[Reprinted from the (Chicago) Medical Current for October, 1886.] 
A PRIOR DISCOVERY. 
medical world is prolific in controversies over prior rtis- 
A coveries in medical and surgical methods, and we presume it 
will continue to be so till man shall have reached that stage of de- 
velopment in which his physical system will be impervious to decay. 
Gynaecology has been particularly fruitful in this respect. History 
shows that two men, in different parts of the world, may follow the 
same line of thought and reach the same conclusion without knowl- 
edge of each other. We believe also that it is a recognized law of 
courtesy, that to the one who first publishes his deductions belongs 
the honor of priority. This does not however, as we understand it, 
discredit the work of the later investigator, so that in calling the 
attention of the medical public to the subjoined comparative data, 
it is only to place on record, and give due credit to, the originator of 
this method of perinaeorrhaphy. 
From The Medical Current, January, 1886. 
METHOD OF PERINEOR- 
RHAPHY. 
reported for the medical current by 
THE EDITOR. 
/X 
JOHN W. STREETER, M.D., 
Professor of the Medical and Surgical Diseases 
of Women in the Homoeopathic Medical 
College of Chicago. 
The method of performing the opera- 
tion for repair of lacerated perinei as 
devised by Dr. Streeter, is to my mind 
superior to any I have ever seen others 
perform or figured in books. 
The patient is placed upon her back, 
the legs flexed upon the thighs and the 
thighs upon the abdomen. The opera- 
From the Canada Medical Record, June, 1886. 
A NEW METHOD FOR RELIEF 
OF RUPTURED PERINEUM. 
At a recent meeting of the Medico- 
Chirurgical Society 01' Montreal, Dr. 
Trenholme read a paper on this subject. 
He describes it as follows: 
I denude the surfaces to the fullest 
extent of the parts injured. This de- 
nudation is accomplished by the removal 
of the covering of the parts to be de- 
nuded, i. e., the cicatricial surface in 
one piece. For this purpose the first 
incision is made at the upper part where 
the edge of the skin coalesces with the 
cicatricial suaface; the knife is entj>fed 
at the highest point on the right side, tor having decided how much of the 
aperture to makes an incision 
along the mutO] cutaneous juncture, 
through the membrane. Then 
with a scalpel, but preferably a pair of 
blunt-pointed scissors, dissects up the 
mucous and submucous tissues in the 
form of a triangle, the base beijig at the 
outlet and the apex at the inlet of the 
vagina, leaving the margins which form 
the sides of the triangle and the apex in- 
tact. No tissue whatever is castaway, as 
in the ordinary method of operating. The 
divided tissue is now lifted up toward 
the symphysis pubis and the wound 
closed with silver sutures as in the or- 
dinary manner. To hold the muco- 
cutaneous margins together, two super- 
ficial stitches of silk, one on either side 
of the united perineal walls, are used. 
To summarize its points of excellence 
we would say : 
1. There is no delay for fear of non- 
union on account of capillary oozing, 
2. The separated tissue of the vaginal 
floor acts as a bridge to the wound and 
thus prevents any vaginal or uterine dis- 
charge coming in contact with the raw 
surfaces, thereby delaying or entirely 
preventing proper union. 
3. The care of the patient is much 
lessened, catherization and vaginal 
douching being absolutely unnecessary. 
and the incision brought down to the 
lowest part of the fourchette, where it is 
met by a similar incision on the left side. 
The lowest part of the angle is then 
seized with the forceps and carefully 
dissected upward, taking special care to 
remove the whole surface without incis- 
ing the flap; this dissection is carried on 
till the surface represented by the origi- 
nal wound is uncovered. 
[Here the Doctor gives instruction 
about inserting the sutures, which, with 
the exception that he uses shield sutures, 
does not materially differ from the or- 
dinary method.] 
The edges of the wound are co-apted 
by horse-hair sutures, and the' upper 
part of the flap and around the right and 
left side are secured by catgut sutures; 
this leaves the united surfaces in the 
shape of the letter T. The vaginal sur- 
face is perfectly covered, and in no way 
can a drop of fluid enter the wound or 
interfere with union by first intention. 
* * * * 
The objection to all other operations 
was that it left the vaginal incision 
open, which sometimes, therefore, inter- 
fered with union by first intention. 
* .* ' * * 
The following points are gained : Per- 
fect union; perfect restoration of the 
perinaeum ; no loss of substance, and no 
after-fever worthy of the name. 
That Dr. Streeter has practiced, and taught this method to his 
classes, for the past ten years, the students' note-books and the 
records of his dispensary and hospital cases will show. S.