File:Treatise on gynaecology - medical and surgical (1894) (14594166507).jpg

Identifier: treatiseongynaec02pozz (find matches)
Title: Treatise on gynaecology : medical and surgical
Year: 1894 (1890s)
Authors: Pozzi, Samuel, 1846-1918 Wells, B. H., tr
Subjects: Gynecology Generative organs, Female Women Gynecology Genital Diseases, Female Gynecologic Surgical Procedures
Publisher: New York : William Wood & Co.
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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in Place. Patient in Position upon the Operating-Table. Where we have contraction or obliteration of the urethra weshould first treat these conditions. For the first we may resort todivulsion or the long-continued use of the sound. In case of obliter-ation of the urethra we may do an operation analogous to that ofexternal urethrotomy in the male; the cicatricial tissue is first to beexcised, after which the vaginal mucous membrane, liberated by means CICATEICIAL FISTULJE OF THE VAGHSTA. 309 of incisions and dissections, may be sutured about a permanent ca-theter so as to form a new canal. Operatwe Technique.—1st. Examination for Fistula.—The posi-tion to be given to the patient will vary with the height of the orifice.The dorso-sacral position is available where the fistula is very low orwhere there is at the same time prolapse of the vaginal wall. As arule, however, Sims position or that of semi-pronation will be re-quired. Where the fistula is located high up, the genu-pectoral
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I Il rmimliiirii ri I iijlliiiipnn^ ;iri ^ V\\»^^j*;^>->i»lfe Fig. 73.—Neugebauers Speculum and Hooks for Retraction in Place. position will be necessary. This possesses the drawback of beinguncomfortable and of rendering the administration of the anges-thetic difficult, notwithstanding the use of special operating-tables.The patient is fastened to the table by Bozeman,^^ and simply placedin position by ISeugebauer,^^ who has a self-retaining speculum heldin place by a belt, also hooks and chains to which are suspendedweights so as to stretch the parts included in the operative field. General angesthesia by chloroform has always been used for thisoperation. It is probable, however, that cocaine applied by com-presses or by submucous injection might be used with success, and 310 CLI)N^ICAL AND OPEEATIVE GYNECOLOGY. general anaesthesia be dispensed witli. Two assistants are required;one to expose the vaginal wall and control bleeding, and the other tohandle the sutures. The op

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