Clinical lectures on the diseases of women and children / by Gunning S. Bedford.

  • Bedford Gunning S., 1806-1870.
Date:
1872
Catalogue details

Licence: Public Domain Mark

Credit: Clinical lectures on the diseases of women and children / by Gunning S. Bedford. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    ing down.” “Do you have any difficulty in passing water?” “I want to pass it very often, sir, and that’s what gives me so much trouble.” “ Do you leave your bed frequently at night for that purpose ?” “ Yes, sir ; I am more distressed at night than in the day time with my water. I wish you, gentlemen, particularly to note this latter circumstance, I shall allude to it again in a few moments. “ Do you have any othei kind of pain than the forcing down of which you speak?” “Yes, sir; I have a dreadful dragging here [the patient places her hand on the um- bilicus], and it is always worse just before I pass my water.” This is another important fact, gentlemen, which 1 wish you to note, and to which your attention will be immediately called. “ Are you troubled, madam, with a discharge?” “Yes, sir; I have the whites.” You perceive, by the answers which have been elicited, only a part of the case now' before you. This patient has been told by her friend Mrs. Mulligan, and also by Mrs. Mulligan’s doctor, that she is affected with falling of the womb. This belief is strongly impressed upon the patient’s mind, so strongly, indeed, that she comes to the Clinique in the hope that she may obtain relief for this supposed affec- tion. Before presenting the case to you, I examined it thoroughly in the presence of my assistants, Drs. Martin, Savage, Butler, Steves, and Tichenor, and what do you suppose is really the difficulty under which this patient labors ? Ctwtainly not falling of the womb, for this organ ia very nearly in situ, but falling of the bladder. It is, 1 think you will agree with me, a matter of some moment to distinguish between the dis- placement of these organs. And what 1 wish more particularly to im- press on your recollection is this—never allow the declarations of your ■patient, or those of her friends, to form the basis of your own professionat opinion. For your own opinions you arc justly responsible; see, therefore, that they rest neither on ignorance nor conjecture, but that they stand on the broad foundation of truth. Falling of the bladder is not of frequent occurrence ; but when this form of displace- ment exists, it is extremely important that there should be no error in the diagnosis. Your own honor as practitioners, and the welfare of your patients call for this accuracy. Causes.—Any thing that is calculated to relax the walls of the. vagina will necessarily, more or less, predispose to fulling of the bladder; such, for example, as repeated births, too early getting up after delivery, etc. Carrying heavy burdens, severe fits of coughing, and constipation, may be enumerated among the exciting causes of this displacement. The bladder may be slightly prolapsed, or it may protrude beyond the vulva (as is the case in the patient before us), forming an external tumor. Symptoms.—In this form of displacement, there will be a sense of fullness and pressure downward, or, as the patient expresses it, a forcing down. This is generally more annoying at night, when the patient is in bed, than at any other time, for the reason that the protruded portion of
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