A dictionary of practical surgery : comprehending all the most interesting improvements, from the earliest times down to the present period : an account of the instruments and remedies employed in surgery : the etymology and signification of the principal terms : and numerous references to ancient and modern works, forming a "catalogue raisonné" of surgical literature / by Samuel Cooper.
- Samuel Cooper
- Date:
- 1825
Licence: Public Domain Mark
Credit: A dictionary of practical surgery : comprehending all the most interesting improvements, from the earliest times down to the present period : an account of the instruments and remedies employed in surgery : the etymology and signification of the principal terms : and numerous references to ancient and modern works, forming a "catalogue raisonné" of surgical literature / by Samuel Cooper. 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.
1177/1282 (page 1165)
![VAcad. de CMr. T. 3,p. 361, andMedecine Ope- ratoire, T. 'I. Ducreux, in Mem. de VAcad. dc CMr. T. 8, p. 493. Osiander, Annalcn, B. 1. p. 175. Bid. des 'Sciences Med. T. 23, art. Hysteroptose.) UTERUS, RETROVERSION OF. Re- troversion of the uterus is said to happen, when its fundus is forced downward and backwards, between the sacrum and the posterior part of the vagina, while its cervix inclines towards the symphysis pubis. The ancients are thought to have had some imperfect notions of this case, and, in proof of this opinion, certain passages are referred to in (Etius, (Tetrab. 4, Serm. 4, C. 77,) Mercurialis, Mercatus, and others. (See Diet, des Sciences Med. T. 23, p. 273.) Be this as it may, it is generally confessed, that the subject had fallen into oblivion, when Dr. Wrn. Hunter called the attention of his pupils to the subject, in 1754, and afterwards drew up an interesting paper concerning it. (Med. Obs. and Inquiries, Vol. 4, Svo. Land. 1771.) Sub- sequently, the knowledge of the subject was extended by the observations of Wlzezeck, (De Utero retroflexo, Prag. 1777,) the remarks of Richter, (CMr. Bibl. B. 5, p. 521, £ B. 9, p. IS^,) and those of Wall, (Diss, de Uteri retroversions, Hal. 1782,) and by the memoir of Desgranges, to which the prize of the Royal Academy of Surgery at Paris was adjudged, in the year 1785. According to Sabatier, retro- version of the womb was a case mentioned by Gre- goirein his private lectures on midwifery, at Paris. Walter Wall, an English surgeon, who had attended Gregoire, suspected, that he had met with a retroversio uteri in a woman, some months advanced in pregnancy, and he called in Dr. Hunter, in order to have the advantage of his advice, The woman was attacked with an obsti- nate constipation, and retention of urine, and died in about a week. A large tumor was found occupying the whole of the pelvis, and pushing the vagina against the os pubis. It had been found impracticable to push the swelling back into the abdomen, although the patient had been put on her knees and elbowsj while one hand had been introduced into the vagina, and two fingers of the other hand into the rectum. Great curiosity existed about what information would be afforded by dissection. On opening the body, the blad- der, which was exceedingly full of urine, filled almost the whole anterior part of the abdomen, in the same manner as the uterus does in the last month of pregnancy. When it had been emptied, that part of it, in which the ureters ter- minate, and which is connected with the vagina and cervix uteri, was found raised up, as high as the upper aperture of the pelvis, by a large tu- mor, which filled the whole cavity of the pelvis, and was found to be the uterus. A catheter, when passed into the vagina, could be made to lift up the latter viscus and the upper part of the tumor. This portion of the swelling, on which the bladder lay, consisted of the cervix uteri, while the fundus of this organ was situated down- wards towards the os coccygis and anus. The uterus was so large that it could not be taken out of the pelvis, before the symphysis pubis was divided, and the two ossa innominata were pulled UTERUS, RETROVERSION OF. 1165 cause for the displacement of the uterus, as the patient had been making no exertion, and had met with no fall, though she is said to have been frightened at something just before the complaint commenced. Dr. Hunter, struck with the singular nature of the case, thought it deserving of the attention of medical men, and he made it the subject of a lecture, which he delivered in 1754. He was afterwards consulted by several persons, who were afflicted with the retroversio uteri; but, not in so acute a way, as in the above instance. All the patients were in the third month of preg- nancy, and first suffered a difficulty of making water, succeeded by retention of urine, and after- wards by constipation. Dr. Hunter always emptied the bladder and rectum by means of a ca- theter and clysters, which measures sometimes ef- fected a cure, the uterus spontaneously resuming its natural position. In every instance, the accident disappeared, when pregnancy was more advanced, and the uterus had acquired larger dimensions. In some cases, in which Dr. Hunter was con • suited too late, the trials to replace the uterus proved fruitless, and the women died. Dr Hunter was so firmly convinced of the impos- sibility of saving patients circumstanced in the above manner, unless extraordinary means were resorted to, that he thought one should endea- vour to diminish the size of the uterus, by intro- ducing a trocar into the body of this viscUs, through the posterior parietes of the vagina, so as to let out the water of the amnios, the relative quantity of which is known to be greater in the early, than in the advanced, stage of pregnancy. (See Jourel in Bulletin de la Faculte dc Med. p.]73, an. 1812.) Such a puncture might certainly be the means of the uterus resuming its natural position ; but there would be considerable danger of its exci- ting the contraction of the uterus, and causing abortion. No risk of this kind would be en- countered by puncturing the bladder above the pubes. In this manner, a free passage would be afforded for the escape of the urine, and the re- duction of the uterus might be effected. Mr. Lynn, a surgeon in Suffolk, knew an in- stance of the bladder bursting, and the urine be- coming fatally extravasated in the abdomen, in a case of retroversion of the uterus, in consequence of the patient's refusal to submit to the preceding operation. Though Callisen met with a case after delivery, and Desault knew an instance in which the dis- placement was produced by a polypus, retroversio uteri scarcely ever occurs, except in the early months of pregnancy, and in women whose pelvis is very wide, while its brim is very contracted. If the uterus, in a pelvis of this conformation, be pushed back by a distended bladder, and pressed against the sacrum, while the soft parts yield, the womb becomes, as it were, wedged, and is incapable of changing its position. In this immoveable state, it presses upon the surrounding parts, and these upon it, so that a very serious train of bad symp- toms are the consequence. The first care of a practitioner, consulted in a case of retroversio uteri, should be to empty the bladder and large intestines, and to relax the](https://iiif.wellcomecollection.org/image/b21047376_1177.jp2/full/800%2C/0/default.jpg)
