), 1849-1914
Subjects: Women
Publisher: New York, W. Wood & Co.
Contributing Library: Yale University, Cushing/Whitney Medical Library
Digitizing Sponsor: Open Knowledge Commons and Yale University, Cushing/Whitney Medical Library

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ce, in the hope that over part, if not the whole,of the wound immediate union may take place. The largerthe piece removed, the greater the ultimate effect, but theless likely is primary union to take place. Many surgeonshave laid stress on small modifications peculiar to themselvesin the method of doing it. Thus the piece cut off hasbeen oval, or round, or triangular, or diamond-shaped, oroblong. It matters not what the shape is, so long as thepiece removed is large. Xor matters it much whetherwire, silkworm gut, silk, or catgut be used for the stitches.I prefer fine catgut, for then you spare the patient thediscomfort of their removal; you can leave them to beabsorbed. Some operators, instead of removing a large piece, UTERINE DISPLACEMENTS; PROLAPSE. 135 have denuded strips of mucous membrane on opposite sidesof the vagina, and brought them together so as to enclosea pouch, or form a shelf. These operations are more difficultto do, and, if successfully done, shut off spaces in which
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Fig. 49.—Clovers crutch. secretions may accumulate—an effect which I think un-desirable. Some have stitched from side to side; othersround the periphery. I think the former better, for youwant to narrow, not to shorten, the vagina. I think thebest shape is oval, with the long axis parallel to that ofthe vagina: and I repeat that the great thing is to takeaway enough. I describe what I take to be the essential features ofthe operation. 136 DISEASES OF WOMEN. Mode of operation.—You need the following instru-ments :— Clovers crutch (Fig. 49). Volsella. Toothed dissecting forceps (Fig. 50). Four pressure forceps. Scalpel. Hall-curved needles and needle-holder No. 1 catgut. Sponges, spoDge-holders, douche, etc. Put the patient in the lithotomy position. Have thecervix held down as far as possible with the volsella, so asto extend the anterior vaginal wall. Mark out with thescalpel the outline of the oval piece of mucous membraneyou intend to remove. Then dissect it off. A few small

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