Selected monographs.

Date:: 1888

Credit: Selected monographs. Source: Wellcome Collection.

288/440 (page 270)

$Freunct^ (97) and HildehrancW (98) have convincingly ' [Fi-eund, Deutsche Naturforf?chor-Vpr.,ammlung, Kiirlsbad, 1862; ' Verhaiicllungen der gynakologischen Section,' S. 119. The.-wliole reference to this paper (which I succeeded in finding in the library of the Eoyal Society, after a fruitless search in those of the Royal Medical and Chirurgical and Obstetrical Societies, the College oE Surgeons, and the British Museum) is as follows : Amtlicher Bericht uber die sieben und dreissigtste Versammlung Deuts- cher Naturforscher und Aerzte in Karlsbad im September, 1862, Karlsbad, 1863, S.295. According to Dr. Ereund hydronephrosis is often found in cases of retroflexion of the uterus : its causes are : I. Actual narrowing of one or both ureters, e.g. from chronic changes in the pelvic cellular tissue. 2. Dislocation of the uterus may cause kinking (Knickung) of the ureters. The ureter is often fastened to the side of the uterus after peri- metritis ; this would explain the symptoms of hydronephrosis during life, namely, violent pains in the loins passing downwards along the ureters, pains in the lower extremities, headaches, frequent desire to pass water, dyspeptic troubles—which have been hitherto, according to Dr. Freund, wrongly attributed to hysteria. The symptoms of hydronephrosis are inter- mittent, the quality of the urine resembles that in catarrh of the bladder. Dr. Freund believes that pyelitis is a frequent sequela; he mentioned a case which ended in cure. After kinking of the ureters hydronephrosis only occurs on the right side ; after narrowing of the ureters, on both sides. As the 3rd cause. Dr. Freund cites atrophy and hypeiirophy of the pelvic contents; the former often extending to the bones, the general suffering small. The origin of both is problematic. This seems nothing more than a collection of general statements; the ' Official Eepoi-t' contains not a single fact in favour of the theoiy laid down in the text.] - \_Hildebrandt, 'Yolkmann's Sammlung Klinischer Voiirage,' Band i, Abth. 3, Gryn. No. 5, Ueber retroflexion des Uterus. Frau H., who had suffered from annoying urinaiy troubles besides the usual symptoms of retroflexion, was sent to me by her family doctor to be examined for a somewhat voluminous soft tumour above the left Poupaii's ligament. I found retroflexion, and gave as my opinion that the tumou-r was to be regarded as a dilatation of the ureter in consequence of the retro- flexion. My diagnosis was verified easily and promptly. I first replaced the uterus with the sound, then introduced the cathether and drew off the water, pressing on the abdominal walls at the same time. The tumour diminished as I did so from the size of a child's head to that of an apple. This case seems far from proven. To have proved Hildebrandt's point it would surely have been as well to pass the catheter before replacing the uterus ; by his method he has desti-oyed the proof that the retroflexion had any connection with the urinary symptoms. i have quoted both passages at length to enable readers to judge for$

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