Lacerations of the perineum : their causes, formation, and primary repair : with report of forty-eight illustrated cases / by Ellice McDonald.

  • McDonald, Ellice, 1876-1955.
Date:
1908
Catalogue details

Licence: In copyright

Credit: Lacerations of the perineum : their causes, formation, and primary repair : with report of forty-eight illustrated cases / by Ellice McDonald. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    XT /Ofr Reprint from Surgery, Gynecology and Obstetrics, January, 1908, pages 47-58 V/ LACERATIONS OE THE PERINEUM1 C. , ' V - . ^ 9 Their Causes, Formation, Primary RepA's^l with Report of Forty-Eight Illustrated C^ses (a) By ELL m ID, m. d. W f'tV*'’ Instructor in Obstetrics, College of Physicians and Surgeons; Clinical11 Assistant in Obstetrics, Vanderbilt Clinic; Instructor in Obstetrics, New York Post-Graduate MeaicaTocnool and Hospital, New York THE subject of perineal lacerations and repair is one which has been debated amongst medical people for many years, and the more debated, the more ob- scure the subject has become. The multitude of operations which have in recent years been exploited is evidence of the lack of uniform appreciation of the underlying causes, pro- cesses, and mode of repair of these wounds. Although modern gynecologists have been most successful in the treatment of these condi- tions, the possibility of their successful treat- ment has long been known. The first historical reference to the subject is found in an early work supposed to have been handed down by tradition and edited by an unknown author who states that Tortula, a midwife attached to the school of Salernum, who lived in the eleventh century, cured a laceration of the perineum by operation — “Postmodum ruptura intra anum et vulvam tribus locis vel quatuor suimus cum filo de serico” (i). Ambrose Pare (2) was another of the early investigators of the subject and is credited with having performed the operation. He reports a cure of two cases, but does not state that the operation was done immediately after labor. He gives directions as follows: “But if through the violence of extraction the genital parts are torn, so that the two cavities, the rectum and vagina, are torn into one, the tear must be stitched up, and the wound cured according to want. I have thus cured two women living in Paris.” Various other investigators followed Pare, amongst them his pupil, Guillemeau, (3) who operated upon one case of complete rupture of the perineum six weeks after labor. He pared the edges of the old cicatrix and used one figure- of-eight and two interrupted sutures. The operation was a success. Others who per- formed the operation for complete tear were De La Motte, Morlanne, Saucerotte, Noel, and Dupuytren in France, Rowley in England, and Osiander and Dieffenbach in Germany. Dief- fenbach (4) wrote extensively upon the subject of complete perineal tear and followed the plan of making lateral incisions at each side of the perineum after suturing the recto-vaginal sep- tum. In 1837 he advised the primary repair of all lacerations of the perineum, including first and second degree tears. Amongst American surgeons Mettauer (5) of Virginia published a report of a successful oper- ation for complete tear six months after its occurrence. He used sutures of lead and fas- tened them by twisting. Roux (6) wrote extensively upon the subject and published many successful cases of com- plete perineorrhaphy. He was an earnest advocate of the operation. Amongst those who did primary operations for incomplete tears of the perineum were Bayer (8) in 1823, Churchill (9) in 1824, and Williams (10) in 1827, while Alcock (n) per- formed the intermediate operation for incom- plete laceration in 1820. The secondary operation for laceration of the second degree tears also was first done about this time. Fricke (13), in 1835, has done the operation four times with three successes. Nick (14) also reported in 1838 that he had done two operations for incomplete tear of the perineum. Baker Brown (15) was, however, the surgeon who did most to bring the operation into general use and encouraged others to study the subject of perineal injuries. In 1866, Baker Brown had done 112 operations upon the perineum. His work stimulated Savage (16) to excellent researches upon the anatomy of the perineum, which have remained classic in gynecological literature. Following after these were Hegar, Sims, Agnew, Emmet, A. Martin, and Lawson Tait. 1 Read before the New York Academy of Medicine on October 25, 1907.