Outlines of the diseases of women / by John Phillips.

  • Phillips, John.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Outlines of the diseases of women / by John Phillips. Source: Wellcome Collection.

    135/332 (page 115)
    (/3) Through the external skin only (b); or (y) As a complete rupture through the mucous mem- brane, muscles and external skin (a, c, b). It is not necessary for a portion of the foetus to pass through the central rupture, but it is produced by over-stretching of the vaginal wall ; the perineal body is pierced through its centre, and there is a band of tissue of greater or less thickness (b, d) between its anterior edge and the scaphoid fossa. This condition may be produced by sloughing a few days after labour. The Causes of Ruptured Perineum are chiefly obstetrical, and, apart from local rigidity, are : (1) Careless use of forceps ; (2) Occipito-posterior present- ations ; (3) The posterior shoulder of a large child in a vertex presentation; (4) The after-coming head. Central rupture may be the result of violent labour pains on an undi- lated vagina, as in primiparse, with albuminuric convulsions. It may be necessary to enlarge the vulval open- ing in removal of large fibroid polypi or total extirpation of the uterus; posterior or lateral incisions are then made. Symptoms attending complete rup- ture are: 1. Incontinence of faeces, often diarrhoea; 2. I nvoluntary passage of flatus ; 3. Difficult sitting and locomotion ; 4. A sensation of dropping of the pelvic floor. A symptom attending partial rupture may be slight feeling of bearing-down, or the patient may experience nothing untoward. Treatment— 1. Immediate suture—i.e., suture by catgut or silk at the time of labour; 2. Remote suture—i.e., later, when the patient is about, and has quite recovered. 1. Immediate Suture.—The patient is placed upon her back, a douche of 1 in 4000 perchloride given, and the vagina stuffed with antiseptic gauze, to prevent the lochial discharge obscuring the operator's vision: the wound will then be found to be irregular, Fig. 57. 10 Diagram of perineal lacera- tions (central). a. Through vaginal mucous membrane only. 6. Through external skin only a, c, b. Complete central rup- ture, d. Fourchette. r. Rectum, u. Uterus.