PREFACE.

I have written this book for the medical student. I have attempted to present the best teaching of modern gynecology, untrammelled by antiquated theories or methods of treatment. I have, in most instances, recommended but one plan of treatment for each disease, hoping in this way to avoid confusing the student or the physician who consults the book for practical guidance. I have, as a rule, omitted all facts of anatomy, physiology, and pathology which may be found in the general text-books upon these subjects. Such facts have been mentioned in detail only when it seemed important for the elucidation of the subject, or when there were certain points in the pathology that were peculiar to the diseases under consideration. I am indebted to Dr. H. D. Beyea for several pathological drawings, and to Dr. Wm. R. Nicholson for the preparation of the Index.

CHAS. B. PENROSE.


CONTENTS.

[CHAPTER I.]
PAGE
[The General Causes of Diseases of Women]15
[CHAPTER II.]
[Methods of Examination]19
[Examination of the Abdomen], 19.—[Examination of the External Genitals and Pelvic Structures], 22.—[Vaginal and Bimanual Examination], 23.—[Examination of the Rectum], 33.—[Examination of the Bladder], 34.—[Antisepsis], 35.
[CHAPTER III.]
[Diseases of the External Genitals]36
[Vulvitis], 36.—[Inflammation of the Vulvo-vaginal Glands], 38.—[Suppuration of the Vulvo-vaginal Gland], 39.—[Cysts of the Vulvo-vaginal Glands], 40.—[Pruritus Vulvæ], 42.—[Kraurosis Vulvæ], 44.—[Varicose Tumors of the Vulva], 46.—[Hematoma of the Vulva], 46.—[Papilloma], 46.—[Elephantiasis], 47.—[Adhesions of the Clitoris], 48.
[CHAPTER IV.]
[Diseases of the Vagina]49
[Inflammation of the Vagina], 49.—[Tumors of the Vagina], 51.—[Atresia of the Vagina], 52.—[Vaginismus], 53.—[Coccygodynia], 54.
[CHAPTER V.]
[Anatomy and Mechanism of the Perineum]56
[CHAPTER V1.]
[Injuries to the Perineum]62
[Slight Median Laceration of the Perineum], 67.—[Median Tear involving the Sphincter Ani], 68.—[Laceration through the Sphincter Ani, involving the Recto-vaginal Septum], 73.—[Laceration in One or Both Vaginal Sulci], 75.—[Subcutaneous Laceration of the Muscles and Fascia], 85.
[CHAPTER VII.]
[Results of Laceration of the Perineum]87
[Rectocele], 87.—[Cystocele], 88.—[Enterocele], 91.—[Subinvolution of the Vagina], 92.
[CHAPTER VIII.]
[The Position of the Uterus and the Mechanism of its Support]94
[CHAPTER IX.]
[Prolapse of the Uterus]101
[CHAPTER X.]
[Anteflexion of the Uterus]119
[CHAPTER XI.]
[Retroflexion and Retroversion of the Uterus]127
[CHAPTER XII.]
[Laceration of the Cervix Uteri]148
[CHAPTER XIII.]
[Inflammation of the Cervical Mucous Membrane (Cervical Catarrh)]166
[CHAPTER XIV.]
[Congenital Erosion and Split of the Cervix]174
[CHAPTER XV.]
[Cervical Polypi; Hypertrophic Elongation of the Cervix; Chancre of the Cervix; Tuberculosis of the Cervix]178
[Cervical Polypi], 178.—[Hypertrophic Elongation of the Vaginal Cervix], 178.—[Chancre of the Cervix], 180.—[Tuberculosis of the Cervix], 180.
[CHAPTER XVI.]
[Cancer of the Cervix Uteri]181
[CHAPTER XVII.]
[Diseases of the Body of the Uterus]199
[Acute Corporeal Endometritis], 199.—[Chronic Corporeal Endometritis], 201.—[Exfoliative Endometritis, or Membranous Dysmenorrhea], 212.—[Senile Endometritis], 213.
[CHAPTER XVIII.]
[Subinvolution of the Uterus; Superinvolution of the Uterus]215
[CHAPTER XIX.]
[Cancer and Sarcoma of the Uterus]218
[Cancer of the Body of the Uterus], 218.—[Malignant Adenoma], 221.—[Sarcoma of the Uterus], 225.—[Diffuse Sarcoma of the Mucous Membrane], 225.—[Sarcoma of the Uterine Parenchyma], 227.—[Chorio-epithelioma or Syncytioma Malignum], 228.
[CHAPTER XX.]
[Fibroid Tumors of the Uterus]230
[Adenomyoma of Uterus], 257.
[CHAPTER XXI.]
[Hematometra; Hydrometra; Pyometra]259
[CHAPTER XXII.]
[Tuberculosis of the Uterus]261
[CHAPTER XXIII.]
[Inversion of the Uterus]264
[CHAPTER XXIV.]
[Diseases of the Fallopian Tubes]272
[Inflammation of the Fallopian Tubes, or Salpingitis], 276.—[Acute Salpingitis], 277.—[Chronic Salpingitis], 279.—[Suppuration of the Pelvic Cellular Tissue], 303.
[CHAPTER XXV.]
[Diseases of the Fallopian Tubes (Continued)]306
[Tuberculosis], 306.—[Adenoma], [Myoma], [Cancer], [Sarcoma], [Actinomycosis], and [Syphilitic Gummata of the Fallopian Tubes], 313.
[CHAPTER XXVI.]
[Tubal Pregnancy]314
[Ovarian Pregnancy], 329.
[CHAPTER XXVII.]
[Diseases of the Ovaries]330
[CHAPTER XXVIII.]
[Diseases of the Ovaries (Continued)]334
[Hernia of the Ovary], 334.—[Prolapse of the Ovary], 335.—[Inflammation of the Ovary, Oöphoritis, or Ovaritis], 339.—[Acute Oöphoritis], 339.—[Chronic Oöphoritis], 341.—[Apoplexy of the Ovary], 346.—[Ovarian Hydrocele], 346.
[CHAPTER XXIX.]
[Cystic Tumors of the Ovary]349
[Oöphoritic Cysts], 350.—[Follicular Cysts], 350.—[Glandular Cysts], 354.—[Dermoid Cysts], 359.—[Teratoma], 361.—[Paroöphoritic Cysts, or Papillomatous Ovarian Cysts], 362.
[CHAPTER XXX.]
[Cysts of the Parovarium]368
[Comparison of Oöphoritic, Paroöphoritic, and Parovarian Cysts], 372.—[Glandular Oöphoritic Cyst], 372.—[Paroöphoritic Cyst], 373.—[Cysts of the Parovarium], 373.
[CHAPTER XXXI.]
[Natural History and Treatment of Ovarian Cysts]374
[Secondary Changes or Accidents of Ovarian Cysts], 374.—[Inflammation and Suppuration], 374.—[Torsion of the Pedicle, or Axial Rotation], 375.—[Rupture of Ovarian Cysts], 377.—[The Clinical History of Ovarian Cysts], 378.—[Examination], 383.—[Treatment of Ovarian Cysts], 387.
[CHAPTER XXXII.]
[Solid Tumors of the Ovary]390
[Fibromata], 390.—[Myomata], 390.—[Sarcomata], 391.—[Carcinomata], 392.—[Ovarian Papillomata], 393.—[Tuberculosis of the Ovary], 393.—[Tumors of the Ovarian Ligament], 394.
[CHAPTER XXXIII.]
[Malformations of the Genital Organs]395
[Uterus Unicornis], 396.—[Uterus Didelphys], 396.—[Uterus Bicornis Duplex], 396.—[Uterus Bicornis Unicollis], 397.—[Uterus Cordiformis], 397.—[Uterus Septus], 397.—[Malformation of the Vagina], 397.—[Hermaphroditism], 399.
[CHAPTER XXXIV.]
[Disorders of Menstruation]402
[Amenorrhea], 405.—[Acute Suppression of Menstruation], 407.—[Scanty Menstruation], 407.—[Vicarious Menstruation], 408.
[CHAPTER XXXV.]
[The Menopause]409
[CHAPTER XXXVI.]
[Genital Fistulæ]412
[Vesico-vaginal Fistula], 412.—[Urethro-vaginal Fistula], 420.—[Vesico-uterine Fistula], 420.—[Uretero-vaginal Fistula], 421.—[Recto-vaginal Fistula], 421.
[CHAPTER XXXVII.]
[Diseases of the Urethra and Bladder]423
[Diseases of the Urethra], 426.—[Urethritis], 427.—[Stricture of the Urethra], 430.—[Prolapse of the Mucous Membrane of the Urethra], 431.—[Vesico-urethral Fissure], 431.—[Dilatation of Urethra], 433.—[Urethrocele], 434.—[Urethral Neoplasms], 434.—[Urethral Caruncle], 434.—[Urethral Cysts], 435.—[Polypus], 435.—[Sarcoma and Cancer of the Urethra], 436.—[Diseases of the Bladder], 436.—[Cystitis], 437.—[Vesical Calculus], 447.
[CHAPTER XXXVIII.]
[Gonorrhea in Women]448
[CHAPTER XXXIX.]
[The Technique of Gynecological Operations]457
[Operating-room], 461.—[Apparatus], 462.—[Operator, Assistants, Nurses], 463.—[Sterilization of Dressings, Towels, etc.], 466.—[Sterilization of Instruments], 466.—[The Water], 467.—[Sponges], 468.—[Discipline of the Operating-room], 469.—[Anesthesia], 470.—[Preparation of the Patient], 471.—[Instruments], 475.—[The Dressing], 479.
[CHAPTER XL.]
[The Technique of Gynecological Operations (Continued)]480
[Abdominal Drainage], 480.—[Gauze-drainage], 482.—[Indications for Drainage], 484.—[Vaginal Drainage], 487.—[The Incision of the Abdominal Wall], 487.—[Exploration of the Abdomen], 489.—[Protection of the Intestines and Omentum], 489.—[Toilet of the Peritoneum], 490.—[Closing the Abdominal Incision], 491.
[CHAPTER XLI.]
[Treatment after Celiotomy]404
[CHAPTER XLII.]
[The Special Technique of Operations upon the Uterus and the Uterine Appendages]502
[Removal of the Uterine Appendages (Salpingo-oöphorectomy)], 504.—[Removal of an Ovarian Cyst], 512.—[Operation for the Removal of Intra-ligamentous Cysts], 514.—[Marsupialization of the Cyst], 516.—[Operation for Removal of the Uterus], 517.—[Supra-vaginal Amputation of the Uterus], 518.—[Preservation of the Ovaries in Hysterectomy], 523.—[Complete Abdominal Hysterectomy], 523.—[Vaginal Hysterectomy], 527.—[Combined Vaginal and Abdominal Hysterectomy], 531.—[Abdominal Myomectomy], 533.
[CHAPTER XLIII.]
[The Effect of the Removal of the Uterine Appendages]535
[Index]537

A TEXT-BOOK
OF
DISEASES OF WOMEN.


CHAPTER I.