Part 20 (2/2)

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ROBINSON, B. Sudden Death, especially from Embolism, following Surgical Intervention. _Medical Record_, 1905, lvii. 47.

SPENCER, H. R. Discussion at Exeter on Uterine Fibroids, &c. _British Medical Journal_, 1907, ii. 452.

TEBBS, B. N. Symptomatic Parot.i.tis. _Med.-Chir. Trans._, 1905, lx.x.xviii.

35.

TRENDELENBURG, F. Zur Herzchirurgie. _Zentralbl. fur Chir._, 1907, No.

44, 1302.

---- Ueber die chirurgische Behandlung der puerperalen Pyamie.

_Munchener Med. Wochenschr._, 1907, x.x.xiv. 1302.

WEIBEL, W. Das Verhalten der Ureteren nach der erweiterten abdominalen Operation des Uteruskarzinoms. _Zeitsch. f. Geb. u. Gyn._, 1908, lxii. 184.

SECTION I

OPERATIONS UPON THE FEMALE GENITAL ORGANS

PART II

v.a.g.i.n.aL GYNaeCOLOGICAL OPERATIONS

BY

JOHN PHILLIPS, M.A., M.D. (Cantab.), F.R.C.P.

Professor of Obstetric Medicine, King's College, London Obstetric Physician and Gynaecologist to King's College Hospital

CHAPTER XII

PREPARATION OF THE PATIENT FOR PERINEAL AND v.a.g.i.n.aL OPERATIONS: OPERATIONS FOR INJURIES TO THE PERINEUM AND PELVIC FLOOR

PREPARATION OF THE PATIENT

In operations upon the perineum and v.a.g.i.n.a, the same scrupulous precautions against sepsis should be taken as in abdominal section.

Before proceeding to practical details, it will be useful to consider a few points regarding the distribution of bacteria in these parts. Not only the ordinary bacteria of the skin, but also those from the r.e.c.t.u.m, and, under certain conditions, from the urine and the v.a.g.i.n.al secretion abound on the perineal and v.u.l.v.al surfaces. The healthy virgin v.a.g.i.n.a may be considered free from pathogenic organisms, harbouring only the harmless v.a.g.i.n.al bacillus of Doderlein. After s.e.xual congress the v.a.g.i.n.a contains pathogenic organisms, and in conditions such as carcinoma of the cervix and body of the uterus, and in all forms of vaginitis, many varieties of bacteria are present in great numbers.

The normal uterus is germ-free; in fact the external os uteri may be said to divide the bacteria-free from the bacteria-containing area of the genital ca.n.a.l. But in carcinoma and in the various forms of septic endometritis, the uterus not only contains many pathogenic bacteria, but acts also as a continual source of infection to the v.a.g.i.n.a and external genital organs. It follows, therefore, that this area may be exceedingly difficult to render sterile, and in certain conditions this is indeed impossible. None the less, every effort should be made to attain this object; for even if the organisms cannot be entirely removed, yet their numbers can be considerably reduced, and it must be remembered that the action of septic organisms is, to a great extent, directly proportionate to their numbers.

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