A treatise on the medical and surgical diseases of women, with their homopathic treatment .. . n or granulation; and the bowelsshould be still longer kept inactive, and the diet of beef teacontinued for perhaps two weeks more. If by this time Avefind we have failed in securing union of the edges of thewound we had better allow the bowrels to move, and restrainthem again for two weeks, especially if we find the appear-ance of the fistula indicates that by that time it may becomeclosed. During this time the daily use of warm water vag-inal injections is of great service. It is adArisable to stit
A treatise on the medical and surgical diseases of women, with their homopathic treatment .. . n or granulation; and the bowelsshould be still longer kept inactive, and the diet of beef teacontinued for perhaps two weeks more. If by this time Avefind we have failed in securing union of the edges of thewound we had better allow the bowrels to move, and restrainthem again for two weeks, especially if we find the appear-ance of the fistula indicates that by that time it may becomeclosed. During this time the daily use of warm water vag-inal injections is of great service. It is adArisable to stitch the lacerated tissues together insome instances where they are extensively divided. To dothis the patient should lie upon the back, with the thighsflexed upon the abdomen. (See chapter on Lacerated Per-ineum.) The vagina is conveniently dilated with two ofDawsons improved Sims speculums, one on either side,screwing open the divided blade to give room to examine thelaceration, and to take the stitches. The same instrumentsare required as in operating for vesico-vaginal fistula, except 34. 530 EATON ON DISEASES OF WOMEN. that no freshening of the edges of the fistula is required inthe very recent case. Where the injury has been received several weeks or monthsprevious to the time weare called to take chargeof the case, or to operate,it is necessary to freshen Fig. No. 57.—Curved Scissors. , .. n the edges ol the fistulabefore stitching them together; and here we may use thecurved scissors. (See Fig. No. 57.) Cases of recto-vaginal fistula which have been causedfrom an abscess between the vagina and rectum may requirea somewhat modified treatment if they are of long collapse of the sac of the abscess, and the adhesion ofits walls in some instances, causes the vaginal walls to be-come so firmly adherent to the rectum and sides of the pelvisthat it is necessary to loosen them from their attachmentsbefore the edges of the fistula can be brought together with-out usi
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