Chapter XV., page 244. It is enough here to counsel a thorough (Part 4)

613 rheumatism in, 616 sexual feeling in, 614 skin diseases in, 617 tables of 115 cases of, 604 tachycardia in, 613 41 Menopause, vesical symptoms at, 621 Menorrhagia, 134 constitutional causes of, 135 differentiation of, from abortion, 441 Menorrhagia and metrorrhagia, differ- entiated from abortion, 441 in married women, 139 in nulliparae, 137 in parous women, 138 in pregnancy, 138 in virgins, 137 local causes of, 135 Menstrual period, a predisposing cause of cystitis, 467 Menstruation, date of beginning of last, 8 delayed, and pelvic disease, 15 description of, 13 during pregnancy, 419 in case record, 7 molimen of, 128 physiology of, 595 precocious, 564 prolonged, 603 vital energy, wave of, governing, 595 wave theory concerning, 595 Mensuration of abdomen, 74 Mental disease at menopause, 615 overwork, a cause of amenorrhea, 142 Metritis, 165 chronic, a cause of hemorrhage at menopause, 618 Metrorrhagia, 134 after menopause a sign of cancer, 138 coming on six weeks after labor may mean chorioepithelioma, 138 differentiated from abortion, 441 may mean extra-uterine pregnancy, 138 may mean uterine polyp, 138 Michaelis' rhomboid, 96 Micturition, frequent, 153 a symptom of pregnancy, 420 painful, 151 "Milk line," 532, Fig. 200, 538 , Miscarriage, definition of, 436 diagnosis of, 440 Miscarriages and abortions, in clinical history, 11 Mittelschmerz, 132 642 INDEX Mole, hydatidiform, in Fallopian tube, 345 tubal, 344 Molimina, menstrual, 128 Mons veneris, Fig. 156, 389 anatomy of, 388 Morgagni, columns of, 123, Fig. 191, 495 crypts of, 123, Fig. 191, 495 hydatid of, 327 valves of, 123, Fig. 191, 495 "Morris' points," 337 Morse, J. L., cases of precocious men- struation and precocious maturity, 564 on bacteriuria, 579 on hematuria in scurvy, 583 Mucous patches. See Vulva and Anus Muller's ducts, 197, Fig. 71, 198 Multiple sclerosis, retention of urine in, 485 Muscular rheumatism, 19 of pectoralis major, 553 Myoma. See Uterus, fibroids of Myoma and cancer to be excluded from statistics on menopause, 590 Nabothian Follicles, cysts of, 41, 185 Nationality, in clinical history, 9 Nausea and vomiting, symptoms of pregnancy, 419 Neisser, gonococcus of, 179 Nephritis, acute, anuria in, 156 Neugebauer, on hermaphroditism, 399 Neugebauer bivalve speculum, 86 Neumann, F., cases of joint disease at menopause, 616 Neuralgia, intercostal, in menopause, 613 mammary, 539, 553 Neurasthenia and dysmenorrhea, 130 Neurasthenia associated with coccy- godynia, 159 New-born, the, genital hemorrhages in, 571 Nipple, anatomy of, 532 discharge from, in late cancer, 553 discharge of blood from, 545, 546 Paget's disease of, 548 retraction of, 553 Nitze cystoscope, Fig. 56, 116 Noble, C. P., case of recto- vesical fistula, 480 views on fibroids, 246, 253, 255, 256 Nuck, canal of, hydrocele of, 213 differentiated from cyst or ab- scess of labium, 412 from hernia, 413 Nymphse, adherent, 394 anatomy of, 390 hypertrophy of, 394 Obesity, amenorrhea a symptom in, 141, 419 associated with premature meno- pause, 599 at menopause, 616 rapidly occurring, a cause of sterility, 151 Occupation, in clinical history, 9 Odor as a diagnostic sign, 60 Old age, 622 conventional time for the beginning of, 588 Olshausen, views on sterility in fibroid tumors, 258 Omentum, cyst of, differentiated from ovarian tumor, 3.13 Oophoron, atrophied because of pres- sure, 290 diagram of, Fig. 120, 290 Os, parous, Fig. 66a, 169 virginal, Fig. 66, 168 Os tincse, 41 Ostheimer and Levi on enuresis, 579 Ostium abdominale of tube, Fig. 116, 285 Ovaritis, 288 acute, diagnosis of, 288 chronic, 290 diagnosis of, 290 differentiation of, from small ovarian tumor, 297 Ovary, adhesions about, a cause of sterility, 150 anatomy and age changes of, 284, 592 and tube seen from behind, Fig. 116, 285 anomalies of, 285 atrophic changes of, in old age, 623 INDEX 643 Ovary, atrophy of, 285 a cause of amenorrhea, 141 of sterility, 150 following steaming of uterine cav- ity, 286 in exanthemata, 285, 599 lactation, 285 cancer of, primary, 322 changes in, at menopause, 592 corpus luteum of, cysts of, 321, for- mation of, 592 function of, 13 cyst and tumor of, regions of, Fig. 120, 290 cyst of. See Ovary, tumors of, va- rieties of: cysts large, differentiated from ascites, 308 from large fibroid, 309 showing emaciation and " facies ovarina," Fig. 125, 294 degeneration of, parenchymatous, 599 small cystic, 290 development of, Fig. 71, 198, 592 diseases of, 284 in the child, 576 displacements of, 286 fibroma of, differentiated from pe- dunculated fibroid, 263 function of, 592 impaired by infectious diseases, 577 Graafian follicles of, degeneration of, after infectious diseases, 577 hernia of, 288 infantile, Fig. 117, 286 inflammation of, 288 normal, palpation of, 41 position of, 48 of mature woman, Fig. 118, 287 prolapse of, 286 sclerosis of, in tuberculosis, 599 senile, Fig. 119, 289 small cystic degeneration of, 290 tumors of, 291 a cause of sterility, 150 aspiration of, 305 association of, with pregnancy, 320 Ovary, tumors of, classification of, 293 complications of, 315 cross section of body in, Fig. 127, 302 degenerative processes in, 319 diagnosis of, in general, 295 in the child, 577 differential diagnosis of pathologi- cal varieties of, 321 etiology and symptoms of, 293 Hegar's method of determining- relation of, to uterus, Fig. 126, 301 in old age, 623 infantile, Fig. 206, 262 infection of, 318 intraligamentous development of, 316 large, diagnosis of, 301 differential diagnosis of, 305 differentiated from cyst of pan- creas, 311 from cysts of omentum, 313 from dilated stomach, 314 from distended bladder, 314 from echinococcus cysts, 314 from fat in abdominal walls, 310 from fecal accumulation, 309 from fibroids, 309 from pregnancy, 305 from tumors of spleen, liver, and kidneys, 312 inspection of, 302 palpation of, 302 percussion of, 303 malignancy of, 293 modes of development of, 292 pedicle formation of, Figs. 121— 124, 292 pedicle of, pain caused by traction on, 296 palpation of, 295 torsion of, 317 rupture of, 319 small, diagnosis of, 297 differential diagnosis of, 297 differentiated from distended bladder, 300 from echinococcus cyst, 299 644 INDEX Ovary, tumors of, small, differentiated from encapsulated peritoni- tis, 298 from extra-uterine pregnancy, 299 from ovaritis, 297 from parovarian cyst, 298 from pregnancy, 300 from subperitoneal fibroid, 297 from tumors of the tube, 298 suppuration of, 318 symptoms of, 294 tapping of, 305 varieties of: adhesions and incarceration, 315 carcinoma, primary, 322 cysts, dermoid, 322 differentiation of, from fibroid, 262 follicular, 321 multilocular, 321 proliferating, 321 simple, 321 endothelioma, 323 fibroma, 322 differentiation of, from fibroid of uterus, 263 perithelioma, 323 sarcoma, 322 teratomata, 322 undescended, 286 Ovulation, prolonged, 603 Ovum, growth of, in early pregnancy, 423 Oxyuris vermicularis, a cause of pruri- tus, 161 Paget's disease of the nipple, 548 Pain following defecation, a symptom of fissure or fistula, 157 in anus, after going to bed, a symp- tom of piles or eczema, 157 in case records, 7 in clinical history, 18 in course of ureter, a symptom of stricture, 489 in fibroid tumors, 261 in groins, in clinical history, 19 intermenstrual, 132 Pain, menstrual. See Dysmenorrhea Palpation, bimanual, diagram of, Fig. 5, 38 for Hegar's sign, Fig. 179, 425 structures to be felt by, 49 in diagnosis, 34 pelvic structures felt by, 40 Palpitation in fibroids, 259 in menopause, 613 Pancreas, cyst of, differentiated from large ovarian tumor, 311 Paralysis, a cause of cystitis, 467 Paravaginitis, 362 phlegmonosa dissecans, 362 Parkinson, J. P., on hematuria, a sign of infantile scurvy, 583 Paroophoron, diagram of, Fig. 120, 290 Parovarium, cyst of, 211 contents of, 211 differentiated from small ovarian tumor, 298 large cyst seen in profile, Fig. 128, 303 diagram of, Fig. 116, 285, 290 Pathology of disease in any organ. See organ affected Patient, preparation of, for examina- tion, 23 Pectoralis major muscle, rheumatism of, 553 Pedicle, See Ovary, tumor of, pedicle torsion of, 317 Pediculus pubis, a cause of pruritus, 161 Pelvic abscess, 193 Pelvic cellulitis, 192. See also Cel- lulitis, pelvic definition of, 187 Pelvic congestion, a cause of leucorrhea, 145 Pelvic inflammation, 187. See also Inflammation, pelvic Pelvic organs of an infant at birth, seen from above, Fig. 206, 562 Pelvic peritonitis, 188. See also Peri- tonitis, pelvic definition of, 187 Pelvimeter, Collyer's, Fig. 42, 98 Pelvimetry, 95 INDEX 645 Pelvis, abdomen and contents of, mechanics of, 44 cancer of, differentiated from fibroid, 263 cavity of, estimating of, 98 circulation of, 46 contents of, anatomy of, 43 from above, Fig. 9, 48 deformities of, 95, 96 diameter of, conjugate, Baude- locque's, 96 external conjugate, 96 oblique conjugate, 97 oblique diagonal, 98 transverse, 98 dimensions of, 95 female normal, Fig. 9a, 50 showing accessibility of contents to palpation, Fig. 10, 52 with hand in position for vaginal examination, Fig. 4, 37 floor of, diagram showing structures of, Fig. 150, 373. injuries of. See Perineum, inju- ries of lacerations of, 372 mechanics of, 221 of new-born child, longitudinal me- dian section of, Fig. 204, 558 outlet of, transverse diameter of, 98 Penrose, C. B., on erosion of cervix in infants, 563 Percussion of abdomen, 71 Perineum ("Perineal body"), 221 development of, Figs. 160-161-162, 395 injuries of, a cause of garrulity of vagina, 378 due to coitus, 376 laceration of, 372 a cause of sterility, 150 complete, 374 median, Fig. 151, 374 partial, 374 lateral, Fig. 152, 375 through the sphincter ani, 37 1 Peristalsis, waves of, seen on inspection of abdomen, 66 Peritoneum, anatomy of, 188 folds of, reflections of, Fig. 70, 189 Peritonitis, body pose in, 67 encapsulated, differentiated from small ovarian tumor, 298 pelvic, 188 acute, 190 chronic, 191 differential diagnosis of, 195 etiology of, 189 in Douglas' cul-de-sac, differen- tiated from cellulitis, 195 tuberculous, 191 Pessaries, a cause of ulceration of vagina, 377 Pfannenstiel, classification of ovarian tumors, 291 Phantom, bladder, Fig. 58, 118 "Phantom tumor," 311 Phthisis, menorrhagia in, 135 Physician, preparation of, for examina- tion, 31 Piles. See Hemorrhoids Pincus, L., views as to atresia of vagina following infectious diseases, 560 "Pinhole os," 41, 81 Pin-worms, a cause of pruritus, 161 Placing patient on table, 33 Poisonings, anuria in, 156 chronic, amenorrhea a symptom in, 419 menorrhagia in, 135 Polypus and polypi. See Endometritis, Uterus, fibroids of, Urethra, and Rectum Position, dorsal, 33 for examination, Fig. 3, 32 knee-chest, Fig. 13, 56 modified for cystoscopy, Fig. 53, 111 side view, Fig. 14, 57 lithotomy, Fig. 15, 58 raised pelvis, Fig. 16, 59 Sims, Fig. 11,53 diagram of, Fig. 12, 54 standing, Fig. 17, 60 Pott's disease, retention and incon- tinence of urine in, 485 Pozzi, S., on development of hymen, 396 Precocious maturity, a case of. Fig. 207, 505 646 INDEX Pregnancy, a cause of amenorrhea, 141 a cause of pelvic congestion, 467 abdominal, 340 secondary, 345 abnormal, diagnosis of, 432 advanced, a cause of retention of urine, 155 associated with ovarian tumor, 320 breasts in, 420, 421 diagnosis of, 417 diagnosis that it has occurred pre- viously, 433 differential diagnosis of, 431 differentiated from fibroid tumor, 264 from large ovarian tumor, 305 from small ovarian tumor, 300 during first three months, diagnosis of, 418 during last six months, diagnosis of, 426 early, bimanual touch in, 423 extra-uterine, 340 differentiated from abortion, 441 from normal pregnancy, 431 from small ovarian tumor, 299 early, 348 ampullar, Fig. 140, 341 mole and fetus removed from tube in, Fig. 141, 342 diagnosis after rupture, 351 late, 350 ampullar, unruptured, Fig. 145, 350 diagnosis of, 353 section of uterus, showing endome- trial modification, Fig. 146, 352 symptoms and signs of, 346 in bicornute uterus, 433 interstitial, Fig. 144, 346 diagnosis of, 433 menstruation during, 419 multiple, diagnosis of, 434 nausea and vomiting, symptoms of, 419 normal, differentiated from small ovarian tumor, 300 ovarian, 345 pernicious vomiting of, 434 salivation in, 420 Pregnancy, symptoms and signs of, table of, 430 tubal, 341 diseases of ovum in, 345 fate of fetus in, 344 mole formed in, 344 multiple, 348 pathology of, 343 repeated, 348 rupture of, 344 uterine decidua formed in, 344 tubo-abdominal, 340 tubo-ovarian, 340 tubo-uterine, 340 Premature labor, definition of, 436 menopause, 598 Prepuce, Fig. 156, 389 a cause of enuresis, 558 adherent, 394 in the child, 557 Present illness, in case records, 7 in clinical history, 13, 22 in interpretation of clinical history, 22 Previous history, 7, 12 Probe, uterine, Fig. 22, 82 Procidentia, Fig. 87, 223 Procreation, factors essential for, 149 Proctitis, 505 acute catarrhal, 506 atrophic, 507 chronic catarrhal, 507 differentiation of atrophic from hypertrophic, 509 dysenteric, 513 gonorrheal, 510 hypertrophic, 508 in children, 585 simple, 506 specific, 510 Proctodeum, development of, Fig. 160, 395 Proctoscope, long, Fig. 61, 124 short, Fig. 60, 123 Proctoscopy, 124 Prolapse. See Uterus, prolapse of Pruritus vulvae, 160, 404 Pseudohermaphroditism, 400 Pseudomasturbation, 574 Puberty, description of, 14 INDEX 647 Puberty, metrorrhagia of, 573 Puerperium, a favorable time for be- ginning of retroversion, 235 Purpura, menorrhagia in, 135 in the child, 572 Pyosalpinx, 332, Fig. 137, 333 differentiated from pelvic cellulitis, 196 from small ovarian tumor, 298 rupture of, 333 Rachford, B. K., on pseudomastur- bation, 574 Raised pelvis position, 58 Reconstruction of uterus, Fig. 64, 166 Rectal speculum, Sims, Fig. 63, 126 Rectal symptoms, 156 Recti muscles, separation of, 66 Rectocele, 369, Fig. 149, 369 at menopause, 621 diagram of, Fig. 149a, 370 Rectum, adenoma of, 523 anatomy of, 121 anomalies of, 495 cancer of, 525 diagnosis of, 528 differential diagnosis of, 528 frequency of, 525 hemorrhage as a symptom of, 157 pathology and course of, 526 symptoms of, 527 chancre of, 512 chancroids of, 512 development of, Figs. 158-162, 395 digital examination of, 123 discharge from, as a symptom, 157 diseases of, 494 in children, 584 exudate about a fistula of, differen- tiated from cancer, 528 fecal accumulation in, as a symptom, 157 fibro-adenoma of, 523 fibroma of, 524 gumma of, 512 differentiated from cancer, 529 hemorrhage from, as a symptom, 157 imperforate, 496, 561 inflammation of, 505. See also Proctitis Rectum, inspection of, 124 lower part of, Fig. 195, 515 lymphadenoma of, 523 new growths of, 522 pain in, as a symptom, 156 polyp of, differentiated from cancer, 529 fibrous, 524 glandular, 524 hemorrhage as a symptom of, 157 mucous, 523 myomatous, 524 myxomatous, 525 prolapse of, 521 complete, 522 hemorrhage as a symptom of, 157 in children, 584 incomplete, 522 sarcoma of, 529 stricture of, 518 congenital, 519 differentiated from cancer, 529 due to pressure from without, 519 inflammatory, 519 spasmodic, 519 syphilis of , 510 syphilitic ulceration of, 512 tuberculosis of, 513 tuberculous ulceration of, differen- tiated from cancer, 528 veins of, 123 villous tumor of, 524 differentiated from cancer, 529 Rectus muscle, fibromyoma of, 310 Reflections of folds of peritoneum, Fig. 70, 189 Rheumatic diathesis and pruritus vulvae, 161 Rheumatism, at menopause, 616 muscular, 19 of pectoralis major, 553 Richardson, M. H., on evils of too posi- tive an opinion about breast tumors, 549 on importance of making a complete physical examination in the case of breast tumors, 554 Riviere, A., case of incontinence of feces in a girl of nine, 586 Robb leg-holders, 57 648 INDEX Rodman, W. L., analysis of 5,000 cases of cancer of the breast, 551 on operability of cancer of the breast, 549 on the three most important points in diagnosis of tumors of the breast, 550 Rossi-Doria, delayed menstruation and pelvic disease, 15 Round ligaments. See Ligaments, round Rupture of ovarian cyst by forcible manipulations, 319 Sacro-iliac subluxation, 18 Sactosalpinx, 332 diagnosis of, 335 Salpingitis, 327 actinomycotic, 332 acute, 327 catarrhal, 327 chronic, 329 diagnosis of, 328 differentiated from appendicitis, 336 echinococcic, 332 follicular, a cause of sterility, 151 gonorrheal, 330 obliterating, a cause of sterility, 150 purulent, 328 symptoms of, 328 syphilitic, 332 tuberculous, 330, Fig. 136, 331 Sampson, J. A., on pain caused by twisting pedicle of tumor, 296 Sanger, M., on chorioepithelioma, 280 Sapremia, 175 Schulkowski, on genital hemorrhage in the new-born, 572 Sclerosis, multiple, retention of urine in, 485 Scurvy, hematuria in, 583 menorrhagia in, 135 Sea voyages, amenorrhea following, 419 Searcher, ureteral, Kelly, Fig. 47, 102 Searching urethra and bladder, 108 Separator, urine, Luys, Fig. 59, 119 Sepsis. See Endometritis, acute septic Septicemia, 175 Sexual feeling at menopause, 614 Simon speculum, 86 " Simpson symptom " of cancer of body of uterus, 276 Sims position, 54 rectal speculum, Fig. 63, 126 vaginal speculum, 88 Sinus, urogenital, persistence of, 393, 444 urogenitalis, Fig. 71, 198, Fig. 157, 392, Fig. 160, 395 Skene's glands, anatomy of, 101 collection of discharges from, 61 lurking-places for infection, 180 Slanting shelf formed by psoas muscles and false pelvis, Fig. 86, 221 Social condition, in clinical history, 10 Souffle, uterine, 429 Sound, uterine, 78, Fig. 21, 78 caution in use of, 82 facts to be learned by use of, 80 how to pass bimanually, 79 by sight, 80 when to pass, 78 Sound touch, 81 Spasm of bladder, 109, 465 Speculum, rectal, Sims, Fig. 63, 126 uterine, Burrage, Fig. 36, 93 vaginal, 85 bivalve, 85 Brewer, Fig. 26, 87 Edebohls, 86, Fig. 32, 91 Graves bivalve, Fig. 27, 87 Sims, 87, Fig. 28, 88. Speese, John, on predisposition to cancer furnished by lactation mas- titis, 544 Sphincter ani, action of, preventing healing of fissure, 123 external, Fig. 195, 515 hypertrophy of, in hemorrhoids, 503 internal, Fig. 195, 515 method of stretching of, 126 Spinal cord, disease of, a cause of in- continence of urine, 155 Spirochoeta pallida, in chancre of vulva, 407 in mucous patches of vulva, 407 Spleen, tumors of, differentiated from ovarian tumors, 312 wandering, differentiated from ova- rian tumor, 312 INDEX 649 Stammering of bladder, 109, 465 Starfinger on sarcoma of vagina in children, 382 Stark, M. M., cases of premature meno- pause, 600 Stephenson. W., on menstrual wave theory, 595 Sterility, 147 age as affecting, 148 conditions of uterine organs that interrupt pregnancy, 150 constitutional diseases causing, 151 due to anomalies and diseases of uterine organs, 150 in the male, 148 Stomach, dilated, differentiated from ovarian tumor, 314 Stone in bladder, 462 in children, 582 Storer, M., cases of bilateral torsion of Fallopian tubes, 336 Straining, a cause of hemorrhoids, 500 at stool, with sense of only partial relief, a symptom of stricture of rectum, 158 Strangury, 152 Stricture of rectum. See