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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![caused it, my good woman? Indeed I do not, sir, except it was hard work. It is impossible, gentlemen to arrive at any accurate opinion touching the nature of this swelling without an examination ; for swelling in the lower part of the person, like swelling in any other portion of the sys- tem, may result from various causes, and assume various phases. [Hero the patient was placed on the bed, and the Professor commenced a care- mi examination of the tumor.] You perceive, in looking at the parts, that the tumefaction is seated in the right labium externum; it is coni- cal in shape, and its long axis is from above downward. In gently grasping the tumor, there is no pain, nor is there any evidence, from the aspect it presents, of inflammatory action. There is an entire absence of fluctuation, and the swelling is evidently movable ; for, as you see, I can make it ascend, and now it has completely disappeared. What, then, is this tumor; what its nature; in one word, what has produced it 1 This is the question for us to determine, and on a proper decision must depend the hopes of this woman for relief. Again, as I remove my finger, which acts as a sort of support, the tumor descends, and causes a protrusion into the labium externum. Madam, will you be kind enough to cough V You perceive, gentle- men, the effect of the effort at coughing 0n the swelling; its volume is increased by the cough, and there is an impulse imparted to the finger, as it grasps the base of the tumor. From this latter circumstance, to- gether with the important fact that the tumor can be made to disappear by properly-directed pressure upward, it is very evident to my mind that the swelling in the labium externum is occasioned by a hernial pro- trusion into that part. I have already spoken to you of the various morbid conditions capable of giving rise to enlargement of the labia ex- terna, and shall not refer to them again, except simply, to remind you of the great necessity of accurate diagnosis in these cases.* But in the present instance, the enlargement is unquestionably due to a hernia, and this is a subject of too much interest to be passed by in silence. Hernia into the labium externum was first described by Sir A. Cooper, and he gave it the name of pudendal hernia: it is of extremely rare occurrence, and, therefore, the case before us is of more than ordinary import. It is sometimes called, when the protruding body consists of intestine, vulvar-enterocele, and when the bladder is thrust into the labium, as is alleged has taken place, it is known as vulvar-cystocelc. In pudendal hernia, the displaced mass descends between the vagina and ramus of the ischium, and forms in one or other of the labia an ob- long tumor, which can be recognized by the touch within the vagina, as high up as the os uteri. In carrying my finger along the vagina, I can very distinctly trace the tumor on its internal wall as far as the neck of * See pages 340-406](https://iiif.wellcomecollection.org/image/b21034357_0586.jp2/full/800%2C/0/default.jpg)
