On the diseases of women : including the diseases of pregnancy and childbed / by Fleetwood Churchill ; a new American edition, revised by the author, with notes and additions by D. Francis Condie.

  • Churchill, Fleetwood, 1808-1878.
Date:
1852
Catalogue details

Licence: Public Domain Mark

Credit: On the diseases of women : including the diseases of pregnancy and childbed / by Fleetwood Churchill ; a new American edition, revised by the author, with notes and additions by D. Francis Condie. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

    84/708
    undiscovered until some mechanical difficulty caused by their presence, or an examination for another purpose, leads to their detection. The mechanical symptoms may rise from pressure on the rectum or bladder impeding the evacuation of their contents, or from the obstacle to sexual intercourse; and labor may be rendered tedious or impracti- cable by the diminution in the caliber of the vaginal canal. I have once or twice found the uterus very much displaced in consequence of the lateral and upper portion of the pelvis being occupied by one of these tumors. In addition, the patient will occasionally complain of a weight in the pelvis, and perhaps of darting pains. There is generally an increase in the natural secretion of the part, but seldom to any great amount. The tumor will be discovered by an internal examination, and its situation, extent, and sometimes its character, may be determined. Many years may elapse without any change in the disease, with very little inconvenience, and no danger. It has sometimes happened that the encysted tumor has been ruptured, and is either refilled or healed up. In the fungus or carcinomatous tumors alone have we to fear ulceration, and when it does take place, it is accompanied by a series of symptoms to be hereafter described. (See Cancer Uteri.) 92. Diagnosis.—Any of the circumstances which have been mentioned, as calling our attention to this disease, requires an immediate internal examination, which will discover the seat and generally the nature of the obstruction. The acute symptoms which accompany the formation of an abscess between the vagina and rectum, the time of its occurrence, its cause, and the peculiar course will enable us to distinguish the tumors I have been describing from that disease. The state of the uterus should be carefully ascertained, as it may throw light upon the diagnosis. 93. Treatment.—If the patient be not pregnant, nor in the way of becoming so, and if the symptoms (mechanical and pathological) be slight, it will scarcely be advisable to interfere, unless, indeed, the tumor be of that form and in that situation which will render its removal easy (as, for example, in polypus of the vagina), or its contents of that character which will afford a probability of their evacuation by puncture, and of the subsequent obliteration of the sac. In such cases, either operation (excision or puncture) may be performed, and in the manner most likely to insure success. But the case is otherwise if the patient be pregnant. From a careful comparison of the cases on record, with the results of different plans of treatment, it is evident that if the tumor contain a fluid, it ought to be opened,1 or if it be solid and removable without much difficulty, it should 1 Three years ago I was called to a case of difficult labor, but made no examination, the child having been delivered by the perforator and crotchet prior to my arrival. A year afterwards the patient was delivered of an immature but living child. The succeeding labor commenced on Friday, the 20th Sept. 1835, and her surgeon was summoned about 10 P. M. My attendance was requested at 8 o'clock the following morning. The pelvis, from the brim to the coccyx, was very nearly filled by a large and apparently unyielding tumor (not unlike B full-sized foetal head) bulging into the rectum, and, from its tension, supposed to • be altogether solid. The head of the child resting over the ossa pubis, could barely be distinguished, and tho pains had been very forcible the nine preceding hours. A long tro- car was passed (per rectum) into the tumor obliquely upwards, and on being withdrawn, ten or twelve ounces of dark serous fluid tinged with blood gushed out forcibly through the