THE IMMEDIATE CLOSURE 
OF 
LACERATION OF THE CERVIX. 
BY 
H. J. GARRIGUES, M.D., 
New York. 
[Reprinted from the American Journal of Obstetrics and Diseases 
of Women and Children, Vol. XXIV., No. 11, 1891.] 
NEW YORK: 
WILLIAM WOOD & COMPANY, PUBLISHERS, 
56 & 58 Lafayette Place. 
1891 THE IMMEDIATE CLOSURE 
OF 
LACERATION OF THE CERVIX. 
BY 
H. J. GARRIGUES, M.D., 
New York. 
[Reprinted from the American Journal of Obstetrics and Diseases 
of Women and Children, Vol. XXIV., No. 11, 1891.] 
NEW XrORK: 
WILLIAM WOOD & COMPANY, PUBLISHERS, 
56 & 58 Lafayette Place. 
1891 THE IMMEDIATE CLOSURE 
OF 
LACERATION OF THE CERVIX. 
Akterial hemorrhage from the cervix is a rare occurrence, 
but sometimes it will occur, and is then a serious thing. A 
few months ago I had such a case, in which the patient came 
very near losing her life. There had also been a laceration 
of the perineum due to the large size of the child. This I 
united with three sutures, and it took some time before I 
realized that there was a source of hemorrhage above the 
united perineum. Loath to sacrifice the work just done, I 
tried first hot-water injections, and then styptic injections 
with diluted liquor ferri chloridi; but the bright-red blood 
continued to flow in a little steady stream, and it became 
necessary to sacrifice the perineum and. apply a tampon. 
When such an accident happens in a hospital it is a small 
matter to lay the patient in Sims' position, introduce his 
speculum, and unite the torn cervix with silver wire. It 
is easily done, it is safe, and is a sure cure. But in private 
practice it is not always feasible, and then tamponade may 
be of the greatest value; but to be effectual the vagina should 
literally be packed full with cotton wrung out of a one-per- 
cent solution of creolin. The tampon must extend through 
the whole vulva out to the lower edge of the labia majora, 
and then a piece of muslin should be pinned very tightly to 
the binder in front and behind, so as to combine pressure 
from without with that against the vaginal wall and the 
styptic effect of the creolin. 4 
GARRIGUES : CLOSURE OF LACERATION OF THE CERVIX. 
The immediate closure of the lacerated cervix with silver- 
wire sutures was practised and recommended by tlie late Dr. 
Fallen 1 in 1874. 
There is no danger that the suture will cut through. On 
the contrary, the cervix becoming smaller every day after 
the birth of the child, the sutures will rather become loose, 
but before that happens union will have taken place. 
In my opinion hemorrhage due to the laceration should be 
the only indication for the immediate closure. I am con- 
vinced from personal experience that many lacerations heal 
spontaneously, so that an operation would be superfluous. 
Furthermore, the immediate closure of the lacerated cervix 
exposes the woman to infection. My rule is, if it can be 
avoided, never to introduce as much as a finger into the par- 
turient canal after the birth of the child. The placenta is 
expressed by Crede's method. After the expulsion of the 
child the parturient canal is full of wounds and abrasions, and 
there is a strong current of blood and lymph toward the in- 
terior of the body. At no time is the susceptibility for in- 
fection greater. 
In this respect there is a fundamental difference between 
the immediate perineorrhaphy and the immediate trache- 
lorrhaphy. The former is an important prophylaxis against 
infection. By disinfecting the torn surface and uniting it 
we exclude a large area through which infection might take 
place, and the operation is performed in such a way that the 
deeper parts are not touched at all, and are even protected 
with a temporary antiseptic tampon above the torn part. In 
order to perform trachelorrhaphy we are, on the contrary, 
obliged to bring the cervix into view and to give the air- 
which, in my opinion, is often the carrier of the microbes 
that cause puerperal infection-access to the uterus. 
But if there is hemorrhage that resists hot water and styp- 
tics, it must be checked, and, performed with proper anti- 
septic precautions, I hold the primary trachelorrhaphy to be 
preferable to the tamponade. If the necessary instruments 
were not at hand, I would even prefer the application of one 
or two of Koeberle's serre-fines to the tampon, since it would 
not interfere with the free flow of the lochial discharge. 
1 American Journal of Obstetrics, 1879, vol. xii., page 322.