Chapter XLIII

THE EFFECT OF THE REMOVAL OF THE UTERINE APPENDAGES.

Removal of the tube and ovary upon one side has no effect upon menstruation or upon any of the other characteristics of the woman.

Removal of the tubes and ovaries upon both sides is followed within forty-eight hours by slight bleeding from the uterus, lasting for one or two days.

If the removal of the tubes and ovaries has been complete, menstruation, in the majority of cases, never reappears.

In a few cases menstruation appears for one, two, or three periods after the operation, usually in diminished amount, and then ceases for ever. In some other cases there is a period of a few months of amenorrhea, followed by two or three scanty menstrual flows, before the bleeding permanently ceases.

These phenomena, it will be observed, are similar to those of the normal menopause.

The woman after double salpingo-oöphorectomy experiences the nervous and gastro-intestinal disturbances that so usually accompany the menopause. She, in fact, passes through a premature menopause, the phenomena of which may persist for one or two years.

The secondary sexual characteristics of the woman--the voice, the figure, and the growth of hair--are not altered if the appendages are removed during adult life. The case may be different if the appendages are removed in the undeveloped girl, in whom the ovarian influence is essential for complete development.

The woman loses none of her feminine attractions. She may, indeed, become better-looking if the operation has relieved chronic suffering. It is said that Gyges, king of Lydia, caused the removal of ovaries from women with a view to prolonging their charms.

Double oöphorectomy may be followed by obesity if the woman have a tendency to form fat. The relief of suffering and the consequent improved nutrition favor the development of obesity. There seems to be nothing inherent in the operation to cause it. Many women remain thin after the operation.

The emotions of the woman are unaltered by double oöphorectomy, with the exception of some cases in which the sexual desire is destroyed. Sexual desire is dependent upon such a variety of conditions, both within and without the woman, that it is difficult to determine the amount of influence that removal of the ovaries exerts upon this feeling.

It is undoubtedly true that sexual desire is sometimes destroyed by the operation. On the other hand, the sexual desire is very often restored by the operation, which relieves the former dyspareunia, or painful coitus.

INDEX.

Abdomen, binder for, 479
distention of, after celiotomy, 497
drainage of, 480, 482
enlargement of, 19
examination of, 19, 21, 22, 28
exploration of, 489
fluctuation in, 24
protection of contents of, during operation, 489
retentive power of, 99
sterilization of, for operation, 473

Abdominal incision, closing of, 491
irrigation, temperature of water for, 468
myomectomy, 255
technique, 530, 533
operations, dressing of, 479
instruments for, 475
section, after-treatment of, 494
surgery, training for, 461
suture, layer method, 493
sutures, removal of, 492
wall, incision of, 487
closing of, 491

Abortion by uterine sound, 35
in endometritis, 206

Abscess, pelvic, 303
of vulvo-vaginal glands, 38, 40

Actinomycosis of tubes, 313

Adeno-carcinoma of cervix, 181

Adenoma of ovary, 354
of tubes, 313
of uterus, malignant, 221

Adenomyoma of uterus, 257

Adhesions of clitoris, 48
pelvic, treatment, 510, 513

Alexander’s operation, 142

Amenorrhea, 405
emansio mensium, 405
in superinvolution, 217
in tubal pregnancy, 326
pelvic massage in, 414
periodical disturbances in, 406
suppressio mensium, 405

Ampullar pregnancy, 315

Anesthesia, 470

Anesthetizer, duties of, 470

Animals, disease of reproductive organs in, 17

Anteflexion of uterus, 119
causes, 119, 122
menstruation in, 122
miscarriage in, 123
pessaries in, 123
pregnancy in, 123
sequelæ, 122
sterility in, 122
symptoms, 122
varieties, 120

Anterior colporrhaphy, 90

Antisepsis, 35

Antiseptics, action of, on peritoneum, 457

Apoplexy of ovary, 346

Apparatus for gynecological operations, 462

Appendix vermiformis, palpation of, 21

Applicator, vesical, 425

Arnold’s sterilizer, 466

Ascites in ovarian cyst, 366
in solid tumors of ovary, 391

Asepsis, importance of, in gynecology, 458

Atresia of cervix, 17
of vagina, 17, 52
diagnosis, 53
symptoms, 52
treatment, 53

Auscultation of abdomen, 22

Barnes’ bag in inversion, 269

Bartholin’s glands, 36

Basham’s mixture, 171

Basins, sterilization of, 463

Bimanual examination, 23-25, 28
in carcinoma of uterus, 224
in endometritis, 206
reposition of uterus, 135

Binder, abdominal, 479

Bivalve speculum, 29, 30

Bladder, base of, 436
body of, 436
catheterization of, 439

Bladder, cervix of, 436
dissection of, from uterus, 519
empty, 436
examination of, 34, 425
fundus of, 436
intra-ureteral ligament of, 437
irrigation of, 443
irritable, 89
meatus internus, situation of, 445
mucous membrane of, 436
neck of, 436
structure of, 436
trigone of, 436
vascular supply of, 437
vesical triangle of, 436

Blaud’s pill, 170

Boldt’s table, 462

Bowels, treatment of, after celiotomy, 496

Braun’s colpeurynter, 118

Broad ligament, hematoma of, 318

Bulbo-cavernosus, 58

Buried sutures, 493

Calculi in vesico-vaginal fistula, 416
vesical, 447

Calibrator, urethral, 423

Canal of Gärtner, 52
of Nuck, 42

Carcinoma, cachexia of, 192
of cervix, 181
adeno-carcinoma, 181
broad ligaments in, 185, 193, 194
caustics in, 196
diagnosis from lupus, 188
from syphilitic ulceration, 188
from uterine polyp, 188
duration, 193
hysterectomy for, 193, 194
remote results, 195
metastasis in, 185
origin, 181
peritoneal involvement in, 185
septic infection in, 192
squamous-cell, 181
symptoms, 189
treatment, 193, 195
ulceration in, 182
ureteral involvement in, 185
urinary fistulæ in, 185
varieties, 181, 183, 184
of Fallopian tubes, 220
of ovaries, 220
of peritoneum, 220
of ureters, 185
of uterus, body of, 218
age, 220
causes, 221
curette in, 224

Carcinoma of uterus in lower animals, 15
influence of fibroids in, 221
leucorrhea in, 223
metastasis in, 220, 223, 224
operation in, 224, 225
symptoms, 222
of vagina, 52
urethral, 436

Carrier for perineal sutures, 66

Caruncle, urethral, 434
results, 435
symptoms, 435
treatment, 435

Catarrh of cervix, 166

Catgut, sterilization of, 477, 478
cumol method, 478
iodin method, 478

Catheter, Skene’s, 429

Catheterization after celiotomy, 495
as cause of cystitis, 438
before operation, 474
of bladder, 439

Celibacy a cause of disease, 18
fibroids in, 18

Celiotomy, 305, 308
abdominal distention after, 497
after-treatment, 494
of bowels, 495
catheterization after, 495
death after, 500
dressings after, 478
food after, 496
hemorrhage after, 500
micturition after, 495
mortality after, 501
opium after, 495
pain after, 495, 497
peritonitis after, 500
pulse after, 498
purgation after, 496
shock after, 498
temperature after, 498
thirst after, 494
urinary secretion after, 496
vomiting after, 497
water after, 494

Cellulitis, pelvic, 303

Cervical catarrh, 153, 166
erosion in, 167
in displacements, 167
in laceration of cervix, 152
sclerosis in, 167

Cervix, amputation of, 162, 163
conception after, 165
in subinvolution of uterus, 216
in uterine prolapse, 117
applications to, 172
artery of, 504
atresia of, 17
carcinoma of, 181.
See also _Carcinoma_.
chancre of, 180
congenital erosion of, 174
split of, 177
cystic degeneration of, 152, 155
dilatation of, 124
results of, 126
direction of, 95
distance of, from coccyx, 95
ectropion of, 150, 152, 159
endometritis of, 166
erosion of, after laceration, 176
erosions of, 152, 155
eversion in laceration of, 150
examination of discharge from, 452
gonorrhea of, 451
hypertrophic elongation of, 178
in infancy, 119
laceration of, 148
diagnosis of, 154
from congenital ectropion, 176
Nabothian cysts in, 152, 184
reflex symptoms, 154
sclerosis in, 152
subinvolution in, 152
symptoms, 153
trachelorrhaphy in, 156
treatment, 156
ulceration in, 152
varieties, 150
with endometritis, 153
of bladder, 436
patulous canal, 206
polypi, 178
polypoid growths, 182
sensation of, 27
splitting posterior lip of, for inversion of uterus, 271
supra-vaginal elongation of, 104
tuberculosis of, 180
ulceration of, 182
vegetating growths of, 182

Chancre of cervix, 180

Chorio-epithelioma, 228
symptoms, 229
treatment, 229

Circular artery, ligation of, 196

Claudius’ method for sterilization of catgut, 478

Clitoris, adhesions of, 48

Clothing as cause of disease, 17

Coccygodynia, 54

Colpeurynter, Braun’s, 118

Colporrhaphy, anterior, 82

Conception after amputation of cervix, 165
after salpingo-oöphorectomy, 512

Corpora fibrosa, 390

Corpus-luteum cyst, 352

Cumol method for sterilization of catgut, 478

Curette in endometritis, 207, 208, 299
in uterine cancer, 224
Martin’s 209
perforation by, 210
reparative process after use of, 212
Sims’, 209

Cyst, intra-ligamentous, removal of, 514
Nabothian, 152
of hernial sac, 42
of Morgagni, 369
of ovary, 15.
See also _Ovary_.
of round ligament, 42
of vagina, 51
of vulvo-vaginal gland, 40
trocar, 477
urethral, 435

Cystitis, 89
chronic, 438
causes, 438, 439
cystotomy in, 444
diagnosis, 439
effect on system, 29
hypertrophy of bladder-wall in, 438
use of endoscope in, 440, 442, 444
obstruction of vesical orifice, 438
result of lacerated perineum, 440
of uterine displacement, 440
symptoms, 439
treatment, 440, 444
ureter and kidney involvement, 438
urinary changes, 438

Cystocele, 88, 107
Dudley’s operation for, 91
Sims’ operation for, 90

Cystoscope, 424

Cystotomy, 444, 445

Death after celiotomy, 500

Depressor for vagina, 29

Dermoid cysts, 359
of ovary, 512
age of occurrence, 359

Developmental errors a cause of disease, 17

Diarrhea, vicarious, 408

Dilatation of cervix, 124
of urethra, 433

Dilator, cervical, 123
vaginal, 416

Diseases of women, causes of, 16

Dorsal position, 31

Drainage, abdominal, by gauze, 482
by tube, 480

Drainage, abdominal, ill effects of, 485
indications for, 484
object of, 485
vaginal, 480, 487

Drainage-tube, 480, 482
cleansing of, 481
syringe for, 481

Dressings for abdominal operations, 478
sterilization of, 466

Duck-bill speculum, 29

Dudley’s operation for cystocele, 91

Dysmenorrhea in anteflexion of uterus 121
in salpingitis, 291
membranous, 212
menstruation in, 210

Ectropion, cervical, 152

Edebohls’ stirrups, 22

Elephantiasis Arabum, 47
of vulva, 47
syphilitic, 47

Emansio mensium, 405

Emmet’s operation for lacerated perineum, 80
perineal needles, 65
scissors, 64
treatment for inversion of uterus, 269, 270

Endometritis, abortion in, 206
acute, 199
cervical, 166
chronic, 201, 207
causes of, 207
curette in, 208
examination in, 206
exfoliative, 212
fungous, 203
gonorrheal, 199
in exanthemata, 199
in lacerated cervix, 153, 204
in subinvolution, 204
in tubal disease, 204
influence on menstruation, 204
with metritis, 199
ovarian disease in, 204
pain in, 205
post-climacteric, 213
puerperal, 199, 200
senile, 213
sterility in, 206
structural changes in, 203
with uterine displacement, 131, 204

Endoscope, 432
in cystitis, 440, 442, 444

Enterocele, 91

Erosion of cervix, 152, 174, 176

Eruptive fever as cause of disease, 344

Exanthemata as cause of chronic pelvic disease, 200
of cystitis, 439
of sexual ill-development, 200
vaginitis in, 49

External genitalia, examination of, 22, 26

Extra-uterine pregnancy, 314.
See also _Tubal pregnancy_.

Facies ovariana, 381

Fallopian tubes, 272
actinomycosis of, 28
adenoma of, 313
anatomy of, 272
cancer of, 313
cysts of Morgagni, 276
development of, 395
examination of, 25
gummata of, 313
inflammation of, 276.
See also _Salpingitis_.
miliary tuberculosis of, 308
myoma of, 313
pregnancy in, 314.
See also _Tubal pregnancy_.
sarcoma of, 313
tubercle of, 307
tuberculosis of, 306, 309, 312
unsuspected, 308

Fibroid tumors, anatomic changes, 235
hysterectomy in, 526
in Africans, 16
in animals, 15
in celibacy, 18
of uterus, 230
and ovarian cyst, 248
and pregnancy, 247, 256
appearance of, 232
circulatory abnormalities in, 245
degenerations of, 237, 238
diagnosis of, 246, 248
duration of life in, 236
frequency of, 241
gangrene in, 239
hemorrhage in, 242
hypertrophy in, 242
hysterectomy in, 254
in menopause, 242
interstitial, 232
intra-ligamentous, 232, 235, 526
intra-uterine polyp, 234, 256
ligation of uterine arteries in, 252
lymphangiectatic, 238
menstruation, in, 241, 242, 249
myomectomy in, 255
necrobiosis of, 239
polypoid, 256
pressure-symptoms of, 245
procreative abnormalities in, 240, 250
prognosis in, 248
salpingo-oöphorectomy in, 252
sarcoma of, 239
submucous, 232, 234
subperitoneal, 232
telangiectatic, 238
treatment of, 249, 251
of vagina, 52
recurrent, 227
inversion of, 227
metastasis in, 227
tubal changes in, 237
sterility in, 18
with cancer, 227

Fibroma, ovarian, 390

Fibro-myoma of uterus, 227

Fibro-sarcoma of uterus, 227

Fissure, vesico-urethral, 431

Fistula in salpingitis, 290
needles for, 418
of vulvo-vaginal glands, 39
recto-vaginal, 421
uretero-vaginal, 421
urethro-vaginal, 420
vesico-uterine, 420
vesico-vaginal, 412

Flatus after abdominal section, 497

Floating kidney, 21

Fluctuation, abdominal, 20

Follicular vulvitis, 36

Food after celiotomy, 496

Forceps, bladder, 423

Four chlorides, 171

Fungous endometritis, 203

Gärtner’s canal, 52
duct, 368

Gauze sponges, preparation of, 468

Genital fistulæ, 412
tract, septic infection of, 17

Genitalia, development, 395
examination, 22
inflammation of glands of external, 454
malformations of, 395
preparations of, for operation, 472

Genu-pectoral position, 32

Glands of Bartholin, 36
of Skene, 426

Gloves, rubber, 465

Gonococci in gonorrhea, 450

Gonococcus, resistance to, 451
of vagina, 453

Gonorrhea, 448
a cause of disease, 17, 37, 450
auto-infection, 453
best time for examination, 455
carbolic acid in, 456
curettement in, 456
epidemics of, 450
gonococci in, 450
in children, 450
liability to, 451
of cervix uteri, 451, 453
examination, 452
of discharge, 452
of rectum, 450
of urethra, 451
of vagina, 453
symptoms of, 454
of vulva, 454
persistence of, 451
results of, 17

Gonorrheal endometritis, 453
macula, 39
vaginitis, 453

Green soap, 26

Gummata of Fallopian tubes, 313

Gynecological operations, apparatus for, 462
performance of, 460
personal sterilization in, 463
rubber gloves in, 465
water in, 467

Gynecology, definition of, 15

Hands, sterilization of, 465

Headache in endometritis, 205
in lacerated cervix, 153

Hematocele, pelvic, 325

Hematocolpos, 53, 399

Hematoma between suture planes, 493
of broad ligament, 318
of vulva, 46
pelvic, 326

Hematometra, 259

Hematosalpinx, 282, 286, 287
after celiotomy, 500
in cervical carcinoma, 190
with hematometra, 260

Hemorrhage after rupture of tubal pregnancy, 317
in carcinoma of fundus uteri, 223
in uterine fibroid, 242

Hemostatic forceps, Tait’s, 470

Hermaphroditism, 309
hypospadia in, 400

Hernia, entero-vaginal, 91

Hernial-sac cyst, 42

Hodge pessary, 134

Hydrocele of canal of Nuck, 42
ovarian, 346

Hydrometra, 259

Hydrosalpinx, 282, 285, 289
with hematometra, 260

Hydrostatics of pelvic contents, 98

Hypertrophic cervical elongation, 178

Hypospadia, 400

Hysterectomy, abdominal, 517, 523
supra-vaginal amputation, 518, 521
combined abdominal and vaginal, 531
advantages of author’s method, 533
Werder’s, 532
for cervical carcinoma, 193, 194
complete, 523
dangers, 523
incisions of vaginal fornix in, 524
indications for, 523
remote results, 195
transplantation of cancer-cells during, 525
for fibroid, 526 ·
for inversion, 271
for prolapse, 117
for salpingitis, 302
for uterine fibroid, 254
preservation of ovaries in, 523
vaginal, 517, 518
removal of tubes and ovaries, 531

Incision of abdominal wall, 487

Infundibular pregnancy, 315.
See also _Tubal pregnancy_.

Inguinal adenitis, 36
hernia, 42

Instillation-tube, 173

Instruments for abdominal operations, 475
sterilization of, 466

Interstitial pregnancy, 315.
See also _Tubal pregnancy_.

Intestinal tract, evacuation before operation, 471

Intestines and omentum, protection of, during operations, 489

Intra-ligamentous cyst, marsupialization, 516
removal, 514

Intra-ureteral ligament, 437

Intra-vesical pressure, 437

Inversion of uterus, 264
Barnes’ bag in, 269
continuous pressure in, 270
diagnosis of, 267
Emmet’s method for, 269, 270
hysterectomy in, 271
splitting posterior lip of cervix for, 271
symptoms and sequelæ of, 266
treatment of, 268
White’s repositor for, 270
with uterine polyp, 271
with vaginal prolapse, 265

Irrigation after curettement, 210
of abdominal cavity, water for, 467

Kelly’s instruments for examination of bladder, 423

Kidney, floating, 21
movable, 21

Knee-chest position, 32
for rectal examination, 33

Kobelt’s tubes, 368

Kolpokleisis, 420

Kraurosis vulvæ, 44

Labor after amputation of cervix, 165
spurious, 321

Laceration of cervix, 148
concealed, 150
incomplete, 150
of perineum, 62

Latero-abdominal position, 31

Le Fort’s operation for prolapse, 112

Leucorrhea, 153
in carcinoma of fundus uteri, 223
vicarious, 408

Levator ani, 53

Ligament, intra-ureteral, 437
of uterus, 95, 96
utero-sacral, 27

Ligation of circular artery, 196
of uterine arteries, 196

Ligatures, 476, 477

Lineæ albicantes, 19

Link ligature, 506, 508

Lupus ulceration, diagnosis from carcinoma of cervix, 188

Lymphadenitis in lacerated cervix, 154

Lymphangitis in lacerated cervix, 154

Malformations of genital organs, 395

Malignant adenoma, 221

Mammary changes in tubal pregnancy, 322
secretion, periodical, 408

Manometer, 437

Marsupialization, 516

Mass suture, 491

Massage, pelvic, 299

Meatus internus, position of, 445

Mechanism of perineum, 56
of uterine support, 95

Median perineal laceration, repair of, 70

Membranous dysmenorrhea, 212

Menopause, 405, 409
due to salpingo-oöphorectomy, 535
in chronic oöphoritis, 344
in ovarian cysts, 380
in salpingitis, 294
in uterine fibroid, 242
operative, 511

Menorrhagia in chronic endometritis, 204
oöphoritis, 344

Menstruation after curettement, 212
after salpingo-oöphorectomy, 535
amount of flow in, 404
and ovulation, coincidence of, 402
arrest of, by operation, 511
cessation of, 405
constituents of fluid of, 404
disorders of, 402
duration of flow, 404
during pregnancy, 247
establishment of, 402
frequency of, 404
in anteflexion, 95
in chronic endometritis, 204
in lacerated cervix, 153
in retro-displacement, 133
in tubal pregnancy, 322
neglect during, 18
precocious, 404
regimen during, 18
scanty, 407
suppression of, acute, 407
systemic effect of, 18
vicarious, 408

Metastasis in carcinoma of cervix, 185

Metritis in subinvolution, 215
with endometritis, 199

Metrorrhagia in chronic endometritis, 204

Micturition after celiotomy, 495

Miliary tubal tuberculosis, 298

Milk as a diagnostic agent in fistulæ, 414, 421

Miscarriage in anteflexion, 123

Morgagni, cysts of, 276, 369

Mortality after celiotomy, 501

Movable kidney, 21

Müller, ducts of, 395

Muscles of perineum, 58

Myo-fibroma, uterine, 230

Myoma of Fallopian tubes, 313
uterine, 230

Myomectomy, abdominal, 255
technique of, 530, 533

Myxoma, ovarian, 390
peritoneal, 378

Nabothian cysts, 152

Necrobiosis in uterine fibroid, 239

Needle for cervix, 156
for fistula, 418
for perineum, 65

Needle-holder, Emmet’s, 65
Reiner’s, 477

Neoplasms of vulva, 46, 49

Normal salt solution, 468

Nuck, canal of, 42

Nurse’s duties in operating-room, 470

Obturator, 33

Oöphoritis, 339.
See also _Ovary, inflammation of_.

Operating-room, 461
discipline of, 470
preparation of, 462
temperature of, 462

Operating-table, 462

Opium after celiotomy, 495

Ostium vaginæ, 57

Ovarian abscess, 283
adenomata, 354
artery, 502
ligation of, 520, 526
carcinomata, 392
cyst, 15
axial rotation in, 375
dermoid, 512
duration of, 382
examination of, 383
inflammation of, 374, 382
malignant degeneration of, 380
marsupialization of, 515
necrosis of, 377
operation for, 389
pregnancy, 329
pressure results of, 379
rapidity of growth, 381, 382
removal of, 512
rupture of, 377, 382
causes of, 383
symptoms of, 383
treatment of pedicle, 514
suppuration of, 375
symptoms of, 378, 382
tapping of, 387, 512, 513
thrombosis, 377
torsion of pedicle in, 375
symptoms of, 382
treatment of, 387, 380
fibroid uterus, changes in, 237
fibromata, 390

Ovarian fibro-myomata, 288
ligament, bimanual examination of, 25
tumors of, 394
myomata, 390
papillomata, 393
sac, 348
sarcomata, 391
tuberculosis, 393

Ovaritis, 339.
See also _Ovary, inflammation of_.

Ovary, accessory, 333
after menopause, 330
anatomy of, 330
apoplexy of, 346
blood-vessels of, 332
chronic inflammation, treatment of, 344
contents of glandular cyst of, 356
corpus luteum, cyst of, 352
cystic, 342
cystic, tumors of, 349
dermoid cysts of, 350, 359
follicular cysts of, 350
hemorrhage in, 346
glandular cysts of, 354, 372
hernia of, 334
conception in, 334
dangers in, 334
menstruation in, 334
ovulation in, 334
treatment of, 335
hydrocele of, 346
in multiparæ, 330
in new-born, 330
inflammation of, acute, 339
causes of, 340
symptoms of, 340
treatment of, 341
chronic, 341
reflex disturbance in, 344
from salpingitis, 283
ligaments of, 331
maintenance of position of, 332
multilocular cyst of, 354
of virgin, 330
of Wolffian body, 333
oöphoritic cysts of, 350, 372
oöphoron, 335
papillomatous cyst of, 362
contents of, 364
in ascites, 366
peritoneal involvement in, 365
rupture of, 365
paroöphoritic cysts of, 362, 373
ascites in, 366, 380
contents, 364
dangers, 365
wall of, 362
paroöphoron, 333
pedicle of glandular cyst of, 358
preservation of, in hysterectomy, 523
prolapse of, 335
causes, 335
diagnosis from retroflexion, 337
pessary in, 339
reflex symptoms, 337
secondary changes, 336
treatment of, 337, 339
tuberculosis of, 393
veins of, 332

Ovulation and menstruation, coincidence of, 402

Oxyuris, 37

Pain after celiotomy, 495, 497
in carcinoma of fundus uteri, 223
in cervical carcinoma, 191
in salpingitis, 292
in uterine fibroid, 244

Palpation of abdomen, 20

Papilloma of ovary, 393
of vulva, 46

Papillomatous ovarian cysts, 362

Parenchyma body, 359

Paroöphoritic cysts, 262, 373

Paroöphoron, 333

Parovarium, 52, 368
cysts of, 368, 370, 373
Gärtner’s duct, 368
Kobelt’s tubes, 368
papillomatous cysts of, 370

Parturition as cause of retro-displacements, 130
results of injuries during, 16

Patient, preparation of, for operation, 471

Pedicle-needle, 476

Pelvic abscess, 303
after rupture of tubal pregnancy, 317
celiotomy for, 305
vaginal evacuation of, 304
contents, hydrostatics of, 98
massage, 299
in amenorrhea, 407
structures, rectal examination of, 28

Pelvis, local washing of, 489
suppuration of cellular tissue in, 302

Percussion of abdomen, 22
in ascites, 22

Perineal laceration involving one or both vaginal sulci, 75, 79, 80
recto-vaginal septum, 73, 74
loss of support in, 69, 75, 130
repair, 70
sphincter-tear, suture-introduction, 68, 71, 72
removal of sutures, 73
subcutaneous, 79, 85
needle, Emmet’s, 65
needle-carrier, 66
scissors, Emmet’s, 64

Perineorrhaphy, 62, 63, 80
after-treatment of, 66
intermediate, 63
passage of sutures in, 67, 68
primary, 62
secondary, 64

Perineum, anatomy and mechanism of, 56
characteristics after sulci-tear, 78, 79
of uninjured, 74
fasciæ of, 57
injuries to, 62
lacerations, classification of, 80
Emmet’s operation for, 80
ligaments, 57
median laceration of, 67
involving sphincter, 68
muscles, 57

Peri-oöphoritis, in inflammation of ovary, 339

Peritoneum, action of antiseptics on, 457
causes of infection of, 485
cleansing before operation, 490
infection in minor gynecology, 458
toilet of, 490

Peritonitis after celiotomy, 500

Pessary, contraindications to use, 141
Hodge, 134
in anteflexion, 123
in retro-displacement, 133, 146
Smith, 133
stem, 123
Thomas, 134
vaginal, 133, 138, 140

Pflüger, tubes of, 354

Phantom tumor, 386

Polypi of cervix, 178, 182
tubal pregnancy and, 314
urethral, 435
uterine, 234, 256
with endometritis, 203

Position, dorsal, 31
genu-pectoral, 31, 32
knee-chest, 31, 33
latero-abdominal, 31
of uterus, 94
Sims’, 31, 32
Trendelenburg, 462, 510

Post-climacteric endometritis, 213

Pregnancy after amputation of cervix, 165
after celiotomy, 389
after curettement, 212
as cause of prolapse, 108
extra-uterine, 314.
See also _Tubal pregnancy_.
in anteflexion, 123
influence on anteflexion, 123
ovarian, 329
tubal, 314.
See also _Tubal pregnancy_.
with uterine fibroid, 247, 256

Probe, vesical, 425

Prolapse of ovary, 335.
See also _Ovary_.
of urethra, 431
of uterus, 75, 101
amputation of cervix in, 117
causes, 102, 108
colpeurynter in, 118
cystocele and rectocele in, 107
diagnosis, 110
hysterectomy for, 117
LeFort’s operation, 112
pessaries, 118
sequelæ, 111
structural changes, 106
subjective symptoms, 108
treatment, 110
ventro-fixation in, 113
of vagina, 75

Pruritus vulvæ, 42
diabetes as cause, 43
etiology, 42, 43
excision of mucous membrane, 44
treatment, 43

Pseudo-hermaphroditism, 400

Pseudomucin, 356

Pulse after celiotomy, 498

Purgation after celiotomy, 496

Pus, sterile, 284, 486

Pyelitis, result of cystitis, 438

Pyocolpos, 53

Pyometra, 259

Pyosalpinx, 260, 282, 284, 287, 509
cholesterin deposits in, 285
conversion into hydrosalpinx, 285
micro-organisms in, 284
reinfection, 285
rupture of, 289
spontaneous evacuation, 284
sterile pus, 284

Rectal examination of pelvic structures, 28
of uterus, 27
specula, 33
tube in abdominal distention, 498

Rectocele, 77, 87, 107

Recto-vaginal fistulæ, 421
septum, laceration of, 73

Rectum examination, 33
knee-chest position for, 33

Recurrent fibroid, 227
metastasis in, 227
origin of, 227
uterine inversion in, 227

Reflux tube in uterine irrigation, 210

Reiner’s needle-holder, 477

Replacement of uterus, 135

Reposition, bimanual, 135
instrumental, 136

Repositor, White’s, 270

Retractor for vagina, 528

Retro-displacement, Alexander’s operation, 142
diagnosis of, 133
menstruation in, 133
operation for, 142
pessaries in, 133
pregnancy and, 130

Retro-displacements, results of, 131
symptoms of, 132
treatment of, 133, 145
ventro-fixation for, 133

Retroflexion of uterus, 127
causes of, 129

Retroversion of uterus, 127
causes of, 129
degrees of, 128

Rheumatism cause of ovarian disease, 340

Robb’s formulæ for celloidin, 479

Room for gynecological operations, 461

Round ligament, ligation of, 520

Round-ligament cysts, 42

Rubber dam, 480
gloves, 465

Salpingitis, 276, 287
abdominal ostium, closure of, 280
acute, 277, 288
adhesions due to, 279, 280
after endometritis, 288, 299
catarrhal, 279
causes of, 276, 279, 287
celiotomy for, 296, 299, 300
chronic, 279
catarrhal, 279
interstitial, 280
cystic distention in, 282
dangers of, 289, 291
diagnosis of, 295
fistula in, 290
hematosalpinx with, 282
hydrosalpinx with, 282
hypertrophy in, 281
hysterectomy for, 302
ovarian abscess and, 283
ovaritis and, 283
pelvic abscess in, 297
massage in, 299
pyosalpinx, 282
salpingo-oöphorectomy for, 302
septic, 277, 288
symptoms of, 291
treatment of, 296, 300
tubal pregnancy from, 314
with tubal abscess, 279, 283

Salpingo-oöphorectomy, 504
adhesions after, 510
for chronic ovaritis, 344
for salpingitis, 302
for uterine fibroid, 252
link-ligature in, 506
menopause due to, 535
menstruation after, 535
secondary effects of, 535
sexual emotion after, 536
Tait knot, 506

Sarcoma of Fallopian tubes, 313
of ovary, 391
of uterus, 15, 225
age of occurrence, 228
duration of, 228
symptoms of, 226
treatment of, 228
urethral, 436

Scissors, Emmet’s perineal, 64

Senile endometritis, 213

Septic foci, dangers of, 37
infection of genital tract, 17

Shock after celiotomy, 498

Shot-compressor, 66

Silk, 476

Sims’ curette, 209
depressor, 29
position, 31
topographical changes in, 32
speculum, 29
as anal retractor, 33
vaginal dilator, 416

Skene’s endoscope, 432
glands, 426
inflammation of, 429
installation tube, 173
reflux catheter, 429

Smith’s pessary, 134

Sound, urethral, 430
uterine, 34
asepsis in use in, 35
diagnosis between inversion and polyp by use of, 268
precautions in use of, 35

Speculum, rectal, 33
vaginal, 28
bivalve, Goodell’s, 29
duck-bill, Sims’, 29
introduction, 29, 33
uses, 28, 30, 31
vesical, 424

Spencer Wells’ forceps, 474

Sphincter ani, 58
atrophy and laceration of, 69
dimple over ends of, 70
laceration, repair of, 69
vaginæ, 58

Split cervix, 177

Sponge-holder, 65

Sponges in abdominal operations, 474
sterilization of, 468

Sprague’s sterilizer, 466

Spurious labor, 321

Squamous-cell carcinoma of cervix, 181

Stem-pessary in anteflexion, 123

Sterility as result of gonorrhea, 17
in anteflexion, 122
in chronic endometritis, 206
in lacerated cervix, 154
in salpingitis, 294

Sterilization, discontinuous, 466
fractional, 466
of dressings, 466
of hands, 465
of instruments, 466
of sponges, 468
of tables, 463
of water, 467
personal, for operations, 463

Sterilizer, Arnold’s, 466
Sprague’s, 466

Stricture, urethral, 430

Subinvolution as cause of ovarian prolapse, 336
of uterus, 215
endometritis in, 215
metritis in, 215
symptoms and treatment of, 216
of vagina, 92

Superinvolution of uterus, 217
amenorrhea in, 217

Suppressio mensium, 405

Supra-vaginal cervix, elongation of, 104

Sutures, 476, 477

Syncytioma malignum, 228
symptoms, 229
treatment, 229

Syphilis acquired during examination, 26
elephantiasis in, 47
primary sore on finger of physician, 26

Syphilitic ulceration, diagnosis from carcinoma of cervix, 188

Syringe for cleansing drainage-tube, 481

Table for operating, 462
sterilization of, 463

Tait knot, 506, 508

Tait’s hemostatic forceps, 474

Tapping of ovarian cyst, 387, 512, 513
dangers of, 388

Temperature after celiotomy, 498

Tenacula, 27, 64

Teratoma, 361

Thomas’s pessary, 134

Through-and-through suture, 491

Tissue-forceps, 65

Trachelorrhaphy, 156
contraindications to, 289
curetting in, 160
preparation for, 160
scissors for, 157

Transplantation of cancer-cells during hysterectomy, 525

Trendelenburg position, 462, 510

Trigone, 436
mucous membrane of, 437

Trocar, 476

Tubal changes in fibroids, 237
pregnancy, 314
abdominal enlargement in, 323
abortion, 316, 318
amenorrhea in, 326
ballottement in, 323
causes of, 314
classification of, 315
curettage for diagnosis in, 315
decidual transformation of endometrium in, 320
diagnosis of, 325
Fallopian tube, changes in, 315
fetal movements in, 323
heart-sounds in, 323
hematoma in, 324
hemorrhage in, 317
mammary changes in, 322
menstruation in, 322
pain in, 322, 324
placental hemorrhage during celiotomy for, 329
polypi as cause of, 314
rupture in, 316, 317, 324, 327
secondary rupture, 317
skin-changes in, 322
spurious labor in, 321
symptoms of, 321
termination of, 316, 328
treatment of, 327
tubal changes in, 315
uterine changes in, 316, 320
vaginal changes in, 322
varieties of, 314

Tuberculosis of cervix, 180
of Fallopian tubes, 306
chronic diffuse, 309
fibroid, 309
diagnosis of, 311
infection of, 310
miliary, 308
primary, 309
prognosis in, 311
secondary, 310
symptoms, 310
treatment of, 312
unsuspected, 308
of ovary, 393
of uterus, 261

Tubo-ovarian abscess, 283, 287
pregnancy, 314.
See also _Tubal pregnancy_.

Ureter, bimanual examination of, 25
carcinoma of, 185
introduction of bougies in hysterectomy, 523
relations of, 445, 521, 526
to uterine artery, 504
vesical orifice of, 437

Ureteritis, result of cystitis in, 438

Uretero-vaginal fistula, 421

Urethra, anatomy of, 426
cancer of, 436
caruncle of, 434
course of, 445
cysts of, 435
dilatation of, 433
prolapse of, 431
sarcoma of, 436

Urethral polyp, 435
sound, 430
stricture, 430

Urethritis, 427, 449

Urethrocele, 434

Urinary excretion after celiotomy, 436

Uterine appendages, removal of, 504
artery, 503
ligation of, 196, 520, 526
relations to ureter, 504
cavity, length of, 34
cornua, bimanual examination of, 25
fibroid, 230
fibro-myoma, 230
forceps, 138
inversion in recurrent fibroid, 227
involvement in cervical carcinoma, 185

Uterine ligaments, action of, 96
structure of, 96
myo-fibroma, 230
myoma, 230
polyp, 234
diagnosis from carcinoma of cervix, 188
with inversion, 271
retro-displacements, parturition as cause, 130
retroflexion, causes of, 129
sound, 34
abortion by use of, 35
asepsis in use of, 35
dangers of, 35
in diagnosis between inversion and uterine polyp, 268
precautions in use, 35

Utero-sacral ligaments, 27, 119

Uterus, absence of, 396
adenomyoma of, 257
anteflexion, 119
causes of normal, 119
classification of, 120
menstruation in, 122
miscarriage in, 123
pathological, 120
pessary in, 123
pregnancy in, 123
sterility in, 122
symptoms of, 122
treatment of, 123
axis of, 95
bicornis duplex, 396
unicollis, 397
bimanual reposition, 135
carcinoma of, 218
age of occurrence, 220
bimanual examination of, 224
curette, 224
leucorrhea, 223
metastasis, 223, 224
operation for, 224, 225
pain, 223
symptoms, 222
cordiformis, 397
development, 395
didelphys, 396
fibroid tumors of, 236
intraligamentous, 235
submucous, 234
subperitoneal, 233
fibro-sarcoma of, 227
instrumental reposition, 136
inversion of, 264
diagnosis from uterine polyp, 268
reposition in, 268
White’s repositor for, 269
irrigation after curettement, 210
ligaments of, 95
mechanism of support, 95, 96
perforation of, by curette, 210
position, 94, 119
prolapse of, 101
amputation of cervix in, 117
causes of, 97, 98, 102, 108
colpeurynter in, 118
cystocele and rectocele in, 107
diagnosis of, 110
Emmet’s operation for, 112
hysterectomy for, 117
LeFort’s operation, 112
pessaries in, 118
pregnancy as cause of, 108
sequelæ of, 111
Sims’ operation for, 115
structural changes in, 106
symptoms, 108
treatment, 110
ventro-fixation for, 113
rectal examination of, 27
relations of, 119
to bladder, 94
removal, 515.
See also _Hysterectomy_.
replacement, 135, 136
contraindications to, 289
retention in position, 142
retro-displacement, congenital, 129, 146
retroflexion of, 127
retroversion of, 127
causes, 129
degrees, 128
sarcoma of, 225
age of occurrence, 228
duration of life, 228
symptoms, 225, 226
treatment, 225
varieties, 225
septus, 397
Skene’s glands, 426
stitching to abdominal wall, 142
subinvolution of, 215
superinvolution after amputation of cervix, 217
supra-vaginal amputation, 518, 521
closure of cervical canal in, 522
sterilization of cervical canal in, 522
tuberculosis of, 261
unicornis, 396
vascular supply of, 437

Vagina, absence of, 398
angle of, 60
anterior wall, length, 60
atresia, 17, 52
carcinoma of, 52
cysts of, 51
development of, 395
dilator for, Sims’, 416
fibroid tumors of, 52
furrows of, 61
incision of, in hysterectomy, 524
inflammation of, 49
long axis of, 60
malformations of, 397
normal condition of, 96
ostium of, 57
posterior wall, length of, 60
preparation of, for operation, 472
prolapse of, 75
sarcoma of, 52
shape of, 60
subinvolution of, 92
sulci of, 60
unilateral, 398

Vaginal arteries, 504
cervix, elongation, 104, 178
drainage, 480, 487
examination, 23
cleansing for, 26
contraindications to, 28
hematocolpos, 53, 399
hysterectomy, 527
removal of tubes and ovaries, 531
pessaries, 133, 138, 140
retractor, 528
speculum, 28
bivalve, Goodell’s, 29
duck-bill, Sims’, 29
uses, 28, 30, 31
sulci, laceration of, 75
tumor, 51
treatment, 52
wall-depressor, 29, 31, 32

Vaginismus, 53

Vaginitis, 49
adhesive, 51
dangers of, 50
emphysematous, 49
epidemics of, 39
etiology, 49
gonorrheal, 453
granular, 49
in children, 49
in exanthemata, 49
senile, 49
simple, 49
symptoms, 50
treatment, 50, 51

Ventral hernia, 492

Ventro-fixation, 142, 143
in uterine prolapse, 113

Ventro-suspension, 142, 143
incision for, 487

Vermiform appendix, 21

Vesical applicator, 425
calculus, 447
in vesico-vaginal fistula, 416
probe, 425
speculum, 424
triangle, 436
mucous membrane of, 437
nerves of, 437

Vesico-urethral fissure, 431

Vesico-uterine fistula, 420

Vesico-vaginal fistula, 412
and calculus, 416
kolpokleisis in, 420
operation for, 417
treatment, 415

Vicarious diarrhea, 408
leucorrhea, 408
menstruation, 408

Vomiting after celiotomy, 497

Vulva, elephantiasis of, 47
gonorrhea of, 454
hematoma of, 46
neoplasms of, 46, 47
papilloma of, 46
pruritus of, 42
etiology, 42, 43
excision of mucous membranes, 44
treatment, 43
varicose tumors of, 46

Vulvitis, 36
causes of, 36, 37
epidemics of, 37
follicular, 36
gonorrhea as cause of, 36
in children, 37
late manifestations of, 37, 38
medico-legal examination in, 37
secondary, 36, 37
symptoms of, 36
treatment of, 37

Vulvo-vaginal glands, cysts of, 40
inflammation of, 38, 39

Water after celiotomy, 494
in gynecological operations, 467
sterilization of, 467

Werder’s combined hysterectomy, 532

White’s repositor, 270

Wolffian canal, 52

FOOTNOTES:

[1] _Diseases of the Ovaries_, 1883, p. 6.

[2] Heape, _Trans. Obstet. Soc. of London_, vols. xxxvi., xl.

[3] _New York Journal of Gynecology and Obstetrics_, March, 1894, p. 282.

[4] “The Ligature in Oöphorectomy,” read before the Philadelphia Academy of Surgery, February 3, 1896.

[Transcriber’s Note:

Inconsistent spelling and hyphenation are as in the original.]