File:The diagnosis of diseases of women (1905) (14576887308).jpg

Identifier: diagnosisofdise00find (find matches)
Title: The diagnosis of diseases of women
Year: 1905 (1900s)
Authors: Findley Palmer. (from old catalog)
Subjects:
Publisher: Philadelphia and New York, Lea brothers & co.
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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l opening. In long-standing cases thepuckered scar tissue and an opening possibly filled with soft mucousmembrane may often be recognized. A sound placed in the bladder and the index finger of the oppo-site hand in the vagina may be brought together through a fistulousopening. Inspection will give positive information as to the location andsize of the fistula. A Sims speculum introduced into the vaginawill expose the fistula if large enough. Sterilized milk or some 522 DIAGNOSIS OF DISEASES OF THE URINARY SYSTEM colored aseptic fluid injected into the bladder may be seen to flowthrough the fistula. The cystoscope will expose the opening fromthe vesical side and at the same time afford information respectingthe condition of the bladder — whether cystitis exists and foreignbodies lie within. Having established the diagnosis of vesicovaginal fistula, itbecomes important to consider the nature of its borders, theirfixation, tension, and the possible existence of other fistulse. Fig. 219
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Cervicovesicovaginal fistula. A communication is established between the cervical canal, vagina, and bladder. (b) Vesicouterine Fistula. When a laceration of the cervixextends into the lower uterine segment and the adherent bladder,it is possible for healing to be complete in the lower portion of thewound, leaving a fistulous opening above between the uterus andbladder. The urine may be discharged in part through the cervix and inpart through the urethra, depending upon the size of the fistulousopening and the position of the patient. To demonstrate a com-munication of the bladder with the uterus, inject sterile milk orsterile colored fluid into the bladder and observe through a speculumthat the fluid escapes from the cervix. To demonstrate that it isnot a ureterouterine fistula observe that the flow of urine from DIAGNOSIS OF DISEASES OF URETHRA AND BLADDER 523 the cervix is not intermittent. Catheterizing the ureters will demon-strate them to be intact. (c) Vesicocervical Fistula. L

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