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McGu^ffTocK relates the case of a woman with inversion of the
uterus of fourteen months' standing. The inversion was not
complete. Several attempts to reduce the tumour failed; the
operation of removal by the ^raseur was practised^ and the patient
recovered.



II, AW0¥AWf3 0? rap TOCWW aE0E^TIQJJ3, TWTTOU W^EASES OP
THU UTEBU8, NBU|U>SEa> ETC,



BoaiokL^lBtertctiiig Ctte of Menttnud Deriatioii. Med. Oentral-Zeitung, Not.

a4tb, 1858. Noiroi't Annuaire for 1858, p. 341.
Blftir.^^Cate of Vicarioui Maattniation ia a Famala nt. 53. Edia. Mad. Jour.,

April, 1859, p. 88a.
Lente. — ^ Case of Regnlar MenttmatioB duriag Pregnaaey. New York Jonrn. of

Mediciaa, March, 1859, P- >S5*
Taylor. — Casa of AmaaarrhoM taeeestfiilly treated hy the applieation of Elec-

tricitr. Lancet, 1859, ^> '35*
Kosas.^ Gates of Disordered Menstruation prodncing Phenomena simnlating the

Symptoms of Orave Diseases. Amer. Joar. of Med. Science, Oct, 1859, p. 355*
Eagon. — Epilepsy succeeding a Suppression of the Menstrual Discharge,&c lb., 569.
XnnUMaan.— Sacalis Comutum tad Digitalis in large doses in the treatment of

Uterine Hasmorrbages. L'Union, 36, 1859. (Sch. 7, 29.)
BeMU-^PsMiv^ Metrorrhagia quickly cheeked by the nse of Powder of Rue and

Savin. Gaz. des Hdp., 141, 1858. (Sch., 5, 188.)
Blim8.^Arseaic in Menorrhagia, Lencorrhoea, Ac Amer. Jour, of Med. Science,

Oct, 1859, 393-
D6Qaiin6.~-^«tronhagia during Menstruation, in consequence of Fungodtiet of

the Uterus ; Advantages of Digitalis after failure of Abrasion and Cauteriza-
tion. Gaz. des H6p., 41, 1859. (Sch., 7, 39.)
BeoqnereL— I>e 1a Dysmenorrboe. [On Dysmenorrhoea.] Gaz. des Hdp., 32,

1858. (Canst., ToL if, 407.)



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872 REPORT ON MIDWIFERY, ETC.

Aran — Note tur Temploi det la? emeott purgaiift dans le traitement du catarrhe
ut^rin. [On Purgative Enemata in Chronic Uterine Catarrh.] BulL da
Th^p., March i5tb, 1858. (Sch., i, 60 ; and Canst., toL \v, p. 407.)

BecqnereL — On Neuralgia of the Utemt. Gaz. des Hdp., 47, 1858.

CoghilL— The Pathology and Treatment of Irritable Utema. Glasg. Med. Joan.,

July, i859» »77-
Hamias ^nd De Christofoiis. — On Tuberculosis of the Uterus and Appendages.

Ann. Uni¥. Agost. et Sett. (Sch., 9, 336.)
Langston Parker. — On Primary and Secondary Syphilis of the Utems. Brit.

Med. Jour., 1859, 484-
KoUook. — ^ Oase of Chancre of the Uterus. Charleston Med. Joum. and ReT.,

March, 1859. C^"*- *"«^ ^^^' Med.-Chir. Rct., July, 1859. P- *730
Langenbeok. — Ueber die Extirpation der interstitiellen Uterusfibroide. [On the

Extirpation of Interstitial Uterine Fibrous Tumours.] Deutsche Kl., i, 1859.

(Sch., 3. 309.)
EUODgtOIL — Reports of Cases of Polypus of the Uterus, with Clinical Observa-
tions. Obstet. Trans., voL 1, p. 113.
Hardy. — Remarkable Case of Uterine Polypus. Dub. Hosp. Gaz., June, 1859, >^3*
Maier. — Ueber Polypenbildung im Uterus. [On the Formation of Polypi in the

Uterus.] Yerhandl. d. Naturf. Ges. zu Freib., i, 309. (Sch., 4, 36.)
Wagner. — Fibrinous Polypus of Uterus. Schmidt's Jahrb., 1859, toL ii, p. 37.

(Sch., 4, 37)
Da crayon du charbon caustique et des prindpales applications dont U est sus-
ceptible, en particulier au traitement des affections de Tut^rus. [The

** Crayon du Charbon Caustique" in the treatment of Uterine Affections.] Bull.

de Th^rap., May 15th, 1858. (Canst., toL iv, 407.)
Soanzoni. — Bi° Todesfall, hervorgerufen durch das Einstrbmen Ton Kohleusanre

in die Uterushohle. [Death from the injection of Carbonic Acid into the

Uterine Carity.] Scanzoni's Beitr. z. Geburtsk, toL iii, 1858. (Canat.,

¥0l. iT, 407.)
VoeggeratiL~~On uterine Injections. New York Joum. of Med., May, 1859.
Sack. — Ueber das Sitzbad bei Frauenkrankheiten. [On the Hip-bath.] Monatsch.

f. Geburtsk, xi. (Canst., toI. It, 407.)
Jacobovics. — Zur Behandlung der chronischen Gebftrmutterentziindung. [Treat.

ment of Chronic Inflammation of the Uterus.] Oester. Zeitsch. f. prak. Heilk.,

38,1858. (Canst., Yol. iT, 407.)
BrOsilU. — Ueber Uterinal Congestion und Gemiithsleiden. [Uterine Congestion

and Cerebral Affections.] Allg. Med. Centr. Ztg., April 3d, 1858. (Canst.,

Tol. iv, 407.)
Hoiiat. — Hysteric te retention d'urine symptomatiques d'une metrite interne et

d'un phlegmon peri-ut^rin. [Hysteria and Retention of Urine symptomatic

of Metritis and Perimetritis.] Gaz. des Hdp., 31, 1858. (Canst., foU iT,

407-)
Storer. — ^^^e Use and Abuse of Uterine Tents. Amer. Joum. of Med. Science,

Jan., 1859.
BeoquereL-^l*^® Chronic Inflammations of the Uterus. Gaz. des Hdp., 87, 93,

1859. (Sch., 11,182.)
De Heric. — Case of Recurrent Fibroid Tumour attached to the Os Uteri. Lancet,

1859, ii, 1 14.



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DISEASES OF WOMEN. 378

BrMlan. — Sdrrfaut det uterus, fibrter Poljp, Pyometn. [Sdrrhot and Fibrous

Polypus of the Uterus.] Moo. Sch. t Geb., ziii, 435. (Sch., 11, 188.)
— — Bin Fall Ton Ecrasement lin^aire einer Carcinomatosen Vaginalportion. [Case

in which Ecrasement of a Cancerous Cenrix Uteri was performed.] Scanzoni's

Beitrage z. Geb., iii. (Canst, toI. It, 408.)
Fftno. — Successful Amputation of the Cerrix Uteri for Carcinoma. Gas. des Hdp.,

40, 1859. (Sch* 8, 191.)
Betl. — Zur Therapie des Clarlte'schen Blumenltohlgewachses. [On the Treatment

of Clarke's Cauliflower Excrescence of the Uterus.] Memorab. a. d. Praxis V,

5, 1859. (Scb., 8, 19a.)
Coftilhes. — Remarks on Chronic Metritis granuloma interna, and its treatment bj

Cauterization. Gaz. Hebd., vi, 3, 1859. (Sch., 10, 7a.)
Tilt. — Chronic Uterine Disease ; Hemorrhage from the Bowels for the last twentj

years; Internal Hsmorrhoids, &c Lancet, 1859, "> 559*
OhAmaL — Considerations sur I'amputation da col deTut^rus parT^craseurlin^re.

[On Amputation of the Cenrix Uteri by the Ecraseur.] Monit. des Hdp., 15

et 14, 1858. (Canst., fol. if, 407.)
KoKnor. — On the Frequency, Importance, and Treatment of Ulcerations of the

Os and Cerrix Uteri. Bmtffor, Maine, U,S., 1859. 8Ta, pp. 46. (North

Amer. Joum. of Med. Science, July, 1859, p. a 15.)

In BosiCKf 8 case of menstraal deviation^ an ulcer on the leg was
the seat of monthly recurring pain and discharge of bloody which
state of things continued during five years. The cure was finally
effected by iron and quinine.

In Blaib's case, hsemoptysis was observed on three saccessive
occasions at the time the catamenial flow would otherwise have
been observed.

In Leute's case, menstruation continued during seven months of
pregnancy.

Moses relates several cases in which " vicarious menstruation ''
occurred, from the umbilicus, the skin, ulcers, lungs and intestines,
and stomach ; also cases of amenorrhoea associated with epilepsy,
tetanic symptoms, &c.

Eagon reports a case of epilepsy following on amenorrhcea, cured
on supervention of dysentery and restoration of catamenia.

Taylob records a case of amenorrhoea, associated with mania.
Electricity, by means of Pulvermacher's apparatus, was had recourse
to, and with a beneficial result.

Teousseau, in reference to the use of ergot and digitalis, states
that, when given just after delivery, ergot produces an effect of a very
quick and decisive character. After abortion and in hemorrhages
of carcinomatous origin, ergot acts very beneficially. Trousseau^s



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874 REPORT ON MIDWIFERY, ETC.

experience of the efficacy ol digitalis is limited^ but so far he is
dissatisfied with the results obtained.

Beau affirms that rue has a specific action on the uterus^ as
digitalis has on the heart. He combines me with savin, in doses
of rather less than a grain of each.

Burns insists on the efficacy of arsenic in cases of hcmorrhagia
and leucorrhoea.

In the treatment of uterine catarrh, Aran recommends the
injection of enemata containing aloes, gamboge, rhubarb, jalap,
scammony, castor oil, croton oil, or purgative salts.

Becquerel considers an idiopathic neuralgia of the uterus to be
not unfrequent. The disease is chronic, mostly intermittent, and
difficult of removal in anaemic subjects.

CoGHiLL considers that the affection known as "irritable uterus"
consists in a disordered state of the innervation of the organ. An
increased vascularity, always present, brings with it morbid sensi-
bility. This vaso-motor irritation has a further result in the
excessive activity of the sensitive apparatus, accounting for the
presence of leucorrhcea. This doctrine is founded on considerations
suggested by Brown-S^quard's recently expressed views.

Nahias believes that tubercle occurs in the genital organs more
frequently than is usually supposed, and that it does not often occur
primarily in the genital organs. He has usually found tubercle in
the uterus in the crude stage. When the Fallopian tubes arc
affected, the canal is not obliterated. In the ovaries the author has
found tubercle in great quantity. De Christoforis contests the
validity of some of the above generalisations.

On the subject of syphilis of the uterus, Parker arrives at the
conclusion that the uterus is capable of being primarily inoculated
with syphilis, the sores being situated on the external surface of the
neck, within the os or canal, or more deeply; that the uterus is
liable to be attacked with the symptoms of secondary syphilis, which
consist in discharges from the canal of the cervix, general or partial
enlargement of the neck and h'ps of the uterus, with congestion,
inflammation, and superficial ulceration ; and that the affection often
persists for years.

KoLLOCK records a case of chancre of the os uteri, proved by
inoculation to be a genuine syphilitic sore.

In cases of fibroid tumour of the uterus, Lakoevbsck advocates



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DISEASES OF WOMEN. 375

the more frequent employment of operative procedures. In la
cases (3 of which are by Langenbeck), operations hare been per-
formed^ and in 7 of them with success. The operation is contra-
indicated^ if the tumonrs are situated in a part of the uterus
covered by peritoneum. If the tumour be in the uterine cavity, the
OS is to be enlarged by sponge-tents, and the tumour removed. The
several steps of the operation are then described.

ElkinOton relates the particulars of six cases in which large
uterine polypi were present, chiefly remarkable for the size ot the
tumours and the difficulties experienced in effecting their removal.
In Haedy's case death followed the ligature of a large fibrous polypus.

In Maier^s case a substance was expelled from the uterus, which
the author concludes was a coagulum of blood, the surface of which
had become organized. Wagneb ('Schmidt's Jahrb.,' 1859, vol.
ii, p. 36)- considers it more likely to have been a fibrous polypus
spontaneously detached, or possibly, an abortion.

Aban recommends the use of a caustic pencil, composed of
charcoal, tragacanth, and saltpetre, in induration and granular
ulcers of the cervix uteri.

ScANzoNi records a case of death, in less than two hours, from
the use of the carbonic-acid uterine douche. Noeogebath relates
four cases in which uterine injections were used; one of the pa-
tients died.

Sack states that his new hip-bath obviates the tendency to pro-
duce prolapsus, fee, connected with the use of the ordinary form
of bath.

Bbosius records two cases in which psychical disturbances were
consequent on the presence of uterine congestion, and disappeared
on the removal of the latter.

Stoeeb details the purposes for which uterine tents are applicable.

BEcquEBBL ascribes a powerful remedial effect to tannin,
applied in the form of solution, in cases of inflammation of the
uterus. After the local affection is rdieved, the concomitant
anemia is to be treated.

Db Mbbic removed a tumour as large as the fist from the cervix
uteri of a patient, set. 40. The tumour is described as '^ albuminous
sarcoma.^' In Fang's case, the cervix uteri, enlarged by encephaloid
disease, was amputated. In Bbsslaxj's case the ^raseur was the
instrument employed.

In cases, where the radical operation for the cure of cauliflower



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376 REPORT ON MIDWIFERY, ETC.

excrescence of the uterus is not admissible^ Betz recommends the
frequent use of caustics.

CosTiLHES recommends the use of nitrate of silver^ applied in the
solid state, for the removal of the fungus-like granulations present
in chronic granular metritis.

Tilt relates a case of chronic uterine disease and internal
hsemorrhoids ; a tumour of the uterus was also present. The
patient had lost much blood, the source of which was not perfectly
dear.

McBuER believes that simple ulceration of the uterus is not ''so
formidable a malady as it is maintained to be by certain writers,"
The author advocates cleansing of the vaginal passage by emollient
or slightly astringent fluids, attention to the general health, rest, &c.,
in order to remove the leucorrhosa. Caustic agents ought never to
be made destructive, and tiie demonstrative use of the speculum is
seldom justifiable or required in the diagnosis.



in. DISEASES OP THE OVARIES, ETC.



Enlenberg. — Ovarian Cyst; Pregnancy; Compresiion of the Tumour by the
Uterus; Radical Cure. Wien. Medizin. Wochenschrift, Med. Nettigkeiten,
Feb. ayth, 1858. (Noirot'i Annuiire, 1858.)

Lumpe. — Ovariencytte hei einer Wochnerin in Folge spontaner Ruptur und Entlee-
rung durcb den Dickdarm geheilt. [Spontaneous Rupture of Ovarian Cytt
into the Large Intestine ; Cure.] Zeitach. d. GeselL d. Aerts. zu Wien., No. aa,

1858. (Canst, vol. iv, 410.)

Clay.— Ovarian Cyst coexisting with Pregnancy, &c Obstet. Trans., vol. i, p. aa6.
PreUSS. — Radikalheilung eines Hydrorariuin. [Radical Cure of Ovarian Dropsy.]

DeuUche Klinik, 48, 1858. (Sch., 3, 309.)
HergOtt— Ovariotomy. Gaa. de Strasb., a, 1859. (Sch. 6, 304.)
Simon. — Zufammenstellung von 61 in Deutschland theils ausgefiihrten, theils ver«

suchten Ovariotomien. [Report of Sixty-one Cases of Ovariotomy.] Scan-

zoni*s Beitrage z. Geburtsk, iii, pp. 98 — 14a.
Spencer Wells.— Fi^e Cases of Ovarian Disease, in three of which Ovariotomy

was performed successfully ; with remarks on the means of diminishing the

Mortality after this Operation. Proc. of Roy. Med. and Chir. Soc. Lancet,

1859, vol. i, p. 186.

Spencer Wells. Three Cases of Ovarian Disease. Med. Times and Gaz., xl, 159. ]

Three Cases of Ovariotomy. lb., 1 1, 3it 59.

—^ Unilocular Ovarian Cyst ; Injection with Iodine ; Successful result. lb.,
xxxix, 548.



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DISEASES OP WOMEN. 877

SpenOttT WdUs. Two Caset of Orariotomy. Med. Timea and Gtx., x1, 605.
Eight Cases of Ovariotomy, with remarks on the means of diminishing the

Mortality of this Operation. Duh. Quar. Jotim., Not., 1859, ^f. J*^
Black. — On a Case of Ofarian Dropsy; Iodine injection; Cure. Lan^ 1859, ^9

36a.
— ^— Ovarian Disease ; Rupture of Cyst ; Recovery; Suhseqaent reaccamulation ;

Death. Med. Times and Gaz., zzxix, 343.
Baker Brown. — ?>▼« Cases of Ovariotomy; Three saccestfhl; with practical re-
marks. Brit. Med. Joum., 1859, 432 — ^440.
— Case of Ovarian Disease; Operation ; Death. Lancet, 1859, ^^^' >* P* S'^*
Death after Paracentesis for Ovarian Dropsy at St. George's Hospital. Reported in

Med. Times and Gaz., zl, 183.
Holt. — Polycystic Ovarian Tumour; Tapped fourteen times; Ovariotomy; Fatal

result. Lancet, 1859, iit 461.
Borlase Childs. — Ovariotomy. Med. Circ., xiv, iii.
Tarry. — Polycystic Ovarian Tumour; Ovariotomy; Death. Med. Times and Gaz.,

zzxiz, 599.
Patt6r80IL - -0ase of Encysted Tumour of the Ovary. Dnh. Hoap. Gaz., July,

1859, 309.
Four Cases of Ovariotomy. Med. Times and Gaz., xxxix, 311.
Hillft T. — Two Cases of Encysted Tumour of the Ovary successfully treated by

Excision, and an attempt to justify the Operation of Ovariotomy under certain

circumstances. North Amer. Journ. of Med. Science, April, 1859, 3'^-
OrcniolL — Childbirth after Ovariotomy. Lancet, 1879, i, p. 143.
Orally Eawitt — Description of the Ovarian or Abdominal Sound, a new Instm-

ment for the Examination of suspected Ovarian Cystic Tumours, &c Lancet,

1859, i, 363, and Obstet. Trans., vol. i, p. 55.
fi. TTvedale West— A Fatal Case of Puerperal Peritonitis, complicated vrith

Ovarian Disease, &c. Obstet. Trans., toI. i, p. 187.
Pneoh. — On Hemorrhage of the Fallopian Tubes. Gaz. Hebd., vi, 3, 1859. (Sch.,

OaXLOliet — Acute Development of Tumours within the Pelvis. L'Union, 38 and 30,

1859. (Scb., 10, 71.)
Xilt. — On Peritonitis in relation to Uterine Pathology. Lancet, 1859, i, 367 ; ii»

133,311,357.
TroilM6ail.'~Hflematocele retro-uterina catamenialis. Gaz. des Hdp., 75, 1858.
Hahn. — Ueber Haematocele retro-uterina. [Retro-uterine Haematocele.] Inaug.

Diss. Rostock, 1858. (Canst, voL It, 410.)
Voisin.— 1^« rhematocdle retro-ut^ne. [Retro-uterine Haematocele.] Thiae,

Pmr.f 1858. (Canst., toI. if, 410.)
WpiuLf,— Note sur Th^matoc^le p^ri-nt^rine. [Peri-nterine Hematocele.] Gat.

Hebd., 33, 1858. (Canst., vol. iv, 410.)
Gallard.— 8ur les h^matocMes p^ri-nt^rines. [Peri-uterine Haematoceles.] Bull.

de la Soc Anat. de Paris, April, 1858. (Canst., voL iv, 410.)
BaoquereL—I^o rh^matoc^e p^ri-ut^nne. [Peri-uterine Hematocele.] Gaz.

des Hdp., 41, 1858. (Canst., vol. iv, 410.)
BrOBlan. — Recto- Vaginalabscess, Mastdarm Scheidenfistel, spontane Heilung.

[Recto-vaginal Abscess; Recto-vaginal Fistula; Spontaneous core.] Monats.

f. Oeburtsk, xi, 5. (Canst., voL if, 410.)



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878 REPORT ON MIDWIFERY, ETC.

EtTLENBERO tecords a case in which a tmnoiiT of supposed ovarian
nature disappeared during pregnancy, and had not appeared again
after a jear from the time of delivery.

In Lumpers case, paracentesis was about to be performed for the
second time, when diarrhoea set in and lasted for nearly five weeks.
The tumour disappeared. The matters passed resembled, after a
time, those which had been evacuated from the eyst by the operation.
Glat records a case in which the ovarian cyst had apparently
evacuated its contents through the bladder.

In Freuss^s case, paracentesis had been performed twice. Inflam-
mation followed the last operation, and thirteen years aft^ , the
patient was perfectly well and the mother of four children.

The report by Simon, of ovariotomy in Grermany, contains 6i
cases, 23 of which have been before published. Of the 61 patients
a radical cure was obtained in I2 cases (19H P^ cent.) In 5
(8 A per cent.), the operation was useless or of transitory benefit;
and 44 (77A pc^ cent.) died from its immediate effect. The
operation was complete in 44 cases ; of these 44, 32 died (72-^ per
cent.), I died subsequently of cancer, and 11 (25 per cent.) were
radically cured. In 15 cases the operation was attempted, but
abandoned or incomplete; of these, in i, radical cure; in 3, no
advantage; in 11, death. In 2 cases, diagnosis at fault; i died.

Hergott records a case of ovariotomy in a woman, set. 50 ; death
took place twenty-three hours after.

Spencer Wells had, up to the end of the year 1859, performed
the operation of ovariotomy in hospital practice ten times, with a
result of seven recoveries and three deaths. These cases are re-
ported at length. The mortality after this operation is to be dimi-
nished, he remarks — (i) by the selection of proper cases; (2) by
determining the stage of the disease proper for operation; (3) by
careful precautions against unnecessary sources of danger; (4) by
the use of anesthetics ; (5) by various precautions in the operation
itself; (6) by careful after-treatment. The propriety of the opera-
tion he justifies by the results of experience and by comparison of
the results of this and other surgical operations, as lithotomy. In-
jections are suitable only for cases of unilocular disease, or cases in
which the secondary cysts are few and small. Spencer Wells re-
cords also three cases of ovarian disease, in two of which iodine was
injected and a cure followed. In a third, death took place after
the operation of paracentesis from cyst-inflammation.



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DISEASES OF WOMEN. 379

In Black's case of iodine injection^ the cyst was unilocular. The
cure was complete.

Bbowk records fire cases in which ovariotomy was performed^
and in three of which a successful result was obtained. In a case
of ovariotomy by Childs, the result was unfavorable ; a part of the
pedicle slipped from the damp^ and hsmorrhage into the abdomen
was fatal twenty-two hours after the operation. In Holt's case of
ovariotomy, the patient died the following day. In Tesat's case
death took place about twenty-four hours after the operation.

Miller relates the details of two successfol cases of ovariotomy.
He discusses the several objections which have been made to the
operation, and expresses himself as very favorably disposed towards
it. He attributes very great importance to the administration of
continued doses of opium, in order to keep the bowels quiet for
some days affcer the operation.

Cbouch states that the results of nine cases of ovariotomy
prove that each ovary is capable of producing children of both
sexes.

Geaily Hewitt describes a new instrument for the diagnosis of
suspected ovarian cysts. It resembles the uterine sound, but is
much longer, and can be used to probe the interior of the cavity,
the contents of which are prevented from escaping during the exa-
mination by a simple contrivance.

Ptjboh analyses three observations of cases in which hseinorrhage
occurred, and is of opinion that the cases in question prove the
existence of tubal hsemorrhage of an independent character.

Gauchet relates three cases in which he believes peri-uterine
hematocele to have been present.

Pelvi-peritonitis is, according to Tilt, of very frequent occur-
rence, associated in some cases with hBcmorrhagia, in others with
ovaritis, originating in ovulation, &c. Pain is usually experienced
in the iliac regions, and a tumefaction surrounding the neck of the
uterus may be felt per vaginam. Bepeated attacks cause adhesion
of the adjoining surfaces of the organs affected, and leave bands of
adhesion liable to cause serious accidents, such as 'incarceration of
tiie intestines, flexions of the uterus, &o. Sterility is frequently
caused by previous pelvi-peritonitis. Leeches, calomel, and opium^
are recommended.

Tbousseau considers that the retro-uterine hematocele is consti-
tuted by the pouring out of blood in the space between the rectum



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880 REPORT ON MIDWIFERY, ETC.

and the uteros. The neck of the uterus is thereby pushed upwards
and forwards. The first symptom is pain, and there is great pale-
ness of the skin, which symptoms occurring in a young woman at
the menstrual period^ the usual discharge being absent or less than
usual, indicate that uterine hsematocele is present. In the treat-
ment of menorrhagia, which is believed to be often followed by
hflematocele of this character, the author recommends quinine in
large doses.

YoisiN has collected forty-two cases of retro-uterine h»ma-
tocele, ten of these observed by himself. The hsemorrhage is, he
believes, always intra-peritoneal. The most favorable time for its
occurrence is at the time of menstruation, especially in conjunction
with traumatic influences, such as blows, falls, &c. The diagnostic
points are — the commencement of the disease at the time of men-
struation, the profuseness of the flow, the sudden occurrence of
attacks like those of peritonitis, the sudden formation of the retro-
uterine tumour, the quickly following an»mia, &c.



IV. DISEASES OP THE VAGINA AND EXTERNAL OENE&ATTVB
ORGANS.



Simon. — Ueber die Heilong der Bluen-Scheiden- nnd Bltten-Gebirmntterfiiteln.

[On the TreAtment of Vetico-Tiginal and Yeuco-uterioe FittalK.] MonatMh.

f. Geburtik, July, 1858.
Konnu.— On the Treatment of Vestoo-faginal Fiitnla. Arch. f. Physiol. Hdlk.,

1858.
Tanner. — On a Case of Vetico-Taginal Flttola. Lancet, 1859, ^^* ^ P- '^
Mft^hftll. — ^Vetioo-vaginal Flstnla cured by Bozeman't Operation. lb., p. 989.
HaoOhie.— Caset of Operation for Yetico-faginal FiituU. Glasg. Med. Jonm.,

July, 1859, P* '9^' ^^ Oct., p. 318.
Fenner.—Vetico-Taginal Fiitala. Am. Jonr. of Med. Science, Oct., 1859,

P- 353.
Baker BrowiL^Fonr Cases of Vedco-Taginal Flstnla. Brit. Med. Jonm., 1859,

267.
Case of Vesico-Taginal Fistula of seien years' duration; Twenty-lbur opera*

tions; Ultimate cnre. Lancet, 1859, toI. i, p. 143.



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