File:Diseases of women. A clinical guide to their diagnosis and treatment (1899) (14768327475).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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ake a needle like theone figured (Fig. 181), threaded with No. 1 silver wire ; enterits point in the mucous mem- ^,L brane close to andin front of the rawsurface oppositethe fistula. Letits point emergethrough the rawsurface at the edgeof the fistula.Enter it againthrough the rawsurface at the op-posite edge of thefistula, and bringit out through themucous mem-brane close to andbehind the rawsurface. Lift thewire out of theneedle with ahook,and withdraw theneedle. Put in astitch on each sideof this, about \ in.from it. Enter the needle through the mucous membrane close to and in front ofthe raw surface ; pass it underneath the raw surface, and bringit out through the mucous membrane close to and behindthe raw surface (Fig. 182). This done, clean the raw surfacefrom adherent clot, and draw together and fasten the sutureswith Avelings coil and shot. Pass the ends of the wiresthrough the coil and shot; hold the shot with pressureforceps, and press it home. Then compress the shot, and the
Text Appearing After Image:
Fig. 182.- -Morte of stitching in closure of a small vesico-vaginal fistula. (After Simon.) 696 DISEASES OF WOMEN. suture is secure. Inject milk into the bladder to see that theclosure is complete. Let the patient empty the bladdernaturally every six hours ; let a catheter be passed onlyif she cannot do this. In a week remove the coil and shotby cutting through the coil at its junction with the shot.Take out the stitches at the end of a fortnight. Fistulae with loan of substance.—Here you have, insteadof a pin-hole, a large irregular gap. First seize different partsof the margin of the opening, and see if, and how best, you jfic Fig. 183.—Miltons knife for vesico-vaginal fistula. can bring its opposite borders into apposition with oneanother. If the fistula is of such size and shape, and itsmargins are so movable that you can get its opposite bordersinto apposition, the operation, though tedious and perhapsdifficult, is simple. For the easy operation I have justdescribed an ordina

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