. The diagnosis, pathology and treatment of diseases of women including the diagnosis of pregnancy. In early pregnancy, difficult micturition, persist-ing for some time and increasing, should lead us to suspect retro-flexion or retroversion to be present; an important fact, for in orderto treat these cases satisfactorily, the early recognition of theirtrue nature is necessary. The other signs of retroversion of thegravid uterus are, flattening of the hypogastric region, involuntarystraining or tenesmus, dragging in the loins and groins, constipa-tion, &c. Enlargement of the uterus, from the pr
. The diagnosis, pathology and treatment of diseases of women including the diagnosis of pregnancy. In early pregnancy, difficult micturition, persist-ing for some time and increasing, should lead us to suspect retro-flexion or retroversion to be present; an important fact, for in orderto treat these cases satisfactorily, the early recognition of theirtrue nature is necessary. The other signs of retroversion of thegravid uterus are, flattening of the hypogastric region, involuntarystraining or tenesmus, dragging in the loins and groins, constipa-tion, &c. Enlargement of the uterus, from the presence of fibrous or othertumors, may also produce difficult micturition; indeed, this symp-tom is very commonly observed in the early stage of this affection. MICTURITION POSSIBLE, BUT DIFFICULT. 103 A difficulty in making water, says Sir C. M, Clarke, is amuch earlier symptom attending the disease than a difficulty ofpassing the faeces.* In such cases, the difficulty is not so con-siderable as in retroflexion of the uterus, and the symptom is, soto speak, more chronic than acute. Fig. In cases of fibrous tumor of the uterus, a curious phenomenonis sometimes observed, not, probably, peculiar to these tumors,namely, the manner in which ability to evacuate the bladder isaffected by the position of the body. Thus, a lady who recentlyconsulted me has had a large fibrous tumor of the uterus for thelast seven years; of late there has been occasional difficulty inmicturition, which she has always been able to overcome by lyingflat on the face. The uterine tumor is movable, and when thepatient throws the body forwards the pressure of the uterine tumoris removed from the vesical outlet. Sir C. M. Clarke records acase in which the patient was capable of voiding small quantitiesoccasionally if she lay on the back with the pelvis a little (See also Enlargement of the Abdomen, in a subsequent chapterof this work, where a very interesting case of retention of urineis related.) *
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