On the retention of urine in the female / by J. Halliday Croom.

  • Croom, J. Halliday (John Halliday), Sir, 1847-1923.
Date:
[1878]
Catalogue details

Licence: Public Domain Mark

Credit: On the retention of urine in the female / by J. Halliday Croom. Source: Wellcome Collection.

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    Case 2.—Retroversion of Gravid Uterus. Retention of Urine. Abortion. Margaret R, set. 35, consulted me in August of last year about a constant pain in her back and occasional difficulty in passing her water. In other respects she was in good health. Her menstrua¬ tion, which had been regular previously, had been suppressed for a month. She had been delivered of a child ten years before at full time. On examination per vaginam I found the vagina capacious, the rectum packed with hardened fseces, and the cervix, which was that of a multiparous woman, directed forwards. I felt the fundus uteri directed backwards and enlarged. Owing to the loaded con¬ dition of the rectum the examination was somewhat unsatisfactory. I therefore asked the patient to return the following day, after having taken a purgative dose of medicine. She did not, however, return to see me, and I heard nothing of her until I was asked to see her in September, a month later. I found her in- bed, moaning heavily, with a high pulse, complaining of bearing down, tenesmus, and much pain in the back. She had been unable to pass water for two days. She said she had suffered from slight attacks of reten¬ tion since last I saw her, but these had always passed off until now, when her suffering had become so great that she was obliged to send for me. On examination I found a distinct tumour, reaching from pubes to umbilicus, which, from its tenseness, dulness on per¬ cussion, tenderness, and fluctuation, was evidently the bladder. The vagina was blocked up] by a round, regular, doughy tumour, in front of which, behind the pubes, I could barely feel the edge of the os uteri. From the position of the os, and the character of the vaginal tumour, as well as the history of the case, the diagnosis arrived at was gravid retroversion, and consequent retention of urine. The patient admitted the possibility of pregnancy. A large quantity of dark-coloured urine was drawn off with a gum- elastic male catheter. On making a second examination, the os could be more easily reached. I tried at the same time to reduce the dislocation, but failed. In the evening of the same day, Dr Andrew was kind enough to see the patient with me, and while he kept her fully under the influence of chloroform, I succeeded in reposition in the ordinary way. A Hodge pessary was introduced next morning. A fortnight later the patient aborted. The two cases just recorded are, I believe, typical examples of the two forms of gravid retroversion. They both occurred at the end of the first trimestre of pregnancy, the usual time for the development of the characteristic symptoms. The subjects, as is generally the case, were both multiparous women. In both, the urgent symptom was retention of urine. They differed, however, very notably in the manner in which the displacement was pro¬ duced, for, while the first was sudden and accidental in its onset, the second was slow and gradual. In the first, the sudden fall. VOL. XXIII.—no. x. 6 a