The principles and practice of obstetrics / by Gunning S. Bedford.
- Gunning S. Bedford
- Date:
- 1863
Licence: Public Domain Mark
Credit: The principles and practice of obstetrics / by Gunning S. Bedford. 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.
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![(wo months, has no appetite, and complains of dragging pains about Lot back and hips. How long, my good woman, since you first experi- enced these disagreeable feelings of which you speak ? I have had them, sir, ever since the birth of my last child, which is now three months old. Do you know what caused them in the first instance ? About two weeks, sir, before my last confinement, I was lifting a heavy tub of water, and I felt as if something gave wTay, and ever since that time my womb has been down, and I have been a great sufferer from constipation, and bearing-down pains. It does not follow, gentlemen, because this poor woman says her womb is down that she is really affected with prolapsion of this organ ; and, therefore, in order that we may know her true condition, it will be necessary to make a critical examination of her case. [The patient was placed upon the bed, and the professor proceeded with the investi- gation.] There is, as you perceive, a tumor projecting beyond the vulva, equaling in volume the ordinary fist. It projects from the posterior portion of the vulva, and is increased in size by any effort of the patient, such as coughing, straining, etc. Now, the interesting question for us to determine is, What is this tumor ? In carrying my finger into the vagina, and directing it toward the uterus, I find this latter organ in its proper position ; therefore, I know that the tumor is not a prolapsed womb. It is not a polypus, nor an ordinary fibrous tumor, nor is it an abscess, for it does not possess the characteristics of these various mor- bid conditions. What, then, is it? Is it a prolapsion simply of the vaginal mucous membrane, or is it a prolapsion into the vagina of the rectum itself? In order to ascertain whether there is really a prolapsion of the rectum into the vagina, constituting the tumor now before us, there is a very certain method of diagnosis. I introduce my index finger into the rectum ; then, carrying it forward, direct it toward the vagina, and, as you now see, pursuing this direction, the finger passes into the vagina, the only intervening substance between it and the vagina being the anterior wall of the rectum, which is thrown forward, forming the tumor of which this woman complains, and which she has supposed to be falling of the womb. This is an extremely interest- ing case, and one of more than ordinary importance. The trouble with which this patient is affected is what has been termed by Mal- gaigne a vaginal-rectocele, which means literally a tumor of the rectum in the vagina. This clever French surgeon* was3 I believe, the first to describe accurately this particular form of tumor. The vagina may become the scat of various protrusions, forming, in a word, so many vaginal hernia?,: for example, there may be prolapsus and procidentia of tin- uterus ; prolapsus and inversion of the mucous mem brane of the vagina ;f prolapsus of the ovary or intestine Into the tri- * Memoirea de l'Academie Royalo de Medecine. tome vii. p. 506. \ See pases 166, 462.](https://iiif.wellcomecollection.org/image/b21034357_0581.jp2/full/800%2C/0/default.jpg)
