A treatise on the medical and surgical diseases of women, with their homopathic treatment .. . Thomas,f is somewhat different. He prepares the parts forthe sutures by freshening the edges in a similar manner, andthen takes stitches with silk thread first, and then, after theyare inserted, he attaches the silver wire to the end of eachsilk ligature, then draws the wire through the tissues withthis, cuts off the silk from the wire, then twists the wireswith his wire twister, which has a slit in it to hold the wires(a sort of fork in shape). We think the introduction of silksutures, to draw the s
A treatise on the medical and surgical diseases of women, with their homopathic treatment .. . Thomas,f is somewhat different. He prepares the parts forthe sutures by freshening the edges in a similar manner, andthen takes stitches with silk thread first, and then, after theyare inserted, he attaches the silver wire to the end of eachsilk ligature, then draws the wire through the tissues withthis, cuts off the silk from the wire, then twists the wireswith his wire twister, which has a slit in it to hold the wires(a sort of fork in shape). We think the introduction of silksutures, to draw the silver wire suture through with, is quiteunnecessary and is liable to many embarrassments. First. As he inserts all the silk sutures before he attachesa wire there is confusion among the threads. Secondly. The silk suture may break when drawn uponfirmly enough to draw through the loop of the wire. Thirdly. We sometimes find it impossible to make thewire come through the opening in the tissues made by theneedle. * Emmets Principles and Practice of Diseases of Women. Plate UTERUS DRAWN DOWN, TO BRING INTO VIEW A VESICO-VAGINAL FISTULA,FOR CONVENIENCE OF OPERATING. VAGINAL FJSTULAl. 535 Fourthly. This plan leaves the fistula entirely open tillall the sutures are placed, and we have trouble in selectingthe right ends to twist together, or get the other wires twistedin with the suture we are attempting to secure. Simons Operation.—He places the patient on her back,with, the hips at the edge of the table, and resting upon alarge, hard pillow—uses wide specula, as retractors. Heincises the vesical mucous membrane in freshening the edgeof the fistula, as I have before mentioned. When possible todo so he draws down the uterus exterior to the body, therebyinverting the vagina and bringing the fistula into view, whichsimplifies the operation materially. (See Plate XVII.) Heplaces two rows of sutures, one to approximate the edges ofthe fistula, and the other, insert
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