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for the operation. The operation was performed poker freezeout wiki in an appar-
ently most unfavorable case, but the patient recovered.
Dr. Malcolm McLean, with all respect to Dr. Barker, must game poker texas free
say that he had had better results in laceration of the perinwum
when he inserted a single silk suture immediately after its oc-
currence than when he trusted simply to cleanliness. The sut-
ure should be deeply and properly placed, and without undue
disturbance to the patient. He would not use silver wire.
Nowadays women felt that the obstetrician had not done his
duty poker casino new york when he left a laceration unrepaired.
Dr. game poker texas boyaa resorts world casino new york video poker H. J. BoLDT protested against the primary operation for '
lacerated cervix, except when there was profuse hsemorrhage.
Dr. Polk, being asked by Dr. Barker his present opinion re-
garding the primary operation for laceration of the perinieum, practice shamrock 7 poker games
said that, unless, as occurred in exceptional cases, there were
shock and exhaustion contra-indicating it, he would close the
wound with silk sutures, not wire.
Dr. Lee did not think it advisable to repair mere abrasions
of the fourchette, but his experience in an institution where
many primiparte were confined, and in private practice, had
confirmed the advantage of the immediate operation in more
marked lesions. He continued the chloroform which was usu-
ally called for during delivery in such cases, turned the patient
across the bed, and in a few minutes the operation was done.
The preparations for the operation were made before the con-
finement. He did not use silver wire.
ALUMNI ASSOCIATION OF THE WOMAN'S HOSPITAL.
Cicatricial Tissue in the Lacerated Cervix Uteri.— Dr.
W. Gill Wylie said that, in a paper read before the New
York County Medical Society in November, 1881, and pub-
lished in the "American Journal of Obstetrics and Diseases
of Women and Children," vol. xv, January, 1882, he had en-
deavored to show that it was diseased gland follicles in the
angle, rather than a cicatricial plug, that caused the trouble.
Undoubtedly an imperfectly developed cervix, or one indurated
and rendered inelastic by disease of the gland follicles, was quite
certain to be torn. Or, if a cervix was torn, and septic endo-
metritis, even of a very mild type, followed the labor, the torn
tissue would not heal, but become chronically diseased. Unless
a tear was associated with diseased tissue, it would do no harm
except in those cases in which the sphincter power of the cer-
vix was injured, unless the tear extended to the vaginal junc-
tion or to the OS internum. As a rule, his object in operating,
in almost all cases, was to heads up poker machine strategy remove the diseased tissue rather
than to close the laceration. The hardened tissue at world series of poker app free download the hot-
PROCEEDINGS OF SOCIETIES.
[N. Y. Meu. Jour.,
torn of the angle was indurated muscular tissue, which was very
hard and tough when normal. A sharp knife, properly used,
could he made to take out a clean-cut triangular piece, when, if
scissors were used, it must be dug out with the points, and was
a ragged ping.
Dr. Clement Cleveland, of New York, said that his views
were in hannony with those of the author on this question.
When he left the Woman's Hospital as an interne he left it
fully believing in Dr. Emmet's views, and a considerable expe-
rience since then had only strengthened that belief. He did
not think, however, that the cicatricial plug alone did the harm.
In most cases there was more or less subinvolution, which played
its part as well as the cicatricial plug. He did not regard it as
necessary to remove every particle of the cicatricial tissue. It
was important to remove a large portion of the mass, but, if a
little only was left, he thought absorption would go on in that
as well as in the remainder of the subinvoluted uterus.
Dr. P. H. Inoalls, of Hartford, thought that removal of the
cicatricial plug, or, at any rate, of the diseased tissue, whether
cicatricial tissue or diseased glands, would often cure the
patient, even though the operation for laceration failed. He poker casino online
had had one such case, having been compelled to operate too
soon, as the patient had to return to her home. He removed
the dense tissue, and thought all was cut away, but the wound
did not unite. There was, however, marked relief from the
nervous symptoms. He had not casino poker near chicago seen the patient since, and was
unable to say wliether the subinvolution disappeared.
Dr. Geokge T. Harrison, of New York, had had extensive
opportunity for observing the eftect of laceration of the cervix
associated with cicatricial tissue, not only in his own practice,
but also in the public and private hospital practice of Dr. Em-
met, and he had seen such benefit follow the operation as per-
formed by Dr. Emmet that he was compelled to acknowledge
the importance of the cicatricial plug, casino arizona indian bend poker room or whatever name it
might receive. The most marked results from the operation
were obtained in cases ameristar casino east chicago poker room of extensive laceration giving rise to
parametritis. There was not only great improvement in the
general condition of the patient, but also relief from reflex neu-
roses. This experience was similar to grand poker casino online that of Dr. Bradsky.
Last December Dr. Harrison operated upon a patient who, be-
fore being ancesthetized, seemed to have only a slight laceration
of the cervix; but, after she was put under the influence of
ether, a very considerable amount of cicatricial tissue was
found. The patient had been suffering from leucorrhcea and a
variety of symptoms, and the relief which followed the opera-
tion was very great.
Dr. Charles H. Riley, of Baltimore, referred to a case in
which a physician had free poker game download play offline operated upon a patient for lacerated
oei-vix, but had failed to remove the cicatricial tissue, and she
had suffered more after the operation than she had before. The
case illustrated very well the fact that, when cicatricial tissue
was present in considerable best poker games in vegas poker casinos in southern california poker casino arizona quantity after an operation, the
operation should be repeated.
Dr. William H. Baker, of Boston, thought the ordinary
operation for laceration of the cervix uteri was especially indi-
cated in the cases related by Dr. Moseley, and that it did good ;
but could we reason, from the fact that good results followed
in these cases, that it was positively the cicatricial tissue which
had caused the symptoms? The last case related Iiy the author,
the one operated upon three times by Dr. Emmet, and also the
case referred to by Dr. Riley, lent pertinence to this question.
Dr. Baker had recently had a similar case. The patient had
been operated upon by some physician, apparently successfully,
except that her symptoms had continued. Subsequently, other
measures having failed, a second operation was performed, at
which a cicatricial plug, of about half the size of the last
phalanx of the little finger, was removed, and the patient left
the hospital completely relieved. Dr. Baker thought there
was something in addition to cicatricial tissue in the cervix
which gave rise to the symptoms. The preponderance of tissue
in the cervix was connective rather than muscular, and a lacera-
tion established hyperaemia, which resulted in hyperplasia of
the connective tissue. Afterward there was contraction, and
the density of the structure was then such that it became diflB-
cult to distinguish it from a true cicatrix.
Dr. A. B. TowxsHEND, of New York, said that the point
made by Dr. Ingalls, that, a large amount of tissue being re-
moved, improvement would follow, although the wound did not
close, was well illustrated in a case that occurred in Brooklyn
about two months ago. The patient had been operated upon
about a year ago by the most superficial denudation, leaving the
dense tissue behind, and covering it by the mucous membrane.
The laceration was posterior. He found that the woman was
completely run down, and suffering from all the reflex symp-
toms imaginable. He operated, and left an excavation, after
removing the cicatricial tissue, which was alarming. The wound
was closed as well as possible. About the seventh day poker games practice after the
operation the patient had a considerable hajmorrhage. The
stitches, or a part of them, had given way, and since then the
closure had been by granulation, just as it, probably, had taken
place after types of poker games at casinos the original tear. But the patient had been relieved
of all her nervous symptoms. It seemed probable that the
pressure of the cicatricial tissue, rather than the original tear,
had caused the symptoms.
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