. Tri-State medical journal . g clearly shown by the cicatrix. It is well to call attention to the not infrequent instances of subcuta-neous rupture of the muscular tissue and fascia of the perineum, relaxingand widening the pelvic floor, thus destroying the perineal support whiletthe skin and mucous surfaces show no tear at all. Such so-called concealedruptures should be brought together by two to four-inch-deep perinealstitches. The repair of the ruptured perineum immediately after the acci-dent is comparatively easy; but, alas, it is too often allowed to go unnoticed Original Articles. 323&
. Tri-State medical journal . g clearly shown by the cicatrix. It is well to call attention to the not infrequent instances of subcuta-neous rupture of the muscular tissue and fascia of the perineum, relaxingand widening the pelvic floor, thus destroying the perineal support whiletthe skin and mucous surfaces show no tear at all. Such so-called concealedruptures should be brought together by two to four-inch-deep perinealstitches. The repair of the ruptured perineum immediately after the acci-dent is comparatively easy; but, alas, it is too often allowed to go unnoticed Original Articles. 323> for months and years, until development of nervous phenomena drives thepatient from home for relief. The rules for doing perineorrhaphy are practically the same as thosefor perineo-plasty after denudation. Of the 331 cases I have operated upon, 195 were lacerations of perin-eum of the first dgree, i. e., down to the sphincter, but not involving it; 99were of the second degree, i. e., ruptured through the sphincter ani; 37. FIGURE 2. Cut number two represents a complete laceration with rectocele, cystocele and urethrocele,.the Septum between bowel and vagina being severed. were of the third degree, i. e. ruptured through the sphincter ani and recto-vaginal septum. Symptoms in many cases of the first degree are prolapsusof vagina with rectocele or cystocele, or both; symptoms of second degreeare sub-involution of vagina, prolapsus uteri, cystocele and rectocele ; gen-eral debility of system in most prolonged cases; third degree, prolapsus ofrectum, with incontinence of feces and intestinal gases. Prolapsus ofuterus, endometritis and endocervicitis, pelvic pain and traction upon the-broad ligaments, most common in third degree. .324 Perineo-Plasty-Mayfield. Sequelae of perineal lacerations are almost innumerable and are con-stantly multiplying until after the change of life. Some are quite remote,and are often overlooked or not attributed to the rupture. I have found many case
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