A text-book of practical obstetrics, comprising pregnancy, labor, and the puerpal state, and obstetric surgery . nd thenurse should be strictly enjoined to exercise scrupulous cleanli-ness of the external genitals. For the first few days the womanhad better be catheterized, or else, and this we prefer, when shepasses water it should be under the administration of a weakcreolin or bichloride douche. It is very questionable if thenormal urine will interfere at all with primary union. In the event of the primary operation proving a failure,the woman should be advised to submit to the secondary op
A text-book of practical obstetrics, comprising pregnancy, labor, and the puerpal state, and obstetric surgery . nd thenurse should be strictly enjoined to exercise scrupulous cleanli-ness of the external genitals. For the first few days the womanhad better be catheterized, or else, and this we prefer, when shepasses water it should be under the administration of a weakcreolin or bichloride douche. It is very questionable if thenormal urine will interfere at all with primary union. In the event of the primary operation proving a failure,the woman should be advised to submit to the secondary opera-tion as early as may be, for the longer she waits the greater thecicatricial tissue, and the more aggravated the rectocele andpossibly the cystocele which will form. 174 OBSTETRIC SURGERY. Fistula. Only exceptionally, nowadays, are fistulas of the genitaltract encountered, for the reason that their chief causes are notallowed, to act. Protracted labor was formerly responsible forthe majority of fistulas. Traumatism, except in the presence ofa major degree of pelvic contraction when surgical interference. Fig. 80.—Repair of a Vesicovaginal Fistula. was demanded, was rarely a causative factor. It is only whena fistula forms as the result of surgical interference that thephysician, in the capacity of accoucheur, will be called uponto perform immediate operation. The fistulas which result fromprolonged pressure of the foetal presenting part on the pelvicfloor rarely make themselves evident until a number of days THE SURGERY OF THE PUERPERIUM. 175 after labor. The process is purely one of sloughing in theselatter instances. Of course, here, as well, it is eminently neces-sary to take measures for repair of the lesion as soon as the con-dition of the woman will allow, since the formation of extensivecicatrices will render the operation most difficult and the resultproblematical.
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