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.

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    sisting for some time and increasing, would lead us to suspect retroflexion or retroversion to be present, an important fact, for in order to treat these cases satisfactorily, the early recognition of their true nature is necessary. The other signs of retroversion of the gravid uterus are, flattening of the hypogastric region, involuntary straining or tenesmus, dragging in the loins and groins, con- stipation, &c. Enlargement of the uterus, from the presence of fibrous or other tumours, may also produce difficult mictm-ition; indeed, this symptom is very commonly observed in the early stage of this affection. In cases of fibrous tumour of the uterus, a curious phenomenon is sometimes observed, not, probably, peculiar to these tumours, namely, the manner in which ability to evacuate the bladder is affected by the position of the body. Thus, a lady who consulted me had had a large fibrous tumour of the uterus for seven yeai^ ; of late there had been occasional difficulty in micturition, which she had always been able to overcome by lying flat on the face. Here the uterine tumour was moveable, and when tlie patient threw the body forwards the pressure of the uterine tumour was removed from the vesical outlet. Sir C. M. Clarke records a case in which the patient was capable of voiding small quantities occasionally if she lay on the back with the pelvis a little raised.* (See also p. 135, where a very interesting case of retention of urine is related.) During the descent of the foetal head through the pelvis in labour, there is difiicult micturition, the canal of the urethra being partially or completely occluded by pressure. In prolapsus of the bladder (cystocele) the same symptom is observed ; the position of the urethra is here precisely the opposite to that in retroflexion of the uterus, the canal being bent down- wards instead of upwards. In these cases of cystocele the patient evacuates the bladder by simply pushing the tumour upwards; this restores the urethral canal nearly to its normal position. Tumours of the ovaries, as'long as they remain in the pelvis^ frequently occasion great difficulty in micturition; when, in process of growth, they rise above the pelvic brim, the pressure on the lu-ethra is removed, and, so far as the symptom now alluded to is concerned, the patient improves. In short, difficult micturition may be caused by any tumour in the pelvis capable of exerting pressure on the canal through which * Oja. cit. p. 254.