The diagnosis, pathology and treatment of diseases of women : including the diagnosis of pregnancy / by Graily Hewitt.

  • Hewitt, Graily, 1828-1893.
Date:
1868
Catalogue details

Licence: Public Domain Mark

Credit: The diagnosis, pathology and treatment of diseases of women : including the diagnosis of pregnancy / by Graily Hewitt. 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.

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    tical interest, for in those instances most may be done in the way of relief to the patient. 1. The indications offered by the state of the breasts. These offer little assistance in enabling us to determine the condition of the internal generative organs. They may be found tolerably well developed in cases where careful examination convinces us that the uterus is wanting, and the vagina absent. And as Kuss- maul very pertinently observes, the mammary glands do now and then become enlarged and developed in the opposite sex. The presence of breasts tolerably large and developed would, however, inform us that the patient had arrived at the age of puberty. 2. The development of the vulva, presence of hairs on the ■ pudendum, &c. The vulva may be apparently well formed, there may be the usual amount of prominence of the mons veneris, the parts may be well covered with hair, and, in fact, the external appearances may be such as are observed under normal circum- stances ; and yet the uterus and vagina may be wanting. Indeed, cases have been observed, as the one related by Dr. Ormerod and Dr. Quain, in which, Avith these external apparent evidences of womanhood and capability for marriage, not only was the uterus absent, but the ovaries were wanting. A small mass, apparently of a glandular structure, found in the left wall of the narrow sac representing the vagina, was the only possible representation of the ovaries.* The patient died in an angemic state at the age of 33, and had suffered from nasal hemorrhages, the monthly peri- odicity of which seemed to point to the existence of a sort of vi- carious menstruation. The case is remarkable as showing very clearly how little relation subsists, necessarily, between the de- velopment of the external and internal sexual organs. I have myself met with a case in which the breasts were normal, the pudendum normal, and well covered with hairs, but there was no evidence of the existence of a uterus, and hardly a trace of a vagina. When it is an object to ascertain by examination whether the uterus and vagina be present or not, the method to be pursued is the following: a catheter is to be introduced into the bladder, which should not be empty at the time the examination is made, and held lightly but firmly therein. One or two fingers of the left hand, well oiled, are then to be introduced as far as possible into the rectum. The catheter can now be felt by the extremity * Transactions of the Pathological Society, vol. vii, p. 271.