the sacro-uterine ligaments, 83. Palpation of the pubo-vesico-uterine

ligament, 86. Palpation of the vagina, 88. Rectal examination of the

pelvic roof, 90. Method of rectal indagation, 91. Digital exploration

through the upper rectum, 93. The recto-vaginal grip, 95.

Circumdigita-

tion of the uterus from the abdomen, vagina and rectum, 95. Palpation of

the interior of the bladder, 96.

CHAPTER III.

EXAMINATION OF THE FEMALE PELVIC ORGANS-CONTINUED.

The pelvic floor and perineum, 98. Vaginal palpation of the pelvic floor, 98.

The small sacro-sciatic ligament, and ischial spine, 99. The pyriformis, 99.

The great sacro-sciatic foramen and sacral promontory, 100. The coccygeus,

101. The levator ani, 101. Control of the pelvic floor muscles by will, 102.

The obturator internus, 103. Rectal examination of the pelvic floor, 104.

Palpation of the arteries of the pelvis, 104. Vaginal palpation of arteries,

105. Rectal palpation of the pelvic arteries, 107. Palpation of pelvic

nerves, 107.
Examination of the perineum, 108. Examination of the

vaginal orifice, 108. The levator vaginæ and levator ani, 108. Examination

of the vulval orifice, 110. The constrictor cunni or vulval sphincter, 111.

The pubic fossa, 111. Transversus perinæi, 112. Characteristics of the

perineal body, 112. Rectal palpation of the perineal body, 113. Digital

eversion of the vagina, 113.

CHAPTER IV.

INSTRUMENTAL EXAMINATION OF THE FEMALE PELVIC ORGANS.

Object in using the sound or probe, 114. Size and length of sound, 114. Mode

of using, 117. Length of the cervical and uterine cavities, 117. Speculum,

120. Position of patient for speculum, 121. Mode of using the speculum,

122. How to find the os uteri, 123. Appearance of the os and cervix in

the virgin, 125. Appearance of the multiparous uterus, 126. Appearance

in the aged, 126. Exceptions to these appearances, 127. Color, 127.

Appearance of secretion, 127. Indication of mucus in abundance, 127.

Indication from pus, 128. Probe and speculum conjointly, 128. Dilata-

tion, 128. Exploratory curetting of the uterus, 133. The use of the

female catheter, 134. The urethral speculum and endoscope, 135. Cath-

eterization of the ureters, 136. General manner of conducting an examina-

tion in making a diagnosis, 138.

CHAPTER V.

DISEASES AND ACCIDENTS OF THE LABIA AND PERINEUM.

Wounds, 142. Sanguineous infiltration, 143. Varices of the labia and vulva,

143. Edema, 144. Phlegmon, 144. Abscesses of the labia, 146.

Labial hydrocele, 146. Labial tumors, 147. Hypertrophied labia, 147.

Cancer of the labia, 149.

CHAPTER VI.

DISEASES OF THE VULVA.

Condylomata of the vulva, 150. Treatment, 150. Inflammations, 150. Treat-

ment, 151. Follicular vulvitis, 152. Causes, 152. Treatment, 152.

Pruritus pudendi, 153. Treatment, 154. Corroding ulcer, 155. Gangre-

nous vulvitis, or noma, 156. Urethral excrescences, 157. Vascular urethra,

158. Hypertrophy of the clitoris and nympha, 159. Treatment, 159.

CHAPTER VII.

LACERATION OF THE PERINEUM AND PELVIC FLOOR.

Preliminary observations upon the conditions leading to injuries of the parturient

canal, 160. The mechanism of laceration and injuries of the perineum and

pelvic floor, 161. The sciatic and coccygeal surface, 161. Plane of obturato-

coccygeus, 162. The levator coccygei, 163. The plane of the levator ani

proper, 164. Plane of the levator vaginæ or vaginal sphincter, 164. Plane

of the constrictor cunni or vulval sphincter, 167. The vulval plane or ring,

167. Lacerations extending into the transversus perinæi and sphincter

ani, 168. Lacerations of the perineal septum, 168. Lacerations of the deep

pelvic fascia, 168. The flap lacerations, 168. Central ruptures, 169.

Irregular lacerations, 169. Concealed lacerations, 170. Contusions about

the bony walls, 171. Lacerations extending into the rectum, 171. Effects

of perineal and pelvic floor lacerations, 171. The immediate effects or those

incident to the puerperal state, 171. Remote effects, 172. Effects upon

the uterus, 172. Effects upon the bladder, urethra, and rectum, 173.

Effects upon the vagina, 174. Other effects, 174. Symptoms of perineal

and pelvic floor lacerations, 174. Secondary symptoms, 174. Varieties of

laceration, 175. Degrees of laceration, 176. Diagnosis of perineal and

pelvic floor lacerations, 177. Palpations of old perineal lacerations, 180.

Diagnosis by rectal palpation, 181. Diagnosis by inspection, 183. Combined

palpation and inspection, 184. Diagnosis of old lacerations extending into

the rectum, 184. Diagnosis of lacerations of the pelvic floor, 184. Deeper

portions of the pelvic floor, 185. Method of diagnosis, 186. Prognosis,

187. Prevention of lacerations, 187. Perineal incisions, 188. Colpotomy,

189. Episiotomy, 189. Perineal tenotomy, 190. Delivery after perineal

incisions, 192. Choice of methods, 192. After management, 193.

Treatment of perineal lacerations, 193. Superficial lesions, 193. Treat-

ment by coaptation, 193. Immediate perineorrhaphy, 194. Reasons for

failure of the immediate operation, 194. Contraindications, 194. The

operation, 195. Lacerations into the rectum, 199. Secondary perineor-

rhaphy, 199. What is to be accomplished, 200. When to operate, 200.

Methods of restoring the perineum when the rectum is not opened, 200.

The median triangular operation, 200. The modified triangular operation,

201. The bilateral operation, 202. Crescent operation, 204. Emmet's

crescent operation, 205. Transverse denudations, 205. Star operation,

205. Flap operations, 206. The triangular flap operation, 206. Bischoff's

operation, 207. Modified Freund's operation, 208. Crescentic flap opera-

tion, 208. Unilateral flap operation, 209. Operations upon uncicatrized

lacerations, 210. Lacerations involving the sphincter ani but not the rectum,

210. Closure of lacerations extending a short distance into the rectum,

210. Flap operations, 211. Lacerations extending high up into the rectum,

214. Choice of methods, 215. Preparation of the patient, 216. Prepara-

tions for operating, 216. Operative detail, 217. Sutures, 218. The

quilled suture, 219. Incision of sphincter ani, 221. After-treatment, 221.

CHAPTER VIII.

DISEASES OF THE BLADDER.

Paralysis of the bladder, 223. Prognosis, 223. Symptoms, 223. Diagnosis,

224. Treatment, 224. Hemorrhage from the bladder, 225. Hyperæsthesia

of the bladder and urethra - irritable bladder and urethra, 225. Causes,

226. Treatment, 226. Chronic inflammation of the bladder, 227. Nature

and progress, 227. Symptoms, 227. Diagnosis, 228. Prognosis, 228.

Treatment, 228. Stone in the bladder, 231. Symptoms, 232. Diagnosis,

232. Treatment, 233. Foreign bodies, 234. Inversion of the bladder,

235.

CHAPTER IX.

AFFECTIONS OF THE VAGINA.

Diagnosis, 236. Atresia vaginæ,

Treatment of atresia and absence

Absence of the vagina, 236. Causes, 236.

237. Diagnosis, 237. Prognosis, 238.

of the vagina, 238. Tumors in the vagina, 240. Vaginismus, 241. Diag-

nosis, 242. Prognosis, 242. Treatment, 242. Acute vaginitis, 243.

Diagnosis, 244. Prognosis, 244. Cause, 244.

vaginitis, 245. Symptoms, 245. Diagnosis, 246.

246. Treatment, 247. Puerperal vaginitis, 248.

ment, 250. Urinary fistula, 251. Diagnosis,

Treatment, 254. Simon's method, 264. Kolpokleisis, 268. Bozeman's

method, 271. Entero-vesical fistula, 274. Entero-vaginal fistula, 275.

Recto-vaginal fistula, 275. Treatment, 275.

CHAPTER X.

Treatment, 244. Chronic

Causes, 246. Prognosis,

Symptoms, 249. Treat-

252. Prognosis, 253.

MENSTRUATION AND ITS DISORDERS,

Puberty, 278. Amenorrhoea, 282. Pathology and morbid anatomy, 283.

Symptoms, 283. Amenorrhoea from retention, 286. Diagnosis, 286. Diag-

nosis of retention, 288. Prognosis, 289. Treatment, 290.

CHAPTER XI.

MENORRHAGIA AND METRORRHAGIA.

Treatment of menorrhagia, 300. Palliative treatment, 301. Curative treatment,

CHAPTER XII.

DYSMENORRHOEA.

Diagnosis, 309. Prognosis, 309. Treatment, 309. The inflammatory form of

dysmenorrhoea, 310. Symptoms, 310. Diagnosis, 311. Prognosis, 311.

Treatment, 311. Membranous dysmenorrhoea, 312. Symptoms, 313.

Diagnosis, 313. Treatment, 314. Obstructive dysmenorrhoea, 314. Symp-

toms, 316. Diagnosis, 316. Prognosis, 317. Treatment, 317. Superficial

trachelotomy-Peaslee's operation, 322. (A) Representing stenosis of the

internal os, 322. (B) Representing stenosis of the external os, 323.

Dilatation, 326.

CHAPTER XIIL

METATITHMENIA, OR MISPLACED MENSTRUATION.

HEMATOCELE.

PERIUTERINE

Symptoms, 332. Diagnosis, 334. Prognosis, 335. Treatment, 336. Chronic

Retrouterine Hæmatocele, 338. Diagnosis, 341. Treatment, 342.

CHAPTER XIV.

CHANGE OF LIFE MENOPAUSE AND SENILITY.

CHAPTER XV.

ACUTE INFLAMMATION OF THE UNIMPREGNATED UTERUS.

Causes, 346. Symptoms, 346. Prognosis, 347. Diagnosis, 347. Treatment,

348.

SYMPATHETIC OR REFLEX SYMPTOMS OF UTERINE DISEASE.

Sympathy of the stomach, 353. Sympathetic disease of the bowels, 354.

Sympathetic affection of the liver, 354. Sympathetic affections of the ner-

vous system, 355. Accompanying manifestations of moral and intellectual

perverseness, 356. Syncopal convulsions- hystero-epilepsy, 356. Moral

and mental derangement, 357. Cephalalgia, 358. Affections of the spinal

cord, 360. Hyperæsthesia, 360. Anæsthesia, 361. Spasms, 361. Sym-

pathetic pains in the pelvic region, 361. Extension of inflammation to the

bladder and rectum, 361. Affections of the sciatic and anterior crural

nerves, 362. Muscular weakness, 362. Circulatory system, 363. Respi-

ration, 364. Sympathy of the excretory organs, 365. Mammary bodies,

366.

LOCAL SYMPTOMS, 369. Pain in the sacral or lumbar region, 369. Pain

in the loins, 370. Inability to walk, 370. Pain in the iliac region, 370.

Soreness in the iliac region, 371. Pain in the side, above the ilium, 371.

Weight, or bearing-down pain, or uterine tenesmus, 371. Leucorrhoea, 371.

Amount of leucorrhoea not always proportioned to extent of disease, 372.

Yellow leucorrhoea, when there is abrasion or ulceration, 373. How is the

pain produced? 373. Bearing-down not always caused by displacements,

373. Severity of suffering not commensurate with amount of disease, 374.

Effects on the functions of the uterus, 374. Pain during menstruation,

375. Kind of pain attendant upon uterine inflammation, 375. Cramping

pain, 375. Effects of partial closure of the os uteri on menstruation, 375.

Manner of flow modified by inflammation and congestion, 376. Duration of

the flow, 376. Menorrhagia, 377. Menorrhagia frequent in endocervicitis,

377. Amenorrhoea sometimes results, 377. Function of generation affected

by it, 378. Sterility, 378. Abortion, 379. Conditions of the uterus in

abortion, 379. Effect upon labor, 380. Effects upon the post-partum con-

dition, 380.

CHAPTER XVIII.

PATHOLOGY OR HYSTEROPATHY.

Mucous inflammation, 386. Seat of mucous inflammation, 387. Cavity of the

body of the uterus, 387. Endocervicitis, 387. Endocervicitis with dimin-

ished size, 388. Endocervicitis in virgins, 388. Endocervicitis in aged

women, 388. External inflammation combined with internal in child-bearing

women, 388.

CHAPTER XIX.

ETIOLOGY OF UTERINE DISEASE.

CHAPTER XX.

DIAGNOSIS OF UTERINE DISEASE.

Characteristic signs of inflammation, 392. Diagnosis of endocervicitis, 392.

Diagnosis of submucous inflammation, 393. Complication of mucous with

submucous inflammation, 393. Size of the uterus ordinarily increased—

exceptions, 393. Atrophy as the result of inflammation, 394.

CHAPTER XXI.

GENERAL TREATMENT OF UTERINE DISEASE.

Main objects of general treatment, 397. General symptoms requiring special

attention, 399. Nervous prostration, 399. Food, etc.; 401. Nervous

excitability, 401. Anæmia, 403. Plethora, 404. Local congestions, 404.

Constipation, 405.