File:The practice of medicine and surgery, applied to the diseases and accidents incident to women (1881) (14765333712).jpg

Identifier: practiceofme00byfo (find matches)
Title: The practice of medicine and surgery, applied to the diseases and accidents incident to women
Year: 1881 (1880s)
Authors: Byford, William Heath, 1817-1890. (from old catalog)
Subjects: Women
Publisher: Philadelphia, Lindsay & Blakiston
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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cases. Urinary Fistula. Although generally resulting from puerperal vaginitis, fistula issometimes produced by other causes. Extensive ulcerations frompessaries sometimes penetrate the septum between the vagina andbladder. Stone or other foreign bodies in the bladder may act as 82 AFFECTIONS OF THE VAGINA causes of ulcerative processes of sufficient gravity to do the sarue.Malignant diseases, as cancer of the uterus, vagina, or bladder, notunfrequently lay open these cavities; and, in some rare instances,perforations by the unskilful use of instruments have been observed.Urinary fistula may be: first, urethro-vaginal; second, vesico-vaginal; third, vesico-uterine; and, fourth, vesico-utero vaginal.In the first variety the opening is through the urethra; In the secondthrough the septum between the vagina and bladder; in the thirdthe vesical wall of the cervix uteri is perforated; in the fourth, twocases of which I have seen, the anterior and posterior portions of the Fig. 10. Fig. 11.
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cervix are both laid open. The cervix is sometimes involved withthe vaginal septum, being torn up from the extremity through theanterior lip into the vaginal cavity. The whole urethra sometimessloughs off, leaving the pubic arch unoccupied by that canal. Inone case I have recently seen, the urethra aud neck of the bladderwere lost, leaving the remainder of the vesico-vaginal septum healthyand entire. In certain other instances the whole lower portion ofthe bladder is wanting, and the uterus more or less mutilated. Tomake the condition more deplorable, in some rare examples of theterrible destruction of the parts, the rectum is involved in the common URINARY FISTULA. 83 ruin. The size of the opening in the urethra or vasico-vaginalseptum is sometimes so small as scarcely to be perceptible, and fromthis it may vary through all grades of dimension to the irreparableloss of tissue above described. The direction may be lengthwise,diagonal, tortuous, or crosswise. The fistula, when establis

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