Diseases of women : a handbook for physicians and students / by Dr. F. Winckel ; authorized translation by J.H. Williamson ; under the supervision and with an introduction by Theophilus Parvin.

  • Franz von Winckel
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of women : a handbook for physicians and students / by Dr. F. Winckel ; authorized translation by J.H. Williamson ; under the supervision and with an introduction by Theophilus Parvin. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    44/712 page 30
    Treatment.—That the physician may be forced to operate, even in cases of monstrosities with the above-mentioned deformi- ties, is proven by that of Olshausen.* Here, owing to the complete absence of the vulva, the bladder, uterus, tubes, and intestines were so distended with urine that it was necessary after the head was born to open the abdomen and remove part of its contents before the body could be delivered. Should the uro-genital sinus persist, the intestine opening into its lower end, the latter may be freed and made to unite with an opening in the skin at the normal position; the narrow genital canal may then be dilated. An operation is decidedly indicated if there be a defect in the superior wall of the urethra, i. e., epispadias, for these patients generally suffer much inconvenience from dribbling of urine. By forming a superior or lateral flap, and liberating the posterior wall of the urethra, and then carefully uniting the two, a normal urethra may be made. Roeser has performed this operation suc- cessfully^ and K. Schroeder reports two successes where the mons veneris and clitoris were cleft, and the anterior wall of the urethra was wanting.^ Kleinwachter's patient, fifteen years old, persistently refused to be operated upon, notwithstanding con- stant dribbling of urine.§ As a matter of course no operation is admissible in herma- phrodism. The diagnosis is of most importance in early life, on account of the bringing up ; later, because of the ordinary duties of the individual, and not at all infrequently on account of in- tended marriage. It is, however, often impossible to determine the sex, even after the most thorough examination. The final conclusion should be based not only upon inspection, the sounding of all canals, palpation and examination per rectum, but all the secretions of the individual must be examined with the microscope and reagents, all of which may require months of close observation. Success may not attend our efforts even then, as has recently been proven by Sippel's case.|] * Archiv, ii., 280. f Wiirtemberger Correspondenzblatt, 1,881, No. 20. X Lehrbuch der Gyn., V. Auflage, p. 510. g Monatsschrift, 34, p. 81. || Archiv fur Gynaecol., xiv.
    digitised image 1
    digitised image 2
    digitised image 3