The pathology, diagnosis, and treatment of diseases of women : including the diagnosis of pregnancy / by Graily Hewitt.

  • Hewitt, Graily, 1828-1893.
Date:
1872
Catalogue details

Licence: Public Domain Mark

Credit: The pathology, diagnosis, and treatment of diseases of women : including the diagnosis of pregnancy / by Graily Hewitt. 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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    knife or curved scissors, by the wire or chain ecraseur, or by the galvano-caustic apparatus. The knife is the more expeditious and manageable; but the haemorrhage from the cut surface is often very troublesome. An objection to the ecraseur is that, unless the chain fits very closely into the apex of the instrument, there is a liability of drawing into the instrument tissues which ought to be left uninjured. Hence, if the chain ecraseur be used, the chain should be applied, not close to the summit of the vagina, but a little below this. The galvano-caustic apparatus has, like the ecraseur, the advantage of preventing haemorrhage. On the whole, the course to be recommended is the use of the knife, or curved scissors, if the neck of the growth be very thick—the actual cautery being ready for use to arrest haemorrhage, and the use of the chain or wire-rope ecraseur (see fig. 68), or the galvano- caustic, when the neck of the tumour is smaller. The actual cautery is of great value in such cases. If, however, there be any objection to the use of the actual cautery, the bleeding may be placed effectually under control by placing a pledget of lint soaked in tincture of sesquichloride of iron on the cut surface, and carefully plugging the vagina by means of the speculum, as in ordinary cases of uterine haemorrhage. In any case, prior to performing the operation, the tumour should be gently pulled down as far as possible, to facilitate the necessary manipulations. It is a wise precaution to transfix the cervix above the line of the contemplated incision, and to pass a stout piece of string through it before performing the excision, for it often happens that the uterus retracts, and bleeding is thereby less under control. Dr. Marion Sims has practised a modification of this operation. This consists in covering the stump, as it may be termed, of the amputated part, by mucous membrane ; the anterior half being covered with mucous membrane previously dissected off, and being made to lap over, as in the flap operation in ordinary ampu- tation ; and the posterior half being covered by a flap similarly made from the under surface of the cervix. When the bleeding is trifling and readily checked, this procedure renders the opera- tion more neat and perfect. If styptics have to be used, the covering of the stump with mucous membrane will be useless, as no union can occur. (b) Cases of Hypertrophy of the Supra-Vaginal Portion of the Cervix Uteri.—Cases of hypertrophic elongation of the cervix are