Cold Douche: to perineumand testicles, in atonic types.
In short, it should be stated that, in order to determine the extent and significance of a mirror, it is necessary to consider the state of the perineum as to fat, and that of the fullness of the udder.
No veins are to be seen either on the perineum or the udder, while those of the belly are slightly developed, and the mirrors are ordinarily small, as in cut L.
The veins of the perineum are not apparent, and those which run along the lower side of the abdomen are small, straight, and sometimes unequal.
These are really but leggins, which run only to the perineum and are simply tied by outer points to a strap from each hip.
The surface between the vaginal orifice and the anus is called the perineum (Do not confuse this with the peritoneum, for they are entirely different).
As the head presses hard against the perineum it tears it.
It is this perineum that sometimes becomes torn during childbirth.
The perineum is the support for the organs of generation and if it is not solid the ovaries, tubes, womb and vagina will sag and fall.
The head advances more and more with each succeeding pain, and the perineum is put on the stretch, each contraction is followed by a resting pause during which the head slips back a little and relieves the perineum.
The head advances with each pain and again recedes until the parts are properly dilated, and the perineum slips backward over the child's face.
A little time and care at the time of labor will save the perineum and every woman is willing to do her share when the conditions are plainly explained to her.
The edge of the perineum should now be closely watched.
In this way the perineum will dilate properly and be torn little, if at all, and perhaps much future trouble for the woman saved.
For retention of urine, place a poultice in the perineum or over bladder on the abdomen.
A small towel wrung out of a bowl of hot water placed handy on a chair, should be held constantly against the perineum to hasten the softening and dilatation of these tissues.
The perineum should be guarded also while the shoulders are being born as it can be torn by them.
A torn perineum is not desirable, because even when sewn up immediately after labor, it may not unite thoroughly, and thus cause displacements of the womb in the future.
Tear of the perineum allows the bottom of the pelvis to relax.
The perineum and cervix are sometimes torn during labor and should be immediately repaired.
This lessens the pain and the child's head emerges slower, and the perineum is saved.
Place the left hand on the belly, about two inches above symphesis and push the soft parts down with the left hand; support the perineum with the right hand until head passes over.
There is no danger of hurting the perineum now since the head has passed the soft parts.
The same general principles apply to the preparation of patients for operations on the perineum and vagina as for operations on other parts of the body.
Cases in which the perineumis apparently intact, but in which the sphincter is not united= (Figs.
The uterine fundus is then anteverted by means of a sound: by pressing the handle of the instrument towards the perineum the fundus is brought into the wound.
These are the cases in which a complete laceration of the perineum is apparently completely healed after operation, but the patient finds that she has incontinence both of flatus and fæces.
The perineum anterior to the anus is firmly healed.
An anæsthetic was used and a cut made through the perineum from the outside into the bladder.
An operation for stone in the bladder in which the perineum and part of the urethra are cut; the prostatic portion of the urethra is dilated to introduce forceps and withdraw the stone.
After eight or nine weeks the catheter was removed, but it was four or five weeks before the wound in the perineum healed.
The wound in the perineum should be large enough to give free access to the urethra, and easy egress to the stone; (2.
If the perineum has not been previously shaved, this is now done.
The operator pierces the raphe of the perineum with a long straight bistoury about half an inch above the verge of the anus, enters the groove of the staff, and cuts inwards, almost, but not quite, into the bladder.
The perineum being shaved, an incision must be made in the middle line from over the point of the catheter to the verge of the anus, if the stricture extends far back.
The high heel of a French boot was driven through the perineum one inch from the median line, midway between the anus and the posterior commissure of the labia majora.
The attachment almost obliterated the vulva and the perineum was displaced far backward.
The raw surface was dressed, the gap in the perineum brought together, and the patient made complete recovery, with preservation of his sexual powers.
The perineum was deep and the tuberosities of the ischii unnaturally approximated.
Hamilton reports a case of laceration of the perineum with penetration of the pelvic cavity to the depth of ten inches by a stick 3/4 inch thick.
The perineum proper was absent, the entire space between the anus and the posterior edge of the scrotum being occupied by the pedicle.
The skin of the penis and the scrotum was entirely torn away; both sphincters of the anus were lacerated, and the perineum was divested of its skin for a space 2 1/2 inches wide.
Brown mentions a case of rupture of the perineum with birth of a child between the vaginal opening and the anus.
The mother suffered a deep laceration of the perineum involving an inch of the wall of the rectum.
The right meatus was normal, and through it most of the urine passed, though some always dribbled through an opening in the perineum at a point where the root of the scrotum should have been.
Brown describes a child with a swelling in the perineumboth painful and elastic to the touch.
Minot speaks of the passage of one prong of a pitchfork through the body of a man of twenty-one, from the perineum to the umbilicus; the man recovered.
This is also a very useful means of allaying irritation, especially the reflex excitability which is often present in the muscles in the vicinity of the perineum and prostate gland, and when there is pain and fullness in these parts.
When great local irritation exists, with considerable pain and spasmodic muscular action, the application of hot fomentations to the perineum will be found the most effectual means of giving relief.
He at the same time elevates the scrotum, and standing behind the patient, leaves the surgeon with both his hands at liberty, and with the patient’s perineum all clear.
On my return I found him insensible, but immediately turned him round in bed, and opened theperineum freely, giving vent to fetid urine, sloughs, and matter.
Leeches to the perineum and hypogastrium—soothing injections into the rectum—opium or hyoscyamus, either by the mouth or in the form of suppository—fomentation and the warm bath—are all valuable remedies in this affection.
The suppuration is often slow in its progress, and imparts to that part of the perineum a stony hardness.
All collateral sinuses extending towards the perineum and buttock must be freely divided, for they cannot be expected to contract otherwise.
Retention from abscess in the perineumwas formerly noticed.
When in the posterior part of the canal, they are reached by incision on the left side of the perineum and opening of the membranous portion.
The whole penis, scrotum, and perineum are swollen, but the swelling is hard, and most marked in the glans and along the course of the urethra.
Washing out the bladder with anodyne or other fluids, and the application of blisters to the perineum and neighbouring parts have been recommended, but are often more injurious than useful.
With this view the perineum is incised, similarly but to a less extent than in the lateral operation, and the membranous part of the urethra opened.
No bulging or fluctuation in the perineum is to be waited for.
In bilateral cases the trunk appears well grown in contrast to the short lower limbs, the hollow of the back is exaggerated, the abdomen protrudes, the perineum is broadened, and the buttocks are unduly prominent.
There is a deep groove at the junction of the perineum and thigh, great prominence of the trochanter, and the pelvis may be tilted to such an extent that the iliac crest comes into contact with the lower ribs.
The perineum (see anatomical Plate II) is only a small though strong part of the pelvic floor.
Lacerations of the perineum generally occur during confinement, in which the vagina tears through the vaginal orifice backwards towards, or into, the rectum.
I have seen the perineum torn asunder from this cause, from the vagina and back into the rectum.
It is the whole pelvic floor that supports the uterus and viscera, not the perineum alone.
As the head approaches the os externum our attention must be directed to giving the perineum such a degree of support, as shall secure it from any serious degree of laceration during its passage.
The greatest danger of ruptured perineum is in primiparae, for the soft parts never having been subjected to such a degree of dilatation before, do not yield so readily as in multiparae.
See an interesting paper "on Laceration of the Perineum during Labour; by Wm.
It appears to be essentially different from the common prurigo, being an aphthous state of the lining membrane of the vagina and skin which covers the perineum and external organs.
In complete fistula there may be more than one external opening, and this is in the majority of cases not far from the anus, but it may open in the perineum or upon any part of the gluteal region.
Fistula is quite common among the phthisical as a result of malnutrition and septicaemia, aided by the constant succussion of the perineum produced by efforts at coughing.
Patients now and again complain of "violent and painful pressure in the rectum, conjoined with active pains in the perineum and anus and in the sexual parts: these symptoms probably have a neuralgic character.
Prolapse of the rectum is common in children, and excoriation of the perineum by the acrid discharges is not infrequent.
Otis[44] has reported a case of malignant stricture in which he completely divided the recto-vaginal septum, sphincter ani, and perineum with great temporary relief to his patient.
An incision is then carried from the centre of the perineum along the raphe to the anterior margin of the anus, encircling the latter by two semicircular cuts and continuing the division directly back to the coccyx.
I have seen from twenty minutes to half an hour elapse in some cases, after the cord had ceased to pulsate, before the perineum would allow the head to escape, during which time the respiration was regularly performed.
The soft parts at the bottom of the basin of the Pelvis, consisting of the perineum and various muscles, are called the floor of the Pelvis--the only passage through which is by the Vulva, or mouth of the Vagina.
During the passage of the shoulders the perineum needs as much care as during the passage of the head, and must be supported in the same way.
Great caution should always be observed in using this powerful drug, as it will sometimes act so energetically as to burst the womb; or expel the child so suddenly as to lacerate the perineum and other parts.
When the perineum or Vulva remains rigid and hard, so that the opening cannot be enlarged sufficiently for the child to pass, it may also be necessary to operate with the knife.
The right hand is placed underneath, so as to push the head gently back, when it presses on the perineum too forcibly, before it is dilated; and also to elevate it towards the pubes.
In other cases the delivery has resulted so suddenly, from the violence of the expulsive efforts, that the vagina and perineum have been lacerated in the most shocking manner.
Keep the blade first introduced in its place with the two lesser fingers of the left hand, and carry the fore-finger of the same hand between the perineum and head of the child as high as you can reach.
Frequently bathing the thighs and perineum with cold water will be sufficient.
Sometimes it is necessary to support the perineum for hours, and to bestow constant attention the whole time.
The hand, in a conical form, and in a state of half supination, must then be pressed steadily forward with a semi-rotatory motion against the perineum and sides of the passage, till it clears the orifice of the vagina.
For want of these precautions there is often serious lacerations of the perineum and vulva, particularly in first labors, and when the parts are unusually rigid.
When the perineum is allowed to be torn, the most serious consequences often ensue, and the patient is made a miserable sufferer for life.
At this time great stress is brought to bear upon the perineum and often, in spite of anything that can be done to prevent it, the perineum is more or less lacerated.
When the head is passing the perineum the gas should be pushed to the point of anesthesia, while the patient's color will suggest the amount of oxygen to be used as well as serve to control the administration of the nitrous oxid.
Pressure of the seat of the chair upon the perineum also causes distress, so the man sits sideways and on the edge of the seat.
In the early stage of an acute attack a dozen leeches upon the perineum may do good.
