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T. Gaillard (Theodore Gaillard) Thomas.

A practical treatise on the diseases of women (1880) online

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MAPLEWOOD.



PRACTICAL TREATISE



DISEASES OF WOMEN



BY

T. GAILLARD THOMAS, M.D.,

PKOFliSSOR OF DISEASES OF WOMEN IN THE COLLEGE OF PHYSICIAXS AXD SURGEONS,

NEW TOKK ;

PRESIDENT OF THE AMERICAN GYNECOLOGICAL SOCIETr FOR 1879;

VICE-PRESIDENT OF THE NEW YORK ACADEMY OF MEDICINE ;

SURGEON TO THE NEW YORK STATE WOMAN'S HOSPITAL ;

PRESIDE! OP THE MEDICAL BOARD OF THE NURSERY AND CHILD'S HOSPITAL, ;«EW YORK ,

CONSULTING PHYSICIAN TO ST. MARY'S HOSPITAL FOR WOMEN, BROOKLYN ;

HONORARY FELLOW OF THE OBSTETRICAL SOCIETY OF LONDON ;

CORRESPONDING FELLOW OF THE OBSTETRICAL SOCIETY OF BERLIN,

OF THE MEDICAL SOCIETY OF LIMA,

AND OF THE OBSTETRICAL SOCIETY OF PHILADELPHIA ;

HONORARY MEMBER OF THE SOUTH CAROLINA MEDICAL ASSOCIATION AND OF THE

LOUISVILLE OBSTETRICAL SOCIETY.



FIFTH EDITION.

ENLARGED AND THOROUGHLY REVISED.

CONTAINING TWO HUNDRED AND SIXTY-SIX ENGRAVINGS ON WOOD.




LIBRARY OF THE

Pittshiirg AcaileDiy of Mmt

NOT TO BE REMGV c^U



PHILADELPHIA:

HENRY C. LEA'S SON" & CO.

1880.



^






y



Entered according to Act of Congress, in the year 1880., bj

HENRY C. LEA'S SON & CO.

in the Office of the Librarian of Congress. All rights reserved.




DOFNAN, PRINTER.



TO

JOHN T. METC ALFE, M.D.,

NEW YORK.

My Dkar Doctor :

I DEDICATE to you the fifth as I have done the four previous editions
of this work. If its merits liave grown with time as steadily as our
friendship has done, I shall feel fully satisfied with the results of my
labors ; and if it receive from my professional brethren only a tithe of
such kindness as that for wliich during a quarter of a century I have
been indebted to you, I shall be grateful indeed.

Sincerely your friend,

T. GAILLARD THOMAS.



(iii)



PREFACE TO THE FIFTH EDITION.



Twelve years have elapsed since the publication of the first
edition of this work. In that time four successive editions
have appeared, and its author, recognizing the great advances
which during that period have been made in gynecology, fully
appreciates the fact that a text-book which aspires to meet
the demands of 1880 must of necessity be very different from
one which was offered to supply those of 1868. He has devoted
two years of labor to the endeavor to bring this edition to
the level of the present state of the science of which it treats ;
with what success the reader will judge.

That many new views, new methods, and new remedies
which have of late years been lauded in gynecology pass
unmentioned will at once be apparent. The author's object has
been to write a practical work, not an encyclopedia; to record
views and methods which recommend themselves on account
of their merit, not merely of their novelty. So rapidly do new
things present themselves in this active department of medicine,
however, that it must be stated that some innovations which
apparently possess merit have been left unmentioned because
sufficient time has not elapsed for their trial.

To the medical profession in America the author would
express his sincere thanks for numberless acts of kindness,

(v)



VI PREFACE TO THE FIFTH EDITION.

encouragement, and courtesy, which have stimulated his ambi-
tion to improve a work which has met their generous endorse-
ment and lightened the labor which has attended his eiforts.

The kindly reception of previous editions of this work in
Europe, as evidenced by its translation into German, French,
Italian, and Spanish, has given the author sincere gratification,
and he avails himself of this opportunity of thanking the
translators for the very careful manner in which they have
performed their work, and the uniform courtesy which they
have shown to him.

Upon two points he would ask the lenient judgment of his
readers : first, the mechanical contrivances for the treatment of
flexions of the uterus, which should be honestly tried before
being judged; and second, the diagrams illustrative of the
perineum and its injuries, which to one who has not carefully
considered the subject may appear exaggerated.

For the index of this edition, which the author regards as a
good type of what an index should be, he is indebted to his
friend Dr. S. Beach Jones.

New York,
294 Fifth Avenue, Sept. 26, 1880.



CONTENTS.



CHAPTER I.

PAGE

Historical Sketch of Gynecology ••....,. 17

A CHAPTER II.

The Etiology of Uterine Disease 41

Neglect of Exercise and Physical Development ...... 43

Excessive Development of the Nervous System ...... 45

Improprieties of Dress .......... 45

Imprudence during Menstruation ........ 47

Imprudence after Parturition ......... 48

Non-recognition or Neglect of Injuries due to Parturition .... 49

Prevention of Conception and Induction of Abortion ..... 50

Marriage with Existing Uterine Disease ....... 51

Insufficient Food ............ 51

Habitual Constipation ........... 52

A CHAPTER III.

General Considerations upon Uterine Pathology and Treatment . . 54

Prognosis in Uterine Affections 60

Reasons for the Frequency of Failure in the Treatment of Uterine Diseases . 61

^ CHAPTER IV.



General Considerations upon some op the most Important Therapeutic

Resources of Gynecology
General System of Diet and Exercise .
Pessaries ......

Precautions to be Observed in Operations
Vaginal Injections ....

The Tampon .....

Means for Controlling Temperature

/ CHAPTER V.

Diagnosis of the Diseases of the Female Genital Organs
Rational Signs of these Diseases .....
Management of Patient during Physical Examination
Means of Physical Diagnosis .....

Ansesthesia ...... v



66
66

67
70
74
77
78



80

82
84
86
87



(vii)



Viii CONTENTS.

PAGE

Vaginal Touch 87

Conjoined Manipulation, or Bimanual Palpation . , . . 88

Abdominal Palpation ........ 89

Abdominal Palpation conjoined with tlie use of the Sound . . 90

Inspection ........... 90

Rectal Touch , , 91

Simon's Method of Rectal Exploration ...... 91

Vesico-rectal Exploration ........ 92

The Speculum 93

The Uterine Sound and Probe ....... 100

Tents 102

The Exploring Needle 109

The Aspirator . 109

The Microscope 110

Auscultation and Percussion ........ Ill

Recapitulation of Means for Exploring Pelvic Viscera and Tissues . Ill

V CHAPTER VI.

Congenital and Infantile Malformations of the P'emale Sexual Organs . 112

Hypertrophy 114

Absence and Rudimentary Development of the Uterus and Ovaries . . llf*

Congenital Misplacement of the Uterus 119

Absence and Rudimentary State of the Ovaries ...... 119

Absence and Rudimentary State of the Vagina ...... 119

Anomalies of Uterine Development during Childhood ..... 119

^' CHAPTER VII.

Diseases of the Vulva 121

Normal Anatomy 121

Vulvitis . . 122

Purulent Vulvitis 122

Follicular Vulvitis .......... 124

Cyst and Abscess of the Vulvo-vaginal Glands 126

Eruptive Diseases of the Vulva 128

Phlegmonous Inflammation of the Labia Majora 129

Rupture of the Bulbs of the Vestibule 130

Pudendal Hemorrhage 130

Pudendal Hematocele . . . . . . • - . .131

Pudendal Hernia 134

Hydrocele 136

. CHAPTER VIII.

Pruritus Vulvae 138

Hypersesthesia of the Vulva . 145

Irritable Urethral Caruncle 147

Urethral Venous Angioma 150

Prolapsus Urethrse 150

Coccyodynia .,.....••••■ 151



CONTENTS,



IX



^CHAPTER IX.

The Female Perineum ; its Anatomy, Physiology, and Pathology

v^ CHAPTER X.



Prolapse of Vagina, Bladder, Rectum, and Intestines
ProlaiDse of the Vagina ....

Cystocele, or Prolapse of the Bladder .
Rectocele, or Prolapse of the Rectum
Enterocele, or Prolapse of the Intestines
Treatment of Vaginal Prolapse and Hernise
Colpori-haphy or Elytrorrhaphy .



PAGE

154



168
168
172
172
173
174
176



i/ CHAPTER XI.

Surgical Means Adapted' to Restoration of the Perineal Body . . . 182
Varieties of Perineal Laceration ......... 186

Time for Operation . . . . . . . • • • .188

Treatment of Cases which have Cicatrized ....... 190

Operation for Partial Rupture 192

Operation for Complete Rupture ......... 198

/ CHAPTER XII.

Vaginismus 203

\l CHAPTER XIII.

Vaginitis . . . . . . . . . • • • .211

Simple Vaginitis ............ 212

Specific Vaginitis or (xonorrhcea ......... 21.')

Granular Vaginitis . . . . . . . . • • .218



^ CHAPTER XIV.

Atresia of the Genital Tract and Retention within it of Menstrual Blood

and other Fluids ........... 220

Atresia of the Uterus . 221

Atresia of the Vagina 224

Operative Procedures ........... 229

^ CHAPTER XV.

Fistula of the Female Genital Organs . . . . • • ' • 233

Urinary Fistulse .........••• 233

Vesico-vaginal Fistula ......•••• 233

Urethro-vaginal Fistula ......•••• 234

Vesico-uterine FistuL-e . . . . . ... • • 234

Vesico-utero-vaginal Fistulas ......-•• 234



0^



X CONTENTS.

PAGE

Treatment 245

Cauterization •••........ 245

Suture ............. 245

Sims's Operation .......... 24(i

Simon's Operation .......... 252

Elytroplasty 258

Closure of the Vagina .......... 259

Urinary Fistulse requiring Special Treatment 261

Vesico-uterine Fistulse .......... 261

Vesico-utero-vaginal Fistulas 262

Fistulse with Extensive Destruction of the Base of the Bladder . . 262

Uretero-uterine and Uretero-vagiual Fistulje 263



i



CHAPTER XVI.

Fecal Fistul^^ 265

Entero-vaginal Fistulse . . . 267

Simple Vaginal Fistulse 267

4 CHAPTER XVII.

Acute Exdometkitis 268

4 CHAPTER XVIII.

Chronic Cervical Endometritis ......... 275

vi CHAPTER XIX.

Chronic Corporeal Endometritis 290

Injections into the Uterine Cavity 301

CHAPTER XX.

Areolar Hyperplasia of the Uterus — The so-called Chronic Parenchyma-
tous Metritis ........... 307

CHAPTER XXI.

Granular and Cystic Degeneration of the Cervix Uteri .... 336

Granular Degeneration of the Cervix ........ 337

Cystic or Follicular Degeneration of the Cervix ...... 342

CHAPTER XXII.

Syphilitic Ulcer of the Cervix Uteri ........ 344

CHAPTER XXIII.

Uterine Fungosities ........... 346



CONTENTS. XI

CHAPTER XXIV.

PAGE

Laceration of the Cervix Uteri ...... . . 352

Tracheloriaphj 359

CHAPTER XXV.

General Considerations upon Displacements of the Uterus . . . 363

CHAPTER XXVI.

Ascent and Descent of the Uterus 381

Ascent of the Uterus ........... 381

Descent or Prolapsus of the Uterus ........ 381

Methods of Replacing the Uterus ......... 394

Methods of Sustaining the Uterus 395

Pessaries ............. 401

CHAPTER XXVII.

Anterior Displacements of the Uterts ....... 405

Anteversion ............. 405

Anteflexion 410

Treatment of Anterior Displacements ........ 413

Means for Reduction ........... 413

Means for Retention of the Uterus in Position ...... 417

Pessaries 420

Operation for Irreducible Cervical, Corporeal, or Cervico-corporeal Flexion . 429

CHAPTER XXVIII.

Posterior Displacements of the Uterus 432

Retroversion and Retroflexion ......... 432

Methods of Reduction 438

Means for Retaining the Uterus in Position 442

Pessaries ............. 445

Lateroflexion ............ 452

CHAPTER XXIX.

Inversion of the Uterus .......... 453

Methods of Checking Hemorrhage, the Uterus being left in situ . . . 462

Methods of Replacing the Uterus ......... 463

Gradual Reduction 465

Rapid Reduction ............. 467

Methods of Amputating the Uterus ........ 471

CHAPTER XXX.

Peri-Utekine Cellulitis 475



Xll



CONTENTS.



CHAPTER XXXI,

PAGE

Pelvic Peritonitis 487

CHAPTER XXXII.

Pelvic Abscess 502

Methods of Operating 507

Means for causing closure of the sac ........ 508

CHAPTER XXXIII.

Pelvic H^iimatocele ........... 509

Methods of Operating 518

CHAPTER XXXIV.

Myo-Fibromata or Fibroid Tumors of the Uterus ..... 519

Palliative Treatment 528

Curative Medicinal Means 529

Curative Surgical Procedures . . . . . . . . . 532

Laparotomy ............. 545

Methods of removal of the Uterus 548



CHAPTER XXXV.

Cysto-fibromata, or Fibeo-cystic Tumors of the Uterus



551



CHAPTER XXXVI.



Uterine Polypi
Palliative Treatment
Curative Treatment



558
563
563



CHAPTER XXXVII.



Sarcoma and Adenoma of the Uterus
Sarcoma .....

Adenoma .....



566
566
570



Cancer op the Uterus
Schirrous Cancer .
Encephaloid Cancer
Epithelial Cancer .
Surgical procedures



CHAPTER XXXVIII.



571

575
576
577
592



CONTENTS. Xlll
CHAPTER XXXIX.

PAGE

Diseases Resulting from Retention and Alteration of the Fcetal Envelopes 602

Uterine Moles 602

Cjstic Degeneration of the Chorion, or Uterine Hydatids .... 604

CHAPTER XL.

Dysmenorrhea ............ 606

Neuralgic Dysmenorrhoea .......... 609

Congestive or Inflammatory Dysmenorrhoea ....„., 611

Obstructive Dysmenorrhoea . . . . . . . . . .613

Membranous Dysmenorrhoea ......... 620

Ovarian Dysmenorrhoea .......... 625

CHAPTER XLI.

Menorrhagia and Metrorrhagia ....,....• 628

CHAPTER XLII.

Amenorrhcea ....I........ 635

CHAPTER XLIII.

Leucorrucea ............ 642

CHAPTER XLIV.

Sterility ............. 648

CHAPTER XLV.

Amputation of the Neck of the Uterus ....... 652

Operation by Bistoury or Scissors ........ 654

Operation by Ecraseur ........... 654

Operation by Galvano-Cautery ......... 655

CHAPTER XLVJ.

Diseases op the Ovaries . 656

Absence . ........... 660

Imperfect Development .......... 660

Atrophy 662

Ovarian Apoplexy ............ 663

Displacement ............ 664

Ovaritis 665

Acute Ovaritis ........... 666

Chronic Ovaritis ........... 669



Xiv CONTENTS.

CHAPTER XLVII.

PAOE

Ovarian Tumors 672

Carcinoma ............. 673

Fibroma or Fibrous Tumor .......... 675

Cysto-Carcinoma ............ 676

Cysto-Fibroma or Cysto-Sarcoma 677

Dermoid Cysts 679

Colloid Degeneration . . . . . . . . . - .680

CHAPTER XLVIII.

Ovarian Cysts and Cystomata 682

Cysts of the Broad Ligaments 696

Parasitic or Hydatid Cysts 697

Tubal Dropsy 697

Subperitoneal Cysts ........... 699

Cysts connected with the Spinal Cord 699

Aspiration . . . . . . . . . . . . .715

Tapping 716

CHAPTER XLIX.

Ovariotomy ............. 722

Vaginal Ovariotomy ........... 731

Abdominal Ovariotomy .......... 733

CHAPTER L.

Oophorectomy ............ 756

CHAPTER LI.

Diseases of the Fallopian Tubes ...... 760

CHAPTER LII.

Extra-uterine Pregnancy ......... 765

CHAPTER LIII.

Chlorosis 778



LIST OF ILLUSTRATIONS.



peculuin (Lebloud)



no.

1. Ancient valvular specula (Scultetiis)

2. Thomas's dressing forceps

3. Davidson's syringe ....

4. Vaginal syringe nozzle, with reverse current

5. Sims's screw for removing a tampon

6. Thomas's gynecological table .

7. Thomas's gynecological table .

8. Practice of conjoined manipulation (Sims)

9. Fergusson's speculum ....

10. Thomas's telescopic speculum

11. Cusco's speculum .....

12. Howard's modification of Cusco's speculum

13. Neugebauer's speculum ....

14. Sims's speculum .....

15. Sims's depressor .....

16. Nott's speculum closed .

17. Hunter's speculum ....
IS. Thomas's modification of Sims's speculum

19. Nurse holding Sims's speculum (Sims) .

20. Position of woman in examining with Sims's s

21. Sounds of Simpson and Sims compared .

22. Jenks's elastic sound ....

23. A sponge-tent, with thread passing through it

24. A sea-tangle tent .....

25. A tupelo tent before and after introduction and expansion

26. Tenaculum for fixing the uterus

27. Introduction of a tent (Sims) .

28. Dieulafoy's aspirator ....

29. Manikin figure for teaching diagnosis

30. Coalescence of MuUerian ducts in a foetal sheep (I. Miiller)

31. A. S., aged 4 years and 9 months. Menstruated regularly from the age

of 21 months .......

32. Bow-shaped rudiment of uterus (Nega) .

33. Bicorn uterus (Schroeder) .....

34. Unicorn uterus (Schroeder) .....

35. Double uterus (from specimen in possession of author)

36. Divided uterus (Kussmaul) .....

37. Development of Graafian vesicles (Kuss. Physiology)

38. Follicular vulvitis (Huguier)

39. Plexus of veins of the vestibule (Kobelt)

(XV)



PAGE

23

74

76

76

78

85

86

89

93

94

94

95

95

96

96

97

97

97

99

99

101

102

103

104

105

106

106

109

112

113

114
115
118
118
118
118
119
125
130



XVI



LIST OF ILLUSTRATIONS,



40. Paquelin's therino-cautery .....

41. Diagram ordinarily used for representing the perineum

42. Transverse section of vagina .....

43. Normal relation of the pelvic viscera

44. Schematic diagram of perineal body

45. The same, perineal body removed ....

46. The perineal body destroyed, the rectal wall descends

47. The perineal body destroyed, both rectal and vesical walls descend

48. An elastic rod when bent yields towards its convex surface .

49. An elastic rod with double curves yields in opposite directions

50. An elastic strip, with decided convex curve below, will very decidedly

yield in the direction of lower arrow .....

51. Sims's operation for colporrhaphy (Sims) ....

52. Sims"s operation. Shape of denudation and position of uterus

53. Emmet's operation : first step ......

54. Emmet's operation : second step ......

55. Ovoid denudation, with sutures passed .....

56. Perineal body perfect ; both vaginal walls sustained

57. Perineal body removed by rupture ; both vaginal walls robbed of support

58. Perineum improperly repaired .....

59. Thomas's tooth forceps .......

60. Slightly curved scissors .......

61. Emmet's scissors, sharply curved .....

62. Profile view of perineum ......

63. Schematic view of part to be denuded ....

64. Denudation for repair of perineum (Savage) .

65. One of the bleeding triangles which are to be created

66. The two bleeding triangles about to be united

67. Shows surface denuded and sutures in position

68. Profile view of recently closed perineum, sutures in place

69. Method of securing the ends of the sutures (Emmet)

70. Diagram of perfect sphincter ....

71. Sphincter ruptured, sutures passed

72. Ends of muscle approximated

73. Ends of muscle in apposition ....

74. Schematic diagram showing the ruptured bowel

75. Surface denuded in complete perineal rupture, and first two sutures in

position .......

76. Jenks's operationj^eolpo-perineorrhaphy

77. Pubo-coccygeus«sR



Online LibraryT. Gaillard (Theodore Gaillard) ThomasA practical treatise on the diseases of women (1880) → online text (page 1 of 93)