Treatise on gynaecology : medical and surgical . ck of beinguncomfortable and of rendering the administration of the anges-thetic difficult, notwithstanding the use of special 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 b
Treatise on gynaecology : medical and surgical . ck of beinguncomfortable and of rendering the administration of the anges-thetic difficult, notwithstanding the use of special 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 operation may be performed under continu-ous irrigation with lukewarm sterilized water; and we may, if neces-sary, use in the place of sponges moistened absorbent cotton carriedby the Fig. (4.—Instruments Used for Vivipication and Suture in Vesico-vaginal Fistula. 1, 2, 3>Straight, convex, and bent bistouries; 4, spatula; 5, 6, blunt and pointed hooks; 7, 8, Coghills wiretwister, and Denouvilliers S-shaped wire twister; 0, Collins spring forceps. The fourchette should be depressed by a short and broad-bladedSimons speculum; a retractor can be nsed to elevate the anteriorvaginal wall if necessary; a metallic sound introduced into the blad-der may be used to bring the base toward the operator; finally, thecervix is fixed and brought down by Museux forceps. Second Stage.— Vimfying the Lips of the Fistula.—For this pur-pose a bistoury having a straight or angular blade is to be preferred. CICATRICIAL FISTULA OF THE VAGHSTA. 311 The scissors, so ingeniously varied in curve by Sims, do the workmore rapidly, it is true, but sometimes bruise the tissues. Denuda-tion may be accomplished in two v/ays. In ordinary case
Size: 1229px × 2033px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1800, bookdec, booksubjectgynecology, booksubjectwomen
