LONDON:-H. K. LEWIS, MEDICAL PUBLISHER, 136 GOWER STREET. PARIS: ADRIEN DE LA HAYE & EMILE LE CROSNIER, 23 PLACE DE L'ECOLE DE MEDECINE. 230. LIBRY * MEDICAL BULLETIN: one. The cystitis, which had developed, went from bad to worse. She passed from one CYSTITIS IN THE FEMALE; ITS physician to another without receiving much TREATMENT BY DILATATION. OPERATION FOR THE CLOSURE OF AN URETHRA TORN BY TOO HEROIC DILATATION-ABDOMI NAL CARCINOMA AFTER OVARIOTOMY. DELIVERED AT THE HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA, BY WILLIAM GOODELL, M.D., Professor of Gynecology in the University of Pennsylvania. [Reported for THE BULLETIN by WM, H. MORRISON, M.D.] ENTLEMEN: The case which I bring before you this morning is one of considerable interest to me, and will, I think, prove instructive to you. G She finally passed into the hands of an excellent surgeon, who dilated the urethra, but the dilatation did no good. This is an excellent plan in chronic cystitis and in those peculiar bladder troubles which cannot be exactly explained, but which are probably examples of nervous or hysterical bladders. There is, however, a drawback to the operation, and that is, that if the urethra is overstretched, permanent loss of control over the urine is liable to follow, and this is a grave accident. This is one reason why, in the case of calculus in the female, if the stone is larger in girth than the index finger and cannot be crushed, it is wiser to remove it through an opening made into the bladder than to remove it through the urethra. We had one case in the hospital last year in which a stone had been removed by a female practitioner of deserved eminence, in which stillicidium had resulted. In the present case, the surgeon, finding that the dilatation had done no good, repeated the operation. This time the dilatation was very great and there has been considerable laceration of the urethra. This was not followed by relief, and this shows the excessively intractable character of the disease. This unfortunate woman had her last labor three years ago, and it, like her previous confinements, was a difficult one, requiring the use of instruments. After this labor she found that she was for some days unable to pass her water. This was followed by cystitis. Now let me say one word while on this subject. Whenever you have a patient, whether male or female, who has the water dribbling away, do not be caught as many physicians are, and suppose that the bladder is empty. This is often the dribbling from an over-distended bladder. Great mischief has been done and lives have even been lost by this The surgeon then, very properly, made an mistake. In this case the nature of the diffi- opening into the bladder, forming an artificial culty was promptly recognized and the water vesico-vaginal fistula. This partly closed up and drawn, but after convalescence she found that she sent for me. The story told me was such she had cystitis. This is by no means uncom- a pitiable one, that, although I am not much mon after a difficult labor, nor is it uncommon in the habit of visiting, I went to her house in to have inability to pass water after an ordinary an alley and found her in a wretched condition. |