Chapter V. The Physical Examination {Continued) 43
III. The examination {continued): 3. Palpation {continued). 4. Odor as a diagnostic sign. 5. The collection of the discharges and tissues for micro- scopic examination.
Chapter VI. The Physical Examination {Continued) 64
III. The examination {continued): 6. Inspection of the abdomen. 7. Palpation of the abdomen. 8. Percussion of the abdomen.
Chapter VII. The Physical Examination {Concluded) 77
III. The examination {continued): 9. Instruments and their use in diagnosis.
Chapter VIII. The Investigation of the Urethra, Bladder, and
Ureters 99
Chapter IX. The Investigation of the Rectum 121
Chapter X. The Significance of the Chief Symptoms of Pelvic
Disease 127
ix
CONTENTS
Chapter XI. Chapter XII. Chapter XIII.
Chapter XIV. Chapter XV. Chapter XVI.
Chapter XVII. Chapter XVIII. Chapter XIX. Chapter XX. Chapter XXI. Chapter XXII.
Chapter XXIII. Chapter XXIV. Chapter XXV. Chapter XXVI. Chapter XXVII. Chapter XXVIII.
Chapter XXIX.
PART II
SPECIAL DIAGNOSIS
PAGE
The Diagnosis of Endometritis, Including Gonor- rhea and Erosions of the Cervix Uteri . . . 16.3
The Diagnosis of Pelvic Inflammation (Pelvic
Peritonitis and Pelvic Cellulitis) . . . 187
The Diagnosis of Congenital Anomalies of the Uterus, Laceration of the Cervix Uteri, and
Diseases of the Uterine Ligaments .... 197
The Diagnosis of Malpositions of the Uterus . 215
The Diagnosis of Fibroid Tumors of the Uterus 244
The Diagnosis of Malignant Diseases of the
Uterus 266
The Diagnosis of Diseases of the Ovaries . . 284
The Diagnosis of Diseases of the Fallopian Tubes 324
The Diagnosis of Extra-Uterine Pregnancy . . 340
The Diagnosis of Diseases of the Vagina . . . 354
The Diagnosis of Diseases of the Vulva . . . 388
The Diagnosis of Uterine Pregnancy, Abortion,
and Hydatidiform Mole 417
The Diagnosis of Diseases of the Urethra . . 444
The Diagnosis of Diseases of the Bladder . . 457
The Diagnosis of Diseases of the Ureters . . 486
The Diagnosis of Diseases of the Rectum . . 494
The Diagnosis of Diseases of the Breast . . 531
The Diagnosis of the Gynecological Affections
of Infancy and Childhood 555
The Menopause and Old Age 587
INDEX . 627
LIST OF ILLUSTRATIONS
FIG. PAGE
Abdomen, cavity of, shape of 86 221
division of, into quadrants and indication of bony landmarks . 18 65
organs of, origin of tumors in . . 129 304
Anal canal 191 495
cast of 192 496
Anal region, diagram of 195 515
Applicator, uterine 37 93
Ascites, abdomen of, seen in profile 131 307
cross section of , dorsal position . 132 310
lateral position 133 311
Bartholin's gland, cyst of left 174 409
Bartholin's glands, abscess of 176 411
abscess of ducts of 175 410
Bladder, ballooned by air, patient in knee-chest position 54 112
base of, showing diverticula 185 458
normal, laid open from in front 51 106
overdistended 84a 217
papilloma of 190 482
stone in 186 463
tuberculosis of ureteral orifice in 187 469
varix of 188 474
Bladder phantom, for practising cystoscopy 58 118
Blood vessels, uterine and ovarian 8 47
Body, vertical median section of 6 44
of childbearing woman 84 216
Breast, diffuse bilateral hypertrophy of 201 541
dissection of lower half of, showing milk ducts 198 534
division of, into quadrants 200 538
lymphatics of 199 535
right, vertical section of 197 533
scirrhous cancer of 202 547
Calibrator, meatus, Kelly 44 101
Carunculse myrtiformes 165 397
Catheter, bladder, long silver 43 101
ureteral, Kelly 48 103
Cervix, adeno-carcinoma of canal of, early stage Ill 268
cancer of, early stage 110 267
erosion of, with lacerations 69 185
fibroid of 108 254
hypertrophic elongation of 88a 225
xi
xii LIST OF ILLUSTRATIONS
FIG. PAGE
Cervix, laceration of, bilateral, with erosions 79 205
crescentic 81 207
stellate 80 206
unilateral (diagram) 83 209
with eversion of lips (diagram) 82 209
prolapse of 88 224
squamous-celled cancer of, early stage 110 267
supravaginal, elongation of 88 224
Controller, current, for use with electric cystoscope 57 117
Curette, uterine 31 90
Cylinder, vertical, filled with fluid, representing abdominal cavity . 7 45
Cystocele 148 367
diagram of 148a 368
Cystoscope, bladder, Kelly 49 104
ureter, Nitze 56 116
Cystoscopy, modified knee-chest position used in 53 111
removing urine from bladder in, by suction apparatus 55 113
Decidua, uterine, in extra-uterine pregnancy 143 345
Depressor, vaginal, Hunter 29 89
Dilator, urethral, double-ended, Kelly 45 102
uterine, Wathen 34 92
uterine, Hanks 33 91
Endometrium, normal 65 167
Enteroptosis, body pose in 19 67
Evacuator, bladder, Kelly 46 102
wash-bottle, Kelly 55 113
Extra-uterine pregnancy, ampullar, early 140 341
mole and fetus removed 141 342
ampullar, late 145 350
isthmial, section of uterus of 146 352
Fallopian tubes, development of, in fetus 71 198
Fissure in ano 194 504
Fistula in ano, blind internal 196a 517
complete 196 517
Fistulse, genital, scheme of, after Dudley 189 476
after Gilliam 155 385
Forceps, bladder, alligator 50 105
curette, Emmet 30 89
rectal, alligator 62 125
uterine dressing, Bozeman 23 83
vulsellum 25 84
Gauze records of abdominal tumors 20 75
Genital organs, development of, five diagrams illustrating . . 158-162 395
external, at beginning of third month 157 392
Gland, Bartholin's, cyst of left 174 409
LIST OF ILLUSTRATIONS xiii
FIG. PAGE
Glands, Bartholin's, abscess of 176 411
abscess of ducts of 175 410
Hand, examining, showing protective sleeve 2 31
Hegar's method of palpating pedicle of ovarian tumor 126 301
sign, bimanual palpation for 179 425
Hematocele, pelvic 142 343
Hematocolpos, diagram of 171 398
Hematometra, diagram of 172 398
Hematosalpinx 139 335
diagram of 173 399
Hemorrhoids, types of 193 499
Hydatidiform mole 182 442
Hydrosalpinx 138 334
Hymen, different forms of 163-170 397
Interstitial pregnancy 144 346
Irrigator, uterine, Bozeman-Fritsch 35 92
Isthmial tubal pregnancy, section of uterus of 146 352
Ligaments, utero-sacral, course of, in intraligamentous tumor . . 135 317
in retroperitoneal tumor 134 316
Maturity, precocious, case of 207 565
"Milk line," 200 538
Os, external, parous „ . 66a 169
virginal . 66 168
Ovaries, infantile 117 286
Ovary, cyst and tumor regions of 120 290
cyst of, adherent, arrangement of peritoneum in 124 292
intraligamentous, arrangement of peritoneum in 123 292
pedicle, arrangement of peritoneum in 122 292
very large, showing emaciation and "facies ovarina " .... 125 294
normal, pedicle, arrangement of peritoneum in 121 292
of mature woman 118 287
senile 119 289
tumor of, cross section of body of 127 302
tumors of, Hegar's method of determining relation of, to uterus . 126 301
pedicle, formation of (4 diagrams) 121-124 292
Ovary and tube seen from behind 116 285
Parovarium, large cyst of, seen in profile 128 303
Pelvimeter , .... 42 98
Pelvis, contents of, from above 9 48
female, normal 9a 50
showing accessibility of contents to palpation 10 52
with hand in position as for vaginal examination 4 37
floor of, diagram showing structures of . 150 373
of new-born child, longitudinal median section of 204 558
xiv LIST OF ILLUSTRATIONS
FIG. PAGE
Perineum, laceration of, complete median 151 374
partial lateral 152 375
Peritoneum, reflections of folds of, in pelvis 70 189
Position, dorsal 3 32
knee-chest 13 56
bladder, vagina, and rectum ballooned by air in 54 112
modified for cystoscopy 53 111
side-view, showing vertical thighs 14 57
lithotomy 15 58
raised pelvis 16 59
Sims 11 53
diagram of 12 54
standing 17 60
Precocious maturity, case of 207 565
Pregnancy, extra-uterine. See Extra-uterine pregnancy
interstitial , . 144 346
tubal, early ampullar, abortion in 140 341
mole and fetus removed from tube 141 342
isthmial, uterus of 146 352
late ampullar, four months' 145 350
section of uterus, showing decidual modification in 146 352
Probe, uterine 22 82
Procidentia 87 223
Proctoscope, long 61 124
short 60 123
Pyosalpinx 137 333
Rbctocele . 149 369
diagram of 149a 370
Rectum, ballooned by air, patient in knee-chest position . .'. . . 54 112
lower part of, diagram of 195 515
Salpingitis, tuberculous 136 331
Searcher, ureteral, Kelly 47 102
Sound, uterine 21 78
Separator, urine, Luys 59 119
Speculum, bivalve. See Speculum, vaginal, Brewer and Graves
rectal, Sims 63 126
uterine, Burrage 36 93
vaginal, Brewer 26 87
Edebohls 32 91
Graves 27 87
Sims 28 88
Table, examining 1 27
Tenaculum, uterine 24 83
Touch, bimanual, diagrammatic drawing 5 38
Tubercles of bladder wall 187 469
LIST OF ILLUSTRATIONS xv
FIG. PAGE
Ureter, orifice of, jet of urine spurting from 52 107
Urethra, caruncle of ' 184 454
mucous membrane of, prolapse of 183 449
Uterine organs of an infant at birth seen from above 205 562
Uterus, anteflexion of, in the little girl 90 230
pathological 91 231
bicornis 74 199
bicornute, one external os, two uterine cavities 78 201
bipartitus 72 199
body of, adeno-carcinoma of, early stage 112 269
horizontal section of upper part of .....' 67 171
sarcoma of . . ' 113 279
cavity of, Kelly's methods of exploration of, exploring with finger 41 97
incising anterior wall 39 95
transverse incision anterior to cervix 38 94
laid open 40 96
chorioepithelioma of posterior wall of 114 281
development of, in fetus 71 198
didelphys 73 199
double, with double vagina 147 358
fibroids of, interstitial and submucous 104 248
intraligamentous . 105 249
large tumor filling pelvis and simulating pregnancy .... 109 256
multiple 102 246
polyp in vagina, large 107 252
submucous, large, showing distortion of uterine cavity .... 106 250
simulating inversion 101 245
pedunculated, simulating inversion 99 241
simulating partial inversion 95 241
subserous, side view of abdomen containing large tumor . . . 103 247
tumor of cervix 108 254
fundus of, height at various weeks of pregnancy 130 306
inversion of acute puerperal 93 239
complete 98 241
with pedunculated subserous fibroid of abdominal evolution . 100 241
partial 97 241
caused by submucous fibroid 296 241
of left horn 94 241
normal, position of 6 44
pregnant, enlargement of, in late pregnancy 181 428
pregnant at sixth week, diagrammatic side view, during contraction 178 423
during relaxation 177 422
section of 178 424
prolapse of 87 223
partial 89 227
reconstruction of, showing shape of uterine cavity and cervical
canal 64 166
retroposition with anteflexion 91 231
retroversion of 92 235
caused by overdistended bladder 84a 217
xvi LIST OF ILLUSTRATIONS
FIG. PAGE
Uterus, sarcoma of 113 279
section of, in isthmial tubal pregnancy 146 352
transverse longitudinal 68 172
septus 75 199
unicornis 76 199
with accessory corau 77 199
Vagina, ballooned by air, patient in knee-chest position 54 112
chorioepithelioma of, metastatic 115 282
cyst of anterior wall of 154 381
cyst of posterior wall of 153 380
development of, in the fetus 71 198
double, with double uterus 147 358
infantile, examination of, with cystoscope 205 559
longitudinal section of, showing S-shaped curve 85 219
prolapse of 88 224
Vulva, at beginning of third month of fetal life 157 392
diagram of 156 389
infantile 203 556