Pathology and treatment of diseases of women.

  • Martin, August Eduard, 1847-1933.
Date:
1912
Catalogue details

Licence: In copyright

Credit: Pathology and treatment of diseases of women. Source: Wellcome Collection.

    53/500 (page 33)
    with crude force, and the curette suddenly passes through the uterine wall into the abdominal cavity. This Perforation has been represented as a very grave accident, after which fatal peritonitis would be almost inevitable. One must admit that many observations justify this pessimistic view, particularly if the Con- tents of the cavum uteri were strongly infectious. On the other hand it should be stated that with correct treatment the Perforation passes usually without any grave consequences. It is only necessary to act accordingly. The curette must be removed immediately, and any further manip- ulation in and around the uterus must be suspended. One should not curette any further, nor use any irrigation, nor any tampon. The patient is put to bed in the dorsal position, an ice-bag is applied over the abdomen, the diet must be liquid. If no alarming Symptoms appear within forty-eight hours, the danger may be considered passed, because within this time the peritoneum has become adherent over the small opening at the point of Perforation; the patient may leave the bed on the fifth day, the same as after a curettage. An excision of a piece of tissue from the portio vaginalis for diag- nostic purposes is necessary in erosions which look suspiciously malig- nant. At times it suffices instead to scrape off a few particles with a sharp spoon and to render a diagnosis from a microscopic examination of the same. A firm packing of the vagina with iodoform gauze will stop safely the hemorrhage which at times is considerable. Anesthesia is not necessary for this interference. If this simple procedure is not sufficient it is advisable to do a com- plete wedge-shaped excision of one or both cervical lips (see Operations on the uterus). Bacteriologic Examination • Literature.—See Menge and Kroenig, Bakteriologie des weiblichen Genitalkanales, Leipsic, 1897; further, v. Rosthorn in Handb. d. Geburtsh, von F. v. Winckel, Vol. I page 574, Frommei’s Jahresber. über Geb. u. Gyn., 1898-1906. The lower portion of the female genital tract—vulva and vagina—is, even under normal conditions, the seat of numerous micro-organisms. These are partly harmless saprophytes, especially bacilli (Doederlein) partly also strepto-.and staphylococci. It is of no importance for practi- cal purposes, whether the latter are identical or not with the forms known as the exciters of septic infection. It suffices that they may be pathogenic, and we must consider them at all times as pathogenic germs (Menge and Kroenig). Even if we are allowed to attribute to the acid secretion of the vagina a bactericidal power, this is, however not suffi- cient for the complete destruction of the infectious germs. For this rea- son a painstaking strict disinfection must be done before each vaginal Operation.