Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

290/440 (page 272)

female geuerativo organs was recognised as a cause of hydro- nephrosis and confirmed by an autopsy, to Virchovj himself, who found in a woman, forty-three years of age, the subject •of an irreducible procidentia, the ureters much constricted as Jar up as the sacro-iliac synchondrosis, and the pelvis of the kidney dilated. This condition was explained by Virchoio from the circumstance that the base of the trigone, that is the spot where the ureters open, was drawn forwards beneath the symphysis pubis, necessitating compression and there- fore obstruction to the passage of urine. Virchow remarks, The possibility of such obstruction, and the production of hydronephrosis in cases of prolapsus uteri of this kind, is well worthy of attention in practice, though not hitherto men- tioned. It stands on the same footing as the hydronephrosis, which so very often accompanies cancer of the womb, and which is also usually disregarded. This hint by Virchow has, however, attracted little notice, for apart from his own observation I have been able to find only one solitary notice of the same kind by Philipps (105), who found in a 4 para thirty-five years of age (who had suffered since her first confinement from procidentia of the uterus and died coma- tose), the capsule of the kidney adherent, the glandular substance much contracted, the pelvis dilated, the pyra- mids flattened and changed into cavities, hardly a quarter of the glandular substance left, the mucous membrane of the ux'inary passages thickened, the ureters dilated to the thick- ness of a finger. The ureters and bladder contained milky purulent u.rine, the muscular tissue of the bladder was hyper- trophied, the uterus lay in front of the vulva as large as an apple. The procident mass consisted of the neck and part of the posterior wall of the bladder in front, and of the pos- terior vaginal wall and greatly thickened peritoneal covering of Douglas's pouch behind. The orifices of the ureters were found beneath the pubic arch and had thus been exposed to a considerable pressure. Although in this case the mechanical cause of the pro- duction of the hydronephrosis doubtless consisted in com- pression of the ureters against the pubic arch, as is proved by the dilatation of the ureters down to their vesical orifices, in other cases it seems to consist in occlusion of the