LIST OF CONTRIBUTORS.

VOLUME XXVIII.

L

26

CINCINNATI LANCET-CLINIC:

A WEEKLY JOURNAL OF

MEDICINE AND SURGERY.

New Series Vol. XXVIII.

JANUARY-JUNE, 1892.

CINCINNATI, January 2, 1892.

Original Articles.

A FEW PRACTICAL POINTS
CONCERNING THE REPAIR
OF THE PERINEUM.
A Paper read before the Academy of Medicine,

October 26, 1891,

BY

GUSTAV ZINKE, M.D.,

CINCINNATI.

There is, perhaps, no accident more common to a woman who has given birth to one or more children than laceration of the perineum. Fortunately the degree of rupture is not always sufficient to disturb the natural relations of the pelvic floor and the structures resting within and above it.

Whole Volume LXVII.

Emmet, Sims, Thomas, Hegar, Bischoff, Martin, Skene, Winkel, Simon, Jenks, Tait, Palmer and Reamy with varying results. Thus I have been method of any one man in all cases; taught that it is an error to follow the that some of the operations, Bischoff's, Simon's, Simpson's and Winkel's are absolutely useless; that all "paring" methods are faulty and not scientific; that perineal sutures alone are unsatisfactory, and the use of silver wire is an extreme nuisance.

Of all the operations implying removal of tissue the Hegar method has given me the best results, when both the vaginal and perineal or stair-sutures (Etagennath) were employed. (It is but just that here I should refer to the fact that long before the vaginal sutures were employed and suggested by Hegar, Prof. C. D. Palmer, of Cincinnati, used it in many of his cases in which I assisted him.)

Again we observe, not unfrequently, that an extensively lacerated perineal body does not cause a serious displacement of the organs supposed to depend on In a few cases, those in which there its integrity for support. There are, how- exists extensive prolapse of the posever, numerous cases, ranging from a terior vaginal wall, and the patient comparatively small rent to a complete having passed the menopause, I still destruction of this important structure, resort to the Hegar operation, but bring in which a series of complications the denuded surfaces in apposition with follow as a consequence. Whether a continued cat-gut suture. The results primarily or secondarily it has caused obtained have been eminently satisor assisted in the displacement of the factory, except in one case, upon which vagina, rectum, bladder, uterus and I was obliged last year to operate a even the small intestines, is not to be second time for procidentia after an considered this evening. My sole object interval of ten years, and again the is to speak of what has impressed itself prolapsus is gradually returning. In upon my mind as the best method of nearly all of the cases operated upon in operating, how to proceed, and what women who subsequently gave birth to sutures to employ to obtain the best a child, and in whom I removed the results. I have faithfully followed in" "flap," rupture of the perineum rethis operation the teachings of Simpson, curred during labor. The same I have