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A TEXT- BOOK OF ''"'-

GYNECOLOGY



If



EDITED BY

CHARLES A. L. feEED, A.M., M. D. ,

President of the American Medical Association ( 1900-19x31 ) ; Gynecologist

and Clinical Lecturer on Surgical Diseases of Women at the Cincinnati

Hospital ; Fellow of the American Association of Obstetricians and

Gynecologists ; Fellow of the British Gynecological Society ;

Corresponding Member of the National Academy of

Medicine of Peru, etc.



ILLUSTRATED BY R. J. HOPKINS



NEW YORK

D. APPLETON AND COMPANY
1901



COPYRIGHT, 1901
BY D. APPLETON AND COMPANY



TO

R. C. STOCKTON REED, M. D., LL. D.

FORMER PROFESSOR OP MATERIA MEDICA AND THERAPEUTICS IN THE
CINCINNATI COLLEGE OF MEDICINE AND SURGERY

THE LABOR OF THE EDITOR

IN THE PREPARATION OF THIS WORK

IS DEDICATED AS AN EXPRESSION OF FILIAL AFFECTION



PREFACE



Ix the preparation of this work there has been held in view the
three following special objects, viz.:

1. The formulation of a Text-Book which shall serve as a working
manual for practitioners and students, and which shall embrace the best
approved developments of gynecology, including those of later date
than are, or can be, included in a work of similar magnitude by a single
author.

For this purpose assignment of topics was made to a considerable
number of writers, but only to those who have acquired reputation in
connection with the subjects upon which they were asked to write.
This division of labour, giving to each writer a relatively small amount
of work, insured a careful preparation of copy in the shortest possible
time, and the issuance of a strictly up-to-date volume.

2. The co-operation of the various departments of medical science
in their synthetic relation to gynecology.

For this purpose contributions were invited from several writers
who are not gynecologists in the strict sense of the term. Thus the
various topics upon pathology were given to pathologists, while those
relating to bacteriology, dermatology, neurology, hygiene, etc., were
assigned with similar appropriateness. As a consequence a single chap-
ter, in some instances, is based upon contributions from several writers,
while the whole has been rendered consecutive, systematic, and homo-
geneous by the Editor. The work is not, therefore, in any sense a mere
aggregation of monographs.

3. The specific recognition of the work of investigators and oper-
ators in gynecology and correlated departments.

For this purpose invitations to contribute to the work were limited
to those who had already contributed something to science. As a con-
sequence writers were asked to treat their respective topics not only in
a general way, but freely to express their individual views relative to
the same.



vi A TEXT-BOOK OF GYNECOLOGY

The Editor has rendered into the third person all references by the
different writers to their own work. In this way and by reference to
the table of contents, the reader is enabled to determine the authorship
of each particular paragraph.

The Editor feels a special sense of obligation to the contributors to
the volume, whose clear and lucid comprehension of his objects and
design and whose scholarly contributions have done much to lessen
his task.

The work of illustration has been in the hands of Mr. R. J. Hop-
kins, whose previous special studies in anatomy as applied to art, and
whose almost intuitive comprehension of the task, combined with ex-
cellent technical skill on his part, has enabled him to add materially to
the value of the book.

Dr. Kenneth W. Millican, Assistant Editor of the New York Medi-
cal Journal, has kindly seen the pages through print, and it is to his
vigilance, industry and scholarly supervision, that the Editor is in-
debted for the elimination of errors, which would have, otherwise,
escaped .detection.

To Miss Georgia A. H. Isaminger, secretary to the Editor, acknowl-
edgments are due for efficient service in transcribing and arranging
manuscript.

To the Publishers, the highest praise must be given for cordial
co-operation at every stage of the work.

CHABLES A. L. REED, Editor.
CINCINNATI, OHIO.



CONTRIBUTORS



J. W. BALLANTYNE, M. D., F. R C. P. E., F. R R.

Lecturer on Midwifery and Gynecology, School of the Royal Colleges. Edin-
burgh, Scotland.

J. H. CARSTENS, M. D.

Professor of Obstetrics and Clinical Gynecology in the Detroit College of
Medicine, Detroit, Mich.

MURDOCH CAMERON, A. M., M. D., F. R C. S.

Regius Professor of Midwifery in the University of Glasgow. Glasgow,
Scotland.

HENRY C. COE, M. D., M. R C. S.

Professor of Gynecology in the University of Bellevue Medical College.
New York, N. Y.

JOHN G. CLARK, M. A., M. D.

Professor of Gynecology in the University of Pennsylvania. Philadel-
phia, Pa.

F. X. DERCUM, A. M., M. D.

Clinical Professor of Diseases of the Nervous System in Jefferson Medical
College. Philadelphia, Pa.

WALTER B. DORSETT, M. D.

Professor of Obstetrics and Clinical Gynecology in the Beaumont Medical
College. St. Louis, Mo.

L. H. DUNNING, M. D.

Professor of the Diseases of Women in the Medical College of Indiana.
Indianapolis, Ind.

FRANK P. FOSTER, M. D.. LL. D.

Editor of the New York Medical Journal. New York, N. Y.

SAMUEL G. GANT, M. D.

Professor of Rectal Surgery in the New York Post-Graduate Medical School.
New York, N. Y.

HOBART AMORY HARE, M. A., M. D.

Professor of Therapeutics in Jefferson Medical College. Philadelphia. Pa.
MALCOLM L. HARRIS, A. M., M. D.

Professor of Surgery in the Chicago Polyclinic. Chicago, 111.
MAXIMILIAN HERZOG, B. S., M. D.

Professor of Pathology in the Chicago Polyclinic. Chicago, 111.

R J. HOPKINS, B. S.

Artist. New York, N. Y.

JOSEPH TABOR JOHNSON, A. M.. M. D.

Professor of Gynecology and Abdominal Surgery in the University of
Georgetown. Washington, D. C.

vii



viii A TEXT-BOOK OF GYNECOLOGY

WYATT G. JOHNSTON, M. D., F. R C. S.

Professor of Bacteriology and Pathology in McGill College and University.
Montreal, Canada.

MATTHEW D. MANN, A. M., M. D.

Professor of Gynecology in the Medical Department of the University of
Buffalo. Buffalo, N. Y.

THOMAS CHARLES MARTIN, B. S., M. D.

Professor of Pathology and Rectal Diseases in the College of Physicians and
Surgeons. Cleveland, Ohio.

LEWIS S. MCMURTRY, M. D., LL. D.

Professor of Gynecology and Abdominal Surgery in the Hospital Medical
College. Louisville, Ky.

DAN MILLIKIN, M. D., LL. D.

Former Professor of Materia Medica and Therapeutics in the Miami Medical
College of Cincinnati. Hamilton, Ohio.

HENRY P. NEWMAN, M. A., M. D.

Professor of Gynecology in the College of Physicians and Surgeons of Chi-
cago. Chicago, 111.

WILLIAM WARREN POTTER, A. M., M. D.

Secretary of the American Association of Obstetricians and Gynecologists,
and Editor of the Buffalo Medical Journal. Buffalo, N. Y.

A. RAVOGLI, M. D., LL. D.

Professor of Dermatology in the University of Cincinnati. Cincinnati, Ohio.

CHARLES A. L. REED, A. M., M. D.

Gynecologist and Clinical Lecturer on Surgical Diseases of Women at the
Cincinnati Hospital. Cincinnati, Ohio.

HUNTER KOBE, A. M.. M. D.

Professor of Gynecology in the Medical Department of the Western Reserve
University. Cleveland, Ohio.

JAMES F. W. Ross. M. D., L. R. C. P.. England.

Lecturer on Clinical Gynecology in the University of Toronto. Toronto,
Canada.

A. W. MAYO ROBSON, F. R. C. S.

Professor of Surgery in the Yorkshire College of the Victoria University.
Leeds, England.

J. L. ROTHROCK, A. M., M. D.

Instructor in Pathology in the University of Minnesota. St. Paul, Minn.

W. JAPP SINCLAIR. M. A., M. D.. F. R. C. S.

Professor of Obstetrics and Gynecology in Owen's College, Victoria Uni-
versity. Manchester, England.

HORACE J. WHITACRE, B. S., M. D.

Lecturer on Clinical Surgery and Demonstrator of Pathology in the Univer-
sity of Cincinnati. Cincinnati, Ohio.

E. GUSTAVE ZlNKE, M. D.

Professor of Obstetrics and Clinical Midwifery in the University of Cincin-
nati. Cincinnati, Ohio.



CONTENTS



CHAPTER I

PROLEGOMENA PAGE

Gynecology defined Reed . . 1

Historical resume . . 1

Gynecology as a specialty ......... . . 2

Nomenclature of gynecology ....... Foster .

Radicalism and conservatism in gynecology .... Reed . 4

CHAPTER TI

GENERAL ETIOLOGY OF DISEASES OF WOMEN

Prevalence Rrr<1

Causes . . 5

Civilization . .

Education . ,. . . 6

Personal habits . . ,.

Occupation . . 8

Diseases ............ . . 9

Copulation . ,. . . 9

Prevention of conception . . . . . . . ,. . .10

Criminal abortion . . 10

Childbirth . . 10

The social evil .......... . . 10



GENERAL PATHOLOGY OF THE FEMALE GENERATIVE ORGANS

Local pathology conforms to general pathologic laws. . Herzog . . 12

Peculiarities depending upon differentiated functions . . . 12

Menstruation .......... ,. . . 12

Ovulation in its relation to pathologic states . . . . .13

Gestation in its relation to pathologic states . . . . . 13

The poise of the uterus and its variations . . . . .. . .15

Bacterial origin of inflammatory diseases of the female genitalia .. . . 15

Tuberculosis . . 17

Syphilis . . 17

Trophic changes . . 17

Neoplasms -. .... 18



A TEXT-BOOK OF GYNECOLOGY



CHAPTER IV

GENERAL THERAPEUTICS OF GYNECOLOGY P AGK

General medication Reed . . 20

Serum therapy 21

Local medication .......... 22

Balneotherapy " . . 22

Suggestion - . . 23

Electricity 23

Massage 24

CHAPTER V

THE GYNECOLOGICAL ARMAMENTARIUM

The gynecological armamentarium Robb . . 27

CHAPTER VI

DIAGNOSIS

Definition and scope . ...... Reed . . 29

Indications and contraindications for vaginal examination . 30

The gynecologic examination Potter . . 30

Physical examination . . 31

The armamentarium . . 31

The examination itself . . 33

Inspection of the external genitals . . 34

Digital examination . . 35

Bimanual examination ., . . 37

Rectal exploration . . 39

Examination under anaesthesia . . 40

Auscultation, percussion, and general palpation of the ab-
domen . . 40

Regions of the abdomen Reed . .41

Instrumental examination . . 42

(n) The speculum . Potter . . 42

(b) The sound . . 45

(r) The dilator . . 45

(d) The curette " . . 46

(e) The aspirator " . .47

Examination of the secretions

Urines, faeces, menstrual fluid Reed . . 47

Examination of the blood . . 49

Examination of the nervous system . . 49

CHAPTER VII

SEPSIS

Sepsis defined . . Reed . . 50

The bacteria of sepsis ,, . . 50

Local sepsis ........... . . 55

Symptoms, pathology, treatment , 5(5

General sepsis 57

Symptoms, pathology, treatment . ' v . . . . .58



CONTENTS xi
CHAPTER VIII

ANTISEPSIS PAGE

Antiseptic provisions of Nature Reed . . 60

Sterilization ,, . . 60

Mechanical means ....,... 61

Heat ,- -61

Germicidal agents 63

The nurse . . 63

The room . . 64

The patient ,, 66

Instruments and dressings 66

Sutures and ligatures ......... 67

Post-operative antisepsis . . 68

The surgeon . ,. . . 69

Hand sterilization 69

Gloves - 70

CHAPTER IX

SHOCK

Definition Reed . . 72

Pathology . . 72

Causes , 72

Symptoms , 72

Diagnosis ............ 73

Treatment 74

Prophylactic 74

Restorative 74

CHAPTER X

HEMORRHAGE AND HEMOSTASIS

Hemorrhage Reed . . 78

Symptoms . . 78

Diagnosis . 79

Treatment of hemorrhage 79

Hemostasis . . . 79

Styptics ~ 79

Heat 80

Pressure 80

Angiotripsy Newman . 81

Electric hemostasis ........ Reed . . 83

Ligatures 86

CHAPTER XI

ANAESTHESIA AND ANAESTHETICS IN GYNECOLOGY

Definition * . Hare . . 87

Anaesthetic agents 87

Race and temperament in the selection of an anaesthetic 88
Indications and contraindications for the use of chloroform

and ether 88



xii A TEXT-BOOK OF GYNECOLOGY

PAGE

Ether in its relation to bodily temperature .... Hare . . 89

Choice of anaesthetics in children ....... 91

Bromide of ethyl . . 91

Ether and its administration 92

Mixed vapours and their administration . . . . 93

Chloroform and its administration , 94

Management of accident in anaesthesia 95

Anaesthetic mixtures . . 9fi

Central anaesthesia by cocaine Reed . . 97

General anaesthesia by alcohol . . 97

General anaesthesia by hypnosis ........ 98

Local anaesthesia 98

CHAPTER XII

ABDOMINAL SECTION

Terminology Reed . . 99

Preliminary treatment of the patient ....... . 100

The evils of hypercatharsis . . 101

Examination of the urines . .102

Instruments Robb . .103

Location of the incision Reed . . 103

Direction and varieties . . 105

The incision itself . . 107

Closure . . 109

Drainage . 114

CHAPTER XIII

THE EXTERNAL ORGANS OF GENERATION IN WOMEN

Definitions Reed . .117

Development . 117

Malformations of

(a) Vulva Ballantyne . 118

(ft) Vagina .126

The hymen Reed . . 131

Malformations of the hymen BaUantyne . 131

CHAPTER XIV

INJURIES OF THE EXTERNAL GENITAL ORGANS

Injuries from

(a) External violence Dorsett . . 135

(6) Parturition . . . . . ',,..'-. . ,, 136

(c) Sexual intercourse ,. . . 136

Pudendal hematocele . . . . . . . . Reed . . 136

Injuries of the vagina ,. . .139

Rupture .*... . 139

Urinary fistulae Ross . . 139

Vesico-vaginal fistulae . . . v . . . . . . 139

Sims's operation . . .'..'...* . . . Reed . . 144



CONTENTS xiii

Vesico-vaginal fistulae PAGE

Ross's operation Ross . . 145

Reed's operation . . 140

After-treatment , . 148

Utero- vaginal fistula; . 151

Treatment . 151

Recto-vaginal fistulae Mayo Roltson. 152

Causes . 152

Operation (Mayo Robson's) . 153

CHAPTER XV

INJURIES OF THE EXTERNAL GENITAL ORGANS (Continued)

Rape W. Johnson . 150

Objective evidences ......'.. ., 150

Local condition ........ . 157

Injuries on other parts . 158

Condition of clothing . . 158

Schedule for examination .15!)

Indecent assault . 100

Prolapse ........... ., . 101

Injuries of perineum, vagina . 102

Uterus .102

CHAPTER XVI

INFECTIONS OF THE EXTERNAL GENITAL ORGANS

Bacteriology of the external genital organs .... Reed . .103

Mixed infections ,, . 105

Gonorrhoea 166

Tuberculosis Whitacre . 171

Erysipelas Reed . . 177

Erysipelas and puerperal infection , . . 178

Diphtheria ,. . 179

Aphthae . 179

Aerogenous infection . . 180

Bilharzia . . 180

Chancroid . . Rnvoffli . .181

CHAPTER XVII

DISEASES OF THE SKIN OF THE FEMALE GENITALS

Intertrigo Rarogli . . 191

Erythema . 194

(Edema " . . 195

Eczema . 190

Folliculitis . 198

Herpes progenitalis . . 200

Pruritus vulva? . . 202

Pathology Reed . . 203

Causes . Rarogli . . 204



x iv A TEXT-BOOK OF GYNECOLOGY

Pruritus vulvae PAGE

Treatment ..'- Ravoffli . . 204

Surgical treatment Reed . . 204

Parasitic affections Kavogli . . 20.1

Atrophy (kraurosis) . . 207

Vulval adhesions Reed . .211

CHAPTER XVIII

HYPERTROPHIC AND HYPERPLASTIC DISEASES OF THE PUDENDAL ORGANS

Hypertrophy of the clitoris Herzog . . 213

Condylomata 213

Treatment Ratogll . . 215

Elephantiasis Herzoy . . 210

Polypi . .219

Treatment . . 219

CHAPTER XIX

NEOPLASMS OF THE EXTERNAL GENITAL ORGANS

Benign neoplasms of the pudendum Herzog . . 221

Varices . 221

Fibromyomata 222

Pure myomata 222

Myxomata . . 223

Lipomata 223

Enchondromata 223

Cysts 223

Benign neoplasms of the vagina ,. 224

Cysts Rol ti rock . 224

Fibromata . ., 220

Treatment of benign neoplasms Reed . . 220

Malignant neoplasms of the pudendum Herzoy . . 227

Carcinomata ,, . . 227

Sarcomata ,. . . 229

Melano-carcinomata . . ., . .231

Malignant neoplasms of the vagina Rotlirock . 231

Sarcomata ., . . 232

Carcinomata ......... .... 233

Treatment Reed . . 234

Clitoridectomy . . . . . . . . ,. . . 234

Extirpation of the vagina ........ . . 235

Palliative treatment . . . . . . . . ., . .230

CHAPTER XX

DISPLACEMENT OF THE VAGINA

The vagina Reed . . 237

Varieties of displacements .......,, . . 237

Cystocele . 238

Rectocele . . 238

Urethrocele , . 238

Colporrhaphy '.. . . . .241



CONTENTS XV
CHAPTER XXI

THE VULVO-VAGINAL GLAND PAOB

Anatomy Rothrock . 243

Gonorrhoeal infections 244

Abscess . . 245

Cysts . 247

Carcinoma '.'. - . . 249

CHAPTER XXTI

THE PELVIC FLOOR AND ITS INJURIES

The pelvic floor Reed . . 250

The " pelvic diaphragm " . . 253

Injuries . . 253

Laceration of the perineum ....... Dorsett . . 253

Restorations of the pelvic floor Reed . . 258

Immediate operation ......... . 258

Instruments Robb . . 259

Operations for incomplete lacerations ..... Reed . . 2(iO

Superficial . 260

Emmet's operation .......... . . 260

Reed's method of suturing . . 263

Modifications . . 265

Operations for complete laceration . . 267

Tait's operation . 267

Modifications . . 269

Repair of deep injuries of the pelvic floor . . . . . .271

Harris's operation . 272

CHAPTER XXIII

CLASSIFICATION

Malformations of the uterus . . . * . . . . Ballantyne . 274

Embryonic . 274

Foetal .274

Postnatal .275

Absence .......... . 276

Uterus unicornis . . 276

Foetal, infantile, pubescent .277

Uterus septus . 277

Uterus bicornis ......... . 278

Duplex uterus . 278

Minor malformations . Reed . . 279

Treatment . ' . . . . .280

Stomatoplasty . 281

CHAPTER XXIV

DISPLACEMENTS OF THE UTERUS

Normal position of the uterus . . .. . . . . Reed . . 284

Displacements in general . 285

Varieties, causes, pathology . . . . . ., t . 285

Treatment Mann . 288



xvi A TEXT-BOOK OF GYNECOLOGY

PACK

Retro-displacements Reed . . 289

Symptoms and diagnosis .....'.. . . 289

Treatment f . . . 290

Massage . . . . . . 291

Pessaries . 293

Surgical Mann . . 295

Shortening the round ligament; Alexander's operation;

vaginal operation ; fixation operations . . . . . 294

Anterior abdominal cuneohysterectomy .... Reed . . 310

Anterior displacements . . 310

Prolapsus Herzog . . 317

Inversion Reed . . 324

CHAPTER XXV

PARTURIENT INJURIES AND FOREIGN BODIES OF THE UTERUS

Parturient injuries Reed . . 331

Rupture '.-... . 331

Laceration of the cervix . 334

Trachelorrhaphy . . . ... ... . . .338

Instruments . . . Robb . . 338

Vesico-uterine fistulae Ross . . 343

Reed's operation Reed . . 344

Nonparturient injuries . . 345

Wounds from external causes . 345

Foreign bodies . ... . . . . . . . . 348

CHAPTER XXVI

INFECTIONS OF THE UTERUS

The uterus . . , McMiirtry . 350

The endometrium ,. 350

The secretion of the uterine cavity . . . - Reed . .351

The myometrium . . . 352

Bacteria of the uterus Sinclair . 352

Infections - ._ Reed . , 357

Endometritis and metritis 357

Pathology . . . . . . . . - - .359

Causes . . . *> 361

Symptoms . . . . . . . . . 363

Diagnosis ...........

Treatment 365

Topical 365

Curettage 368

Instruments Robb . . 368

CHAPTER XXVII

INFECTIONS OF THE UTERUS (Continued)
Specific

Gonococcous infection Reed . . 372

Streptococcous infection 370



CONTENTS xvii

Specific PAGE

Tuberculosis infection Whitucrc . 384

Syphilitic infection Reed . . 391

Echinococcous infection .......,, . . 393

CHAPTER XXVIII

NEOPLASMS OF THE UTERUS

Neoplasms of the uterus in general ..... Herzoy . . 390

Benign neoplasms ......... ,. . . 390

FiBromyomata .......... ,. . . 390

Causes, pathology, history 3915-397

Secondary degenerations ....... ., . . 399

Diagnosis .......... McMnrtry . 402

Complicating pregnancy . 403

Treatment ,, . 404

Medicinal and electrical ....... ,, . 404

Surgical .404

Indications .......... Ross . . 405

Myomectomy ,, . . 407

Supravaginal hysterectomy . . . . . . ., . .410

Panhysterectomy . ., . . 415

Reed's operation Reed . . 417

Vaginal myomotomy Diinniny . 420

Extirpation of polypi . ., . 424

CHAPTER XXIX

NEOPLASMS OF THE UTERUS (Continued)

Malignant neoplasms Reed . . 42(i

Syncytioma malignum ........ Herzog . . 426

Pathology . 427

Histology . . 427

Causes Reed . . 428

Symptoms ............ . . 428

Treatment . 429

Adenoma . . . . . . . . . . . Herzoy . . 429

Symptoms Reed . . 431

Diagnosis . . 431

Treatment ,. . 431

Sarcoma ........... Herzog . . 432

Pathology . . 432

Histology . . 433

Symptoms Reed . . 435

Causes ,. . . 430

Treatment . . 436

Carcinoma Herzog . . 437

Pathology . . 438

Histology . . 439

Causes Reed . . 440

Symptoms ,, . . 442

Pregnancy as a complication . 443



xviii A TEXT-BOOK OF GYNECOLOGY

Carcinoma PAOK

Palliative treatment Carstens . 444

Radical treatment Reed . . 447

Vaginal hysterectomy Newman . 447

Instruments Robb . . 448

Abdomino-vaginal panhysterectomy .... Carstenx . 453

Extended operation Reed . . 453

Byrne's operation of electro -hysterectomy . . 450

Results of hysterectomy . . 458

CHAPTER XXX

C.ESAREAN SECTION AND ITS MODIFICATIONS

Definition Cameron . 400

Historical resume . 4(50

Preparations . 4ti5

Position of child and placenta . 405

The operation . 400

Sanger's method . 470

Porro's modifications .471

CHAPTER XXXI

MALFORMATIONS AND DISPLACEMENTS OF THE FALLOPIAN TUBES

Absence and defective development BaUantyne . 473

Supernumerary and accessory tubes ..... . 474

Accessory ostia . . .474

Displacements . 477

CHAPTER XXXII

NEOPLASMS OF THE FALLOPIAN TUBES

Benign neoplasms ......... Reed . . 478

Papillomata . . . 478

Cystomata . . 480

Lipomata . . 480

Fibromyomata . . 481

Malignant neoplasms . . 481

Carcinomata . . . 481

Sarcomata . . 482

CHAPTER XXXIII

INFECTIONS AND INFLAMMATION OF THE FALLOPIAN TUBES

Infections in general ........ Reed . . 483

Bacteria of the Fallopian tubes in health . . . . Sinclair . 484

Bacteria of the Fallopian tubes in disease .... 484

Relations of infections to inflammation of the tubes . . Clark . . 487

Catarrhal salpingitis . 489

Morbid histology of salpingitis ., . 489

Acute . 489

Chronic . ... . . .... ... . -491

Hydrosalpinx .... ... . . . . . 495



CONTENTS x i x

PAGE

Hematosalpinx Clark . . 499

Pyosalpinx , . . . . . 499

Symptoms and diagnosis of salpingitis . . . . Robb . . 501

CHAPTER XXXIV

INDIVIDUAL INFECTIONS OF THE FALLOPIAN TUBES

Infections by

Gonococcus Reed . .512

Streptococcus . 516

Bacillus tuberculosis Whitacre . 519

Bacillus coli comraunis Reed . . 528

Pneumococcus . . 529

Staphylococcus . . 530

Saprophytes . . 530

Septic vibrion . 531

Actinomyces . 531

CHAPTER XXXV

TREATMENT OF INFECTIONS OF THE FALLOPIAN TUBES

The natural course and termination of inflammatory dis-
eases of the Fallopian tubes Clark . . 532

Hygienic treatment Coe . . 535

Medicinal treatment . . 536

Local treatment . . 537

Massage . . . 538

Electricity Reed . . 539

Drainage . . 540

Vaginal incision . . . . . . . . . .541

Inguinal or inguino-vaginal ........ . . 542

Abdominal and abdomino-vaginal . . 544

Rectal puncture . . 546

Aspiration . 546

Conservative operations on the tubes Coe . . 546

Radical treatment Reed . . 549

Salpingectomy ,. . . 549

Tait's operation . . . . x . . . . . 551

Modifications of Tait's operation . 553

Abdominal panhysterectomy . . 554

Doyen's operation . . 556

Modifications, indications, and limitations ., . 557

CHAPTER XXXVI

MALFORMATIONS AND DISPLACEMENTS OF THE OVARIES

Malformations Ballantyne . 560

Absence . . . . .560

Rudimentary development ....... . 560

Accessory ovaries 561

Coexistence of ovaries and testicles ..... . 562



xx A TEXT-BOOK OF GYNECOLOGY

PACK

Displacements of the ovary Reed . . 563

Decensus and prolapsus ......... . 563

Hernia . 564

CHAPTER XXXVII

INFECTIONS AND INFLAMMATIONS OF THE OVARIES

Classification . . Whitacre . 567

Hyperaemia . Reed . . 567

Acute inflammation . . 568

Chronic inflammation Whitacre . 569

Bacteria of the ovaries Sinclair . 570

Individual infections . .571

Streptococcous infection Reed . .571

Gonococcous infection . . . 574

Pneumococcous infection ........ . . 574

Bacillus coli communis infections . . 575

Tubercular infections Whitacre . 575

CHAPTER XXXVIII

TREATMENT OF INFECTIONS OF THE OVARIES

Preliminary consideration ........ Reed . . 579

Natural terminations . 579

Palliative treatment . . 581

Conservative treatment , . . 582

Radical treatment . . 584

Oophorectomy J. T. Johnson. 584

Unilateral . Reed . . 585

Effects: primary, secondary , 586

CHAPTER XXXIX

TROPHIC DISEASES OF THE OVARIES

Atrophy ........... Coe . . 592

Cirrhosis . . . . Whitacre . 593

Hypertrophy . . . . . . . . . Coe . . 594

CHAPTER XL

NEOPLASMS OF THE OVARIES

Small benign cysts . . Rothrock . 597

Follicular cysts 598

Cysts of the corpus luteum . . 599

Tubo-ovarian cysts 601

Neoplastic cysts . . . 602

Proliferation cysts . . 602



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