The diagnosis of diseases of women

Front matter

THE

DIAGNOSIS

OF

Preface

It has been the endeavor of the author to write a work on the Diagnosis of Diseases of AVomen that will be equally adapted to the needs of student and practitioner, and in line with the most modern views. The recognition of the pathology of the pelvic organs in large measure constitutes a diagnosis. Because of this fundamental fact the author has deemed it desirable to incorporate a thorough discussion of the morbid anatorny, both macroscopic and microscopic, and to point out its clinical indications. Special stress has been placed upon the microscopic diagnosis of the various lesions, not alone on account of its scientific interest, but also, and more particularly, because of its great clinical importance. Without the microscope a diagnosis is not always possible.

Medical literature in the English language has not hitherto included a work on this subject. In the effort to supply this desideratum the author has aimed to satisfy the requirements of those who have felt the need of more comprehensive and practical information than can be given in the general text-books on gynecology. It is hoped that this work will be serviceable to those who do not have access to foreign literature.

The author desires to express appreciation of the services rendered in the writing of the book. Dr. D. P. Johnson gave invaluable assistance in the critical reading of the manuscript; Dr. Charles G. Farnum in the correction of the proof; Miss Mamie Findley and Dr. Carl AVahrer in the production of illustrations. Indebtedness is also acknowledged to "Veto's Handbuch fur Gynakoloc/ie, vi PREFACE.

Winter's Gyndkologische Biagnostik, Webster's Ectopic Pregnancy, Cullen's Cancer of the Uterus, Kelly's Operative Gynecology, and Dudley's Gynecology. The author furthermore desires to express appreciation of his very cordial relations with the publishers, which have at all times been most gratifying.

PALMEK FINDLEY.

100 State Street, Chicago, 1903.

Chapter I

A Plea for an Early Diagnosis Form of Case Record .

Address .

Age

Occupation

Nationality- Social State

Number of Children and Miscar

Family History ....

Previous Illnesses ....

Present Complaints

Menstrual History ....

Hemorrhage from the Genital Tract

Menstruation

Anatomy of Menstruation

Menstruating Fallopian Tube Uterine Hemorrhage

Systemic Causes

Local Causes .

Amenorrhoea

General Causes

Local Causes .

Menstrual Molimena Dysmenorrhoea

Idiopathic (Primary)

Secondary

Membranous .

Sterility in Women

General Causes

Local Causes .

PAGE

Vlll

Percussion of the Abdomen

CHAPTER VI. Auscultation and Mensuration of the Abdomen

CHAPTER VIL

Examination of the External Genitals

Digital Examination of the Internal Genitals Vagina ....

Choice of Hand One or Two Fingers Used ?

Bimanual Examination .

Abdomino-vaginal Examination .

Examination under Narcosis .

Digital Examination of the Rectum Abdomino-rectal Examination Abdomino-vagino-rectal Examination Digital Examination of the Bladder Pelvimetry

CONTENTS.

IX

Uterine Curette

CHAPTER XIII. Microscopic Examination of Scrapings and Excised Pieces . 91

Removal of Scrapings • . . . .91

Test Excision from the Cervix ......... 92

Test Curettage of the Uterus 92

Frozen Sections ............ 92

Fixing the Specimens ........... 95

Hardening and Embedding . . . . . . . . . .95

Method of Staining and Mounting 97

Inspection of the Uterus after Removal 99

CHAPTER XIV. Exploratory Punctures and Incisions

CONTENTS.

Part II Special Diagnosis

CHAPTEK XV.

The Diagnosis of Pregnancy

First Trimester .....

I. Subjective Signs

1. Cessation of Menstruation .

2. Morning Sickness

3. Salivation ....

4. Nervous Phenomena .

5. Irritable Bladder II. Objective Signs

1. Mammary Glands

2. Discoloration of Vulva and Vagina

3. Softening of Cervix .

4. Lower Uterine Segment

5. Leucorrhoea

6. Change in the Position, Size, Fori Second Trimester

I. Subjective Signs II. Objective Signs

Active Foetal Movements .

Passive Foetal Movements .

Direct Palpation of the Foetus Intermittent Uterine Contractions Auscultation .

Foetal Heart Tones .

Foetal Souffle .

Placental Souffle Kate of Growth of Uterus . 7. Changes in Position, Size, Form,

Third Trimester

I. Subjective Signs ...

II. Objective Signs Diagnosis of the Life or Death of the Foetus Diagnosis of the Time of Pregnancy and Prediction Diagnosis of Multiple Pregnancy .

Diagnosis of the Causes of Hemorrhage Occurring Diagnosis of Abortion ....

Anatomical Diagnosis of Pregnancy m, and Consistency of Uterus and

Consistency of Uterus of Date of Confinement during Pregnancy .

PAGE

Diagnosis of Malformations of the Uterus

Uterus Deficiens .

Uterus Rudimentarius .

Uterus Fcetalis Uterus Unicornis .

Uterus Septus (Bilocularis) Uterus Bicornis Uterus Didelphys .

Uterus Accessorius

CHAPTER XXI. Diagnosis of Malposition of Uterus and its Neighboring Organs

Pathological Mobility of the Uterus Pathological Fixation of the Uterus

171 171

Xll

CONTENTS.

Anteposition

Retroposition

Lateroposition

Elevatio Uteri

Torsion of the Uterus

Prolapsus Uteri .

Inversion of the Uterus

Anteversion of the Uterus

Anteflexion of the Uterus

Retroversio-fiexion of the Uterus

Hernia of the Uterus (Hysterocele

PAGE

CHAPTER XXII. Diagnosis of Disease

Anomalies in Development

Vulvitis

Circulatory Disturbances

Atrophy (Kraurosis Vulvse)

New Formations .

Ulcers ....

Pruritus Vulvae

Hymen or the Vulva

CHAPTER XXIII. Diagnosis of Diseases of the Vagina . . . 221

Maldevelopments and Malformations ........ 221

Vaginitis (Colpitis) 225

New Formations 229

CHAPTER XXIV. Clinical Classification

1K1TJ

1. Acute Endometritis ....

•

2. Chronic Endometritis

Anatomical Classification ....

I. Macroscopic

II. Microscopic

Diagnosis of Uterine Scrapings in Endometritis

Endocervicitis ......

Erosions of the Cervix ....

Ulcers of the Cervix

CONTENTS.

xm

Tuberculosis of the Cervix Chronic Metritis .

PAGE

254 255

The Diagnosis of Sarcoma of the Uterus

Etiology

Anatomical Diagnosis Microscopic Diagnosis Clinical Diagnosis

306 306 307 308

CHAPTER XXVIII. Methods of Examination .......... 310

Anomalies in the Structure .......... 310

Changes in the Position .......... 311

Circulatory Disturbances 312

XIV

CONTENTS.

Inflammations and Infections

Granulomata .

Classification of Salpingitis

Catarrhal Salpingitis

Salpingitis Isthmica Nodosa

Hydrosalpinx

Tubo-ovarian Cyst .

Hematosalpinx

Purulent Salpingitis

Diagnosis of Sactosalpinx

Differential Diagnosis of Salpingitis

Tuberculous Salpingitis .

Syphilis of the Fallopian Tube

Actinomycosis of the Fallopian Tube

Parasites of the Fallopian Tube New Formations of the Fallopian Tube

CHAPTER XXIX. The Diagnosis of the Diseases of the Ovary

Normal Anatomy .

Histology ....

Methods of Examination Anomalies in Development .

Changes in Position Descensus Ovarii .

Hernia .....

Hypertrophy

Atrophy ....

Parasites and Foreign Bodies Circulatory Disturbances Inflammations (Ovaritis)

Acute Ovaritis

Chronic Ovaritis .

Cystic Degeneration

Abscess ....

Clinical Diagnosis of Ovaritis

Differential Diagnosis Simple Cysts Infectious Granulomata

Tuberculosis .

Syphilis

Actinomycosis

Leprosy .

New Formations

Etiology

Classification

Carcinoma

CONTENTS.

xv

New Formations — Dermoid Cysts Fibroma Myoma .

Sarcoma Endothelioma Parovarian Cysts

Clinical Diagnosis of New Formations Intraligamentary Development Adherent Tumors .

Torsion of the Pedicle .

Rupture of an Ovarian Cyst Leakage of an Ovarian Cyst Hemorrhage into the Cyst Suppuration of the Cyst Malignant Degeneration of the Cyst Ovarian Tumors Complicating Pregnancy Diagnosis of the Variety Fate of Ovarian Tumors

Chapter XXX

General Peritonitis Tuberculous Peritonitis Carcinomatous Peritonitis Pelvic Peritonitis .

PAGE

393 395 395

CHAPTER XXXI. The Diagnosis of Parametritis (Pelvic Cellulitis^

Definition Classification Acute Parametritis Chronic Parametritis .

Differential Diagnosis .

402 402 403 404 406

PAKT III

DIAGNOSIS OF DISEASES OF THE URINARY SYSTEM. CHAPTER XXXII.

The Diagnosis of the Diseases of the Urethra and Bladder . 409

Anatomy 409

Physiology 411

XVI

CONTENTS.

PAGE

Topography 411

Natural Landmarks 412

Methods of Examining 413

Percussion 414

Palpation 415

Catheter and Sound 415

Inspection 415

Urethroscopy 415

Cystoscopy 415

Segregator .....'. 430

Malformations and Diseases of the Urethra ....... 432

Malformations and Diseases of the Bladder ....... 437

Diagnosis of the Causes of Too Frequent and Painful Urination . 474