The admission of air is liable to cause decomposition of retained fluid, and this in time produces septicæmia. Further, the sudden admission of air where there has been none before is liable to cause inflammation of the lining membrane of the uterus and tubes, resulting in septic peritonitis. To avoid such risks as have been enumerated two plans are recommended by authors—one being a slow draining away of the menstrual fluid and the other its rapid evacuation and washing out of the uterus and vagina. Graily Hewitt makes an opening of a valvular character in the hymen, permitting only a slow escape of the fluid. Others use a small trocar and draw off the fluid slowly, and at different times if there is a large quantity.
The aspirator is to be preferred to the trocar for emptying the vagina, and of late years has been more generally used; either instrument, but especially the former, permits of the discharge of the fluid at different times, and in such quantities as the physician may desire, without the admission of air. The rapid evacuation is best represented by Emmet's mode of procedure. He first cuts the protruding membrane sufficiently to admit the index finger, and tears the tissues enough to allow the fluid to escape rapidly, and then washes out the vagina and uterus with warm water, after which he introduces a glass plug for the purpose of dilatation and to prevent the action of air upon the parts.
Atresia Vaginæ.
Atresia of the vagina may be congenital or accidental, and, like atresia of any other portion of the genital canal, may be partial or complete. In complete congenital atresia of the vagina an examination per rectum with the index finger fails to discover the fluctuation of menstrual fluid, as in atresia from imperforate hymen, but in its place can usually be felt what seems like a hard fibrous cord. If, however, this cannot be discovered, no doubt remains of entire absence of the vagina. Sometimes the cord can be felt a portion of the distance, which indicates that there is a corresponding portion of an undilated vagina.
In case of complete congenital atresia of the vagina an operation should be avoided, unless there is an accumulation of menstrual fluid or a uterus can be distinctly felt by rectal and vesical examination, or the patient is suffering from the absence of menstruation. To these may possibly be added instances, as mentioned by Thomas, where there exists an imperative necessity for sexual intercourse. Where there is no menstrual molimen or distension of the uterus cannot be detected, and there is non-development of the uterus and ovaries, as shown by the condition of the external organs, surgical interference should be indefinitely postponed.
Accidental atresia of the vagina may be produced by causes heretofore mentioned. When the canal, which has previously been pervious, is entirely obliterated from any cause, an operation becomes, as a rule, an imperative necessity by reason of the accumulation of menstrual fluid and consequent distension of the uterus and Fallopian tubes.
In partial or incomplete atresia it frequently happens that a sinuous canal remains which serves as a guide to the surgeon.
The reader is referred to systematic treatises on surgical diseases of women for the details of the various modes of operating for these affections.
Prolapsus Vaginæ.