Lacerations of the female perineum : and vesico-vaginal fistula : their history and treatment / by D. Hayes Agnew ; with numerous illustrations.

  • Agnew, D. Hayes (David Hayes), 1818-1892.
Date:
1873
Catalogue details

Licence: Public Domain Mark

Credit: Lacerations of the female perineum : and vesico-vaginal fistula : their history and treatment / by D. Hayes Agnew ; with numerous illustrations. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    that in eighty-six cases operated upon, sixty-four occurred in first labors, and in those which have suggested this paper, all were in the persons of primiparse, none of whom but two at the time of the injury exceeded twenty-five years of age. Causes.—These may be arranged under three heads. First, such as relates to the mother; second, to the child ; and third, to instruments. Under the first, may be mentioned powerful expulsive uterine contractions extruding the foetus before the parts are sufficiently extended;. or an unyielding perineum, its tissues being rigid; or where the-muscular structure is deficient in tone and inadequate to react against the pressure of the advancing head ; and again, where the uterine contrac- tions are suspended at a period when the perineum is greatly stretched, and then, without premonition, recommence with unusual power. In such a case laceration occurs in one of two modes ; either by the muscles contracting powerfully to meet the emergency ; or by their being so enfeebled by pro- tracted extension, as to be powerless to resist. The form of the perineum itself must not be overlooked. There are congenital peculiarities which complicate the me- chanism of a labor, resulting from redundancy of tissue asso- ciated often with an unusual straight sacrum, in consequence of which, the presenting part of the foetus tends to direct protrusion, instead of being deflected in the axis of the pelvic curve. A very narrow pubic arch may predispose to the accident by preventing the usual extension. Under the second head are such as relate to the child. Of these may be specified unusual size of the head or breadth of the shoulders, either from natural or morbid causes, de- manding for their passage an extraordinary dilatation of the vaginal outlet ; or, unusual position of the foetus. It is a question by no means clear, whether the passage of the shoulders does not often produce the damage ascribed to the head. The third cause of lacerations is the use of instruments. These come in usually for a very large share of animadver- sion, but it is only in unskilful hands they can be said to do harm in this way. If a child is dragged through the ma-