The perineum : its anatomy, physiology, and methods of restoration after injury / by Henry O. Marcy.

Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: The perineum : its anatomy, physiology, and methods of restoration after injury / by Henry O. Marcy. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    from adjacent tissues without removing the scissors, first going up the septum as far as desired, and then laterally, first on one side and then on the other, without removing the scissors or once bring- ing their points from beneath the mucous membrane. Then, with blunt-pointed scissors, I cut away the dissected flap.” This anterior flap I utilized by coapting its inverted ^-shaped freshened surface, and united the lower sides of the triangle, the perineum proper, by lateral supporting pins1 (Plate VI., Fig. 1). “ This is effected by means of a double pin, the halves of which are nearly alike. The pin is made of German silver wire, gauge No. 20 or 22, since this material does not irritate the tissues and possesses stiffness and elasticity, qualities which are essential. The end is bent in a small loop and turned one-fourth of an inch there- from at a right angle, and the shaft is two to two and a half inches in length, sharpened like the point of the needle of a subcutaneous syringe. The one half is introduced from the vagina, within out- ward, quite deep into the tissues laterally, the direction being deter- mined by the finger placed in the rectum, to which the pin should be parallel. The other half of the pin, similarly constructed, is introduced from without inward upon the opposite side in the same manner, the point of which is caught in the loop of the first part and adjusted without. Thus a kind of ‘safety pin’ is con- structed, and, when fitted to retain properly the enclosed portions, the loops are clamped down by compression forceps and the ends cut square. This is found to hold sufficiently firm ; but at first, fearing it might not be secure, I also clamped a perforated shot upon the wire. The shot renders the end of the pin less liable to cause irritation. If properly adjusted, the elasticity of the wire compen- sates for the collateral edema, and does not impair the circulation in the inclosed parts, while complete approximation is obtained, and no force is exercised in the direction of the long axis of the triangle. Two to four pins are required as the case may demand (Plate VI., Fig. 2). The subsequent treatment consists, in most instances, of a daily washing out of the rectum by means of a large double rubber tube with a considerable quantity, usually from three to four quarts—of water as hot as comfortable to bear. Upon the eighth or tenth day, as thought wise, each pin is gently pushed upward and 1 American Medical Association Journal, Oct. 27, 1S83.