Gynecologist

“ The orthopedic surgeon will be wise to refer to the gynecologist for a preliminary examination and opinion by which to guide treatment, those cases in which the history, or the replies to the usual questions, are suggestive of uterine disease. This is especially important when the symptoms suggest the possible presence of inflammatory disease of the intrapelvic organs, since in these cases, as has been said above, alteration of attitude, such as would be indicated by the back-strain alone, may be distinctly harmful. ”

“ The reproach often directed at gynecologists, of a disposition to magnify their specialty, falls pointless before such important facts; and since it is not uncommon for diseases of organs in close proximity to the uterus, as those of the urethra, bladder, and rectum, to be mistaken for or confounded with diseases of the uterus itself, there is abundant warrant for urging the closest scrutiny as to a possible uterine origin of remote diseases, especially those of a nervous character. ”

“ Many a woman who is operated on is benefited only for the time being, and her old symptoms return after a time. Dr. Goodell, one of our first great gynecologists, used to warn his students insistently that women had many organs outside of the pelvis. The individuality in gynecology is extremely important. Some women suffer what they describe as excruciating pain or unbearable torture from pathological conditions that other women do not notice at all. ”

“ Obstetricians of the highest eminence stand ready to examine her and counsel her; gynecologists are at hand to perform any necessary operations; trained nurses call at her home, supply and prepare her diet, warn her against a too animated social life, hand her instructive literature, and entertain her with anecdotes suitable to her condition. ”

“ In 1881 he returned to Buffalo and began to make a specialty of gynecology and obstetrics, helping to organize the American Association of Obstetricians and Gynecologists, becoming first secretary and editor of the transactions and filling the dual position for twenty-two years. ”

“ Local application to the vagina and uterus can be done satisfactorily by the physician or nurse only. The insertion of a suppository or douching can be easily done by the patient herself.
While it is always best and safest to consult a physician, and, while self-medication is generally inadvisable, there are occasions when a physician is not available; in some small places a woman may, for various reasons, have a strong objection to gynecological examination and treatment; and some women may be too poor to pay the doctor. ”

“ She has a good appetite, sleeps well, and in no particular shows any sign of ill health. The uterine examination reveals a short vagina, and a small, round cervix uteri, rather less in size than the average, and projecting very slightly into the vaginal canal. Depth of uterus from os to fundus, two and a quarter inches, is very nearly normal. No external sign of abnormal ovaries. She is a well-developed, healthy young woman, performing all her physiological functions naturally and regularly, except the single function of menstruation. ”

“ In the injured woman the vagina is open and the pressure is resisted by weak vaginal walls and uterine supports. She feels that her point of resistance is gone. The best proof of the profound effect of injury to the perineum upon the general strength of a woman is given by the operation of perineorrhaphy. 110 The repair of this apparently slight lesion restores the woman to her former strength.
The diagnosis of prolapse of the uterus is readily made by examination. In the extreme cases the cervix and the greater part of the body of the uterus are found outside the vulva. ”

“ The couple, all of whose children had died soon after birth, longed once more for children. The woman had aborted several times, and both were intelligent enough to see that everything could not be right with the sexual organs, and even begged for a gynæcological examination. The result was in a few words: inflammation of both lips of the uterus, a thickening of the cervical canal with a swelling of the posterior uterine wall as hard as cartilage, and retroversio uteri. Menstruation too early, dysmenorrhœa, blood dark, tarry, passing in clots. Yellowish, fetid leucorrhœa. ”

“ All physicians are convinced of the good that has been done by the extension of the application of surgery to women's diseases during the pest generation. On the other hand, there are probably very few, except the ultra-specialists, who are not quite sure that there has been too much surgery in gynecology, and that many a woman has been operated on without sufficient reason and without definite indications. In suitable cases surgery is sometimes life-saving and is often the only means of relief for suffering that is seriously disturbing the general conditions and is making life unbearable. ”

“ In 1871 the character of the man was displayed in the successful establishment of the Woman's Hospital of Illinois, of which he was the first surgeon-in-chief. After this he limited his practice entirely to gynecology.
In 1872 he was elected lecturer on gynecology at Rush Medical College, and held the position until 1877, when he resigned. In 1882 he established and incorporated, with the aid of two colleagues, the College of Physicians and Surgeons of Chicago, and was its president and professor of gynecology until removed by death. ”

“ Any thing that enfeebles the functional powers of the system is liable to disqualify the female for reproduction.
Treatment. An extensive observation and experience in the treatment of sterility, convinces us that, in the majority of cases, barrenness is due to some form of disease which can be easily remedied. If the passages through the neck of the uterus be closed or contracted, and this is the most frequent cause of sterility, a very delicate surgical operation, which causes little if any pain or inconvenience to the patient, will remove the impediment to fertility. ”

“ Every woman who uses a pessary should be under the supervision of a physician, and for this reason it is often most advisable to recommend immediate operation to poor women as the quickest and surest method of cure.
Immediate operation should always be advised in all cases of retroversion with adhesion or with disease of the tubes and ovaries.
It should not be forgotten that we occasionally see women with retroversion of the uterus who present no symptoms whatever referable to this lesion. In such cases no treatment is required. ”

“ Elevation of the foot of the bed and application of ice-bag to the abdomen are also employed.
In severe cases, the doctor may give an intra-uterine douche of hot, sterile salt solution and if this fails he may pack the uterus tightly with sterile gauze. The douche and pack represent operative maneuvers and, therefore, are never to be undertaken by the nurse. Her assistance is important, however, as strictest asepsis is imperative and she will have to prepare the patient and the necessary articles with the greatest care. ”

“ More frequently, but in quite the same way, we find that nursing causes uterine contractions in the early part of the lying-in period, when they are called after-pains. Women who experience them tell us they are more severe while the infant nurses; and they also say that the discomfort disappears after several days, a fact which indicates that involution has made notable headway. The physician is not dependent on such evidence, however; for a simple examination reveals at any time how far involution has progressed. By this means we have learned that nursing facilitates the involution process. ”

“ Since satisfactory involution is necessary to the patient’s future health, its progress should be watched with deep concern and interest, and all possible effort made to promote it; firm consistency of the uterus and a steady descent into the pelvis and normal lochia being the chief evidences of satisfactory involution. There is evidently a close relation between the functions of the breasts and of the uterus during the puerperium, and as a rule involution accordingly progresses more normally in women who nurse their babies than in those who do not. ”

“ Treatment. This condition admits of relief only by operative surgery. The operation consists in dividing the hymen by a crucial incision, thus allowing the accumulated fluid to be discharged, after which the vagina is cleansed by syringing it with warm water.
Absence of the Ovaries. Let us suppose the case of a young woman who has fully reached the period of puberty without having menstruated. All the organs which we have described, are manifestly developed, she is healthy, vigorous, robust, and able to exercise freely or to engage in laborious occupations. ”

“ Specialists are so busy with their own particular subjects and general practitioners are so taken up with their daily routine that they cannot give to the problem of contraception the attention it must have. Consultation rooms in charge of reputable physicians who have specialized in contraception, assisted by registered nurses—in a word, clinics designed for this specialty, would meet this crying need. Such clinics should deal with each woman individually, taking into account her particular disease, her temperament, her mentality and her condition, both physical and economic. ”

“ My informant added that he believed not a single insane woman had ever received special treatment for affections in any of the hospitals under the care of male physicians. While we realize that great advantages would have come to these poor unfortunates by proper treatment, we feel that no male physician having due regard for his own reputation, should attempt to treat an insane woman for uterine diseases by means used in private practice, or even in hospitals with sane women. And this shows the importance of women physicians for women insane. ”

“ Should a woman have her womb and ovaries removed because of these conditions?—Only in the most extreme cases, and, even then, only upon the united opinion of several capable and honest physicians. In recent years operations for these troubles have been too frequent. A woman is never quite herself after one of these operations. If women were taught plainly and scientifically how to obey the laws of sex they would in almost all cases recover without an operation. It is generally estimated by hospital authorities that from sixty-five to eighty per cent. ”

“ Attention must be drawn to the fact that the vagina, cervix, uterus and tubes form a continuous canal from the vulva to the easily infected peritoneum, a fact which makes absolute surgical cleanliness in obstetrics virtually a matter of life or death to the patient. ”

“ This modern warfare which physicians are waging upon the unoffending womb is a most irrational practice. Our grandmothers got along very well without exposing themselves to the humiliation and tortures of this new-born empiricism. We do not wish to be understood as undervaluing or denying the necessity, in rare cases, of examinations of the uterus, or as being unappreciative of the aid afforded in such investigations by the speculum, and the beneficial effects of local applications made directly to the womb through that instrument. ”

“ There is a close correlation between the rise of modern gynæcology, and the rise of the movement for readmitting women to the medical profession, where they once held a place, and whence they had been forcibly extruded. While it is far from true that women physicians are intended only for obstetrics and gynæcology, it is unquestionably true that these two great branches of medicine peculiar to their sex constitute the great opportunity, the main portal, through which women have passed, and are destined to pass, to general medicine. ”

“ Retention of the menses may result from malformation of the vaginal canal, which sometimes terminates before it reaches the womb, being simply a short, closed sac. If the uterus and ovaries are perfect, all the feminine characteristics are manifest, and a vaginal exploration discloses the nature of the difficulty. If, however, the sides of this passage adhere in consequence of previous inflammation, they may be carefully separated by a surgical operation, and this function restored. ”

“ The individual may be delicate in organization, graceful in bearing, refined and attractive in all feminine ways, and yet this organ may be so defective as to preclude the establishment of the menstrual function. Sometimes there is merely an occlusion of the mouth of the uterus, the perforation of which removes all difficulty. In others, the neck of the womb is filled with a morbid growth, or the walls of its canal are adherent, as the result of inflammation, and may be separated by a small silver or ivory probe, and the menses be thus liberated. ”

“ Sometimes during life the cause of the sterility is entirely overlooked, and only discovered by chance or in post mortem examination. Although the vagina usually shares to a marked extent in the defects of the uterus, and at puberty undergoes a rudimentary development merely, the marital intercourse of such individuals commonly appears to be perfectly normal. As a result of frequently repeated and vigorous attempts at intercourse, the rudimentary vagina becomes accommodated to the needs of the case ”

“ In sterile women, if on gynecological examination we find certain characteristic changes in the reproductive organs, a strong suspicion will be aroused that the sterility is due to abnormal modes of sexual gratification. The changes in question are: hypertrophy of the clitoris, enlargement and a bluish colouration of the labia minora, retroversion of the uterus, neuralgia and displacement of the ovaries, leucorrhoea, and menorrhagia. ”