Volume 1

System of gynecology / by American authors ; edited by Matthew D. Mann.

Date:
1887-1888
Catalogue details

Licence: Public Domain Mark

Credit: System of gynecology / by American authors ; edited by Matthew D. Mann. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    to exert any force on the organ, he introduced also the middle finger; and in his effort to push the uterus back turned his hand i)alm upward and then downward, when all at once he could feel neither the womb nor the walls of the vagina. Immediately the woman declared she was relieved. As she turned on her side there was a sudden explosion, as though of air escaping from the bowel. He was satisfied, however, that the air was not from this source, but was from the vagina, and concluded that his traction on the i)erineum had suddenly created a vacuum into which the air rushed and expanded the vagina to its fullest capacity. Fired with a new idea which had just been forced upon him, he hurried home in order to test it in the case of the unfortunates suffering from vesico-vaginal fistula in his hospital. On his way he had stopped and bought a large pewter spoon, which he bent so as to secure the necessary ])urchase for retracting the perineum, as he had discovered he had accidentally done in the case of the woman suffering from the dislocation of the womb. Selecting one of his patients, he placed her on a table in the genu-pectoral position, and, placing a student on each side, instructed them to lay hold of the nates and pull them open. Before he could get the bent spoon-handle into the vagina the air rushed in with a puffing noise, dilating the cavity to its fullest extent. On making further traction with the spoon he had revealed to him a sight which had never before been seen by any man. The fistula with its edges clearly defined was plainly visible; the wall of the vagina could be seen closing in every direction; the neck of the uterus was distinct and well defined, and even the secretions therefrom could be plainly seen. He at once devised and had made for him the instruments which he considered to be necessary for closing up the fistula. Among these instruments was the duck-bill speculum, to which his name has been inseparably attached; and it is a singular fact that the original design of that instrument has never been altered. It took him three months to have the necessary instruments made, and the case Avhich he selected for the operation was an unusually bad one, the whole base of the bladder being destroyed, leaving an opening between the vagina and that viscus at least two inches in diameter. This was in December, 1845, and before the discovery of anesthesia. He succeeded in clos- ing the fistula in about an hour's time. In order to prevent the urine from dripping through into the vagina, he placed a piece of sponge in the neck of the bladder, through Avliich he ran a silk string which he hoped would act as a cajMllary tube that would serve to turn the course of the urine from the fistula. This latter device proved to be a very unfortunate one. At the end of five days the patient was very ill from what, in more recent times, has come to be known as blood- poisoning. On attempting to remove the sponge, he found that it had