. Clinical gyncology, medical and surgical. the median line one centimetre above the vesicalorifice of the urethra. The parts are steadied with a tenaculum and areincised upon the top of the sound. The blunt blade of the scissors is car-ried through the incision into the bladder, and the opening lengthened inthe direction of the cervix uteri to the distance of three or four prevent the fistula from closing, the vesical and vaginal mucous mem-branes should In1 stitched together, or the patient may maintain the openingby passing the finger through it night and morning. Instead of
. Clinical gyncology, medical and surgical. the median line one centimetre above the vesicalorifice of the urethra. The parts are steadied with a tenaculum and areincised upon the top of the sound. The blunt blade of the scissors is car-ried through the incision into the bladder, and the opening lengthened inthe direction of the cervix uteri to the distance of three or four prevent the fistula from closing, the vesical and vaginal mucous mem-branes should In1 stitched together, or the patient may maintain the openingby passing the finger through it night and morning. Instead of the knifeor scissors, the Paquelin cautery at a dull red heat may be used. Byrne, of Brooklyn, has modified the operation, making it easy andexpeditious, by the use of a specially constructed forceps, one blade ofwhich is passed into the bladder, the other into the vagina, thus graspingthe vesicovaginal septum; the vaginal blade is fenestrated and the vesicalblade grooved. (Fig. 24.) The thermo-cautery knife is introduced through Fig. Byrnes cystotomy forceps. the fenestra at a didl red heat and the septum divided, the knife beingcompletely controlled and guarded by the fenestra and groove in theforceps. The operation must, of course, be done under an anaesthetic, bestwith the patient in the dorsal position. By the use of the cautery not onlyare hemorrhage and sepsis prevented, but the operation is accomplished withgreater rapidity and the fistula is readily kept open. Suprapubic cystotomyhas been done in obstinate cases of cystitis, but it offers no advantage overthe vaginal operation. Tuberculosis.—Tuberculosis of the bladder is regarded as a very raredisease. It is possible, however, that cystitis may yet prove to be morefrequently of tuberculous origin than has hitherto been assumed. Rovsingfound tuberculous bacilli in the bladder-discharges of three out of thirtycases of cystitis. In the great majority of instances it is dependent upongeneral tuberculosis, or is ass
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