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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    but especially in tlie right iliac fossa; per vaginam there was a soft doughy bulging in the space of Douglas. During the night Pro¬ fessor Simpson was kind enough to see the lady in consultation, and confirmed the diagnosis of a hsematocele. The following morn¬ ing the swelling in the retro-uterine space was more marked, of a firmer consistence, and extended on either side of the uterus. The uterus was pressed upwards and forwards against the neck of the bladder and was fixed. The same evening the patient was unable to pass her urine, which had accumulated to a considerable extent. The catheter was used. The causation and management of the hematocele are no concern of the present paper. The progress of the case is alone of interest. Without being tedious, it was simply this, that within a fortnight all trace of the hemorrhage had entirely disappeared. The swelling in the space of Douglas was the last portion of the effusion to be absorbed. Retention of urine lasted but for the first three days, when the post-uterine tumour was largest, and the cervix uteri consequently most firmly pressed upwards and forwards against the neck of the bladder. Although the mechanical pressure of displacements or tumour just mentioned forms, apart from labour, the most common cause of retention of urine, yet causes acting reflexly are more frequent, perhaps, than appear at first sight. Take, for example, the follow¬ ing case :— Miss B., ret. 55, has been at various periods under my care for trifling ailments. In January 1876, she told me that for some months she had great pain on passing her water—so much so that occasionally she had been unable to pass it at all, except when sitting over very hot water. When the urine did pass she felt as if a red-hot wire were in the urethra. The urine passed in jerks and in a small stream. I explained that a local examination was absolutely necessary. To this nothing would induce her to submit. Some weeks afterwards I was summoned to her one evening', and found her suffering much from a distended bladder. She had not passed any urine for two days. The bladder could be felt dis¬ tinctly enlarged through the abdominal walls. The patient said that all the remedies which had hitherto been useful, such as sitting over steam, warm baths, and warm fomentations had on this occasion failed. On introducing my finger to the meatus with the view of passing the catheter the patient screamed and drew hersell up in bed. A visual examination' was insisted on, and obtained with much difficulty. Round the meatus urinarius the red, vascular, sensitive excrescence characteristic of the urethral caruncle was observed. The little tumour, which was about the size ot a small cherry, entirely encircled the meatus. The catheter was introduced and the water drawn off. The following day, while the patient was under chloroform, I snipped off the caruncle and cauterized its base with a red-hot knitting-wire. I saw the patient lately, and she has not again suffered from reten-