Harriette Lombard Hennessy

“ It is now known that fertilization of the human ovum by the spermatozoon may take place even when the ovum is in its follicle in the ovary, for oosperms have been found in the ovary and Fallopian tubes as well as in the uterus. Belief in ovarian pregnancy is of old standing, and had been regarded as possible but unproved, no case of an early embryo in its membranes in the sac of an ovary being forthcoming, until the remarkable case published by Dr Catherine van Tussenboek of Amsterdam in 1899 (Bland-Sutton) . Tubal pregnancy is most frequent in the left tube ”

“ It is doubtful if they ever originate after the menopause. Indeed if uncomplicated by changes in them they share in the general atrophy of the sexual organs which then takes place. They are divided according to their position in the tissues into intramural, subserous and submucous (the last when it has a pedicle forms a polypus) , or as to the part of the uterus in which they develop into fibroids of the cervix and fibroids of the body. Intramural and submucous fibroids give rise to haemorrhage. The menses may be so increased that the patient is scarcely ever free from haemorrhage. ”

“ From the researches of von Gurlt, compiled from the Vienna Hospital Reports, embracing 15,880 cases of tumour, females exceed males in the proportion of seven to three, and of this large majority uterine growths account for 25%. When we consider its periodic monthly engorgements and the alternate hypertrophy and involution it undergoes in connexion with pregnancy, we can anticipate the special proneness of the uterus to new growths. Tumours of the uterus are divided into benign and malignant. The benign tumours known as fibroids or myomata are very common. ”

“ Inversion occurs when the uterus is turned inside out. It is only possible when the cavity is dilated, either after pregnancy or by a polypus. The greater number of cases follow delivery and are acute. Chronic inversions are generally due to the weight of a polypus. The symptoms are menorrhagia, metrorrhagia and bladder troubles; on examination a tumour-like mass occupies the vagina. Reduction of the condition is often difficult, particularly when the condition has lasted for a long time. The tumour which has caused the inversion must be excised. ”

“ When the uterus lies in the vagina it is spoken of as prolapse, when it protrudes through the vulva it is procidentia. The causes are directly due to increased intra-abdominal pressure, increased weight of the uterus by fibroids, violent straining, chronic cough and weakening of the supporting structures of the pelvic floor, such as laceration of the vagina and perinaeum. Traction on the uterus from below (as a cervical tumour) may be a cause; advanced age, laborious occupations and frequent pregnancies are indirect causes. ”

“ In acute cases multiple abscesses in the kidney may give rise to pain and albuminuria, abscesses in the lungs to dyspnoea, while acute peritonitis may arise from rupture of a splenic abscess into the peritoneal cavity, and sudden blindness be the result of the plugging of the arteria central is retinae. The duration of a case of pyaemia depends on the severity of the infection. Death may occur from the formation of abscesses in vital organs such as the brain and heart, or from exhaustion from continued suppuration, or chronic forms may after months pass on to complete recovery. ”

“ The symptoms which induce women to seek medical aid are haemorrhage, foetid discharge, and later pain and cachexia. An unfortunate belief amongst the public that the menopause is associated with irregular bleeding and offensive discharges has prevented many women from seeking medical advice until too late. It cannot be too widely understood that cancer of the cervix is in its early stages a purely local disease, and if removed in this stage usually results in cure. ”

“ The abdomen is soft and flaccid and the affected coil is rarely to be felt. The symptoms vary with the situation of the obstruction and are generally more urgent the nearer to the duodenum. Foreign bodies that have been swallowed by accident or otherwise may give rise to obstruction, though extraordinary objects, as knives, coins, pipes, flints, &c. swallowed by jugglers, are known to have passed by rectum without injury. In cases where the foreign body lodges in the intestine the caecum and duodenum are favourite situations for obstruction. ”

“ In many cases it destroys life with a rapidity unequalled by any other kind of growth. It quickly ulcerates and infiltrates the uterine tissues, forming metastatic growths in the lung and vagina. Clinically it is recognized by the occurrence after pregnancy of violent haemorrhages, progressive cachexia and fever with rigors. Recent suggestions have been made as to chorion-epithelioma being the result of pathological changes in the lutein tissue of the ovary. The growth is usually primary in the uterus, but may be so in the Fallopian tubes and in the vagina. ”

“ Amenorrhoea may arise from physiological causes, such as pregnancy, lactation, the menopause; constitutional causes, such as phthisis, anaemia and chlorosis, febrile disorders, some chronic intoxications, such as morphinomania, and some forms of cerebral disease; local causes, which include malformations or absence of one or more of the genital parts, such as absence of ovaries, uterus or vagina, atresia of vagina, imperforate cervix, disease of the ovaries, or sometimes imperforate hymen. ”

“ In thin persons large enteroliths and foreign bodies may be palpable. The symptoms are those similar to obstruction by a large gall-stone.
Acute Intussusception forms about 30% of all cases of intestinal obstruction, and is the most common variety found in children. More than 50% of the cases are found during the first ten years of life, and half that amount in babies under one year; the large preponderance is in males. By intussusception is meant an invagination or protrusion of a part of the intestine in the lumen of the intestine immediately below it ”

“ Partial strictures of the intestine, if the stricture be not too narrow, may pass unnoticed for years, and final complete obstruction may result from a blockage of the stricture by some foreign substance such as a plug of hard faecal matter or a fruit stone.
Treatment of Acute Intestinal Obstruction.—Early diagnosis and early laparotomy are essential, and it is important to operate before the patient is poisoned by the absorption of toxins from the bowel. To administer purgatives is worse than useless. ”

“ There are classes for mothers on the care of their health during pregnancy, infant feeding, home nursing, cooking and needlework. Poor mothers unable to contribute get free dinners for three months previous to the birth of their child and for nine months after if the child is breast-fed. Two doctors are in attendance, and mothers are encouraged to bring their children fortnightly to be weighed, and receive advice. The average attendance is ninety. A baby is said to have “graduated” when it is a year old. ”

“ The treatment of cancer of the cervix is free removal at the earliest possible moment. Cancer of the body of the uterus is rare before the 45th year. It is most frequent at or subsequent to the menopause. The majority of the patients are nulliparae (Bland-Sutton) . The signs are fitful haemorrhages after the menopause, followed by profuse and offensive discharges. The uterus on examination often feels enlarged. The diagnosis being made, hysterectomy (removal of the uterus) is the only treatment. Cancer of the body of the uterus may complicate fibroids. ”

“ The most important part of the toilet of a new-born infant is the care of the eyes, which should be carefully cleansed with gauze dipped in warm water and one drop of a 2% solution of nitrate of silver dropped into each eye. The clothes of a newly born child should consist exclusively of woollen undergarments, a soft flannel binder, which should be tied on, being placed next the skin, with a long-sleeved woven wool vest and over this a loose garment of flannel coming below the feet and long enough to tuck up. ”

“ The micro-organisms are conveyed by the blood-stream to different parts of the body, in which as in the original wound itself they both multiply and set up factories for the production of toxins. The disease commonly follows blows or wounds which have not been treated on surgical lines. Much laceration of the tissues at the time of the injury offers increased liability to infection. Septicaemia is frequent in spreading gangrene, in diseases of the periosteum, and in fevers such as scarlatina, diphtheria or plague, and in the puerperal state. ”

“ Early in the case the abdomen is but little distended, and in about half the cases a distinct tumour can be felt. In some cases the invaginated gut may be felt protruding through the sphincter. Chronic intussusception occurs more frequently in adults than in children; the symptoms may resemble chronic enteritis and be so masked that the nature of the illness remains undiagnosed until an acute attack supervenes, or the patient succumbs to the diarrhoea, vomiting and haemorrhage. ”

“ At the sixth month it should be twice the weight at birth. The average weight at the twelfth month is 20 to 21 ℔. The increase of weight in artificially fed is less regular than in breast-fed babies.
Food.—There is but one proper food for an infant, and that is its mother’s milk, unless when in exceptional circumstances the mother is not allowed to nurse her child. Artificially fed children are much more liable to epidemic diseases. The child should be applied to the breast the first day to induce the flow of milk. ”

“ An occasional cause of pyaemia is infective endocarditis, while puerperal pyaemia may arise from infection of the genital tract. When the emboli lodge in the lung there is a breaking down of the tissue in front of the embolus, a hemorrhagic infarct being formed. The clinical symptoms of acute pyaemia generally start with a rigor repeated at periodic intervals; the skin becomes hot and the patient soon develops an earthy colour, the pulse becomes frequent and weak and the tongue dry. In about a week secondary abscesses appear, most frequently in the region of joints. ”

“ The cause of cirrhosis of the ovaries is unknown, though it may be associated with cirrhotic liver. The change is met with in women between 20 and 40 years of age, the ovaries being in a shrunken, hard, wrinkled condition. Under ovarian neuralgia are grouped indefinite painful symptoms occurring frequently in neurotic and alcoholic subjects, and often worse during menstruation. The treatment, whether local or operative, is usually unsatisfactory. The ovary is frequently the seat of tumours, dermoids and cysts. Cysts may be simple, unilocular or multilocular, and may attain an enormous size. ”

“ Diseases of the Fallopian Tubes.—The Fallopian tubes or oviducts are liable to inflammatory affections, tuberculosis, sarcomata, cancer, chorion-epithelioma and tubal pregnancy. Salpingitis (inflammation of the oviducts) is nearly always secondary to septic infection of the genital tract. The chief causes are septic endometritis following labour or abortion, gangrene of a myoma, gonorrhoea, tuberculosis and cancer of the uterus ”

“ The hymen may be occasionally imperforate and require incision. Cysts and painful carunculae may occur on the clitoris. Any part of the vulva may be the seat of new growths, simple or malignant.
Diseases of the Vagina.— (1) Malformations. The vagina may be absent in whole or in part or may present a septum. Stenosis of the vagina may be a barrier to menstruation. (2) Displacements of the vagina; (a) cystocele, which is a hernia of the bladder into the vagina; (b) rectocele, a hernia of the rectum into the vagina. The cause of these conditions is relaxation of the tissues due to parturition. ”

“ The symptoms may become merged in those of general peritonitis. In chronic disease there is a history of puerperal trouble followed by sterility, with excessive and painful menstruation. Acute salpingitis requires absolute rest, opium suppositories and hot fomentations. With urgent symptoms removal of the inflamed adnexa must be resorted to. Chronic salpingitis often renders a woman an invalid. Permanent relief can only be afforded by surgical intervention. ”

“ The prompt removal of the cause of septic absorption, the flushing out of the wound with weak antiseptic solutions, in order to mechanically remove any decomposing masses, and the establishment of proper drainage in deep wounds, is usually followed by a fall in temperature and an improvement in the general condition. A strong, preferably mercurial, purgative should be given to aid in the elimination of toxic material. For the same purpose the injection into the veins or into the cellular tissue of large quantities of normal saline solution is useful. ”