File:The diseases of women - a handbook for students and practitioners (1897) (14776034124).jpg

Identifier: diseaomenh00blan (find matches)
Title: The diseases of women : a handbook for students and practitioners
Year: 1897 (1890s)
Authors: Bland-Sutton, John, Sir, 1855-1936 Giles, Arthur E. (Arthur Edward), 1864-
Subjects: Women Generative organs, Female Genital Diseases, Female
Publisher: London : Rebman Philadelphia : W.B. Saunders
Contributing Library: Yale University, Cushing/Whitney Medical Library
Digitizing Sponsor: Open Knowledge Commons and Yale University, Cushing/Whitney Medical Library

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a aregently irrigated with warm water and the patient returnedto bed. After-treatme?it.—It is advisable as soon as the patient re-covers consciousness to allow her to lie on her side or evenin the prone position. Some operators prefer to keep a catheter in the bladderfor several days: others of equal experience reject thismethod and enjoin the regular careful use of the catheter.It is important to keep the bowels regular. Removal of Sutures.—These may be withdrawn about theeighth or tenth day, and this is best effected under an an-aesthetic. When the fistula is small, its complete closure may be 23 354 DISEASES OF WOMEN. effected by a single operation, but in many cases, especiallywhen the hole is large, a small fistula will remain and re-quire a second and even repeated operations for its completeocclusion. It is wise to allow a good interval to elapse before per-forming a second operation, to allow the wound to contract,and the patient to benefit by change of air and scene after
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Fig. 102.—Method of passing the suture in the operation for vesico-vaginal fistula. the confinement to bed. The misery these patients suffermakes them importunate in regard to operation. The most difficult fistulae to close are those situated nearthe vesical orifice of the urethra and those near to or actu-ally involving the ureteric orifice. Uretero-vaginal Fistulse.—These often close spon-taneously ; failing this, attempts should be made to closethem by a plastic operation on the principles employed forthe occlusion of a vesico-vaginal fistula. In some cases OPERATIONS FOR VAGINAL FISTULM, ETC. 355 surgeons have removed the kidney in order to relieve wo-men of their almost insufferable distress. Utero-vesical Fistula.—This is very rare, and in orderto deal with it the surgeon will find it necessary to separatethe bladder from the neck of the uterus, as advised in thefirst steps in the operation of vaginal hysterectomy, in orderto expose the vesical portion of the fistula. Rect

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