Provincial Medical & Surgical Journal

fistulas connected with the bladder, uterus, and rectum, it is necessary not only to pare the edges of the fistula and to bring them in apposition by suture, but also to suzppb,from the adjacent parta the loss of substance which has taken place. M. Jobert maintains that all vesico-vaginal and vesico-uterine fistulas, except where the vagina is reduced to the size of a crow-quill, and even those fistulas in which the bladder, womb, and rectum, are all opening into one cloaca, are capable of alleviation by autoplastic operation, and that by means. of the univalve speculum, without having recourse to any division of the perinaeum, this operation may always be concluded. The results of Mi. Jobert's practice, as detailed by him, are so completely at variance with the acknowledged want of success in this country, in similar operations, that we can scarcely give ful credence to his assertions. But nevertheless, it is not because these accidents are the opprobria of our art in this country, that we should resolutely shut our eyes to what is. put forth in another, and therefore we have thought it right to draw the attention of those who may be called upon to treat any of the various forms of fistula, to the work of M. Jobert. In the treatment of vesico-vaginal fistula, M. Jobert leans to the simple occlusion of the os tinee, in which case the secretions from the lining membrane of the uterus are all poured into the bladder through the original fistula, and the incontinence of urine is got rid of,. which is the most disgusting symptom attendant upon these unfortunate cases; but in addition, he gives a method of operating, which, however, does not appear to partake of the nature of auEoplasty, but simply to consist in a tedious dissection and final paring of the lips of the fistula, which is then to be brought together by suture. In proceeding to operate upon those lamentable cases in which the vesico-vaginal septum is destroyed as well as the anterior wall of the uterus, M. Jobert sometimes malkes use of the neck of the uterus itself to supply the deficiency, and he finds that union by the first iutention is procured as easily as in any other itrieture. In other cases the labia are the parts which are compelled to take a new position in supplying the defective parts; and sometimes even the cellular couch surrounding the orifice of the urethra, with a part of that organ included. In the details of the operation M. Jobert is most minute; and as far as description can supply the place of ocular demonstration, his book wili be sufficient for all who may think it desirable to follow his steps. We may remind our readers, that the operations described have all, or nearly all, been performed in public, and that the treatise is published in Paris, where the correctness of the statements may easily ber ascertained.