Minor surgical gynecology : a treatise of uterine diagnosis and the lesser technicalities of gynecological practice, including general rules for gynecological operations and the operations for lacerated cervix and perineum, and prolapsus of uterus and vagina for the use of the advanced student and general practitioner

Front matter

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Preface To First Edition". V

I am under obligations to Messrs. Geo. Tiemann & Co., T. Reynders & Co., Philip H. Schmidt, F. G. Otto & Sons, and W. F. Ford, instrument-makers of this city, for the loan of numerous woodcuts.

If this book in any manner renders the study and practice of Gynecology more easy for the beginner, its object will be accomplished.

PAUL F. MimDE.

30 West Forty-Fifth Street, New York, December 1, 1880.

Preface To Second Edition

The favorable reception of this work by the profession, when it appeared in Wood's Library for 1880, has induced me to give it a thorough revision, and to add to it, not only numerous interpolations and emendations, but also a new part, containing the rules governing gynecological operations in general, and a minute description of the operations for laceration of the cervix and perineum, and prolapsus of the uterus and vagina.

The particular object of this w^ork being to supply the details of gynecological technique and practice, for which the more comprehensive textbooks cannot, or at least do not, spare the space, I found the task of writing a comjylete treatise on Operative Gynecology, in which each subject should be handled with the same minuteness, greater than time or strength at my present disposal permitted ; and hence I have chosen, for the present, several minor operations which are now agitating the professional mind more particularly, and which bid fair to become more universally popular, leaving for a future time the preparation of a complete work.

I am aware that practical gynecology can be learned only by actual experience at the examining and operating table, and that a skilled touch cannot be acquired by reading the description of what the finger should feel in certain pathological conditions of the female pelvic organs. But, unfortunately, only a small portion of the profession can avail themselves of the clinical advantages offered by our hospitals and the new Schools of Practical Medicine springing up throughout our country. And even these fortunate ones need some guide, some aid to their memories when they attempt to apply in their practice the clinical teachings which they have received. It is all very well to tell a man to introduce a pessary, or dilate a uterus, or make an intra-uterine application, or even show him on the living subject how to do it, or indeed allow him to do it himself a few times. But he needs some means of refreshing his memory as to the details of these manoeuvres —

VIU PKEFACE TO SECOND EDITION.

of the size, shape, etc., of tlie pessary, of the indications and dangers of dilatation, and the methods and benefits of applications — when he returns to his home, perhaps in the coimtrv, where lie lias no one to consult or call to his assistance. For such men, then, and chiefly for those who cannot avail themselves of the clinical advantages referred to, this book has been prepared, as a means of starting them on the path of an increased knowledge of practical gynecology. To make experts of them is not my intention or expectation, but merely to teach them to treat female diseases carefully and intelligently, and do as little harm as possible.

A majority of the illustrations are new, having been drawn under my directions, partly with a view to presenting new diagrams to the reader, instead of the old, time-worn and hackneyed cuts which have been copied from book to book for the last generation. If at times perfect anatomical correctness has not been attained, it must be remembered that often it is impossible to depict all the desired conditions in a single drawing, and that thei-efore to be clear and distinct many cuts must be exaggerated and diagrammatical. Many cuts of instruments have been omitted for esthetic reasons.

For valuable assistance in correcting proof, and for the compilation of the Index, Contents, and List of Illustrations, I am greatly indebted to Dr. B. Hughes Wells.

For the preparation of new cuts of instruments I am under obligation to Mr. Philip II. Schmidt, and for the loan of cuts of instruments to Messrs. Tiemann & Co., Keynders & Co., Otto & Sons, and W. F. Ford, instrument-makers of this city.

I can but hope that the work in its new, enlarged, and improved shape, with clear type, good paper, and distinct and iiovel illustrations, will meet with a proportionate increase of the favor shown to its predecessor.

PAUL F. MU^DE.

No. 20 West FoETY-FrPTH Street, New Yokk, March 15, 1885.

Contents

Introduction 1-9

General Cousiderations Influencing the Diagnosis and Treatment of Gynecological Cases.

Part I. Gynecological Exa^onation

1. Verbal Examination 10-16

Method of Taking History, 11 ; Estimation of the Value of Symptoms, 12 ; Significance of Pain, 12 ; Causative Agencies, 16 ; Necessity of Following a Specified Order in Taking a History, 16.

2. Methods op Local Examination lG-18

Non-instrumental, 17 ; Instrumental, 17 ; Order and Plan of Examination, 18 ; Most Favorable Time for Examination, 18.

3. Positions for Examination 18-28

Dorsal- recumbent, 19 ; Lateral, 23 ; Latero-abdominal, 24 ; Genu-pectoral, 25 ; Abdominal, 25 ; Erect, 27.

4. Examination Couches 28-32

Advantages of Having a Proper Table, 29 ; Examination Chairs and Tables, 30.

5. Examination without Instruments 32-65

Inspection, 32 ; Auscultation and Percussion, 35 ; Abdominal Palpation, 36 ; Digital Examination, 41 ; Vaginal Touch, 42 ; Rectal Touch, 54 ; Vesical Touch, 56 ; Bimanual Examination, Vagino-abdominal, 58 ; Recto-abdominal ; Vesicoabdominal, 61 ; Digital Eversion of the Rectum, 62 ; Normal Position of the Uterus, 63.

6. Examination by Means of Instruments 65-126

Disinfection of Instruments, 65 ; Method of Cleaning Sponges, 67 ; Examination of the Urethra and Bladder by Sound, Catheter, or Speculum, 68 ", Examination of Ureters, 71 ; Examination of the Vagina, Cervix, and External Os with the Speculum, 72 ; Varieties of Specula and Methods of Using them, 73 ; Sims' Speculum, 82 ; Examination of the Utei'us with the Sound and Probe, 95 ; Indications and Precautions for the Use of the Sound, 97 ; Manner of its Introduction,

Z CONTENTS.

PAGE

103 ; Dilatation of the Uterus for Purposes of Diagnosis, 108 ; Examination of the Uterus with the Curette for Diagnostic Purposes, 110 ; Artificial Prolapse of the Uterus for Diagnostic Purposes, 113 ; Examination of the Rectum with the Speculum, 115 ; Mensuration of the Abdomen and Pelvis, 117 ; Aspiration of Abdominal and Pelvic Tumors, 117; Examination by Eetlected Light, 122; Gynecological Case Schedule, 125.