Diseases of women : a text-book for students and practitioners.

  • Webster, John Clarence, 1863-1950.
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of women : a text-book for students and practitioners. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    672/736 (page 644)
    heal by the use of the cautery or nitrate of silver. If of some size, operative repair is to be carried out. The same principles are to be observed as have been noted in the repair of vesico-vaginal fistulse. Thus a posterior colporrhaphy may be sufficient to bring about closure. The dedoiiblement method is valuable in some cases. When the fistula is low in the recto-vaginal septum, it is best to divide the perineal body in the middle line below the fistula and then to repair the parts as in the case of a complete tear into the anus. Rectal fistula.—This may be complete, when it extends from the skin to the nmcosa, or it may be incomplete, where there is only one opening; of the latter, there are two varieties, in one of which the opening is internal—blind internal fistula; in the other of which it is external—blind external fistula. Most commonly the cause is ischio-rectal abscess, which may be independent of or due to changes in the bowel wall. Sometimes there may be more than one external opening, but there is usually only one internal. Sometimes the internal and external openings may be on opposite sides of the bowel, horse-shoe fistula. On examining the patient the internal opening is hard to find. The condition is a distressing one, causing escape of gas or faecal discharge and incomplete fistula, sometimes blood. Tenesmus may be present. If the fistula get blocked, pain may be set up and a second suppuration started. Treatment.—If the tissue around the fistula is in a healthy condition, the following plan may be carried out:— A probe is passed to the top of the fistula into the bowel. With a bistoury the tissues are divided from the anus to the probe. Any secondary sinus or fistula is then opened up, and the fistulous surface is curetted until it is raw. The wound and the bowel are thoroughly cleansed with an antiseptic, and then the raw surface is completely closed with continuous catgut or with interrupted sutures.