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Bepeated examinations are necessary determine the size, seat, and complications the fistula, to determine in which position the fistula can best exposed, and decide beforehand upon the method operating.

Now as the patient's position. Dieffenbach, Jobert, Baker Brown and others prefer the simple dorsal or lithotomy position. Deep fistula? can well exposed anesthetization easy and rapid. But fistula? seated high cannot well-exposed from the inclination the pelvis. Simon has, therefore, introduced the dorsal position with the pelvis elevated that lies somewhat above the level the abdomen and chest.

The thighs are flexed upon the abdomen, and the legs are extended. Thus the field operation free, assistance can rendered with certainty, the use several specula and retractors pay for essay writing at the same time, possible, and narcosis well applied. Nevertheless the patient's position, even when the head supported a cushion, unpleasant and tiresome, and some patients feel sick for days after being in The lateral position much more convenient for the patient, and the side corresponding the fistula should selected. pay someone to write your paper Less assistants are needed, unconstrained, anesthetization can easily us essay writing service affected, and the height the buttocks can varied for higher or lower fistulae.

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For those unused the exposure the fistulse and the use instruments will present some difficulty in this position.

Sims its chief advocate. His pupil, Bozeman, has, however, selected the knee-elbow position, which Schreger, Wutzer, and Simpson had already employed.

Bozeman uses a special speculum consisting two lateral blades united a metallic bar, which bears the screw when dilated a certain extent, the blade for the posterior vaginal wall can inserted.

essay editing checklist Simon was convinced, seeing one Bozeman's operations, that with his position and speculum the fistula can admirably exposed, and the result every cut and every stitch can seen during the entire operation.

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But believes that very difficult handle the instruments, since Bozeman used the scissors in fistula which were easily exposable and took off considerable tissue, while Simon for various reasons prefers the knife, and spares the substance the septum as much as can. However that may the accompanying illustration from Neugebauer custom essay meister review plainly shows that the knee-elbow position the least convenient all for the patient, the worst for anesthetization, the most complicated in the apparatus requires, and the most annoying for the operator, since the legs are here more in the way than in any other position. These are serious objections help essay and since Bozeman in the competitive operations attained no better result than did Simon with his position, Simon's or Sims's positions are always preferred. After the patient has been placed in one or other these positions, she must held in the assistants. Since patients often make vigorous movements while narcotized, I have repeatedly tried means broad padded leather pelvic girdles, fasten the patient's pelvis the table, and prevent motion. But the girdle always pressed upon the abdomen between the anterior superior iliac spines, and several unpleasant cases of asphyxia while under chloroform occurred that I had give the Narcosis not always necessary. After the patient has been placed in the proper position, may proceed expose the fistula. Jobert and Simon drag down the uterus, while Bozeman and Sims not displace the fistula, but operate in situ. All operators first lift the posterior vaginal wall with a blade or plate, and then draw asunder the two sides with retractors. If the patient in Simon's or the lateral position, and the anterior vaginal wall falls down under the fistula, must elevated with one Simon's vaginal retractors, or may be lifted with a sharp hook. 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