Complete laceration of the perineum and part of the recto-vaginal septum, resulting from forceps delivery : primary operation, complicated with traumatic erysipelas / by A.B. Cook.

  • Cook, A.B.
Date:
[1885]
Catalogue details

Licence: Public Domain Mark

Credit: Complete laceration of the perineum and part of the recto-vaginal septum, resulting from forceps delivery : primary operation, complicated with traumatic erysipelas / by A.B. Cook. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    s redness over right hip and thigh, due to lying in one position. Ordered the red surface painted with collodion for protection from pressure and moisture. To secure more perfect coaptation of the perineal wound—length three-fourths inch, depth one-half inch—and facilitate, if possible, union by adhesion or granulJition, I applied over the nates two strips of rubber adhesive plaster, one and a half inches wide by eighteen inches long, the center of the strips corre- sponding to the wound. The cleft of the nates was drawn moderately tight to hold the surfaces of the wound in apposition. After the plaster was adjusted the patient expressed a feeling of relief and comfort. General and local treat- ment continued. 6 P. M., pulse loi, temperature 101^“^. She had a good day, slept quietly a great part of the time, food relished, no gas or pain in the bowels, no dis- charge from the wound since the rubber plaster was applied. The patient again spoke of the great comfort from the support of the plaster. February 22, 10 A. M., pulse 96, temperature 99^°; 6 P.M., pulse 100, tem- perature 102*^. No thirst to-day, slept soundly, no secretion from the wound, rubber plaster firmly adherent, some gas passed per recUmi, no complaint except fatigue and pain in the right hip-joint. Free secretion of urine, which is now limpid and almost natural in color. During the erysipelas it was high colored and turbid. The secretion has, throughout the treatment, been copious. The catheter, for two days past, has been used every three or four hours; previous to this, every six hours. The free secretions of the skin and kidneys seem to act as safety-valves, and compensate for the lockup of the bowels. Ordered three grains bisulphate quinine and one-fourth grain morphia every six hours, and the under surface of right hip and thigh painted with collodion. All symptoms of erysipelas having disappeared, I could now distinctly feel the cicatrix the entire length of the wound in the recto-vaginal septum, indicating union of the parts lacerated, as noted above. February 23, 10 A.M., pulse 100, temperature 101°. Despite the elevation of temperature, the patient feels comfortable. There is no abnormal heat of the vagina, no gas, no impaction of excrement in the rectum, and no oozing of any secretion from the perineal wound. The rubber plaster still adheres well and does not in the least interfere with local manipulation, and injections. The catheter has been used less frequently the past twenty-four hours. The quinine was suspended, morphia given as usual, and concentrated nourishment taken at regular intervals. February 24, 10 A.M., pulse 102, temperature lOi? ; 6 P.M., pulse 108, tem- perature 102°. No change worthy of note ; treatment continued and collodion painted over all red surfaces. February 25, 10 A. M., pulse 96, temperature loi®; 6 P. M., pulse 102, temperature Profuse perspiration last night; had a comfortable day, excepting uneasiness for a short time from gas. Permission was given to turn and change position at pleasure. When turned on the left side, the full extent of the surface affected by erysipelas was apparent. The inflammation extended