Clinical gyncology, medical and surgical

Preface

The impulse which lias been given to the clinical teaching of medicine and surgery during the past ten years by the establishment of numerous post-graduate schools throughout the country has been communicated to recent text-books, in which the practical has largely superseded the theoretical. The practitioner at the present day is not only keenly alive to the fact that immense advances have been made in medicine since his studentdays, but is filled with the laudable ambition to keep abreast of them. To enable him to do this, information must be imparted to him in a clear, concise, and more or less dogmatic form. This is the object aimed at in the present volume, which represents the combined experience of a number of clinical teachers selected by the former editor as men who, while disposed to be conservative, were none the less progressive and free from hobbies. The success which has attended the publication of the volumes of the International Clinics led the publishers to believe that a work on gynaecology treated from a clinical stand-point would find a place in the voluminous literature of diseases of women.

Owing to the untimely death of Dr. Keating, the completion of the work devolved upon the present editor, who has as far as possible carried out the plans and wishes of his lamented predecessor. While seeking to preserve that coherence which is desirable in a text-book, he has in the main allowed each contributor to consult his own judgment with regard to the arrangement and phraseology of his article, believing that in this way the individuality of each would be best preserved. In view of the needs of the student and busy practitioner, especial attention is given to diagnosis and treatment, the sections on pathology being less extended than in most text-books on gynaecology.

Especial care has been taken in the preparation of the illustrations, a large proportion of which have been drawn or photographed for this work under the immediate supervision of the contributors. Occasionally illustrations from other sources have been used, when particularly useful

IV PREFACE.

and appropriate. Numerous cuts of various gynaecological instruments have been kindly lent by surgical instrument makers, to whom a grateful acknowledgment is due.

The editor takes this occasion to fulfil a promise made to the late Dr. Keating. It was the latter's expressed wish, when he recognized the fact that he would be unable to complete this work, that he should not be held responsible for any views contained in it regarding the destruction of the living foetus which might appear to be contrary to the tenets of the Catholic Church.

The introductory pages will be read with mournful interest as the last words of a gifted teacher whose voice and pen exercised a potent influence upon the medical world for over a quarter of a century. To those who have felt their spell in the past his latest utterances will appeal with peculiar force.

Contents

PAGE

INTRODUCTORY. By William Goodell, M.D 1-25

Chapter I

METHODS OF GYNECOLOGICAL EXAMINATION AND GENERAL OUTLINES OF DIFFERENTIAL DIAGNOSIS. By William H.

Baker, M.D., and Francis H. Davenport, M.D 26-86

Verbal History — Physical Examination — Various Positions — Bimanual Examination : Digital Examination of the Vagina, Palpation of the Cervix, Normal Position of Cervix, Position of the Cul-de-Sac, Use of the Hand on the Abdomen, Bimanual Palpation of the Uterus, Bimanual Examination of the Appendages, Use of Right Forefinger, Use of Two Fingers in the Vagina, Bimanual Examination of Virgins, Difficulties of' Bimanual Examination— Visual Inspection of the External Genitals — Examination in the Semi-Prone Posture — Examination in the Erect Posture — The Knee-Chest Position — The Trendelenburg Posture — With the Speculum: Valvular Specula, Situs's Speculum, Self-Retaining Speculum — Use of the Probe or Sound — Inspection of the Abdomen : Palpation, Percussion, Measurements — Bimanual Examination of the Rectum— The Recto- Vesical Examination — Examination of the Urethra and Bladder — Digital Examination of the Bladder — Palpation of the Ureters — Examination of the Rectum and Anus : Methods of Examination — Examination of the Interior of the Uterus — General Outlines of Differential Diagnosis: Pain, Disorders of Menstruation, Leucorrhcea, Enlargements, Disturbances of Function, Reflex Symptoms.

Chapter II

GYNECOLOGICAL TECHNIQUE. By Hunter Robb, M.D 87-169

I. Importance to the Surgeon of Bacteriological Training — Sepsis and Wound- Infection— Micro-Organisms concerned — Asepsis — Antisepsis. II. Principles of Sterilization — Cht mical Disinfection. III. Practical Application of the Principles of Sterilization— Operating Suits — Preparation of the Surgeon and his Assistants. IV. The Preparation of Patients for Operations, Major and Minor — Means employed to obtain an Aseptic Field. V. Gynaecological Instruments— Methods of Sterilization — Instrument Trays — Care of the Instruments after Operations. VI. Aseptic Sutures, Ligatures, and ( 'amors— Suture Materials— Sterilization and Preservation of the Various Kinds. VII. Sterilized Dressings : Cotton, Gauzes, Bandage?, Tampons, Sponges. VIII. Aseptic Drainage: Class and Rubber Drainage, Gauze Drains, Care of Rubber Materials, Rubber Dam, Rubber Tubing, Rubber Gloves. IX. Fluids for Irrigation : Plain Sterile Water, Antiseptic Fluids for Irrigation, Sterile Physiological Salt Solution, Antiseptic Powders, Iodo-

VI CONTEXTS.

PACiE

form Oil, Bichloride Celloidin, Iodoformized Celloidin. X. Certain Procedures sometimes necessary before and after Operations, which must be conducted aseptically — Hypodermic Injections — Exploratory Punctures— Catheterization — Bladder- Washing — Ureteral Catheterization. XI. The Gynaecological Operating-Koom — Operating-Table — Instrument-Cases and other Furnishings. XII. The Organization of Operations — The Maintenance of an Aseptic Technique during Operations. XIII. Post-Operative Care : Position in Bed, Diet, Vomiting, Rectal Feeding, Shock, Pain and Restlessness, Constipation, Catheterization, Convalescence, Removal of Stitches, Dressing subsequent to Operation, Hemorrhage, Intestinal Obstruction and Infection. XIV. Operations in the Country, in Private Houses, or in other Places where the Technique must necessarily be more or less Imperfect — The Armamentarium — An Improvised Operating Room — Modifications in Technique.

Chapter III

OUTLINE OF GYNAECOLOGICAL THERAPEUTICS. By Bache McE.

General Hygienic Care : Rest and Exercise, Dietetics — General Remarks on Local Therapeusis : Blisters, Bloodletting — Treatment of Congestion of the Hemorrhoidal System — Massage — Gynaecological Electro-Therapeutics — -Amenorrhcea, Suppressed or Defective Menstruation, Galvanism in Stenosis of the Uterine Canal, Galvanism and Faradism in Dysmenorrhoea, Galvanism in Membranous Dysmenorrhoea, Electricity in the Treatment of Subinvolution of the Uterus, Galvanism in Endometritis, Galvanism in Plastic Exudations, Galvanism in Salpingitis and Oophoritis, Electricity in Ovarian and Pelvic Neuralgia — Treatment of Uterine Fibroids by Galvanism, Treatment of Ectopic Gestation.

Chapter IV. Anomalies Of Development In The Genital Tract

By Barton C. Hirst, M.D 222-260

Ovaries — Fallopian Tubes — Uterus : Absence or Rudimentary Development of the Uterus, Arrested Development of One of the Duets of Muller, Uterus Unicornis, Arrested Fusion of the Ducts of Muller, Uterus Didelphys, Double Uterus, Uterus Bicornis Duplex, Uterus Bicornis Unicollis, Bifid Uterus, Uterus Cordiformis, Uterus Septus, Subseptus, Partitus, Semi-Partitus — Anomalies of Development in the Cervix : Atresia of the Cervix, Congenital and Acquired, Arrested Development of the Cervix, Hypertrophy of the Cervix — Vagina : Unilateral Vagina, Double Vagina, Stenosis of the Vagina — Vulva : Atresia of the Vulva, Arrested Development of the Uro- Genital Sinus, Hyperplasia and Hypertrophy of the Vulva, Non-Development of the Vulva, Hypertrophy of the Clitoris, Anomalies of the Hymen — Hermaphroditism : True Hermaphroditism, Pseudo-Hermaphroditism — Retention of Mucus and Blood within the Genital Tract in Consequence of Atresia.

Chapter V. Traumatic Lesions Of The Vulva, Vagina, And Cervix

By Mattiikw D. Mann, M.D 2G1-285

"Wounds due to External Violence and Coitus: Injuries of the Vulva; of the Vagina; of the Cervix — Injuries during Parturition : Injuries of the Vulva and Perineum; Lacerations of the Cervix Uteri.

CONTEXTS. Vll

Chapter VI. Page

INFLAMMATION OF THE FEMALE GENITAL ORGANS. By

William M. Polk, M.D 286-382

Inflammation of the Vulva, of the Vagina, of the Uterus : Acute Endometritis, Acute .Metritis, Chronic Endometritis, Chronic Metritis, Cervicitis and Endo- Cervicitis : Pathology, Symptoms, Signs, Diagnosis, Prognosis, Treatment — Inflammation of the Uterine Appendages and the Peritoneum (Pelvic Inflammation): Acute Salpingitis, Chronic Salpingitis, Hydrosalpinx, Hematosalpinx— Inflammation of the Ovaries: Acute Oophoritis, Chronic Oophoritis, Lymphangitis, Cellulitis, Peritonitis, Pelvic Abscess — Cancer, Hematocele, Fibroid Tumors, Psoas Abscess, Appendicitis : Signs, Symptoms, Diagnosis, Prognosis, Treatment — Treatment of Pelvic Inflammation.

Chapter VII

GENITAL TUBERCULOSIS. By J. Wiiitridge Williams, M.D. . . . 383-390 Vulva — Vagina — Uterus — Tubes — Ovary — Frequency — Etiology — Clinical History— Diagnosis — Prognosis — Treatment.

Chapter VIII

AND CONNECTIVE TISSUE. By Henry T. Byford, M.D. . . . 400-4G0 Pelvic Peritonitis: Acute Primary Pelvic Peritonitis — Acute Secondary Pelvic Peritonitis — Chronic Primary Pelvic Peritonitis — Chronic Secondary Pelvic Peritonitis — Specific Peritonitis — Post-Operative Peritonitis. Pelvic Cellulitis: Acute Primary or Traumatic Cellulitis — Acute Secondary Cellulitis, or Acute Parametritis — Chronic Secondary Cellulitis, or Chronic Parametritis — Septic Cellulitis and Pelvic Abscess.

Chapter IX

DISPLACEMENTS OF THE UTERUS. By Paul F. Munde, M.D. .461-526 Normal Anatomy and Topography of the Pelvic Organs : Supports of the Uterus, Normal Position of the Uterus — General Remarks on Displacements: Varieties, Relative Frequency of Versions and Flexions, Relative Significance of Displacements, Causes of Displacement*, General Symptoms, General Therapeutics, Mechanical Supports — Anteversion: Degrees, Causes, Frequency, Significance, Symptoms, Diagnosis, Complications, Treatment — Anteflexion : Anatomy, Degrees, Causes, Frequency, Significance, Diagnosis, Symptoms, Treatment — Anteflexion of the Cervix — Anteflexion with Retroposition — Retroversion and Retroflexion : Degrees, Complications, Causes, Frequency, Significance, Symptoms, Diagnosis, Treatment — Latero- Version and Latero- Flexion — Ascent of the Uterus — Prolapsus Uteri : Degrees, Anatomy, Causes, Complications, Frequency, Significance, Diagnosis, Prognosis, Treatment — Inversion of the Uterus: Degree-, Causes, Frequency, Significance, Symptoms, Diagnosis, Treatment — Hernia Uteri.

VI 11 CONTENTS.

Chapter X. Page

NEOPLASMS OF THE VULVA AND VAGINA. By Hermann J.

Condyloma — Lipoma — Myoma, Fibroma, Myo-Fibroma, Myxoma, and Mixed Growths — Elephantiasis Vulva — Vulvo-Vaginal Cysts, Cysts of Bartholin's or Duverney's Gland — Varicose Tumors — Polypi — Lupus — Cancer of the Vulva — Sarcoma — Cysts — Fibro-Myomata (Polypi) — Cancer of the Vagina — Sarcoma.

Chapter XI

BENIGN NEOPLASMS OF THE UTERUS. By Hermann J. Boldt,

Myxoma — Cysts — Fibro-Myomaof the Uterus: Minute Anatomy, Degeneration, Etiology, Symptoms and Course, Diagnosis, Treatment, Castration, Myomectomy, Total Extirpation of the Fibro-Myomatous Uterus, Trendelenburg's Posture, Pregnancy — Cavernous Angioma of the Uterus — Adenoma.

Chapter XII

MALIGNANT NEOPLASMS OF THE UTERUS. By Hermann J.

Myeloma or Sarcoma — Malignant Deciduoma — Cancer of the Uterus.

Chapter XIII

NEOPLASMS OF THE OVARIES, TUBES, AND BROAD LIGA- MENTS. By Henry C. Coe, M.D 621-741

Introductory — Neoplasms of the Ovary: Ovarian Cysts, Tubo-Ovarian Cysts, Extra-Peritoneal Cysts, Dermoid Cysts, Solid Tumors of the Ovary, Mode of Growth, Complications of Ovarian Tumors, Clinical History, Diagnosis, Deferential Diagnosis, Treatment of Ovarian Tumors, Ovariotomy — Neoplasms of the Tubes : Benign Neoplasms, Malignant Neoplasms — Neoplasms of the Broad Ligaments: Parovarian Cysts, Simple Cysts of the Broad Ligament, Solid Tumors, Parovarian Varicocele, Tumors of the Round Ligament.

Chapter XIV

ECTOPIC PREGNANCY. By William T. Lusk, M.D 742-767

Tubal Pregnancy — Pregnancy in the Rudimentary Cornu of a One-Horned Uterus — Interstitial Pregnancy — Ovarian Pregnancy — Abdominal Pregnancy— Tubo-Abdominal and Tubo-Ovarian Pregnancy : Symptoms, Terminations, Diagnosis, Treatment — Intra-Peritoneal Pelvic Hematocele — Extra-Peritoneal Hematocele (Hematoma).

Chapter XV

FUNCTIONAL DISEASES. By Chauncey D. Palmer, M.D 768-822

Menstruation — Disorders of the Uterine Function : Amenorrhoea, Vicarious Menstruation, Menorrhagia, Dysmenorrhea, Sterility, Chlorosis — Diseases of the Nervous System dependent upon Disorders of the Pelvic Organs:

CONTEXTS. IX

PAGE

Chores, Hysteria, Migraiue, Neurasthenia and Spinal Irritation, Insanity, Nymphomania, Perverted Sexual Appetite, Vaginismus, Remote Efl'ects of Oophorectomy.

CHAPTEE XVI.

DISEASES OF THE URETHRA, BLADDER, AND URETERS. By

Charles Jewett, M.D., and John Polak, M.D 823-878

The Urethra — Anatomy — Malformations — Diseases : Urethritis, Stricture, Prolapse of the Urethral Mucous Membrane, Vesico-Urethral Fissure, Dislocations, Fistula, Caruncle, Varices, Glandular Neoplasms, Fibroma and Sarcoma, Carcinoma and Epithelioma, Polypus, Foreign Bodies in the Urethra. The Bladder — Anatomy — Malformations (Exstrophy, Double Bladder) — Cystoscopy — Functional Derangements — Cystitis — Inversion — Vesico- Vaginal Fistula — Vesical Calculi — Foreign Bodies in the Bladder — Vesical Tumors. The Ureters — Anatomy — Methods of Examining— Malformation — Diseases and Injuries of the Ureters: Stone in the Ureter, Obstruction of the Ureter, Operative and other Injuries.

Chapter XVII

DISEASES OF THE RECTUM AND ANUS. By Edward E. Montgomery, M.D 879-909

Injuries — Foreign Bodies — Anal Pruritus — Fissure of the Anus — Proctitis — Phlegmons or Abscesses of the Anus and Rectum — Fistula in Ano — Recto- Vaginal Fistulse — Hemorrhoids — Polypi — Prolapse of the Rectum — Stricture of the Rectum — Cancer of the Rectum.

Chapter XVIII

DISEASES OF THE FEMALE BREAST. By Dudley P. Allen,

Anomalies of the Breast : Microthelia, Athelia, Polythelia, Micromazia, Polymazia, Hypertrophy, Agalactia — Eczema — Molluscum — Sebaceous Cysts — Dermoid Cysts — Injuries of the Breast — Neuralgia and Neuromata — Hydatids of the Breast — Mastitis— Tuberculosis — Syphilis— Chalky Concretions — Angioma— Cysts— The Classification and Origin of Tumors and Connective- Tissue Formations — Lipoma — Adenoma— Fibroma— Sarcoma — Myxoma — Carcinoma.