A practical treatise on the diseases peculiar to women, illustrated by cases, derived from hospital and private practice

Front matter

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Preface

TO THE

ENGLISH EDITION.

It is now more than twenty years since my attention was particularly directed to the important branch of Medical Science which constitutes the subject of the following pages. During ^ great part of this period, Guy^s Hospital, with its extensive Lying-in Charity, and my own private and consultation practice in female diseases, have afforded me opportunities falling to the lot of few practitioners. I do not, however, on this account urge any exclusive claim to the publication of a work of this kind, nor do I ask for its opinions and practice any exclusive or undue deference ; but I trust the truth of the principles, and the treatment recommended in the book, will obtain for it the sanction and confidence of my professional brethren.

The disposition to publish has been strengthened by an opinion I have long entertained, that practitioners, who hold important public appointments, are boun^, so far as their sources of authentic information can be made subservient, to improve and increase the common stock of professional knowledge. It may, too, be urged in favour of my attempt, that some production of the kind is really wanted; for, while

VI PREFACE.

we possess many valuable individual essays on female diseases, there are few complete and practical works.

This treatise was commenced years ago, and but for its difficulty and extent, it would long ere now have been completed. It must be remembered, that it is strictly devoted to pathology and treatment, not to anatomical detail and physiological research. The latter sciences will therefore be introduced for the sole purpose of illustrating disease and the influence of remedies; further they would be irrelevant.

Numerous cases are narrated, in order that their symptoms may show whether the histories of the various diseases are accurately given, and from their successful or unfavourable issue, the danger of the malady and the worth of the treatment may be demonstrated. These motives will, with practical men (and for them I have written,) sufficiently apologize for the increased size of the volume. Perhaps it may be also urged, that cases add greatly to the interest of an elementarj^ work, as they relieve the dullness from which a constant repetition of principles, without such portraits, is nearly inseparable.

The book contains little which is not the result of my own practice and observation ; and if I have not quoted largely from the works of others, it has not arisen from any want of due appreciation of their excellence, nor from* an unwillingness to acknowledge obligation, but from a conviction that every practical book ought mainly to rest on what its author knows and has proved for himself to be true and valuable. Where such is the case, a writer naturally uses a phraseology of his own; the dress in which he appears before the public is seen to belong, not to another but to himself; and there is, consequently, a consistency of arrangement and character throughout the whole. Nevertheless, it will be seen on perusal, that I

PREFACE. VU

have not omitted to mention the names of those from whom I have derived assistance.

Many formulee of remedies are appended to the various chapters, and this has been done, because it harmonized with the practical plan I had prescribed to myself; and because there are young practitioners without sufficient therapeutical knowledge, and older ones with too many demands on their time, nicely to test the value, and accuratively to determine the doses and other important conditions on which the efficient use of remedies so much depends.

My aim has been, to produce a treatise on female diseases, true, simple, and practical, which may form a safe and efficient guide to the elucidation and curative treatment of many of these intricate, rapidly-progressing, and dangerous maladies. If success attend the effort, that alone vrill be a sufficient reward for the labour I have bestowed on the work. I have endeavoured to write in a plain and perspicuous style, with scrupulous accuracy as •to facts; and in reference to opinions and treatment, nothing is recommended, the probability or worth of which, my own experience has not confirmed.

The first part of my undertaking is now before the profession, and in reference to it I may say, in the words of the great and lamented Dr. Gooch, ''When an author attempts to execute his own view of a subject, he is the last person in the world to judge whether he has succeeded or failed. When be has finished his book, it is impossible for him to see it in the same point of view, and in the same light, as the public will: and as be himself would, if he could, forget its thoughts and phrases, and read it with a fresh and impartial mind : he may show it to a judicious and wellinformed friend, but this is a poor thermometer of public

VIU PREFACE.

opinion : the only one is publication, and to this I must trust the fate of mv volume."'

In conclusion. I acknowledge with pleasure some valuable assistance afforded me by the late Mr. Tweedie, Dr. Lever and Dr. Oldham, the Obstetric Assistants of Guy's Hospital.

Graftcn Street, Bond Street, London.

Xovemher, 1S44.

PREFACE

TO THE

AMERICAN EDITION.

An apology would seem to be due to the Airrerican medical public for presenting them with a work on the diseases of females at the present time ; but the editor of the following pages is convinced that an examination of them will afford a better excuse than he is able to give. They will be found so replete with facts, so full of just observations and plain practical deductions that no medical man can peruse them without experiencing both pleasure and profit.

Dr. Ashwell has had most enlarged opportunities, has observed much and thought deeply and profitably, and in addition to these advantages evidently possesses a mind well stored with knowledge derived from extensive reading. His chapters, themselves full and corncomprehensive, are accompanied by cases carefully and graphically described. Occasional notes have been appended to this edition, and a few cases inserted by the American editor which he hopes will not be thought to mar the integrity of the work.

February f 1845.

CONTENTS,

PAGE

Preface to the English Edition - - , - . y

Preface to the American Edition - . - - ix

Pathology of Functional Diseases of the Uterine System - - xiii

CHAPTER I. Complication of, with Amenorrhoea - - - - - 21

with Hematemesis - . - . 23 with Chronic Derangement of Digestion and Nutrition ------ 23

with Functional Affection of the Cerebrum - 24

with Disorder of the Vascular System - - 26

with Ascites ----- 26

with Structural Change of Lung - - - 26

Cases of Simple Chlorosis - - - - - 33

Cases of Confirmed Chlorosis ----- 36

Cases of Chlorosis complicated with Vicarious Discharges of Blood,

and disorders of the Stomach and Bowels - - - 38

Cases of Chlorosis, complicated with Cerebral Affection - - 43 Cases of Chlorosis complicated with Functional or Structural Disease

of the Lungs -->.,- 45

CHAPTER n.

Araenorrhosa of Retention - , . - . 49

Amenorrhoea of Suppression , . - - . 5g

Xll CONTENTS.

Emmenagogues ------- 62

Cases of Amenorrhcea dependent on Congenital Deficiency, Malformation, or disease of tlie Genital Organs - - - 68

CHAPTER III. Of Vicarious Menstruation . . . - . 75

Cases ofVicarious Menstruation ----- 78

CHAPTER IV. Of Dysmenorrhoea ----._ qq

Irritable or Neuralgic Dysraenorrhcsa - - - - 80

Plethoric Dysmenorrhcea - - - - - gl

Congestive Dysmenorrhcea - - - - - - 82

Dysmenorrhcea dependent on Mechanical Obstruction - - 82

Cases of the various kinds of Dysmenorrhcea - - - §8

CHAPTER VI. Of Menorrhagia - - - - - - jqj

Profuse Menstruation - - - - - - 101

Profuse Menstruation, accompanied by direct Loss of Blood from the

Uterine Arteries - - " - . . . ^qj

Acute or Active Menorrhagia - - - . . io5

Spasmodic Menorrhagia - - - . . jq?

Passive or Chronic Menorrhagia ----- 107

Congestive Menorrhaaia - - . _ . 109

Cases of Spasmodic Menorrhagia - - - - - 114

Cases of Congestive Menorrhagia - - . . xi5

CHAPTER VH.

Of LEucoRRHa:A - - - . . . -122

Common Leucorrhoea ----.. 122

Inveterate Chronic Leucorrhoea - - - . . 126

Symptomatic Leucorrhoea - - - . . 128

Perulii^r form of Leucorrhoea - - - . . i29 Inflammation of llie Cervix Uteri Cases of Inveterate Leucorrhoea Case attended bv Accumulation of Pus

140 142

Cases from M. Tealier ----.. 145

CONTENTS. Xlll

Chapter VIII. Page

Of the Disorders attendant on the Decline of Menstruation - 148

Functional derangements of the Brain and Nervous System - - 149

Increased Action and Congestion of different Organs - - 150

Lesions of Structure and Malignant Disease - - - - 152

Of Irritable Uterus - - - - - - 1 80

Cases of Irritable Uterus * <• - - - -185

PART 11.

Of the Organic Diseases of the Internal and External Female Genitals.

Chapter I

General Remarks on the History and Symptoms, Diagnosis, Pathology, AND Prognosis of the Organic Diseases of the Uterine

The History of the Symptoms ----- 189

Examination by Touch - - - - - . 192

the Speculum - - - * . 2OO

the Stethoscope ----- 202

the Discharges - - - - > 203

B

XIV CONTENTS.

PAGE

CHAPTER II. Of the Tumours op the Walls of the Uterus, cHARAcTkRi5iED by

Tumours Growing Externally, covered by Peritoneum - - 211

Growing Internally, invested by the Uterine Mucous

Cases of the different kinds of Uterine Tumours - - - 220

CHAPTER HI.

On Premature Labour in Pregnancy, Complicated with OrgaxVic

CHAPTER IV. Organic Diseases of the Cervix and Os Uteri - - - 258

Congestion of the Uterus ----- 258

Acute Metritis - - - - - -•- 260

Chronic Metritis ------ 261

Cancer of the Uterus ------ 263

Of the advanced stage of Cancer ----- 286

Of Excision of the Neck of the Uterus - - - - 295

Of Extirpation of the entire Uterus - - - - - 298

Simple Ulceration of the Cervix and Os Uteri - - - 302

Corroding Ulcer of the Uterus . - - - - 306

CauHtiower Excrescence of the Uterus - - - - 308

Occlusion and Rigidity of the Os Uteri - - - - 314

Cases of entire Occlusion ------ 321

Cases of Contracted Os Uteri - - * - - 333

• CHAPTER V.

Organic Diseases of the Mucous Membrane of the Cavity of the

Polypus of the Uterus - - - - ^ . 33q

Malignant Growths and Ulcerations of the Uterine cavity - 350

Physometra, or Tympanites of ihe Uterus - - . - 352

Hydromeira, or Dropsy of the Uterus - - u , 354

Abscess in the Walls of the Uterus - - ^ . 354

Cases - - - . oA^

CONTENTS. XV

PAGE

Of Uterine Moles - - - - - - 366

Vesicular Moles, or Hydatids of the tJterus - - - - 368

Osseous and Calcareous Tumours of the Cavity of the Uterus - 374

Phlebolites ----.-. 375

Atrophy and Hypertrophy of the Uterus - - - . 375

CHAPTER VI. Relaxation, Prolapse, and Procidentia Uteri - - - ' 377

Inversio Uteri ------- 39g

Anteversion and Anteflexion of the Uterus - - - 411

Retroversion of the Uterus - - - . _ 4ig

Retroflexion of the Uterus - - - - - 432

Hernia of tlie Unimpregnated Uterus - - - - 434

CHAPTER VH.

Acute Ovaritis - - - - - - - 438

Chronic Ovaritis - - - - - - 441

Dropsy of the Ovary - - - - - . 444

Prognosis, Terminations, and Extirpation of the Ovary - - 453 Cases .---.*.. 470

Observations on Cases - - - - - - 479

Organic and Malignant Diseases of the Ovary - - . 481

Atrophy of the Ovary ------ 482

Fibrous Tumours of the Ovary , * - * - - 482

Malignant Diseases of the Ovary - - - . 483

CHAPTER Vni.

On the Diseases op the External Organs of Generation in the

Phlegmonous Inflammation of the Labia - t - 587

Encysted Tumour of the Labium ----- 588

Oozing Tumour of the Labium ----- 589

Warty Tumours of the Vulva ----- 59O

Inflammation of the Mucous Membrane of the Vulva ^ * 691

Inflammation of the Vulva in Adults _ - . . 592

Eczema of the Vulva ------ 594

Follicular Inflammation of the Vulva - - , - 596

Enlargement of the Clitoris - * ^ * - ^ 599

XVI CONTENTS.

PAGE

Vascular Tumour of the Meatus Urinarius - - - 501

Thickening of the Cellular Membrane surrounding the Urethra - 502 Diseases of the Vagina — Prolapse of the Walls of the Vagina - 503