Gynecology

“ They must be made to realize that the women of the past, before the development of modern gynecology, not only lived useful lives without any of the modern gynecological operations, but that most of them were quite happy in so doing. Even though many of them had physical symptoms, the lack of unfavorable suggestion as to the significance of these prevented mental exaggeration, and morbid dwelling on them was not allowed to produce such a deterioration of the physical condition as to emphasize the pathological conditions. ”

“ Regularly every year a new edition of this excellent text-book is called for, and it appears to be in as great favor with physicians as with students. Indeed, this book has taken its place as the ideal work for the general practitioner. The author presents the best teaching of modern gynecology, untrammeled by antiquated ideas and methods. In every case the most modern and progressive technique is adopted, and the main points are made clear by excellent illustrations. ”

“ Emmet is entitled to great credit for having given to the profession an operation which brings the posterior vaginal walls up against the anterior more perfectly than any other, and which, being mostly inside of the vagina, is therefore followed by very little of the pain during convalescence which formerly rendered perineorrhaphy one of the most trying operations in gynecology. ”

“ THE practice of medicine as a whole appeals strongly to women, because of their sympathy for the sick and afflicted and their innate desire to relieve such distress, while obstetrics and gynecology are the special branches that they naturally choose. ”

“ 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. ”

“ In such circumstances the operator admits to himself that his patient was lucky. The element of luck should be entirely eliminated. Nothing should be trusted to luck.
Fortunately, most of the operations of gynecology are performed for conditions of such a character that there is no demand for instant operation. The woman can usually wait until suitable conditions are furnished. In cases of emergency the surgeon can only do his best under the existing circumstances, not his best under the best circumstances. ”

“ Professor of Diseases of Women, New York Post-Graduate Medical School. “I have looked it through and must congratulate you upon having produced a text-book most admirably adapted to teach gynecology to those who must get their knowledge, even to the minutest and most elementary details, from books.”
Webster's Diseases of Women
Diseases of Women. By J. Clarence Webster, M.D. (Edin.) , F.R.C.P.E., Professor of Gynecology and Obstetrics in Rush Medical College. Octavo of 712 pages, with 372 illustrations. Cloth, $7.00 net; Half Morocco, $8.50 net. ”

“ It embraces all the more important diseases and the principal operations in the field of gynecology, and brings to bear upon them all the extensive practical experience and wide reading of the author. It is an indispensable guide to every practitioner who has to do with the diseases peculiar to women. Third Edition. With 112 illustrations. Thoroughly" revised and greatly enlarged. One volume, large octavo, 578 pages.
Price, in United States and Canada, Cloth, $5.00 ; Full Sheep, $6.00. Discount, per cent., making it, net, Cloth, $4.00 ; Sheep, $1.80. ”

“ 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. ”

“ Inevitably, if it be a woman long ill and long treated, we shall have to settle the question of uterine therapeutics. A careful examination is made, and we learn that there is decided displacement. In this case it is well to correct it at once and to let the uterine treatment go on with the general treatment. If there be bad lacerations of the womb or perineum, their surgical relief may await a change in the general status of health,—say at the fourth or fifth week. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ The cervix protrudes into the anterior wall of the vagina for about one-half inch and almost at right angles, since the vagina slopes down and forward to the outlet.
The upper part of the uterus is held in position by means of ligaments, the lower part being embedded in fat and connective tissue between the bladder and rectum. This more or less of a floating position makes possible the enormous increase in size and upward push or extension of the uterus during pregnancy. The pregnant uterus becomes soft and elastic as it grows. ”

“ 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. ”

“ Vicarious menstruation is a rare condition. It may occur in defective development of the uterus and ovaries. It is usually found in debilitated nervous women, and accompanies a deficient menstrual discharge from the uterus.
Treatment.—Direct local treatment should be applied to the vicarious bleeding only when it becomes excessive. The general health of the woman should receive attention. Treatment should be applied to any local lesion of the genital apparatus that may be discovered. The directions given for amenorrhea are also applicable here. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ In these lectures the situation, figure, and structure of all the parts of the human body will be demonstrated, their respective uses explained, and as far as a course of anatomy will permit, their diseases, with the indications and methods of cure briefly treated of. All the necessary operations in surgery will be performed, a course of bandages exhibited, and the whole concluded with the explanation of some of the curious phenomena that arise from an examination of the gravid uterus, and a few plain general directions in the study and practice of midwifery. ”

“ The discharge from the uterus is largely augmented by mucus secreted in increased quantity at this period from the enlarged uterine glands.
The tubes take some part in the process of menstruation; their mucous membrane is swollen, the epithelium is shed in places, and they are filled with a thin bloody fiuid, containing blood-corpuscles and cast-off epithelium cells.
The menstrual wave continues from puberty to the menopause; it is a nervous phenomenon. Ovulation is a progressive, non-periodic process; it begins before birth and continues till the ovarian tissue is atrophied or worn out. ”

“ If an attempt at menstruation is made, as shown by periodical local pain and general disturbance, and the uterus is found to be small 407 and sharply anteflexed, benefit may sometimes result from thorough dilatation of the cervix.
Most cases of amenorrhea demand general treatment. The mode of life should be regulated according to strict hygienic principles. Fresh air, sunshine, baths, and suitable exercise should be prescribed. Studious girls should be made to lead more active lives. A change of surroundings is beneficial. ”

“ The uterus lies just under the incision, and the operator ascertains that it lies centrally (often the uterus is somewhat rotated to the right or left) , and then makes a free incision through the uterine wall and extracts the fœtus and placenta; as the uterus contracts, he slips his left hand behind the fundus, and grasps the uterus near the cervix, and effectually controls the bleeding. The assistant passes a large warm flat dab into the belly to restrain the intestines and omentum. ”

“ The vagina, like all organs supplied with a mucous membrane, is self-cleansing. Water, or any other fluid thrown into this organ, has a tendency to disorder the mucous follicles, to dry up their secretions and thus prevent the efflux of some of Nature's necessities. From this cause alone there will be a reaction upon the vaginal walls, upon the neck of the uterus and the uterus itself; the ovaries also become disordered; the lungs sympathize as well as the throat and bronchial tubes, producing hoarseness, hacking cough and a host of troubles following in their train. ”

“ The obstruction in the vagina, occasioned by a preternatural formation of the hymen, may be either complete or incomplete. In the former case the imperfection may remain undiscovered, until the menstrual secretion has accumulated within the cavities of the uterus and vagina, and has distended the former, so as to excite suspicion of the existence of pregnancy. As the aggregation of the menses, and consequent enlargement of the uterus advance, some difficulty in discharging the urine takes place, constituting dysury ”

“ 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. ”

“ The uterus diminishes in size; the vaginal cervix may disappear; the utricular glands diminish in size and number; the endometrium atrophies. The Fallopian tubes shrink and become shortened, and the fimbriæ disappear. Similar atrophic changes affect the vagina, the external genitals, and the mammary glands.
If the woman is in good general health, and has no disease of the uterus, the tubes, or the ovaries, the menopause may become established without any marked general disturbance. ”

“ Treatment.—In all these cases the general principles of management are plain and easily understood. We must, of course, as far as possible, remove the causes of the difficulty; we must also treat the system constitutionally in order to improve the general strength. Cooling wet compresses 339upon the abdomen and genitals, frequent ablutions, the sitting-bath, and in some cases the packing wet-sheet, will prove a highly useful means; vaginal injections of water, tepid injections in the bowels, and drinking of pure, soft water, are also to be recommended. ”

“ The top of the uterus, or fundus, may be felt just below the navel and the inner surface where the placenta was attached, is raw and bleeding. At the end of six or eight weeks the organ has descended into the pelvic cavity and resumed approximately its original position and size and its former weight of 2 ounces. This return of the uterus to practically its pre-pregnant state is called involution and in the interest of your immediate recovery and future health it is important that this shall progress normally. ”