. The Richmond and Louisville medical journal. en Months1 Standing—Cureat the first operation.—Mina S., a healthy-looking woman, thir-ty-five years of age, was admitted May 18, 1875. Has hadtwelve children, four of which, however, after a tedious labor,were still-born. The last confinement took place seven monthsago, when the forceps were employed and labor terminated afterforty-eight hours duration. The pelvis measured in the antero-posterior diameter 9,5 centimetres. The patient was able toretain the urine for hours while lying on her back, but on herarising it escaped immediately. Since her
. The Richmond and Louisville medical journal. en Months1 Standing—Cureat the first operation.—Mina S., a healthy-looking woman, thir-ty-five years of age, was admitted May 18, 1875. Has hadtwelve children, four of which, however, after a tedious labor,were still-born. The last confinement took place seven monthsago, when the forceps were employed and labor terminated afterforty-eight hours duration. The pelvis measured in the antero-posterior diameter 9,5 centimetres. The patient was able toretain the urine for hours while lying on her back, but on herarising it escaped immediately. Since her last confinementmenstruation has twice taken place; then it ceased for twomonths with symptoms of pregnancy. Three previous opera-tions were attempted for closure of the fistule, without givingher any relief. Five days after the second operation a two-months ovum was expelled, it having been destroyed by theexudation of blood within the decidua. July 13, Bozeman explored the fistule with speculum No. 4 30 VESICOVAGINAL FISTULE. Figure and corresponding rectal plate. The fistule was as large as abean, situated a little to the right of the median line at a dis-tance of three centimetres from the cervix uteri. The bordersof the fistule and surrounding tissue seemed at first sight to benormal, but on closer examination a cicatrix could be seen andslightly felt running in a transverse direction just below thefistule. Bozeman introduced the largest cylindrical dilator intothe rather large vagina, but finding simple dilatation insuffi-cient, he incised the cicatrix after two days and continued thedilatation. On the 21st he again, in thepresence of Professor Salzer, ex-plored the vagina with speculumNo. 3, when the cicatrix couldbe neither seen nor felt. He thenrapidly freshened the edges, some-what less steep and a little furtherfrom the fistulous border thanin his previous operations, as is also done by Simon wheneverthere is an uncomplicated vesico-vaginal fistula. He thenc
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