F. (Franz) Winckel.

The pathology and treatment of childbed: a treatise for physicians and students online

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THE



PATHOLOGY AND TREATMENT



CHILDBED:



A TREATISE



PHYSICIANS AND STUDENTS.

^вЦ†BY

Dr. F. WI^CKEL,

FORMERLY PROFESSOR ASV DIRECTOR OP THE GYNECOLOGICAL CLINIC
AT THE UNIVERSITY OF ROSTOCK.



FROM THE SECOND GERMAN EDITION,
>WITH MANY ADDITIONAL NOTES BY THE AUTHOR.



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TRANSLATED BY



JAMES R. CHADWICK, M.D.,

CLINICAL LECTURER ON DISEASES OF WOMEN, HARVARD UNIVERSITY.




PHILADELPHIA:

HEK^EY 0. LEA.

1876.




\>



Entered according to Act of Congress, in the year 1876, by

HENRY C. LEA,

in the Office of the Librarian, at Washington. All rights reserved.




PHILADELPHIA :
COLLINS, PRINTER,

70o Jayne Street.



TRANSLATOR'S NOTE.



The treatise of Dr. Winckel is, in Germany, the standard
authority in this hranch of medicine, and will, I trust, prove
a valuable addition to American medical literature, in that it
presents in the most impartial manner the views of all the
distinguished men who have contributed to a better appre-
ciation of the pathology and treatment of the Diseases of
Childbed.

In this American Edition it has been thought expedient to
omit one or two of the cases, and a table showing the " Condi-
tion of the Genital Organs in 100 Lying-in Women at the
time of their discharge from the Establishment." The space
thus gained has been used to accommodate considerable addi-
tions kindly made by the author to bring this Edition abreast
of recent advances in medicine.

The markings of the temperature have been converted from
the Centigrade into the Fahrenheit system of notation.

The decimal sj-stem of weights and measures has been
retained with a view to familiarizing the Profession with this
system, and thus aiding to secure its adoption in this country.

To Dr. Arthur H. i^ichols, of this city, I am indebted for a
thorough revision of my manuscript.

JAMES R. CHADWICK.

Boston, March 1, 18T6.



1^



C3



PREFACE TO THE SECOND EDITION.



The chapters upon uterine diphtheria, puerperal thrombosis,
and the etiology of puerperal fever epidemics have been in
many respects altered. Some portions have been entirely re-
written. In place of puerperal ichorrhemia, the forms and
nomenclature of the severe puerperal fevers are discussed in
Chapter VI. of the first section.

Puerperal salpingitis and oophoritis are no longer treated
speciall}^ but, in consideration of Breisky's criticism on the
first edition of this work, are included under the head of peri-
tonitis.

The records of cases before appended have been enlarged by
the introduction of Nos. 9, 13, 15, 19, 20, 23, 24, 37, and 50,
many practitioners having assured me that the cases reported
have proved very instructive.

Where authors have been quoted in the text, the places
where they expressed their opinions are designated either in
tlie bibliographical list appended to that chapter, or to one of
those immediately preceding.

The printing of this second edition began in February, 1869,
so that only the literature up to the end of the year 1868, and
a small number of the publications of the year 1869 were
available.

I trust that the alterations and additions may prove useful,
and that the book may more and more fulfil the end for whicli
it was designed.

THE AUTHOR.

Rostock, eud of July, 1869,



PEEFACE TO THE FIRST EDITION.



The writer of the present treatise had been devoting him-
self for many years to the special study of the puerperal
diseases, when this predilection Avas strengthened by his
appointment to the Rostock Lying-in Establishment, Since
the opportunities of showing interesting cases of childbirth,
or of women's diseases, are not of daily occurrence in the
small gynecological clinics, it naturally results, that the nor-
mal and abnormal childbeds are observed much more assid-
uously. The necessity of bringing this part of gynecological
instruction into prominence causes us to recognize at once the
fact that, in the modern treatises and manuals, the pathology
and treatment of childbed are far from being thoroughly
understood. In most of the obstetrical books used by students,
such as those of Busch, Kilian, Hold, Spiegelberg, Scanzoni's
compendium and Naegele and Grenser, this part is entirely
omitted ; it is also wanting in the works upon the diseases of
women that have been most popular among the German stu-
dents, such as Scanzoni's and Langenbeck's translation of
West. In the more extensive obstetrical treatises, like Scan-
zoni's for instance, only the most important affections of
childbed are briefly given in outline, the justice of which is
not apparent, or else are, as in the work of C. Braun (1857),
dogmatically and superficially condensed into a small space.
In other volumes upon the diseases of women, they have only
been here and there touched upon (Kiwisch). This neglect is
not confined to German writers alone, but English and French
works of this same description also sufter from the like defect
(Tyler Smith, Meadows, Velpeau, Cazeaux, etc.).

For the above reasons, it is often perplexing to determine
what book to recommend for the study of the pu_erperal dis-
eases, especiall}' as the older monographs by Helm (1839),



Vlll PREFACE TO THE FIRST EDITION.

Kiwisch (1840-1842), Benidt, Jr. (1846), no longer answer to
the present requirements of science. It is, moreover, in the
last 20 years that our knowledge of the diseases peculiar to
lying-in women has been particularly extended and enriched
by a number of remarkable investigations, so that it seems to
me liigh time that the fruits of these assiduous labors should
be brought within the reacli of practitioners and students.

"With this view, I began to deliver lectures upon these
topics as early as the winter term of 18(34-65, and repeated
them in the ensuing year. All the chapters have been dis-
cussed with my students at the same length as they here
appear, except several of the smaller divisions (eclampsia,
mental diseases, and skin diseases) ; they have therefore been
subjected during these 18 months to a repeated thorough re-
vision and reconsideration, so that I now no longer hesitate
to give them a wider circulation.

In not following the classifications of Kiwisch into epi-
demic and sporadic diseases, or that of Berndt into puerperal
fever and inflammations, I have manifestly deferred to the
universally accepted views of the present day, that every dis-
ease must be classified according to its pathologico-anatomical
characteristics, and not according to the mode of its appearance.
On the other band, puerperal diseases are not so restricted in
their location and extent, that they can be divided according
to the organs which they involve. Aftections of several
organs, for instance, of the external genitals and the vagina,
of the vaginal cul-de-sac and the vaginal portion, etc., verj^
frequently concur to make up a certain type of disease,
because, as a rule, the same causes unite to produce them all,
for the further reason that the outlines of the separate organs
are less sharply definable in the beginning of childbed tlian at
other times.

I have appended to each chapter a short summary of its lit-
erature, but as the authors prior to 1840 have all been fully
quoted by Kiwisch and Berndt, I have confined my notices to
the writers of the last 25 years. And even of these, mention
could not be made of all, owing to the constant increase in the
volume of literature. Many of the works cited were unfortu-
natel}' not accessible to me in the original, so that I had to



PREFACE TO THE FIRST EDITIOX. IX

content nijself with the abstracts in Schmidt's Jahrbiieher.
It would also have been prolix to name all the articles that
liave appeared upon the several diseases, so that the names
of those authors only have been given whose works have been
consulted in the preparation of that chapter.

In appending records of cases, I had a threefold object in
view. First of all, typical cases are meant to be given to stu-
dents for comparison with other cases ; a few cases were in-
serted as contributions to the settlement of mooted points,
(examinations of the pulse, temperature, and urine, and the
etiology of epidemic puerperal diseases); finally, many are
introduced to enrich the literature of rare affections (lesions
of the vagina, diseases of the symphyses, thrombosis of the
genitals).

In conclusion, I would add a word of apology for having
discussed several diseases but briefly in the following pages.
Kuptures of the uterus, for instance, which are essentially
complications of delivery, are considered only in connection
wath the numerous other lesions of the genitals in lying-in
women ; they are, of course, only inserted because of their
occurrence in puerperas, in order not to leave that important
chapter incomplete. In the same way, displacements of the
womb, with the exception of inversion, are touched upon in
the most concise manner possible, because they are very prop-
erly considered at great length in the treatises upon women's
diseases.

I have avoided, when possible, all far-fetched deductions and
unprofitable hypotheses, which would be quite out of place in
such a manual. Instead of adducing arguments, I have en-
deavored to set forth clearly all well authenticated principles
that are based upon experience; to acquire new facts, and
corroborate old ones, often by means of very tedious researches.
For the above-mentioned reasons, the author craves indulgence,
if important works in any department have been overlooked.

I submit the result of many years' labor to my colleagues,
in th



Online LibraryF. (Franz) WinckelThe pathology and treatment of childbed: a treatise for physicians and students → online text (page 1 of 54)