Identifier: principlespracti00dudl (find matches)
Title: The Principles and practice of gynecology : for students and practitioners
Year: 1904 (1900s)
Authors: Dudley, E. C. (Emilius Clark), 1850-1928
Subjects: Gynecology
Publisher: Philadelphia : Lea Brothers & Co.
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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tomatically satisfactory.In some cases the much contracted bladder even may resume itsphysiological calibre. The operation of vaginal cystotomy is the de-vice of T. A. Emmet. OPEEATioisr.—The patient is preferably in Sims position, with theanterior vaginal wall exposed by Sims speculum. A large sound isintroduced through the urethra, and its point pressed against thevesical mucosa in the middle of the long axis of the vesicovaginalseptum. An incision is now made upon the sound through the septumwith the knife or scissors. The point of the sound then will pass CYSTITIS. 331 through into the va<;in:i. The ofxiiing thus made is enlarged so as toextend one inch in the median line of the long axis of tlie vesico-vaginal septum. Its upper end will be about one-halt inch Ironi theanterior wall of the eervix uteri, and its lower end the same distancefrom the neck of the bladder. The margins of the vesical and vagi-nal mucosa then are united by tine interrupted catgut sutures. Figure 150.
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Vaginal cystotomy. A dilator is passed through the urethra into the bladder, and theblades of it are pressed against the vesicovaginal septum at a point in the median line mid-way between the uterus and urethra, and separated. The vesicovaginal sepitum is incised bymeans of the scalpel or pointed scissors, which are forced through the septum between theblades of the dilator. The point for incision is determined by the position of the dilator, andeasily can be lelt by means of the index-finger in the vagina. In the lower part of the Figurethe dilator and scissors are shown comDlete, and in the position in which they are when theincision is made. The accompanying illustration shows a device which renders theoperation both precise and simple; it consists in the introductionof a small uterine dilator instead of the sound mentioned above,through the urethra into the bladder. The curved blades of thisdilator are turned toward the vaginal wall, the points of the blades 332 INFECTIONS, INFLAM

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