On the treatment of vesico-vaginal fistula / by J. Marion Sims.

  • Sims, J. Marion (James Marion), 1813-1883.
Date:
1853
Catalogue details

Licence: Public Domain Mark

Credit: On the treatment of vesico-vaginal fistula / by J. Marion Sims. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    VESICO-YAGINAL FISTULA Vesico-Vaginal Fistula—an abnormal communication between the blad- der and vagina, allowing an involuntary discbarge of urine—is produced gene- rally by tedious labour. The impacted foetal head, jamming the anterior vagiual parietes against the symphysis pubis, obstructs the circulation of the parts, which results in a slough of greater or less extent, according to the degree and duration of the impaction. Almost the only hope of preventing so serious a disaster under such circumstances is the timely resort to instrumental delivery. By this means I have seen the slough confined to the vaginal mucous mem- brane, where, otherwise, it would unquestionably have extended entirely through the vagino-vesical septum. It occurs principally in first labours where the pelvis is small, the soft parts unyielding, and the foetal cranium large; but I have seen it in those advanced in life, who had given birth previously to many children. Authors are disposed to attribute the accident, in many cases, to the awkward use of obstetrical instruments; but, from a careful analysis of these cases, and from my own experience, I am well satisfied that for one case thus produced, their judicious application has prevented it fifty times. Other causes produce it occasionally, such as a prolonged retention of a pes- sary in the vagina, a calculus or other foreign body in the bladder, abscesses, venereal ulcerations, &c. I have seen one case where the whole base of the bladder was destroyed by a corroding ulcer, which, originating in the cervix uteri, extended forward to the urethra. Whatever may be the cause of this distressing affection, it is a matter of serious importance to both surgeon and patient that it be rendered susceptible of cure. Its diagnosis is sufficiently easy. Incontinence of urine, following a tedious labour after a lapse of from one to fifteen days, will always prove its existence. But to determine the exact size, shape, and relative position of the artificial opening requires some nicety of examination. The consequences of the in- voluntary discharge of urine are indeed painful. The vagina may become in- flamed, ulcerated, encrusted with urinary calculi, and even contracted; while the vulva, nates, and thighs are more or less excoriated, being often covered 2