Vesica- Vaginal Fistula 863 



The external wounds are then to be closed by appropriate deep 

 interrupted sutures. Because of' the great danger from suture 

 infection in this part, the sutures, before introduction, should 

 be thoroughly saturated with a disinfectant, preferably by im- 

 mersion of the sutures for a day in tincture of iodine. The ex- 

 ternal sutures may be rendered safer by applying to each, after 

 insertion, a drop of the tincture of iodine. 



When the suturing has been completed, the rectum and vagina 

 should be carefully wiped with sterile cotton or gauze, and the 

 wound line, especially in the rectum, liberally sprinkled with 

 iodoform. 



When recto-vaginal fistula exists, the operation is analogous. 

 The sutures are to be made in the same manner. The anus 

 should be widely dilated with retractors, and the margins of the 

 fistula grasped and drawn out through the anus. 



The after-handling of the wound is highly important. The 

 chief concern of the operator is the prevention of the befouling 

 of the wound by means of contact with the fecal matter, followed 

 by swelling, infection and tearing out of the sutures. The ani- 

 mal should not be allowed any solid food, but may have gruels 

 or liquid foods, especially milk. The bowels may be largely 

 blocked up, and the passage of feces into the rectum decreased, 

 by small doses, )4 to 1 gr. of morphia repeated every 3 or 4 hours. 

 The expulsion of such feces as may gain the rectum should be 

 facilitated by injections of warm antiseptic solutions, especially 

 of weak solutions of lysol or of a weak carbolized oil warmed to 

 the temperature of the body. 



The handling of the third group of injuries to the perineum, 

 the external lacerations which do not divide the sphincters, offers 

 nothing special, and consists in the closure of the wound by 

 means of sutures, in accordance with general surgical principles. 



15. Vesico- Vaginal Fistula. 



Fleming, citing Dupont, records an instance of vesico-vaginal 

 -fistula, but fails to give exact data in regard to it. Rupture of 

 the bladder in an ordinary case of birth, due to the passage of 

 the fetus over it, is improbable, .since normally the bladder is 

 completely emptied before the fetus enters the birth canal, and 

 the empty organ lies in a depressed and smooth area upon the 

 pelvic floor, covered over by the floor of the vagina. Should 



