. The Principles and practice of gynecology : for students and practitioners. achelorrhaphy in suitable cases, properly performedwith due regard to asepsis, is one of the most satisfactory operationsin gynecology. Union by first intention is the almost invariablerule. The relief from symptoms is often very great. Disappointment in the operation, as already stated, may result: 1. From neglect to treat the complicating endometritis. 2. From the rolling in of hopelessly diseased structures, which ought to have been excised. 3. From disregarding such contraindications as pelvic suppura- tion. 4. F
. The Principles and practice of gynecology : for students and practitioners. achelorrhaphy in suitable cases, properly performedwith due regard to asepsis, is one of the most satisfactory operationsin gynecology. Union by first intention is the almost invariablerule. The relief from symptoms is often very great. Disappointment in the operation, as already stated, may result: 1. From neglect to treat the complicating endometritis. 2. From the rolling in of hopelessly diseased structures, which ought to have been excised. 3. From disregarding such contraindications as pelvic suppura- tion. 4. From closing the os externum so tightly as to obstruct the natural outflow of uterine secretions. 5. From the unwise selection of cases. 6. Above all, from faulty technique in the operation itself. CHAPTER XLIII GENITAL Priority in the Operation for Genital Fistulae. Up to forty years ago, Avhen the operation for the elosure ofvaginal fistnlse was developed and, in practical form, given to theworld by J. Marion Sims, these most distressing injuries had Figure Vesico-uterine fistula. Vesico-uterovaginal fistula. Vesicovaginal fistula. Urethrovaginalfistula. Rec-lovaginal fistula. Perineo-anal fistula. Anal fistula. been incurable. The invention of Sims speculum, which made theoperation possible, has a significance, however, more far-reachingthan the mere recognition of a valuable operation, for it marks anepoch in the history of gynecology. The operation furnished the 579 580 TRAUMATISMS. initiative for the period of great practical activity which followed. Itwill in no respect detract from the credit which justly belongs to thegreat pioneer if we admit the fact that the honor of perfecting andperpetuating the methods upon which his operation was based, andupon which modern gynecology has made its greatest development,must be divided between J. Marion Sims and Thomas Addis Emmet. Varieties of Genital Fistulae. A fistulous opening may connect the interior of the ut
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