A handbook of diseases of women : including diseases of the bladder and urethra / by F. Winckel ; authorised translation edited by Theophilus Parvin.

Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: A handbook of diseases of women : including diseases of the bladder and urethra / by F. Winckel ; authorised translation edited by Theophilus Parvin. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    The treatment is direct removal of the calculus, and this may be accomplished by dilatation of the urethra, with subsequent extraction of the stone with the forceps without reduction of its size, by lithotripsy or litholapaxy, the stone being broken or crushed and the fragments removed, and by lithotomy. Dilata- tion is to be preferred when the stone is not so large that it cannot pass through the urethral canal stretched to the degree indicated by Simon. Lithotripsy or litholapaxy is indicated in women if the stone be large, its diameter more than 2.5 centime- ters, and when incrustations have formed about a foreign body, such as a needle-case, wood, bone. Vesico-vaginal lithotomy is indicated when the stone is so hard that it cannot be crushed or broken, and is more than three centimeters in size in children. But the calculus may be so large that it cannot be brought through the small pelvis, or at least without some laceration of the soft parts, and this may even be the fact in the adult, as in the case of Josephi, in which an extrauterine gestation cyst had perforated the bladder. Suprapubic lithotomy, epicystotomy, sectio alta, is only indicated in women when, from the size and number of the calculi or from the narrowness of the soft parts, vaginal section does not suffice. Of four cases of hypogastric lithotomy in girls from 4-8 years old, two terminated fatally and two in recovery. CHAPTER X. NEUROSES OF THE FEMALE BLADDER.—CYSTOSPASM AND CYSTOPLEGIA. Anomalies of the bladder without structural disease or abnor- mality of its contents, which thus have their seat in the nervous apparatus of the organ, are designated neuroses. They are spasm and paresis and paralysis of the bladder. In most of these cases there is also local structural disease, of which the nervous dis- orders are only a symptom ; the existing structural affection, however, is not always to be recognized. There is no doubt that the more generally dilatation of the urethra is employed as a