VESICO-VAGINAL FISTULA* 
BY F. W. P. BUTLER, M. D., U. S. A. 
While practicing in civil life in my native town, I find, 
in referring to iny notes, a very interesting case. On 28th 
March, 1888, I was called in the country to see G. D., who 
was in labor. She was 29 years old, and had had five chil- 
dren, two born dead and one miscarriage. I reached my 
patient about dark and found labor progressing favorably, 
os well dilated and soft. I rode horseback, and failed to 
bring my forceps. Everything went well with the woman 
till about 2 A. M , when the uterus seemed to fall into 
a state of inertia. I waited on it for at least four hours, 
when 1 determined to return home, get my forceps and 
deliver the child. I mounted my horse, but before leav- 
ing gave the patient a full dose of Fid. Extr. Ergot and 
returned for my instruments, but left the suffering woman 
with a midwife. Before I got back the ergot had revived 
the contractions of the uterus, and the child was born dead. 
The woman appeared to be doing well on my first visit 
after delivery. I gave the usual directions under the cir- 
cumstances, and left her. About three days after my last 
visit I was sent for and found the woman unable to hold 
her water, saying she did not make water through the nat- 
ural way. As soon as I entered the room I recognized the char- 
acteristic odor arising from decomposed urine, which is famil- 
iar to most people. I concluded almost before an examina- 
tion that I had a Vesico-Vaginal Fistula case to deal with. 
Notwithstanding this, I proceeded to make a thorough ex- 
amination. 1 noticed considerable irritation about the 
labia, due to constant incontrollable flow of urine. My 
forefinger told me of a decided rent in the vaginal walls, 
adjoining the vesical walls. I judged the opening to bo 
about the size of a five cent piece, and the uterine sound 
was passed into the bladder and easily appeared into the 
vagina ; this was conclusive proof of the Vesico-Vaginal 
Fistula. It was evidently caused from long pressure of head 2 
Vesico- Vaginal Fistula—F. W. P. Butler, M. D., U. S. A. 
on the vaginal walls, and I would like to know from some 
of the older men if the administration of ergot previous to 
the total expulsion of the child had any thing to do with 
producing this fistula ? After having consultation with Dr. 
.J. W. Hill, wFio concurred with me in my diagnosis, I con- 
cluded to operate after preparing my patient for this diffi- 
cult ordeal. I administered a tonic with supportive treat- 
ment with a liberal and easily digestible diet, with fcopious 
hot water injections into the vagina. The water I ordered 
to he strongly impregnated with red oak bark and carbolic 
acid, to the gallon of water, to be injected twice a day. 
This treatment was continued for a month and a half. Pre- 
vious to the day we had fixed for the operation I rode out 
and told the woman to come into town the next day in a 
wagon, with a mattress to recline on. The appointed day 
came, and at the elected hour the poor woman whom we 
expected to see on a wagon, arrived on us, having walked 
four miles in the hot sun, with little or no trouble. Every 
tiling was prepared for the operation, for my preceptor, Dr. 
Hill, had every modern facility for so large an operation. 
We determined to adopt Simons’ position, with patient 
upon her back, with raised hips and thighs flexed as far as 
possible upon the abdomen. 
The woman was thoroughly put under the influence of 
chloroform. I proceeded to pass the sound into the ure- 
thra to locate the fistula, but I searched in vain, for the red 
oak bark and carbolic acid had not left enough opening 
even for the passage of a small size uterine sound. I gave 
it up and asked Dr. Hill to try his hand, and to our sur- 
prise he, too, failed ; so we were denied the interest and 
pleasure of the operation which we had looked forward to 
with so much anxiety and pleasure. Since I have delivered 
this woman of a child full grown, but dead. I used the 
forceps, after waiting a reasonably long time. She has no 
trouble with her urine, it having again assumed its natural 
exit. I would like very much to hear an expression of 
opinion in regard to the administration of Fid. Ext. of 
Ergot previous to a complete expulsion of the contents of 
the uterus. My experience has led me to adopt the plan of 
giving it before the third stage of labor. This, I know, is 
contrary to the latest mode of treatment.