The diagnosis of diseases of women

Front matter

Qass.

Book.

COPYRIGHT DEPOSIT

Preface To The Second Edition

In the comparatively brief period which has sufficed to exhaust the first issue of this work there have been no revolutionary developments in its subject. There has been, however, a substantial growth, and this is represented by an increase of nearly one hundred pages in the text and by the addition of a large number of new and original illustrations and colored plates. Each topic has been presented thoroughly to date, and as completely as is desirable from the standpoint of practicality. Much has been added upon the differential diagnosis of the various diseases of the genitourinary organs.

The latest developments have been presented in subjects still in dispute, especially cystic degeneration of the ovaries, chorioepithelioma malignum, and diseases of the ureters and kidneys.

New chapters have been added upon Examination of the Blood and Bacteriological Examinations, subjects which have a most important bearing in Gynecological Diagnosis.

The author again commits the book to the medical profession in the hope that it will continue to render substantial service.

P. F.

100 State Street, Chicago, 1905.

Preface To The First Edition

It has been the endeavor of the author to write a work on the Diagnosis of Diseases of Women 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 anatomy, 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 Wahrer in the production of illustrations. Indebtedness is also acknowledged to Veit's Handhuch jilr Gyiidkologie,

(vii)

Viii PREFACE TO FIRST EDITION

Winter's Gyndkologische Diagnostik, 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.

PALMER FINDLEY.

100 State StreeT; Chicago, 1903.

Contents

PAET I.

GENERAL DIAGNOSIS.

Chapter I. Page

A Plea for an Early Diagnosis . . . . . . . . .17

Form of Case Record . . . . . . . . . .19

Address 21

Age 21

Social State 22

Number of Children and Miscarriages ...... 23

Family History 23

Previous Illnesses . . . . . . . , . .23

Present Complaints . . . . . . . . . .24

Menstrual History ......... 24

Hemorrhage from the Genital Tract ....... 24

Menstruation ..... 1 .... 25

Anatomy of Menstruation . ....... 26

Menstruating Fallopian Tube . . ...... 28

Uterine Hemorrhage .......... 29

Systemic Causes . . . . . . . ... .29

General Causes. . . . . . . . . . . 36

Menstrual Molimina . . .- . . . . . .38

Dysmenorrhoea . . . . . . . . . . .39

Idiopathic (Primary) 40

Secondary 41

Membranous 42

Nasal 43

Sterility in Women 43

General Causes 45

Local Causes • • .46

(ix)

X CONTENTS

PAGE

Factors Influencing ...... ... 49

Delayed 50

Influence on Morbid Conditions of Pelvis ...... 52

Normal Secretions .... ..... 53

In Period of Sexual Maturity ........ 54

Auscultation and Mensuration of the Abdomen

CHAPTER VII. Examination of the External Genitals

Digital Examination of the Internal Genitals Vagina .....

Choice of Hand One or Two Fingers Used Bimanual Examination Abdominovaginal Examination Examination under Narcosis Digital Examination of the Rectum Abdominorectal Examination Abdominovaginorectal Examination Digital Examination of the Bladder Pelvimetry ....

The Uterine Curette .... 88

Contraindications . . . . . . . . . . .90

Dangers Involved . . . . . . . . . . .90

Technique , . . . , 91

CHAPTER XIII. Microscopic Examination of Scrapings and Excised Pieces 93

Removal of Scrapings .......... 93

Test Excision from the Cervix ......... 94

Test Curettage of the Uterus 94

Frozen Sections .94

Fixing the Specimens .......... 96

Hardening and Embedding ......... 97

Method of Staining and Mounting 99

Inspection of the Uterus after Removal 100

Bacteriological Examinations . . . ,116 xii CONTENTS

PAKT 11.

SPECIAL DIAGNOSIS.

Chapter XVII. Page

The Diagnosis of Pregnancy . . . ,125

First Trimester 125

1. Cessation of Menstruation . . . . . . .125

2. Morning Sickness 127

3. Salivation . . 127

4. Nervous Phenomena . . . . . . . .128

5. Irritable Bladder . 128

2. Discoloration of Vulva and Vagina ....... 128

3. Softening of Cervix 128

4. Lower Uterine Segment . . . . . . . .130

6. Changes in Position, Size, Form, and Consistency of the Uterus 131 Second Trimester ........... 131

1. Active FcBtal Movements . . . , . . . 131

2. Passive Foetal Movements . . . . . . .132

3. Direct Palpation of the Foetus . . . . . .132

4. Intermittent Uterine Contractions . . . . . .132

Fetal Heart Tones 133

Fetal Souffle 133

Placental Souffle .• . . .133

6. Rate of Growth of Uterus ....... 134

7. Changes in Position, Size, Form, and Consistency of the Uterus 134 Third Trimester - 134

Diagnosis of the Life or Death of the Foetus ...... 135

Diagnosis of the Time of Pregnancy and Prediction of Date of Confinement 136 Diagnosis of Multiple Pregnancy . . . . . . . .137

Diagnosis of the Causes of Hemorrhage Occurring during Pregnancy . 137 Diagnosis of Abortion . . . . . . . . . .139

Anatomical Diagnosis of Pregnancy . . . . . . . 140

Chapter XVIII

The Microscopic Diagnosis of Expelled Membranes from the Uterus 144 Membranous Dysmenorrhoea , , , . , ♦ , ,145

CONTENTS xiii

Chapter XIX Page

Classification ........ ... 149

Retrogressive Changes in the Foetus .156

Anatomical Changes in the Tube . . . . . . . .157

Clinical Diagnosis ........... 160

Subjective Signs . . . . . . . . . .160

Objective Signs . . . . . . . . . 161

Differential Diagnosis .166

CHAPTER XX. The Diagnosis of Hydatiform Mole . . .173

Synonyms 173

History 173

Microscopic Examination . . . . . . . . .177

Malignant Degeneration . . . . . . . . .182

Diagnosis 186

CHAPTER XXI. The Diagnosis of Chorioepithelioma Malignum . .192

Macroscopic Appearance . . . . . . . . .194

Primary Outside of the Placental Site . . . . . . ,196

CHAPTER XXII. The Diagnosis of Malformations of the Uterus . 203

Uterus Deficiens , 203

Uterus Rudimentarius 204

Uterus Foetahs 204

Uterus Unicornis . . . . . . . . . . . 206

Uterus Septus (Bilocularis) 208

Uterus Bicornis . . . . . . . . . . . 208

Uterus Didelphys 210

Uterus Accessorius . . . . . . . . . .210

CHAPTER XXIII. The Diagnosis of Malposition of Uterus and its Neighboring.Organs 212

Pathological Mobility of the Uterus ........ 215

Pathological Fixation of the Uterus . . . , . . . .215

XIV

PAGE

Retroposition . , . 216

Elevatio Uteri 219

Torsion of the Uterus .......... 220

Prolapsus Uteri . . . . . . . . . . 220

Inversion of the Uterus .......... 231

Anteversion of the Uterus ......... 237

Anteflexion of the Uterus ......... 238

Retroversio-flexion of the Uterus . . . . . . . , 240

Hernia of the Uterus (Hysterocele) . 247

CHAPTER XXIV. The Diagnosis of Diseases of the Vulva . . 248

Anomalies in Development ......... 248

Vulvitis 250

Atrophy (Kraurosis Vulva?) ......... 256

Ulcers 262

Pruritus Vulvae 263

Hymen 264

CHAPTER XXV. The Diagnosis of Diseases of the Vagina . . 267

Maldevelopments and Malformations 267

Vaginitis (Colpitis) 272

Chapter XXVI. . 284

Clinical Classification .....

. 285

1. Acute Endometritis ....

. 285

2. Chronic Endometritis

. 286

Anatomical Classification

.290

I. Macroscopic

. 290

11. Microscopic

. 292

Diagnosis of Uterine Scrapings in Endometritis

. 299

Endocervicitis ........

. 299

Erosions of the Cervix ......

. 301

Ulcers of the Cervix .......

. 305

Tuberculosis of the Cervix .....

. 305

XV

Chionic Metritis Abscess of the Uterus

PAGE

306 306

CHAPTER XXVII. The Diagnosis of Fibromyoma of the Uterus

Influence of Menstruation, Pregnancy, and Climacteric upon Fibromyo

mata ....

Histogenesis Anatomical Diagnosis Recurrence of Uterine Fibroids Microscopic Diagnosis Adenofibromyoma Uteri Degeneration of Fibroids

Changes in the Endometrium, Myometrium, Tubes, and Ovaries Clinical Characteristics .

Clinical Diagnosis , Differential Diagnosis Fibroids Imperil Life

308 308

CHAPTER XXVIII. The Diagnosis of Carcinoma of the Uterus

Topographical Classification Etiology ....

Anatomical Diagnosis Clinical Diagnosis Microscopic Diagnosis Differential Diagnosis Diagnosis of Extension .

Diagnosis of Recurrence .

Endothelioma ,

CHAPTER XXIX. The Diagnosis of Sarcoma of the Uterus

Etiology . . .

Anatomical Diagnosis Microscopic Diagnosis Olinical Diagnosis .

371 372 374 375

CHAPTER XXX. . The Diagnosis of Diseases of the Tubes

Methods of Examination Anomalies in the Structure Changes in the Position

377 378 378

XVI

Inflamraations and Infections .

Granulomata

Classification of Salpingitis Catarrhal Salpingitis Salpingitis Isthmica Nodosa Hydrosalpinx , Tubo-ovarian Cyst .

Hsematosalpinx 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

378 379

CHAPTER XXXI. The Diagnosis of Diseases of the Ovary . . . 407

Histology 408

Anomalies of Development . . . . . . . . .410

Changes in Position . . . . . . . ..... 412

Descensus Ovarii . . . . . . . . . . . 412

Hypertrophy . . . . . . 414

Atrophy . 414

Parasites and Foreign Bodies . . . . . . . .415

Inflammations (Oophoritis, Ovaritis) . . . . . . .419

Acute Ovaritis . 419

Chronic Ovaritis .......... 420

Cystic Degeneration ......... 420

Clinical Diagnosis of Ovaritis ........ 426

Differential Diagnosis . . . . . . . . • 428

Simple Cysts ■ 429

Infectious Granulomata . . . . . . . . . .431

Syphilis 433

Classification ........... 434

CONTENTS xvii

PAGE

Dermoid Cysts 443

Fibroma 447

Sarcoma . 448

Endothelioma 449

Parovarian Cysts .......... 449

Clinical Diagnosis of New-formations . . . . . .451

Intraligamentary Development ....... 462

Adherent Tumors 462

Torsion of the Pedicle 463

Rupture of an Ovarian Cyst . . . . . . . . . 465

Leakage of an Ovarian Cyst ........ 465

Hemorrhage into the Cyst . . . . . . . . 465

Suppuration of the Cyst ........ 465

Malignant Degeneration of the Cyst ....... 466

Ovarian Tumors Complicating Pregnancy ....... 467

Diagnosis of the Variety 467

Fate of Ovarian Tumors . . . . : ... . 468

CHAPTER XXXII. General Peritonitis . . 472

Tuberculous Peritonitis 472

Carcinomatous Peritonitis ......... 472

Pelvic Peritonitis . . . 473

CHAPTER XXXIII. The Diagnosis of Parametritis (Pelvic Cellulitis) 479

Definition 479

Acute Parametritis .......... 480

Chronic Parametritis .......... 481

Differential Diagnosis . . . . . . . . . . 483

PAKT III.

DIAGNOSIS OF DISEASES OF THE URINARY SYSTEM.

CHAPTER XXXIV. The Diagnosis of Diseases of the Urethra and Bladder . 487

Physiology . . . 490

XVIU

Topography

Natural Landmarks

Methods of Examining

Percussion

Palpation

Catheter and Sound

Inspection

Urethroscopy .

Cystoscopy

Segregator

Malformations and Diseases of the Urethra

Malformations and Diseases of the Bladder

PAGE

GENERAL DIAGNOSIS.