Chapter I: 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 VI.

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.