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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![an opinion as to the cause of the abdominal enlargement. Thia woman thinks herself pregnant, and with this hypothesis there is no difficulty in accounting for the protuberant abdomen. But, from a very thorough examination before introducing the patient here, I have come to a differ- ent conclusion, and do not think the enlargement is due to pregnancy. [Here the patient was placed on the bed, and particular attention directed to the appearance of the abdomen ; the aspect presented was that of a six months' gestation, the fundus of the uterus being on a level with the umbilicus, &c] It seems to me that this case involves two considera- tions : 1st. Is the enlargement of the abdomen dependent upon enlarge- ment of the uterus 1 2d. If so, what is the cause of the uterine develop ment ? You should remember that the abdomen may become increased in size from various conditions, such, for example, as pregnancy, ascites, ovarian disease, tympanites, enlarged liver, a fatty omentum, physometra and hydrometra; hydatids of the uterus; from various morbid growths, polypus, sub-mucous fibrous tumor, sub-peritoneal tumor, interstitial tumor of the uterus, &c. The question, then, for us to determine is, as to which of these causes is in operation here. I have examined this patient both by the vagina and rectum, and I have very distinctly ascer- tained that the uterus is enlarged in size corresponding with the develop- ment of a six months' gestation. The cervix and body of the organ present no evidences of disease. I have made repeated attempts to rec- ognize the pulsations of the foetal heart, both by mediate and immediate auscultation ; in this I have failed. I have failed, also, in detecting either the active or passive motion of the foetus ; although the breasts are en- larged, there is an absence of the true areola, which I hold, with Mont- gomery and others, to be almost characteristic of pregnancy ; neither have I succeeded in detecting the bruit placentaire, that peculiar souffiet connected with the utero-placental circulation. In percussing the enlarged uterus, there is a dull, flat sound—no resonance ; and, therefore, I conclude it is not a case of physometra, which consists in a collection of flatus within the uterine cavity. So far there has been no flooding, and, therefore, I infer it is not a polypoid growth, or a sub-mucous fibrous tumor of the uterus, the prominent and almost universal characteristic of which is profuse hemorrhage. So, gentlemen, I might proceed with an analysis of the various causes of uterine enlarge- ment, but I do not deem it necessary. My own opinion is, that this patient is affected with hydatids of the uterus ; and this view is based upon what my examination has revealed—in the first place, an entire absence of all the characteristic evidences of pregnancy ; and secondly, an absence of the other morbid phenomena capable of producing enlarge- ment of the organ. There is one peculiar symptom of hydatids of the uterus, and that symptom is present in this case—I allude to the period- ical discharge of water per vaginam. It is not difficult to explain this discharge of water Uterine hvdatids usually consist of small oblong](https://iiif.wellcomecollection.org/image/b21034357_0064.jp2/full/800%2C/0/default.jpg)
