CHAPTER XLIII.

THE EFFECT OF THE REMOVAL OF THE UTERINE APPENDAGES.

Removal of the tube and ovary upon one side has no effect upon menstruation or upon any of the other characteristics of the woman.

Removal of the tubes and ovaries upon both sides is followed within forty-eight hours by slight bleeding from the uterus, lasting for one or two days.

If the removal of the tubes and ovaries has been complete, menstruation, in the majority of cases, never reappears.

In a few cases menstruation appears for one, two, or three periods after the operation, usually in diminished amount, and then ceases for ever. In some other cases there is a period of a few months of amenorrhea, followed by two or three scanty menstrual flows, before the bleeding permanently ceases.

These phenomena, it will be observed, are similar to those of the normal menopause.

The woman after double salpingo-oöphorectomy experiences the nervous and gastro-intestinal disturbances that so usually accompany the menopause. She, in fact, passes through a premature menopause, the phenomena of which may persist for one or two years.

The secondary sexual characteristics of the woman--the voice, the figure, and the growth of hair--are not altered if the appendages are removed during adult life. The case may be different if the appendages are removed in the undeveloped girl, in whom the ovarian influence is essential for complete development.

The woman loses none of her feminine attractions. She may, indeed, become better-looking if the operation has relieved chronic suffering. It is said that Gyges, king of Lydia, caused the removal of ovaries from women with a view to prolonging their charms.

Double oöphorectomy may be followed by obesity if the woman have a tendency to form fat. The relief of suffering and the consequent improved nutrition favor the development of obesity. There seems to be nothing inherent in the operation to cause it. Many women remain thin after the operation.

The emotions of the woman are unaltered by double oöphorectomy, with the exception of some cases in which the sexual desire is destroyed. Sexual desire is dependent upon such a variety of conditions, both within and without the woman, that it is difficult to determine the amount of influence that removal of the ovaries exerts upon this feeling.

It is undoubtedly true that sexual desire is sometimes destroyed by the operation. On the other hand, the sexual desire is very often restored by the operation, which relieves the former dyspareunia, or painful coitus.

INDEX.

Abdomen, binder for, 479 distention of, after celiotomy, 497 drainage of, 480, 482 enlargement of, 19 examination of, 19, 21, 22, 28 exploration of, 489 fluctuation in, 24 protection of contents of, during operation, 489 retentive power of, 99 sterilization of, for operation, 473

Abdominal incision, closing of, 491 irrigation, temperature of water for, 468 myomectomy, 255 technique, 530, 533 operations, dressing of, 479 instruments for, 475 section, after-treatment of, 494 surgery, training for, 461 suture, layer method, 493 sutures, removal of, 492 wall, incision of, 487 closing of, 491

Abortion by uterine sound, 35 in endometritis, 206

Abscess, pelvic, 303 of vulvo-vaginal glands, 38, 40

Actinomycosis of tubes, 313

Adeno-carcinoma of cervix, 181

Adenoma of ovary, 354 of tubes, 313 of uterus, malignant, 221

Adenomyoma of uterus, 257

Adhesions of clitoris, 48 pelvic, treatment, 510, 513

Alexander’s operation, 142

Amenorrhea, 405 emansio mensium, 405 in superinvolution, 217 in tubal pregnancy, 326 pelvic massage in, 414 periodical disturbances in, 406 suppressio mensium, 405

Ampullar pregnancy, 315

Anesthesia, 470

Anesthetizer, duties of, 470

Animals, disease of reproductive organs in, 17

Anteflexion of uterus, 119 causes, 119, 122 menstruation in, 122 miscarriage in, 123 pessaries in, 123 pregnancy in, 123 sequelæ, 122 sterility in, 122 symptoms, 122 varieties, 120

Anterior colporrhaphy, 90

Antisepsis, 35

Antiseptics, action of, on peritoneum, 457

Apoplexy of ovary, 346

Apparatus for gynecological operations, 462

Appendix vermiformis, palpation of, 21

Applicator, vesical, 425

Arnold’s sterilizer, 466

Ascites in ovarian cyst, 366 in solid tumors of ovary, 391

Asepsis, importance of, in gynecology, 458

Atresia of cervix, 17 of vagina, 17, 52 diagnosis, 53 symptoms, 52 treatment, 53

Auscultation of abdomen, 22

Barnes’ bag in inversion, 269

Bartholin’s glands, 36

Basham’s mixture, 171

Basins, sterilization of, 463

Bimanual examination, 23-25, 28 in carcinoma of uterus, 224 in endometritis, 206 reposition of uterus, 135

Binder, abdominal, 479

Bivalve speculum, 29, 30

Bladder, base of, 436 body of, 436 catheterization of, 439

Bladder, cervix of, 436 dissection of, from uterus, 519 empty, 436 examination of, 34, 425 fundus of, 436 intra-ureteral ligament of, 437 irrigation of, 443 irritable, 89 meatus internus, situation of, 445 mucous membrane of, 436 neck of, 436 structure of, 436 trigone of, 436 vascular supply of, 437 vesical triangle of, 436

Blaud’s pill, 170

Boldt’s table, 462

Bowels, treatment of, after celiotomy, 496

Braun’s colpeurynter, 118

Broad ligament, hematoma of, 318

Bulbo-cavernosus, 58

Buried sutures, 493

Calculi in vesico-vaginal fistula, 416 vesical, 447

Calibrator, urethral, 423

Canal of Gärtner, 52 of Nuck, 42

Carcinoma, cachexia of, 192 of cervix, 181 adeno-carcinoma, 181 broad ligaments in, 185, 193, 194 caustics in, 196 diagnosis from lupus, 188 from syphilitic ulceration, 188 from uterine polyp, 188 duration, 193 hysterectomy for, 193, 194 remote results, 195 metastasis in, 185 origin, 181 peritoneal involvement in, 185 septic infection in, 192 squamous-cell, 181 symptoms, 189 treatment, 193, 195 ulceration in, 182 ureteral involvement in, 185 urinary fistulæ in, 185 varieties, 181, 183, 184 of Fallopian tubes, 220 of ovaries, 220 of peritoneum, 220 of ureters, 185 of uterus, body of, 218 age, 220 causes, 221 curette in, 224

Carcinoma of uterus in lower animals, 15 influence of fibroids in, 221 leucorrhea in, 223 metastasis in, 220, 223, 224 operation in, 224, 225 symptoms, 222 of vagina, 52 urethral, 436

Carrier for perineal sutures, 66

Caruncle, urethral, 434 results, 435 symptoms, 435 treatment, 435

Catarrh of cervix, 166

Catgut, sterilization of, 477, 478 cumol method, 478 iodin method, 478

Catheter, Skene’s, 429

Catheterization after celiotomy, 495 as cause of cystitis, 438 before operation, 474 of bladder, 439

Celibacy a cause of disease, 18 fibroids in, 18

Celiotomy, 305, 308 abdominal distention after, 497 after-treatment, 494 of bowels, 495 catheterization after, 495 death after, 500 dressings after, 478 food after, 496 hemorrhage after, 500 micturition after, 495 mortality after, 501 opium after, 495 pain after, 495, 497 peritonitis after, 500 pulse after, 498 purgation after, 496 shock after, 498 temperature after, 498 thirst after, 494 urinary secretion after, 496 vomiting after, 497 water after, 494

Cellulitis, pelvic, 303

Cervical catarrh, 153, 166 erosion in, 167 in displacements, 167 in laceration of cervix, 152 sclerosis in, 167

Cervix, amputation of, 162, 163 conception after, 165 in subinvolution of uterus, 216 in uterine prolapse, 117 applications to, 172 artery of, 504 atresia of, 17 carcinoma of, 181. See also _Carcinoma_. chancre of, 180 congenital erosion of, 174 split of, 177 cystic degeneration of, 152, 155 dilatation of, 124 results of, 126 direction of, 95 distance of, from coccyx, 95 ectropion of, 150, 152, 159 endometritis of, 166 erosion of, after laceration, 176 erosions of, 152, 155 eversion in laceration of, 150 examination of discharge from, 452 gonorrhea of, 451 hypertrophic elongation of, 178 in infancy, 119 laceration of, 148 diagnosis of, 154 from congenital ectropion, 176 Nabothian cysts in, 152, 184 reflex symptoms, 154 sclerosis in, 152 subinvolution in, 152 symptoms, 153 trachelorrhaphy in, 156 treatment, 156 ulceration in, 152 varieties, 150 with endometritis, 153 of bladder, 436 patulous canal, 206 polypi, 178 polypoid growths, 182 sensation of, 27 splitting posterior lip of, for inversion of uterus, 271 supra-vaginal elongation of, 104 tuberculosis of, 180 ulceration of, 182 vegetating growths of, 182

Chancre of cervix, 180

Chorio-epithelioma, 228 symptoms, 229 treatment, 229

Circular artery, ligation of, 196

Claudius’ method for sterilization of catgut, 478

Clitoris, adhesions of, 48

Clothing as cause of disease, 17

Coccygodynia, 54

Colpeurynter, Braun’s, 118

Colporrhaphy, anterior, 82

Conception after amputation of cervix, 165 after salpingo-oöphorectomy, 512

Corpora fibrosa, 390

Corpus-luteum cyst, 352

Cumol method for sterilization of catgut, 478

Curette in endometritis, 207, 208, 299 in uterine cancer, 224 Martin’s 209 perforation by, 210 reparative process after use of, 212 Sims’, 209

Cyst, intra-ligamentous, removal of, 514 Nabothian, 152 of hernial sac, 42 of Morgagni, 369 of ovary, 15. See also _Ovary_. of round ligament, 42 of vagina, 51 of vulvo-vaginal gland, 40 trocar, 477 urethral, 435

Cystitis, 89 chronic, 438 causes, 438, 439 cystotomy in, 444 diagnosis, 439 effect on system, 29 hypertrophy of bladder-wall in, 438 use of endoscope in, 440, 442, 444 obstruction of vesical orifice, 438 result of lacerated perineum, 440 of uterine displacement, 440 symptoms, 439 treatment, 440, 444 ureter and kidney involvement, 438 urinary changes, 438

Cystocele, 88, 107 Dudley’s operation for, 91 Sims’ operation for, 90

Cystoscope, 424

Cystotomy, 444, 445

Death after celiotomy, 500

Depressor for vagina, 29

Dermoid cysts, 359 of ovary, 512 age of occurrence, 359

Developmental errors a cause of disease, 17

Diarrhea, vicarious, 408

Dilatation of cervix, 124 of urethra, 433

Dilator, cervical, 123 vaginal, 416

Diseases of women, causes of, 16

Dorsal position, 31

Drainage, abdominal, by gauze, 482 by tube, 480

Drainage, abdominal, ill effects of, 485 indications for, 484 object of, 485 vaginal, 480, 487

Drainage-tube, 480, 482 cleansing of, 481 syringe for, 481

Dressings for abdominal operations, 478 sterilization of, 466

Duck-bill speculum, 29

Dudley’s operation for cystocele, 91

Dysmenorrhea in anteflexion of uterus 121 in salpingitis, 291 membranous, 212 menstruation in, 210

Ectropion, cervical, 152

Edebohls’ stirrups, 22

Elephantiasis Arabum, 47 of vulva, 47 syphilitic, 47

Emansio mensium, 405

Emmet’s operation for lacerated perineum, 80 perineal needles, 65 scissors, 64 treatment for inversion of uterus, 269, 270

Endometritis, abortion in, 206 acute, 199 cervical, 166 chronic, 201, 207 causes of, 207 curette in, 208 examination in, 206 exfoliative, 212 fungous, 203 gonorrheal, 199 in exanthemata, 199 in lacerated cervix, 153, 204 in subinvolution, 204 in tubal disease, 204 influence on menstruation, 204 with metritis, 199 ovarian disease in, 204 pain in, 205 post-climacteric, 213 puerperal, 199, 200 senile, 213 sterility in, 206 structural changes in, 203 with uterine displacement, 131, 204

Endoscope, 432 in cystitis, 440, 442, 444

Enterocele, 91

Erosion of cervix, 152, 174, 176

Eruptive fever as cause of disease, 344

Exanthemata as cause of chronic pelvic disease, 200 of cystitis, 439 of sexual ill-development, 200 vaginitis in, 49

External genitalia, examination of, 22, 26

Extra-uterine pregnancy, 314. See also _Tubal pregnancy_.

Facies ovariana, 381

Fallopian tubes, 272 actinomycosis of, 28 adenoma of, 313 anatomy of, 272 cancer of, 313 cysts of Morgagni, 276 development of, 395 examination of, 25 gummata of, 313 inflammation of, 276. See also _Salpingitis_. miliary tuberculosis of, 308 myoma of, 313 pregnancy in, 314. See also _Tubal pregnancy_. sarcoma of, 313 tubercle of, 307 tuberculosis of, 306, 309, 312 unsuspected, 308

Fibroid tumors, anatomic changes, 235 hysterectomy in, 526 in Africans, 16 in animals, 15 in celibacy, 18 of uterus, 230 and ovarian cyst, 248 and pregnancy, 247, 256 appearance of, 232 circulatory abnormalities in, 245 degenerations of, 237, 238 diagnosis of, 246, 248 duration of life in, 236 frequency of, 241 gangrene in, 239 hemorrhage in, 242 hypertrophy in, 242 hysterectomy in, 254 in menopause, 242 interstitial, 232 intra-ligamentous, 232, 235, 526 intra-uterine polyp, 234, 256 ligation of uterine arteries in, 252 lymphangiectatic, 238 menstruation, in, 241, 242, 249 myomectomy in, 255 necrobiosis of, 239 polypoid, 256 pressure-symptoms of, 245 procreative abnormalities in, 240, 250 prognosis in, 248 salpingo-oöphorectomy in, 252 sarcoma of, 239 submucous, 232, 234 subperitoneal, 232 telangiectatic, 238 treatment of, 249, 251 of vagina, 52 recurrent, 227 inversion of, 227 metastasis in, 227 tubal changes in, 237 sterility in, 18 with cancer, 227

Fibroma, ovarian, 390

Fibro-myoma of uterus, 227

Fibro-sarcoma of uterus, 227

Fissure, vesico-urethral, 431

Fistula in salpingitis, 290 needles for, 418 of vulvo-vaginal glands, 39 recto-vaginal, 421 uretero-vaginal, 421 urethro-vaginal, 420 vesico-uterine, 420 vesico-vaginal, 412

Flatus after abdominal section, 497

Floating kidney, 21

Fluctuation, abdominal, 20

Follicular vulvitis, 36

Food after celiotomy, 496

Forceps, bladder, 423

Four chlorides, 171

Fungous endometritis, 203

Gärtner’s canal, 52 duct, 368

Gauze sponges, preparation of, 468

Genital fistulæ, 412 tract, septic infection of, 17

Genitalia, development, 395 examination, 22 inflammation of glands of external, 454 malformations of, 395 preparations of, for operation, 472

Genu-pectoral position, 32

Glands of Bartholin, 36 of Skene, 426

Gloves, rubber, 465

Gonococci in gonorrhea, 450

Gonococcus, resistance to, 451 of vagina, 453

Gonorrhea, 448 a cause of disease, 17, 37, 450 auto-infection, 453 best time for examination, 455 carbolic acid in, 456 curettement in, 456 epidemics of, 450 gonococci in, 450 in children, 450 liability to, 451 of cervix uteri, 451, 453 examination, 452 of discharge, 452 of rectum, 450 of urethra, 451 of vagina, 453 symptoms of, 454 of vulva, 454 persistence of, 451 results of, 17

Gonorrheal endometritis, 453 macula, 39 vaginitis, 453

Green soap, 26

Gummata of Fallopian tubes, 313

Gynecological operations, apparatus for, 462 performance of, 460 personal sterilization in, 463 rubber gloves in, 465 water in, 467

Gynecology, definition of, 15

Hands, sterilization of, 465

Headache in endometritis, 205 in lacerated cervix, 153

Hematocele, pelvic, 325

Hematocolpos, 53, 399

Hematoma between suture planes, 493 of broad ligament, 318 of vulva, 46 pelvic, 326

Hematometra, 259

Hematosalpinx, 282, 286, 287 after celiotomy, 500 in cervical carcinoma, 190 with hematometra, 260

Hemorrhage after rupture of tubal pregnancy, 317 in carcinoma of fundus uteri, 223 in uterine fibroid, 242

Hemostatic forceps, Tait’s, 470

Hermaphroditism, 309 hypospadia in, 400

Hernia, entero-vaginal, 91

Hernial-sac cyst, 42

Hodge pessary, 134

Hydrocele of canal of Nuck, 42 ovarian, 346

Hydrometra, 259

Hydrosalpinx, 282, 285, 289 with hematometra, 260

Hydrostatics of pelvic contents, 98

Hypertrophic cervical elongation, 178

Hypospadia, 400

Hysterectomy, abdominal, 517, 523 supra-vaginal amputation, 518, 521 combined abdominal and vaginal, 531 advantages of author’s method, 533 Werder’s, 532 for cervical carcinoma, 193, 194 complete, 523 dangers, 523 incisions of vaginal fornix in, 524 indications for, 523 remote results, 195 transplantation of cancer-cells during, 525 for fibroid, 526 · for inversion, 271 for prolapse, 117 for salpingitis, 302 for uterine fibroid, 254 preservation of ovaries in, 523 vaginal, 517, 518 removal of tubes and ovaries, 531

Incision of abdominal wall, 487

Infundibular pregnancy, 315. See also _Tubal pregnancy_.

Inguinal adenitis, 36 hernia, 42

Instillation-tube, 173

Instruments for abdominal operations, 475 sterilization of, 466

Interstitial pregnancy, 315. See also _Tubal pregnancy_.

Intestinal tract, evacuation before operation, 471

Intestines and omentum, protection of, during operations, 489

Intra-ligamentous cyst, marsupialization, 516 removal, 514

Intra-ureteral ligament, 437

Intra-vesical pressure, 437

Inversion of uterus, 264 Barnes’ bag in, 269 continuous pressure in, 270 diagnosis of, 267 Emmet’s method for, 269, 270 hysterectomy in, 271 splitting posterior lip of cervix for, 271 symptoms and sequelæ of, 266 treatment of, 268 White’s repositor for, 270 with uterine polyp, 271 with vaginal prolapse, 265

Irrigation after curettement, 210 of abdominal cavity, water for, 467

Kelly’s instruments for examination of bladder, 423

Kidney, floating, 21 movable, 21

Knee-chest position, 32 for rectal examination, 33

Kobelt’s tubes, 368

Kolpokleisis, 420

Kraurosis vulvæ, 44

Labor after amputation of cervix, 165 spurious, 321

Laceration of cervix, 148 concealed, 150 incomplete, 150 of perineum, 62

Latero-abdominal position, 31

Le Fort’s operation for prolapse, 112

Leucorrhea, 153 in carcinoma of fundus uteri, 223 vicarious, 408

Levator ani, 53

Ligament, intra-ureteral, 437 of uterus, 95, 96 utero-sacral, 27

Ligation of circular artery, 196 of uterine arteries, 196

Ligatures, 476, 477

Lineæ albicantes, 19

Link ligature, 506, 508

Lupus ulceration, diagnosis from carcinoma of cervix, 188

Lymphadenitis in lacerated cervix, 154

Lymphangitis in lacerated cervix, 154

Malformations of genital organs, 395

Malignant adenoma, 221

Mammary changes in tubal pregnancy, 322 secretion, periodical, 408

Manometer, 437

Marsupialization, 516

Mass suture, 491

Massage, pelvic, 299

Meatus internus, position of, 445

Mechanism of perineum, 56 of uterine support, 95

Median perineal laceration, repair of, 70

Membranous dysmenorrhea, 212

Menopause, 405, 409 due to salpingo-oöphorectomy, 535 in chronic oöphoritis, 344 in ovarian cysts, 380 in salpingitis, 294 in uterine fibroid, 242 operative, 511

Menorrhagia in chronic endometritis, 204 oöphoritis, 344

Menstruation after curettement, 212 after salpingo-oöphorectomy, 535 amount of flow in, 404 and ovulation, coincidence of, 402 arrest of, by operation, 511 cessation of, 405 constituents of fluid of, 404 disorders of, 402 duration of flow, 404 during pregnancy, 247 establishment of, 402 frequency of, 404 in anteflexion, 95 in chronic endometritis, 204 in lacerated cervix, 153 in retro-displacement, 133 in tubal pregnancy, 322 neglect during, 18 precocious, 404 regimen during, 18 scanty, 407 suppression of, acute, 407 systemic effect of, 18 vicarious, 408

Metastasis in carcinoma of cervix, 185

Metritis in subinvolution, 215 with endometritis, 199

Metrorrhagia in chronic endometritis, 204

Micturition after celiotomy, 495

Miliary tubal tuberculosis, 298

Milk as a diagnostic agent in fistulæ, 414, 421

Miscarriage in anteflexion, 123

Morgagni, cysts of, 276, 369

Mortality after celiotomy, 501

Movable kidney, 21

Müller, ducts of, 395

Muscles of perineum, 58

Myo-fibroma, uterine, 230

Myoma of Fallopian tubes, 313 uterine, 230

Myomectomy, abdominal, 255 technique of, 530, 533

Myxoma, ovarian, 390 peritoneal, 378

Nabothian cysts, 152

Necrobiosis in uterine fibroid, 239

Needle for cervix, 156 for fistula, 418 for perineum, 65

Needle-holder, Emmet’s, 65 Reiner’s, 477

Neoplasms of vulva, 46, 49

Normal salt solution, 468

Nuck, canal of, 42

Nurse’s duties in operating-room, 470

Obturator, 33

Oöphoritis, 339. See also _Ovary, inflammation of_.

Operating-room, 461 discipline of, 470 preparation of, 462 temperature of, 462

Operating-table, 462

Opium after celiotomy, 495

Ostium vaginæ, 57

Ovarian abscess, 283 adenomata, 354 artery, 502 ligation of, 520, 526 carcinomata, 392 cyst, 15 axial rotation in, 375 dermoid, 512 duration of, 382 examination of, 383 inflammation of, 374, 382 malignant degeneration of, 380 marsupialization of, 515 necrosis of, 377 operation for, 389 pregnancy, 329 pressure results of, 379 rapidity of growth, 381, 382 removal of, 512 rupture of, 377, 382 causes of, 383 symptoms of, 383 treatment of pedicle, 514 suppuration of, 375 symptoms of, 378, 382 tapping of, 387, 512, 513 thrombosis, 377 torsion of pedicle in, 375 symptoms of, 382 treatment of, 387, 380 fibroid uterus, changes in, 237 fibromata, 390

Ovarian fibro-myomata, 288 ligament, bimanual examination of, 25 tumors of, 394 myomata, 390 papillomata, 393 sac, 348 sarcomata, 391 tuberculosis, 393

Ovaritis, 339. See also _Ovary, inflammation of_.

Ovary, accessory, 333 after menopause, 330 anatomy of, 330 apoplexy of, 346 blood-vessels of, 332 chronic inflammation, treatment of, 344 contents of glandular cyst of, 356 corpus luteum, cyst of, 352 cystic, 342 cystic, tumors of, 349 dermoid cysts of, 350, 359 follicular cysts of, 350 hemorrhage in, 346 glandular cysts of, 354, 372 hernia of, 334 conception in, 334 dangers in, 334 menstruation in, 334 ovulation in, 334 treatment of, 335 hydrocele of, 346 in multiparæ, 330 in new-born, 330 inflammation of, acute, 339 causes of, 340 symptoms of, 340 treatment of, 341 chronic, 341 reflex disturbance in, 344 from salpingitis, 283 ligaments of, 331 maintenance of position of, 332 multilocular cyst of, 354 of virgin, 330 of Wolffian body, 333 oöphoritic cysts of, 350, 372 oöphoron, 335 papillomatous cyst of, 362 contents of, 364 in ascites, 366 peritoneal involvement in, 365 rupture of, 365 paroöphoritic cysts of, 362, 373 ascites in, 366, 380 contents, 364 dangers, 365 wall of, 362 paroöphoron, 333 pedicle of glandular cyst of, 358 preservation of, in hysterectomy, 523 prolapse of, 335 causes, 335 diagnosis from retroflexion, 337 pessary in, 339 reflex symptoms, 337 secondary changes, 336 treatment of, 337, 339 tuberculosis of, 393 veins of, 332

Ovulation and menstruation, coincidence of, 402

Oxyuris, 37

Pain after celiotomy, 495, 497 in carcinoma of fundus uteri, 223 in cervical carcinoma, 191 in salpingitis, 292 in uterine fibroid, 244

Palpation of abdomen, 20

Papilloma of ovary, 393 of vulva, 46

Papillomatous ovarian cysts, 362

Parenchyma body, 359

Paroöphoritic cysts, 262, 373

Paroöphoron, 333

Parovarium, 52, 368 cysts of, 368, 370, 373 Gärtner’s duct, 368 Kobelt’s tubes, 368 papillomatous cysts of, 370

Parturition as cause of retro-displacements, 130 results of injuries during, 16

Patient, preparation of, for operation, 471

Pedicle-needle, 476

Pelvic abscess, 303 after rupture of tubal pregnancy, 317 celiotomy for, 305 vaginal evacuation of, 304 contents, hydrostatics of, 98 massage, 299 in amenorrhea, 407 structures, rectal examination of, 28

Pelvis, local washing of, 489 suppuration of cellular tissue in, 302

Percussion of abdomen, 22 in ascites, 22

Perineal laceration involving one or both vaginal sulci, 75, 79, 80 recto-vaginal septum, 73, 74 loss of support in, 69, 75, 130 repair, 70 sphincter-tear, suture-introduction, 68, 71, 72 removal of sutures, 73 subcutaneous, 79, 85 needle, Emmet’s, 65 needle-carrier, 66 scissors, Emmet’s, 64

Perineorrhaphy, 62, 63, 80 after-treatment of, 66 intermediate, 63 passage of sutures in, 67, 68 primary, 62 secondary, 64

Perineum, anatomy and mechanism of, 56 characteristics after sulci-tear, 78, 79 of uninjured, 74 fasciæ of, 57 injuries to, 62 lacerations, classification of, 80 Emmet’s operation for, 80 ligaments, 57 median laceration of, 67 involving sphincter, 68 muscles, 57

Peri-oöphoritis, in inflammation of ovary, 339

Peritoneum, action of antiseptics on, 457 causes of infection of, 485 cleansing before operation, 490 infection in minor gynecology, 458 toilet of, 490

Peritonitis after celiotomy, 500

Pessary, contraindications to use, 141 Hodge, 134 in anteflexion, 123 in retro-displacement, 133, 146 Smith, 133 stem, 123 Thomas, 134 vaginal, 133, 138, 140

Pflüger, tubes of, 354

Phantom tumor, 386

Polypi of cervix, 178, 182 tubal pregnancy and, 314 urethral, 435 uterine, 234, 256 with endometritis, 203

Position, dorsal, 31 genu-pectoral, 31, 32 knee-chest, 31, 33 latero-abdominal, 31 of uterus, 94 Sims’, 31, 32 Trendelenburg, 462, 510

Post-climacteric endometritis, 213

Pregnancy after amputation of cervix, 165 after celiotomy, 389 after curettement, 212 as cause of prolapse, 108 extra-uterine, 314. See also _Tubal pregnancy_. in anteflexion, 123 influence on anteflexion, 123 ovarian, 329 tubal, 314. See also _Tubal pregnancy_. with uterine fibroid, 247, 256

Probe, vesical, 425

Prolapse of ovary, 335. See also _Ovary_. of urethra, 431 of uterus, 75, 101 amputation of cervix in, 117 causes, 102, 108 colpeurynter in, 118 cystocele and rectocele in, 107 diagnosis, 110 hysterectomy for, 117 LeFort’s operation, 112 pessaries, 118 sequelæ, 111 structural changes, 106 subjective symptoms, 108 treatment, 110 ventro-fixation in, 113 of vagina, 75

Pruritus vulvæ, 42 diabetes as cause, 43 etiology, 42, 43 excision of mucous membrane, 44 treatment, 43

Pseudo-hermaphroditism, 400

Pseudomucin, 356

Pulse after celiotomy, 498

Purgation after celiotomy, 496

Pus, sterile, 284, 486

Pyelitis, result of cystitis, 438

Pyocolpos, 53

Pyometra, 259

Pyosalpinx, 260, 282, 284, 287, 509 cholesterin deposits in, 285 conversion into hydrosalpinx, 285 micro-organisms in, 284 reinfection, 285 rupture of, 289 spontaneous evacuation, 284 sterile pus, 284

Rectal examination of pelvic structures, 28 of uterus, 27 specula, 33 tube in abdominal distention, 498

Rectocele, 77, 87, 107

Recto-vaginal fistulæ, 421 septum, laceration of, 73

Rectum examination, 33 knee-chest position for, 33

Recurrent fibroid, 227 metastasis in, 227 origin of, 227 uterine inversion in, 227

Reflux tube in uterine irrigation, 210

Reiner’s needle-holder, 477

Replacement of uterus, 135

Reposition, bimanual, 135 instrumental, 136

Repositor, White’s, 270

Retractor for vagina, 528

Retro-displacement, Alexander’s operation, 142 diagnosis of, 133 menstruation in, 133 operation for, 142 pessaries in, 133 pregnancy and, 130

Retro-displacements, results of, 131 symptoms of, 132 treatment of, 133, 145 ventro-fixation for, 133

Retroflexion of uterus, 127 causes of, 129

Retroversion of uterus, 127 causes of, 129 degrees of, 128

Rheumatism cause of ovarian disease, 340

Robb’s formulæ for celloidin, 479

Room for gynecological operations, 461

Round ligament, ligation of, 520

Round-ligament cysts, 42

Rubber dam, 480 gloves, 465

Salpingitis, 276, 287 abdominal ostium, closure of, 280 acute, 277, 288 adhesions due to, 279, 280 after endometritis, 288, 299 catarrhal, 279 causes of, 276, 279, 287 celiotomy for, 296, 299, 300 chronic, 279 catarrhal, 279 interstitial, 280 cystic distention in, 282 dangers of, 289, 291 diagnosis of, 295 fistula in, 290 hematosalpinx with, 282 hydrosalpinx with, 282 hypertrophy in, 281 hysterectomy for, 302 ovarian abscess and, 283 ovaritis and, 283 pelvic abscess in, 297 massage in, 299 pyosalpinx, 282 salpingo-oöphorectomy for, 302 septic, 277, 288 symptoms of, 291 treatment of, 296, 300 tubal pregnancy from, 314 with tubal abscess, 279, 283

Salpingo-oöphorectomy, 504 adhesions after, 510 for chronic ovaritis, 344 for salpingitis, 302 for uterine fibroid, 252 link-ligature in, 506 menopause due to, 535 menstruation after, 535 secondary effects of, 535 sexual emotion after, 536 Tait knot, 506

Sarcoma of Fallopian tubes, 313 of ovary, 391 of uterus, 15, 225 age of occurrence, 228 duration of, 228 symptoms of, 226 treatment of, 228 urethral, 436

Scissors, Emmet’s perineal, 64

Senile endometritis, 213

Septic foci, dangers of, 37 infection of genital tract, 17

Shock after celiotomy, 498

Shot-compressor, 66

Silk, 476

Sims’ curette, 209 depressor, 29 position, 31 topographical changes in, 32 speculum, 29 as anal retractor, 33 vaginal dilator, 416

Skene’s endoscope, 432 glands, 426 inflammation of, 429 installation tube, 173 reflux catheter, 429

Smith’s pessary, 134

Sound, urethral, 430 uterine, 34 asepsis in use in, 35 diagnosis between inversion and polyp by use of, 268 precautions in use of, 35

Speculum, rectal, 33 vaginal, 28 bivalve, Goodell’s, 29 duck-bill, Sims’, 29 introduction, 29, 33 uses, 28, 30, 31 vesical, 424

Spencer Wells’ forceps, 474

Sphincter ani, 58 atrophy and laceration of, 69 dimple over ends of, 70 laceration, repair of, 69 vaginæ, 58

Split cervix, 177

Sponge-holder, 65

Sponges in abdominal operations, 474 sterilization of, 468

Sprague’s sterilizer, 466

Spurious labor, 321

Squamous-cell carcinoma of cervix, 181

Stem-pessary in anteflexion, 123

Sterility as result of gonorrhea, 17 in anteflexion, 122 in chronic endometritis, 206 in lacerated cervix, 154 in salpingitis, 294

Sterilization, discontinuous, 466 fractional, 466 of dressings, 466 of hands, 465 of instruments, 466 of sponges, 468 of tables, 463 of water, 467 personal, for operations, 463

Sterilizer, Arnold’s, 466 Sprague’s, 466

Stricture, urethral, 430

Subinvolution as cause of ovarian prolapse, 336 of uterus, 215 endometritis in, 215 metritis in, 215 symptoms and treatment of, 216 of vagina, 92

Superinvolution of uterus, 217 amenorrhea in, 217

Suppressio mensium, 405

Supra-vaginal cervix, elongation of, 104

Sutures, 476, 477

Syncytioma malignum, 228 symptoms, 229 treatment, 229

Syphilis acquired during examination, 26 elephantiasis in, 47 primary sore on finger of physician, 26

Syphilitic ulceration, diagnosis from carcinoma of cervix, 188

Syringe for cleansing drainage-tube, 481

Table for operating, 462 sterilization of, 463

Tait knot, 506, 508

Tait’s hemostatic forceps, 474

Tapping of ovarian cyst, 387, 512, 513 dangers of, 388

Temperature after celiotomy, 498

Tenacula, 27, 64

Teratoma, 361

Thomas’s pessary, 134

Through-and-through suture, 491

Tissue-forceps, 65

Trachelorrhaphy, 156 contraindications to, 289 curetting in, 160 preparation for, 160 scissors for, 157

Transplantation of cancer-cells during hysterectomy, 525

Trendelenburg position, 462, 510

Trigone, 436 mucous membrane of, 437

Trocar, 476

Tubal changes in fibroids, 237 pregnancy, 314 abdominal enlargement in, 323 abortion, 316, 318 amenorrhea in, 326 ballottement in, 323 causes of, 314 classification of, 315 curettage for diagnosis in, 315 decidual transformation of endometrium in, 320 diagnosis of, 325 Fallopian tube, changes in, 315 fetal movements in, 323 heart-sounds in, 323 hematoma in, 324 hemorrhage in, 317 mammary changes in, 322 menstruation in, 322 pain in, 322, 324 placental hemorrhage during celiotomy for, 329 polypi as cause of, 314 rupture in, 316, 317, 324, 327 secondary rupture, 317 skin-changes in, 322 spurious labor in, 321 symptoms of, 321 termination of, 316, 328 treatment of, 327 tubal changes in, 315 uterine changes in, 316, 320 vaginal changes in, 322 varieties of, 314

Tuberculosis of cervix, 180 of Fallopian tubes, 306 chronic diffuse, 309 fibroid, 309 diagnosis of, 311 infection of, 310 miliary, 308 primary, 309 prognosis in, 311 secondary, 310 symptoms, 310 treatment of, 312 unsuspected, 308 of ovary, 393 of uterus, 261

Tubo-ovarian abscess, 283, 287 pregnancy, 314. See also _Tubal pregnancy_.

Ureter, bimanual examination of, 25 carcinoma of, 185 introduction of bougies in hysterectomy, 523 relations of, 445, 521, 526 to uterine artery, 504 vesical orifice of, 437

Ureteritis, result of cystitis in, 438

Uretero-vaginal fistula, 421

Urethra, anatomy of, 426 cancer of, 436 caruncle of, 434 course of, 445 cysts of, 435 dilatation of, 433 prolapse of, 431 sarcoma of, 436

Urethral polyp, 435 sound, 430 stricture, 430

Urethritis, 427, 449

Urethrocele, 434

Urinary excretion after celiotomy, 436

Uterine appendages, removal of, 504 artery, 503 ligation of, 196, 520, 526 relations to ureter, 504 cavity, length of, 34 cornua, bimanual examination of, 25 fibroid, 230 fibro-myoma, 230 forceps, 138 inversion in recurrent fibroid, 227 involvement in cervical carcinoma, 185

Uterine ligaments, action of, 96 structure of, 96 myo-fibroma, 230 myoma, 230 polyp, 234 diagnosis from carcinoma of cervix, 188 with inversion, 271 retro-displacements, parturition as cause, 130 retroflexion, causes of, 129 sound, 34 abortion by use of, 35 asepsis in use of, 35 dangers of, 35 in diagnosis between inversion and uterine polyp, 268 precautions in use, 35

Utero-sacral ligaments, 27, 119

Uterus, absence of, 396 adenomyoma of, 257 anteflexion, 119 causes of normal, 119 classification of, 120 menstruation in, 122 miscarriage in, 123 pathological, 120 pessary in, 123 pregnancy in, 123 sterility in, 122 symptoms of, 122 treatment of, 123 axis of, 95 bicornis duplex, 396 unicollis, 397 bimanual reposition, 135 carcinoma of, 218 age of occurrence, 220 bimanual examination of, 224 curette, 224 leucorrhea, 223 metastasis, 223, 224 operation for, 224, 225 pain, 223 symptoms, 222 cordiformis, 397 development, 395 didelphys, 396 fibroid tumors of, 236 intraligamentous, 235 submucous, 234 subperitoneal, 233 fibro-sarcoma of, 227 instrumental reposition, 136 inversion of, 264 diagnosis from uterine polyp, 268 reposition in, 268 White’s repositor for, 269 irrigation after curettement, 210 ligaments of, 95 mechanism of support, 95, 96 perforation of, by curette, 210 position, 94, 119 prolapse of, 101 amputation of cervix in, 117 causes of, 97, 98, 102, 108 colpeurynter in, 118 cystocele and rectocele in, 107 diagnosis of, 110 Emmet’s operation for, 112 hysterectomy for, 117 LeFort’s operation, 112 pessaries in, 118 pregnancy as cause of, 108 sequelæ of, 111 Sims’ operation for, 115 structural changes in, 106 symptoms, 108 treatment, 110 ventro-fixation for, 113 rectal examination of, 27 relations of, 119 to bladder, 94 removal, 515. See also _Hysterectomy_. replacement, 135, 136 contraindications to, 289 retention in position, 142 retro-displacement, congenital, 129, 146 retroflexion of, 127 retroversion of, 127 causes, 129 degrees, 128 sarcoma of, 225 age of occurrence, 228 duration of life, 228 symptoms, 225, 226 treatment, 225 varieties, 225 septus, 397 Skene’s glands, 426 stitching to abdominal wall, 142 subinvolution of, 215 superinvolution after amputation of cervix, 217 supra-vaginal amputation, 518, 521 closure of cervical canal in, 522 sterilization of cervical canal in, 522 tuberculosis of, 261 unicornis, 396 vascular supply of, 437

Vagina, absence of, 398 angle of, 60 anterior wall, length, 60 atresia, 17, 52 carcinoma of, 52 cysts of, 51 development of, 395 dilator for, Sims’, 416 fibroid tumors of, 52 furrows of, 61 incision of, in hysterectomy, 524 inflammation of, 49 long axis of, 60 malformations of, 397 normal condition of, 96 ostium of, 57 posterior wall, length of, 60 preparation of, for operation, 472 prolapse of, 75 sarcoma of, 52 shape of, 60 subinvolution of, 92 sulci of, 60 unilateral, 398

Vaginal arteries, 504 cervix, elongation, 104, 178 drainage, 480, 487 examination, 23 cleansing for, 26 contraindications to, 28 hematocolpos, 53, 399 hysterectomy, 527 removal of tubes and ovaries, 531 pessaries, 133, 138, 140 retractor, 528 speculum, 28 bivalve, Goodell’s, 29 duck-bill, Sims’, 29 uses, 28, 30, 31 sulci, laceration of, 75 tumor, 51 treatment, 52 wall-depressor, 29, 31, 32

Vaginismus, 53

Vaginitis, 49 adhesive, 51 dangers of, 50 emphysematous, 49 epidemics of, 39 etiology, 49 gonorrheal, 453 granular, 49 in children, 49 in exanthemata, 49 senile, 49 simple, 49 symptoms, 50 treatment, 50, 51

Ventral hernia, 492

Ventro-fixation, 142, 143 in uterine prolapse, 113

Ventro-suspension, 142, 143 incision for, 487

Vermiform appendix, 21

Vesical applicator, 425 calculus, 447 in vesico-vaginal fistula, 416 probe, 425 speculum, 424 triangle, 436 mucous membrane of, 437 nerves of, 437

Vesico-urethral fissure, 431

Vesico-uterine fistula, 420

Vesico-vaginal fistula, 412 and calculus, 416 kolpokleisis in, 420 operation for, 417 treatment, 415

Vicarious diarrhea, 408 leucorrhea, 408 menstruation, 408

Vomiting after celiotomy, 497

Vulva, elephantiasis of, 47 gonorrhea of, 454 hematoma of, 46 neoplasms of, 46, 47 papilloma of, 46 pruritus of, 42 etiology, 42, 43 excision of mucous membranes, 44 treatment, 43 varicose tumors of, 46

Vulvitis, 36 causes of, 36, 37 epidemics of, 37 follicular, 36 gonorrhea as cause of, 36 in children, 37 late manifestations of, 37, 38 medico-legal examination in, 37 secondary, 36, 37 symptoms of, 36 treatment of, 37

Vulvo-vaginal glands, cysts of, 40 inflammation of, 38, 39

Water after celiotomy, 494 in gynecological operations, 467 sterilization of, 467

Werder’s combined hysterectomy, 532

White’s repositor, 270

Wolffian canal, 52

FOOTNOTES:

[1] _Diseases of the Ovaries_, 1883, p. 6.

[2] Heape, _Trans. Obstet. Soc. of London_, vols. xxxvi., xl.

[3] _New York Journal of Gynecology and Obstetrics_, March, 1894, p. 282.

[4] “The Ligature in Oöphorectomy,” read before the Philadelphia Academy of Surgery, February 3, 1896.

[Transcriber’s Note:

Inconsistent spelling and hyphenation are as in the original.]