The diagnosis, pathology, and treatment of diseases of womem : including the diagnosis of pregnancy / by Graily Hewitt.

  • Hewitt, Graily, 1828-1893.
Date:
1872
Catalogue details

Licence: Public Domain Mark

Credit: The diagnosis, pathology, and treatment of diseases of womem : including the diagnosis of pregnancy / by Graily Hewitt. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    704/760 (page 678)
    or with imperforate condition of the os uteri. Incomplete (i.e permeable) congenital stricture of the vagina miglit be confounded with obstruction from resistant hymen. The diagnosis in these several instances would be made out by careful combined examin- ation by the vagina and rectum. The finger being introduced into the rectum, the observer is enabled to determine whether the obstruction felt be really the extremity of the vagina or not; the position of the uterus would indicate this clearly enough. The cases of acquired complete stricture of the vagina are very easily distinguished from those of the congenital variety by the circumstance that in the latter cases the patient has never men- struated. In acquired stricture of the vagina the canal at the seat of the stricture is generally irregular in form and shape, contorted or knotty, and firm fibrous bands are to be felt under the finger. The seat of the stricture may be high up in the vagina, or low down; any part of the canal may be affected. Menstruation more often still persists, but the stricture, if complete, causes complete suppression; and, moreover, the patient in the latter case remains afterwards sterile. The history very generally points conclusively •to the diagnosis in these instances of acquired stricture of the vagina. Extreme narrowness of the vagina, hardly amounting to stric- ture, may be met with, the canal being quite patent, although exceedingly small; the condition simply interfering with due performance of sexual intercourse, though not necessarily with impregnation. It has importance, for this reason in the first place, and in the second from the circumstance that when the vagina is very narrow it is also often short, and the uterus is found imperfectly developed. All degrees of this narrowness may be met with in different cases. It may be worth while in this place to mention the fact that, in cases of vaginal stricture or narrowness, sexual intercom'se has been known to have been effected by the urethra; the latter canal has in such cases been found to have undergone gi-eat dilatation. The treatment of these various conditions will be considered presently.