{"1": {"fulltext": "", "height": "4535", "width": "3011", "jp2-path": "atlasepitomeofgy00scha_0001.jp2"}, "2": {"fulltext": "G!ass_\\nBook.\\nCOPYRIGHT DEPOSIT", "height": "4619", "width": "3004", "jp2-path": "atlasepitomeofgy00scha_0002.jp2"}, "3": {"fulltext": "", "height": "4579", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0003.jp2"}, "4": {"fulltext": "", "height": "4619", "width": "3004", "jp2-path": "atlasepitomeofgy00scha_0004.jp2"}, "5": {"fulltext": "", "height": "4578", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0005.jp2"}, "6": {"fulltext": "", "height": "4619", "width": "3004", "jp2-path": "atlasepitomeofgy00scha_0006.jp2"}, "7": {"fulltext": "", "height": "4614", "width": "2693", "jp2-path": "atlasepitomeofgy00scha_0007.jp2"}, "8": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0008.jp2"}, "9": {"fulltext": "ATLAS AND EPITOME\\nGYNECOLOGY\\nDR. OSKAR SCHAEFFER\\n1 1\\nPrivatdocent of Obstetrics and Gynecology in the University\\nof Heidelberg\\nAUTHORIZED TRANSLATION FROM THE SECOND\\nREVISED AND ENLARGED GERMAN EDITION\\nEDITED BY\\nRICHARD C. NORRIS, A.M., M.D.\\nSurgeon-in-charge, Preston Retreat, Philadelphia; Gynecologist to the Methodist\\nEpiscopal Hospital and to the Philadelphia Hospital Consulting Gyne-\\ncologist to the Southeastern Dispensary and Hospital for Women and\\nChildren; Lecturer on Clinical and Operative Obstetrics,\\nMedical Department, University of Pennsylvania.\\nWITH 207 COLORED ILLUSTRATIONS ON go PLATES,\\nAND 62 ILLUSTRATIONS IN THE TEXT\\nPHILADELPHIA\\nW. B. SAUNDERS COMPANY\\nI goo\\nU", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0009.jp2"}, "10": {"fulltext": "18524\\nOf\\nLibr*t/ y of Con\\nJUL 12 1900\\nCopvrgnt tntiy\\nS\u00c2\u00a3amn COPY.\\nto\\nOKGLti DIVISION.\\nJUL 13 1900\\nCopyright, 1900, by W. B. Saunders Company.\\n71043\\nPRESS OF\\nW. B. SAUNDERS COMPANY.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0010.jp2"}, "11": {"fulltext": "EDITOR S PREFACE.\\nThe value of this Atlas to the medical student and to\\nthe general practitioner will be found not only in the con-\\ncise explanatory text, but especially in the illustrations.\\nIt occupies a position midway between the quiz compend\\nand the more pretentious works on gynecology. The\\nlarge number of illustrations and colored plates, reproduc-\\ning the appearance of fresh specimens, will give the stu-\\ndent an accurate mental picture and a knowledge of the\\npathologic changes induced by disease of the pelvic organs\\nthat can not be obtained from mere description. JNext to\\nthe study of specimens, which for evident reasons are not\\navailable outside of large clinics, well-chosen illustrations\\nmust be utilized. The Atlas serves that purpose so well\\nthat its translation and publication for the English-speak-\\ning profession seemed very desirable.\\nThe translator, Dr. W. Hersey .Thomas, has carefully\\nfollowed the author s te^^wln^h, while concise, covers\\nthe subject systematically, and with sufficient detail to give\\nthe reader a comprehensive knowledge of gynecologic dis-\\norders. The paragraphs devoted to the treatment of the\\nvarious diseases are very conservative, in some instances\\nperhaps too much so for the aggressive surgeon. The\\nauthor s conservatism will be appreciated, however, by\\nthe student and the practitioner, who necessarily wish to\\nbe informed on nonoperative gynecology.\\nEditorial comments have occasionally been inserted, in\\norder to harmonize or point out the difference between\\nthe author s teaching and that generally approved in\\nAmerica.", "height": "4592", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0011.jp2"}, "12": {"fulltext": "PREFACE TO THE SECOND\\nEDITION.\\nEvery one concerned in the production of the second\\nedition of this volume has helped to make it represent all\\nthe advances in our technical knowledge. A statement\\nof the latest scientific acquisitions has been incorporated\\ninto the original text. The greatest stress has been laid\\nupon the accumulation of new illustrative material from\\nautopsies and operations as well as from the living. The\\ndelineations of the artist, Mr. A. Schmitson, are meri-\\ntorious and true to nature. The new material has been\\nobtained partly from the Heidelberg Pathologic Institute,\\npartly from our surgical and gynecologic clinics, and partly\\nfrom my private practice. I take this opportunity to\\nexpress my heartiest thanks to the Directors of the Insti-\\ntute, to Professors Arnold, Czerny, Kehrer, and their\\nassistants, and especially to Professors Ernst and Jordan\\nfor the use of their instructive fresh specimens.\\nThe publisher has spared neither trouble nor expense\\nin the reproduction of the water-colors, which are abun-\\ndant and as true to nature as possible.\\nO. SCHAEFFER.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0012.jp2"}, "13": {"fulltext": "PREFACE TO THE FIRST EDITION.\\nIn spite of the existence of excellent shorter works and\\ncompends, as well as of good comprehensive atlases, the\\nauthor feels that there is need of a book that will give the\\nstudent and the practitioner an opportunity to elucidate\\nand to complete his necessarily limited personal observa-\\ntions and examinations in the clinic and dispensary. If\\nthe entire work were carried out upon a purely diagram-\\nmatic basis, it would probably be more readily grasped by\\nthe majority of readers not every one, however, possesses\\nthe gift of translating such pictured relations into living\\nclinical entities. On the other hand, the strict reproduction\\nof anatomic preparations renders difficult that clear repre-\\nsentation which is necessary to sift the essential from the\\nnonessential facts.\\nI have consequently decided, in many cases, to combine\\nboth methods of illustration that is, to reproduce accu-\\nrate anatomic specimens, and then to emphasize more\\nsharply the changes under consideration. I have further\\nendeavored to show every subject from as many stand-\\npoints as possible (that is, regarding their etiology, develop-\\nment, secondary influence, progress, and termination), and\\nconsequently have further elucidated the pictures of speci-\\nmens by diagrammatic and semidiagrammatic drawings.\\nThanks to my former assistantship at the Munich\\nFrauenklinik, and in no slight degree to the indulgent\\npermission and stimulating counsel of Professor v.\\nWinckel, I have been able to employ, almost without ex-\\nception, original anatomic and clinical material. I wish\\nto take this opportunity to express my thanks to this\\n3", "height": "4604", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0013.jp2"}, "14": {"fulltext": "4 PREFACE TO THE FIRST EDITIOX.\\ngentleman, and also to Professor Kehrer, who most\\namiably allowed me to use his clinical material.\\nThe text has been divided into two parts. The con-\\ntinuous text is, without exception, written from a practical\\nstandpoint the text of the, plates, on the contrary, con-\\ntains the purely theoretic, scientific, anatomic, microscopic,\\nand chemic notes, and facts of general significance (con-\\ncerning sounds, pessaries, etc.), so that in referring to the\\nwork the one text will not have a disturbing influence\\nupon the other.\\nTo avoid needless repetition, frequent references have\\nbeen made to my Atlas of Obstetric Diagnosis and\\nTreatment/ The necessity for this will be readily under-\\nstood when we consider the identity of the anatomic data\\nand the intimate mutual relations existing between the\\nchild-bearing process and the majority of gynecologic\\naffections.\\nThe material has been classified from an etiologic stand-\\npoint as for as possible to carry this out rigidly, how-\\never, would have led to diffuseness. The chapters upon\\nsepsis, gonorrhea, genital tuberculosis, and venereal dis-\\neases are based upon this classification. Cystitis, which\\ncomes within the domain of the gynecologist so frequently,\\nhas received special attention.\\nParticular effort has been directed to the clear presenta-\\ntion of the subject of differential diagnosis. The methods\\nwhich I have chosen are the comparative and the tabular.\\nThe subject receives full attention in the chapters on\\nMyomata, Cystomata, Carcinoma, Tumors of the Ante-\\nuterine and Retro-uterine Spaces, and others.\\nAt the conclusion of the work I have placed a Thera-\\npeutic Table of the ordinary remedies used in gynecology,\\nand have indicated the appropriate methods of prescribing\\nthem chiefly as intra-uterine pencils, vaginal and rectal\\nsuppositories, baths, and injections.\\nO. SCHAEFFEE.\\nHeidelbeeg, Xo vernier, 1895.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0014.jp2"}, "15": {"fulltext": "CONTENTS.\\nGroup I.\u00e2\u0080\u0094 Anomalies of Formation and Arrested Develop=\\nment.\\nCHAPTER I.\\nPAGE\\nFetal Anomalies of Formation 17\\n1. Aplasia and Hypoplasia of the Fetal Rudiments 17\\n2. Hyperplastic Anomalies of Formation of the Fetal\\nRudiments 29\\nCHAPTER II.\\nArrested Development and Anomalies of Infancy and\\nPuberty 35\\n3. Infantile Anomalies of Formation 35\\n4. Anomalies of Menstruation 38\\n5. Sterility 46\\nGroup II. Changes of Shape and Position.\\nCHAPTER I.\\nHernia 48\\n6. Hernia and Other Changes of Shape of the Vulva 48\\nCHAPTER II.\\nInversion and Prolapsus 50\\n7. Inversions of the Vagina and Uterus 50\\n8. Prolapse of the Vagina and Uterus. Elevatio Uteri 57\\nThe Normal Situation and Position of the Uterus 57\\nCHAPTER III.\\nPathologic Positions, Versions, and Flexions of the\\nUTERUS 73\\n9. Pathologic Positions of the Uterus and Its Adnexa 73\\n10. Anteversions and Anteflexions of the Uterus 76\\n11. Retroversions and Retroflexions of the Uterus 79\\nDirections for the Application of Pessaries 84\\n5", "height": "4590", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0015.jp2"}, "16": {"fulltext": "b CONTEXTS.\\nGroup III. Inflammatory and Nutritional Disturbances.\\nCHAPTER I. page\\nInflammation axd Its Coxsequexces Acquired Stexoses\\naxd Atresias, Coxtractiox of Orgaxs, Exudations, axd\\nAdhesioxs 92\\n12. Gonorrhea 93\\n13. Chronic Endometritis. Erosion and Ectropion of the\\nExternal Os 100\\nCatarrh of the Cervix and Chronic Cervicitis and Their\\nConsequences Erosion and Ectropion 101\\nEndometritis Corporis Uteri 107\\n14. Chronic Metritis Ill\\n15. Sepsis (Acute Vulvitis, Vaginitis, Endometritis, Myo-\\nmetritis, Salpingitis, Parametritis and Perimetritis,\\nPeritonitis) 117\\n16. Chronic Salpingitis 124\\n17. Chronic Oophoritis 126\\n18. Chronic Perimetritis, Oophoritis, and Salpingitis.\\nChronic Pelvic Peritonitis 131\\n19. Chronic Parametritis and Paracolpitis 134\\nl 20. Genital Tuberculosis 136\\n21. Venereal Diseases 139\\n22. Catarrh of the Bladder and Cystitis 140\\nCHAPTER II.\\ng 23. Disturbances of Nutrition and Circulation. Neuroses 149\\nGroup IV.\u00e2\u0080\u0094 Injuries and Their Consequences.\\nCHAPTER I.\\nDefects with Cicatricial Changes 155\\n24. Injuries of the Vulva Including Fissures and Perineal\\nDefects, Incontinentia Vulvae .155\\n25. Lacerations of the Vagina and Cervix 160\\n26. Traumatic Stenoses and Atresias of the Vulva, of the\\nVagina, and of the Uterus 162\\nCHAPTER II.\\nFistulas 165\\n27. Classification of Fistulas 165\\nA. Fistulas of the Urinary Organs 165\\nB. Intestinal Fistulas 168\\nCHAPTER III.\\nTraumatic Effusioxs of Blood 175\\nI 28. Hematoma: (a) Vulvar (b) Extraperitoneal 175\\n29. Intraperitoneal Retro-uterine Hematocele 176", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0016.jp2"}, "17": {"fulltext": "CONTENTS. i\\nCHAPTER IV. page\\nForeign Bodies in the Genital Canal and in the\\nBladder 180\\n30. Foreign Bodies (Including Vesical Calculi) 180\\nGroup V.\u00e2\u0080\u0094 New Growths.\\nCHAPTER I.\\nBenign Tumors 186\\n31. Benign Tumors of the Mucous Membranes Covered\\nwith Squamous Epithelium 186\\n32. Benign Tumors of the Uterus 189\\n33. Benign Tumors of the Uterine Adnexa 199\\nCHAPTER II.\\nTumors of Benign Structure That May Become Dan-\\ngerous under Certain Conditions 202\\nI 34. Fibromyomata 202\\n35. Ovarian Cystomata 211\\nCHAPTER III.\\nMalignant Tumors 234\\n36. Malignant Tumors of the Vulva, Bladder, and Vagina 234\\n37. Malignant Tumors of the Uterus 237\\n38. Malignant Tumors of the Adnexa, Especially of the\\nOvaries 245\\nI. Carcinoma 245\\nII. Sarcoma 247\\nTherapeutic Table 249\\nIndex 263", "height": "4608", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0017.jp2"}, "18": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0018.jp2"}, "19": {"fulltext": "LIST OF PLATES.\\nPAGE.\\nPlate 1. The Vulva of a Nonpregnant Multipara. Anomaly of\\nthe Hymen 32\\nPlate 2. Fig. 1. Intra vaginal Cervix of an Infantile\\nUterus 32\\nFig. 2. Duplication of Cervix in a Case of Uterus Bi-\\ncornis Septus with a Single Vagina.\\nPlate 3. Fig. 1. Impressio Fundi Uteri 54\\nFig. 2. Partial Inversion of the Uterus.\\nFig. 3. Complete Inversion of the Uterus.\\nFig. 4. Complete Inversion and Prolapse of the\\nUterus.\\nFig. 5. Complete Prolapse of the Retroflexed Uterus\\nand of the Vagina, with Laceration of the\\nPerineum Cystocele.\\nPlate 4. Fig. 1 Incomplete Prolapse of a Retro verted Uterus\\nMarked Rectocele Vaginal Inversion 58\\nFig. 2. Incomplete Prolapse of the Uterus, Due to\\nHypertrophy of the Intermediate Portion\\nof the Neck Inversion of the Vagina with\\nCystocele.\\nFig. 3. Total Prolapse of Anteflexed Uterus and of\\nthe Anterior Vaginal Wall, with Cysto-\\ncele Characteristic Flexion of the\\nUrethra.\\nFig. 4. Complete Prolapse of Retroflexed Uterus\\n(First Degree) and of Vagina.\\nPlate 5. Fig. 1. Prolapse of Posterior Vaginal Wall Recto-\\ncele Descent of Retroflexed Uterus Sec-\\nond Degree) 58\\nFig. 2. Prolapse of Anterior Vaginal Wall Extreme\\nGrade of Cystocele Anteflexion of the\\nUterus (First Degree) Descent of the\\nUterus.\\nFig. 3. Reposition of Prolapsed Uterus by a Mar-\\ntin Stem-pessary.\\nFig. 4. Hypertrophy of the Anterior Lip of the\\nUterus, Producing Inversion of the Ante-\\nrior Vaginal Wall and Cystocele.\\nPlate 6. Inversion of the Posterior Vaginal Wall. Leukorrhea. 62\\n9\\n^i", "height": "4607", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0019.jp2"}, "20": {"fulltext": "10\\nLIST OF PLATES.\\nPlate 7. Fig. 1. Inversion of the Vagina from a Perineal\\nTear of the Third Degree 64\\nFig. 2. View of the Cervix in a Case of Elevation of\\nthe Uterus.\\nPlate 8. Complete Prolapse of an Anteflexed Uterus Cysto-\\ncele 68\\nPlate 9. Extreme Inversion of the Vagina, with Cystocele and\\nIncomplete Prolapse of the Retroverted Uterus 70\\nPlate 10. Incomplete Prolapse of the Uterus Simple Erosion\\n1 i Circular Thickening of Cervix Rectocele 70\\nPlate 11, Anteflexion of the Uterus in a Child 72\\nPlate 12. Incomplete Prolapse of the Uterus Elongation of the\\nIntermediate Portion of the Neck, with 1 1 Circular\\nHypertrojmy of the Vaginal Portion Inversion of\\nthe Anterior Vaginal Wall Cystocele 74\\nPlate 13. Artificial Prolapse for Operative Purposes, with the\\nArising Inversion of the Vagina and with Cystocele 74\\nPlate 14. Fig. 1. Normal Anteversion of the Uterus 78\\nFig. 2. Pathologic Anteversion of the Uterus.\\nFig. 3. Myoma of the Anterior Uterine Wall, Simu-\\nlating an Anteflexion of the Second or\\nThird Degree.\\nFig. 4. Anteversion of a Fixed Uterus (at the Same\\nTime Retroposition from a Full Bladder).\\nPlate 15. Fig. 1. Anteflexion of the Uterus of the Second De-\\ngree from Posterior Perimetritic Ad-\\nhesions 80\\nFig. 2. Anteflexion of the Uterus of the First De-\\ngree with the Neck Lying Horizontally.\\nFig. 3. Anteflexion of the Infantile Uterus with\\nStenosis of the Cervix and Internal Os\\nDysmenorrhea.\\nFig. 4. Anteflexion of the Uterus of the Third De-\\ngree from a Submucous Uterine Polyp.\\nPlate 16. Fig. 1. Retroversion of a Fixed Uterus 80\\nFig. 2. Retroflexion of a Fixed Uterus (First De-\\ngree).\\nFig. 3. Slight Retroflexion and Descent of the Puer-\\nperal Uterus from Relaxation of the Geni-\\ntalia.\\nFig. 4. Retroversion of the Uterus (Third Degree)\\nfrom Pressure of an Ovarian Cyst.\\nPlate 17.\u00e2\u0080\u0094 Fig. 1. Encapsulated Peritoneal Exudate in Doug-\\nlas Pouch. Descent and Anterior\\nPosition of a Fixed Uterus 82\\nFig. 2. Retroposition of the Uterus by a Full Blad-\\nder.\\nFig. 3. Descent and Retroflexion of the Uterus of\\nthe First Degree, Brought About by Re-\\nlaxation of the Folds of Douglas.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0020.jp2"}, "21": {"fulltext": "LIST OF PLATES. 11\\nPAGE.\\nPlate 17. Fig. 4. Retroflexion of the Uterus of the First De-\\ngree 82\\nPlate 18. Fig. 1. Retroversion of the Uterus from Two Intra-\\nmural Myomata 86\\nFig. 2. Transition from Retroversion to Retroflexion\\nof the Uterus from an Intramural Myoma\\nof the Anterior Wall.\\nFig. 3. Retroflexion of the Uterus of the Third De-\\ngree.\\nFig. 4. Inveterate Retroflexion of the Uterus of the\\nThird Degree.\\nPlate 19. Fig. 1. Retroversion of the Uterus Vaginal Ovario-\\ncele 86\\nFig. 2. Bimanual Examination from the Rectum of\\na Case of Cord-like Total Atresia of the\\nVagina with a Rudimentary Solid Uterus.\\nPlate 20. Fig. 1. Reposition of a Retro verted Uterus by Means\\nof Kustner s Bullet-forceps 88\\nFig. 2. Reposition of a Retroverted Uterus by Means\\nof the Sound.\\nFig. 3. Introduction of the Elastic Ring of Mayer by\\nMeans of Fritsch s Forceps.\\nFig. 4. Introduction of Hodge s Pessary.\\nPlates 21 and 22. Manual Reposition of a Retroflexed Uterus 90\\nPlate 23.\u00e2\u0080\u0094 Massage (Thure Brandt) 90\\nPlate 24. Fig. 1. Gonorrheal Papilloma of the Cervix\\n(Mracek) 94\\nFig. 2. Gonorrheal Cervicitis.\\nFig. 3. Gonococci and Pus-corpuscles.\\nPlate 25. Bartholinitis Dextra Gonorrhceica. Perforation of the\\nAbscess Urethritis 96\\nPlate 26. Bartholinitis Sinistra Gonorrhceica. Abscess Forma-\\ntion (Mracek) 96\\nPlate 27. Gonorrheal Vulvitis and Vaginitis 98\\nPlate 28. Fig. 1. The Microscopic Structure of the Parts of\\nthe Vulva 98\\nFig. 2. Longitudinal Section Through the Cervix in\\na Case of Old Prolapse of the Uterus.\\nFig. 3. Simple, Papillary, and Follicular Erosion of\\nthe Cervix.\\nPlate 29.\u00e2\u0080\u0094 Fig. 1.\u00e2\u0080\u0094 Elephantiasis Vulvae 100\\nFig. 2. Condyloma Acuminatum.\\nFig. 3. Vaginal Secretion.\\nFig. 4. Cross-section of an Ovule of Naboth.\\nPlate 30.\u00e2\u0080\u0094 Fig. 1.\u00e2\u0080\u0094 Normal Uterine Mucosa 102\\nFig. 2. Hyperplastic Glandular Endometritis.\\nFig. 3. Malignant Adenoma (Glandular Cancer).\\nFig. 4. Hypertrophic Glandular and Interstitial\\nEndometritis.\\nPlate 31. Fig. 1. Acute Interstitial Endometritis 104", "height": "4597", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0021.jp2"}, "22": {"fulltext": "12 LIST OF PLATES.\\nPAGE.\\nPlate 31. Fig. 2. Chronic Interstitial Endometritis 104\\nFig. 3. Postabortive Endometritis.\\nPlate 32. Fig. 1. Marked Congestion and Beginning Simple\\nErosion of the Posterior Lip of the Os, as\\na Sign of Uterine Inflammation; Endome-\\ntritis and Metritis 106\\nFig. 2. Slight Congestion of the Cervix of a Multi-\\npara with a Characteristic, Broad, Fis-\\nsured External Orifice.\\nPlate 33. Fig. 1. Congenital Simple Erosion of the Cervix of\\na Virgin 106\\nFig. 2. Leukorrhea and Simple Erosion.\\nPlate 34. Ectropion, with Extreme Relaxation of the Cervical\\nWall and Intact Commissures of the External Os 108\\nPlate 35. Mucous Polyp and Ectropion of the Anterior Lip of the\\nUterus 108\\nPlate 36. Fig. 1. Different Molds of the Uterocervical Canal\\nas Shown by Swollen Laminaria 110\\nFig. 2. Curetment in Fungous Endometritis.\\nPlate 37.\u00e2\u0080\u0094 Fig. 1.\u00e2\u0080\u0094 Chronic Metritis with Ovula Nabothi 112\\nFig. 2. Gonorrheal Endometritis with Simple Ero-\\nsion and Ovules of Xaboth Inflammatory\\nHyperemia.\\nPlate 38. Retroversion of the Fixed Uterus (First Degree) and\\nAgglutination of the Cervix (Acquired) 112\\nPlate 39. Acute Purulent Pelvic Peritonitis (Peritonitis of Per-\\nforation) 114\\nPlate 40. Fig. 1. Acute Catarrhal Parenchymatous Salpingitis\\n(Due to Gonococci and Streptococci) 118\\nFig. 2. Hematosalpinx.\\nFig. 3. Pyosalpinx.\\nPlate 41. Fig. 1. Acute Purulent Parenchymatous and Inter-\\nstitial Salpingitis 122\\nFig. 2. Parametritis Acuta of the Broad Ligament.\\nFig. 3. Chronic Oophoritis with Oligocystic Degen-\\neration.\\nPlate 42. Double Py \u00c2\u00a9hydrosalpinx, Chronic Adhesive Perime-\\ntritis and Oophoritis 124\\nPlate 43. Chronic Adhesive Perimetritis and Salpingitis with\\nUterine Myomata 126\\nPlate 44. Pelvic Peritonitis, Peri-oophoritis, Perisalpingitis, and\\nRight-sided Pyosalpinx 128\\nPlate 45.\u00e2\u0080\u0094 Fig. 1.\u00e2\u0080\u0094 Pelvic Peritonitis 130\\nFig. 2. Left-sided Dermoid C} T st Perforating into\\nthe Rectum.\\nPlate 46. Genital Tuberculosis of Both Tubes, of Both Ovaries.\\nand of the Pouch of Douglas .132\\nPlate 47. Cystitis; Ureteritis (Pyonephrosis) as a Result of Lith-\\niasis Metritis with Endometritis Fungosa Cervici-\\ntis with Marked Dilatation of the Cervical Canal\\nYaginitis 134", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0022.jp2"}, "23": {"fulltext": "LIST OF PLATES.\\n13\\nPAGE.\\nPlate 48. Chronic Cystitis with Acute Exacerbations 136\\nPlate 49. Fig. 1. Syphilitic Ulcer of the Vaginal Cervix.\\n(Mracek.) 138\\nFig. 2. Syphilitic Ulcers of the Vaginal Mucosa.\\n(Mracek.\\nPlate 50. Papular Gummata of the Vulva, of the Anus, and of\\nthe Inner Side of the Thigh. (Mracek.) 140\\nPlate 51. Fig. 1. Elephantiasis Vulvae Originating in the La-\\nbium Ma jus Dextrum and Polypoid Ex-\\ncrescences of the Mucous Membrane at the\\nUrethral Orifice 152\\nFig. 2 \u00e2\u0080\u0094Phlebectasia of the Labia Majora, of the Cli-\\ntoris, and of the Nymphae the Eight\\nLabium Ma jus Contains a Hematoma\\n(Thrombus Vulvas) and Hemorrhoids.\\nPlate 52. Edema of the Nymphae from a Moribund Patient with\\na Cardiac Lesion 154\\nPlate 53. Phlebectasia with Phleboliths of the Ligmenta Lata\\nCorresponding to the Ovarian Vessels and the Pam-\\npiniform Plexus 156\\nPlate 54. Fig. 1. The Normal Perineum 158\\nFig. 2. Perineal Laceration of the Third Degree\\ninto the Rectum\\nFig. 3. Perineal Laceration of the Second Degree.\\nFig. 4. Perineal Laceration of the Third Degree.\\nPlate 55. Fig. 1. Torsion of the Cervix Produced by Scar Tis-\\nsue 162\\nFig. 2. Star-shaped Laceration of the External Os.\\nPlate 56. Fig. 1. Laceration of the Left Commissure of the Os\\nUteri, with Marked Ectropion and Ovules\\nof Naboth on the Projecting Hyper-\\ntrophied Cervical Mucosa 162\\nFig. 2. Old Ectropion and Congestion of the Cervix.\\nPlate 57. Recto-uterine Hematocele in Combination with an\\nExtra-uterine Gestation Sac 174\\nPlate 58. Fig. 1. Free Ascites in the L T pright Position 178\\nFig. 2. Intraperitoneal Retro-uterine Hematocele.\\nFig. 3. Extraperitoneal Retro-uterine Hematoma.\\nFig. 4. Large Subserous Posterior Myoma of the\\nUterus Simulating a Retroflexion.\\nPlate 59. Fig. 1. Left-sided and Posterior Parametritis 182\\nFig. 2. Intraligamentous and Retroperitoneal Mul-\\ntilocular Glandular Mucoid Cyst of the\\nLeft Ovary.\\nFig. 3. Left-sided Pyosalpinx.\\nFig. 4. Carcinomatous Cystadenoma of the Ovary.\\nDiagrammatic.\\nPlate 60. Fig. 1.\u00e2\u0080\u0094 Polyps of the Uterine Mucous Membrane 188\\nFig. 2. Simple Erosion with Ovules of Naboth.\\nPlate 61. Fig. 1. Subserous Polvpoid Fibromvoma of the\\nUterus 188", "height": "4597", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0023.jp2"}, "24": {"fulltext": "14 LIST OF PLATES.\\nPAGE.\\nPlate 61.\u00e2\u0080\u0094 Fig. 2.\u00e2\u0080\u0094 Myomatosis Uteri 188\\nPlate 62. Several Polypoid Myomata of the Fundus, which Pro-\\nduced Uncontrollable Hemorrhage at the Time of\\nthe Menopause 190\\nPlate 63. Intraperitoneal Surface of an Amputated Myomatous\\nUterus (Submucous Myoma) 192\\nPlate 64. Several Bleeding Myomatous Polyps of the Fundus 194\\nPlate 65. Completely Extirpated Myomatous Uterus 194\\nPlate 66. Inner Surface of a Uterus with an Incised Intramural\\nSubmucous Hemorrhagic Myoma of the Posterior\\nWall 196\\nPlate 67. Polypoid Subserous Fibromyoma; Polyps of the Mu-\\ncous Membrane in the Dilated Cervical Canal 204\\nPlate 68.\u00e2\u0080\u0094 Fig. 1.\u00e2\u0080\u0094 Unilocular Ovarian Cysts 210\\nFig. 2. Thin-walled Multilobular Glandular Mucoid\\nCyst.\\nPlate 69.\u00e2\u0080\u0094 Multilocular Glandular Mucoid Cyst 212\\nPlate 70.\u00e2\u0080\u0094 Multilocular Glandular Mucoid Cyst 214\\nPlate 71. Fig. 1. Histologic Structure of a Uterine Mucous\\nPolyp 214\\nFig. 2. Microscopic Section through the Transition\\nZone of a Minute Myoma that is Becom-\\ning Encapsulated into the Surrounding\\nNormal Uterine Muscularis.\\nFig. 3. Vaginitis (Colpitis).\\nPlate 72. Fig. 1. Primary Formation of Cysts from a Multi-\\nlocular Glandular Mucoid Cyst of the\\nOvary 220\\nFig. 2. Papillary Proliferating Cyst of the Ovary.\\nFig. 3. Necrotic Cyst- wall.\\nFig. 4. Sediment from the Fluid of an Ovarian\\nCyst.\\nPlate 73. Fig. 1. Myxosarcoma of the Uterus 222\\nFig. 2. Spindle-cell Sarcoma of the Uterus.\\nFig. 3. Malignant Adenoma Growing through a\\nCyst- wal 1 Semi-diagrammatic\\nFig. 4. Angioma of the Urethra.\\nPlate 74. Figs. 1 and 2. Bimanual Examination of a Pyosal-\\npinx with a Full and with an Empty\\nEectum 226\\nFig. 3. Bimanual Examination, with Assistance, of\\nthe Pedicle of an Ovarian Cyst.\\nPlate 75. Figs. 1 and 2. Two Different Cut Surfaces of a Sar-\\ncoma of the Ovary 228\\nPlate 76.\u00e2\u0080\u0094 Fig. 1.\u00e2\u0080\u0094 Sarcoma of the Ovary 228\\nFig. 2. A Case of Commencing Sarcomatous Degen-\\neration of the Ovary.\\nPlates 77 and 78. Multiple Extraperitoneal Extravasations of\\nBlood, Especially in the Great Omentum 230\\nPlate 79. Fig. 1.\u00e2\u0080\u0094 Epithelioma of the Vulva 232", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0024.jp2"}, "25": {"fulltext": "LIST OF PLATES.\\n15\\nPAGE.\\nPlate 79. Fig. 2. Part of an Epitheliomatous Papilloma of\\nthe Vaginal Cervix 232\\nFig. 3. Epitheliomatous Pearls from an Ulcer\\nof the Cervix.\\nFig. 4. Dermoid Cyst.\\nPlate 80. Fig. 1. Ulcerated Epithelioma of the Left Labium\\nMajus 236\\nFig. 2. Flat Ulcerating Epithelioma of the Poste-\\nrior Lip of the Os Uteri and of the Poste-\\nrior Vaginal Vault.\\nPlate 81. Fig. 1. Nodular Epithelioma of the Vaginal Cervix.\\nFig. 2. Epitheliomatous Papilloma of the Anterior\\nLip of the Os Uteri 236\\nPlate 82. A View of an Epitheliomatous Ulceration of the Mu-\\ncous Membrane of the Cervical Canal 238\\nPlate 83. \u00e2\u0080\u0094Figs. 1 and 2. Epitheliomatous Ulcer of the Cervix. 240\\nPlate 84. Fig. 1. Epitheliomatous Papilloma of the Anterior\\nLip of the Os Uteri and of the Anterior\\nVaginal Vault 240\\nFig. 2. Beginning Epithelioma of the Cervix.\\nPlate 85. Fig. 1. Epitheliomatous Papilloma of Both Lips of\\nthe Os 242\\nFig. 2. Epitheliomatous Ulcer of the Cervix.\\nPlate 86. Fig. 1. Epithelioma of the Cervix that has Perfo-\\nrated into the Bladder 242\\nFig. 2. Perforation of an Epithelioma of the Cervix\\ninto the Bladder and Rectum.\\nPlate 87. Fig. 1. Carcinoma of the Uterine Body 244\\nFig. 2. Sarcoma of the Uterus.\\nPlate 88.\u00e2\u0080\u0094 Fig. 1.\u00e2\u0080\u0094 Flat Cervical Epithelioma of Both Lips of\\nthe Os Uteri Involving Both Vaginal\\nVaults 244\\nFig. 2. Epitheliomatous Papilloma of Both Lips of\\nthe Os Uteri.\\nFig. 3. Polypoid Epitheliomatous Papilloma of the\\nAnterior Lip of the Os Uteri.\\nFig. 4. Epitheliomatous Papilloma of the Posterior\\nLip of the Os Uteri Filling the Entire\\nPosterior Vaginal Vault.\\nFig. 5. Villous Cancer of the Bladder in Its Most\\nFrequent Position.\\nFig. 6. Rectal Carcinoma (Glandular Cancer) Infil-\\ntrating the Rectovaginal Septum.\\nPlate 89. Fig. 1. Cancer Xodules in the Cervix. Which Has\\nNot Yet Ulcerated 246\\nFig. 2. Epitheliomatous Ulcer of the Cervix.\\nFig. 3. Epitheliomatous Ulcer of the Cervix Which\\nHas Invaded the Uterine Body.\\nFig. 4. Carcinoma of the Body of the Uteres Which\\nHas Perforated into the Bladder", "height": "4587", "width": "2762", "jp2-path": "atlasepitomeofgy00scha_0025.jp2"}, "26": {"fulltext": "16 LIST OF PLATES.\\nPlate 89. --Fig. 5. Epitheliomatous Ulcer of the Cervix Which\\nHas Perforated into the Bladder 246\\nFig. 6. Epitheliomatous Ulcer of the Cervix Per-\\nforating into Both Bladder and Eectum.\\nPlate SO. Fig. 1. Fungous Endometritis and Ectropion 246\\nFig. 2. Epitheliomatous Papilloma of Both Lips of\\nthe Os.\\nFig. 3. Ovules of Naboth in a Mucous Polyp Visible\\nat the Os Uteri.\\nFig. 4 Fibroid Polyp Separating the Lips of the Os\\nUteri.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0026.jp2"}, "27": {"fulltext": "Tab. 1.", "height": "4587", "width": "3184", "jp2-path": "atlasepitomeofgy00scha_0027.jp2"}, "28": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0028.jp2"}, "29": {"fulltext": "", "height": "4599", "width": "3228", "jp2-path": "atlasepitomeofgy00scha_0029.jp2"}, "30": {"fulltext": "ne", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0030.jp2"}, "31": {"fulltext": "DUPLICATION.\\n33\\nexplains the association of all degrees of the bicornate\\nuterus with septa of varying extent in the uterus or vagina.\\nWe may thus have a uterus bicornis septus or bicollis,\\nand subseptus or unieollis, or, again, both may be com-\\nbined with vagina septa or subsepta. (Plate 2, Fig. 2,\\nand Figs. 20 and 21.) One duct may be occluded, as has\\nbeen already mentioned, producing a unilateral atresia.\\nA hymen septus or bifenestratus may be present, and, by\\nFig. 21. Uterus et vagina septa (Munich Frauenklinik).\\nreason of its resisting power, may play quite an important\\nrole in the pathology of the sexual life. (Fig. 2.)\\nSymptomatology. The influence of these malforma-\\ntions upon labor has been described in my Atlas of\\nObstetric Diagnosis and Treatment.\\nConception frequently does not occur in consequence\\nof the feeble development of the entire genitalia. These\\nindividuals are usually weaklings with amenorrhea, and\\nshould be advised not to marry.\\n3", "height": "4606", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0031.jp2"}, "32": {"fulltext": "34 ANOMALIES OF FORMATION.\\nTreatment. Ligation or division (Paquelin) of the\\nsepta. It is to be remembered that after castration or\\ntotal extirpation of the uterus for myomata the presence\\nof a third ovary may nullify the result, or may explain\\na subsequent abdominal pregnancy.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0032.jp2"}, "33": {"fulltext": "CHAPTER II.\\nARRESTED DEVELOPMENT AND ANOMALIES OF\\nINFANCY AND PUBERTY.\\n1. Uterus fetalis (often planifundalis).\\n2. Uterus infantilis and uterus membranaceus.\\n3. Anteflexio uteri infantilis.\\n4. Stenosis cervicis et orificii externi.\\n5. Stenosis vulvovaginal or hvmenalis.\\n6. Evolutio prsecox.\\n7. Oligomenorrhea and amenorrhea.\\n8. Dysmenorrhea.\\n9. Menorrhagia\\n10. Sterility.\\n|3. INFANTILE ANOMALIES OF FORMATION.\\n1 and 2. Those formative arrests designated as uterus\\nfcetalis or infantilis are combined with functional distur-\\nbances (symptoms) to be described under the headings\\nfrom 3 to 10 and with a generally weakened constitution,\\nIdiocy, etc. In the fetal form the body of the uterus fails to\\ngrow, and the neck is relatively larger the vaginal cervix\\nis very small, and is provided with a minute opening.\\nThe latter is also true of the infantile uterus (Plate 2, Fig.\\n1), but here the body has grown until its muscular coat is\\nas well developed as is that of the neck. The body, instead\\nof being pear-shaped and forming the largest part of the\\nuterus, is simply a cylindric continuation of the cervix.\\nThe uterus membranaceus is due to a simple primary\\natrophy of the organ. (Fig. 22.) All three forms are\\ncharacterized by their diminutiveness.\\n35", "height": "4604", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0033.jp2"}, "34": {"fulltext": "36\\nANOMALIES OF F0R3IATI0K\\nThe diagnosis is made by bimanual exploration (through\\nthe rectum, if necessary) and by the cautious introduction\\nof the uterine sound. 1\\nTreatment. Treat the anemia or tuberculosis with\\nroborants. Increase the local blood supply by massage,\\nwarm sitz-baths, stimulating vaginal douches, the stem-\\npessary, frequent scarifications, and mustard plasters on\\nthe thighs during the menstrual molimina. Faradization\\nis also employed, one pole being introduced into the\\nuterus and the other being placed upon\\nthe mons veneris.\\n3 and 4. Infantile anteflexion\\n(Plate 15, Fig. 3) of a small organ is\\noften associated with stenosis of the\\ncervical canal or its external orifice.\\nPuerile anteflexion consists in a\\nsharp bending forward of a normal,\\nlarge, flexible organ, with a shortened\\nanterior vaginal wall, in the elongated\\naxis of which the hypertrophic supra-\\nvaginal cervix is found.\\nSymptoms. Dysmenorrhea (8)\\nand sterility. Both may be purely\\nmechanical, from the narrowed lumen,\\nor the angle of flexion, especially when\\nthe latter has become rigid from long\\nduration and secondary inflammatory\\nchanges. The more frequent cause of both, however, is\\nthe passive hyperemia and the resulting congestive endo-\\nmetritis, while the sterility is still further accounted for\\nby the frequent hypoplasia.\\nDiagnosis. After emptying the bladder the anteflexion\\nis recognized bimanually, the form and direction of the\\nvagina being noted. (Plate 22.) The sound demon-\\nstrates the direction of the cervix and the size of its\\nFig. 22. -Uterus\\nmembranaceus.\\n1 The normal length of the uterus, as measured by the sound, is six\\ncentimeters.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0034.jp2"}, "35": {"fulltext": "INFANTILE ANTEFLEXION 37\\nlumen, 1 whether it is narrowed throughout or at one of its\\norifices only, and whether secondary dilatation of the uter-\\nine cavity or cervical canal has taken place. (Plate 1 5,\\nFig. 3.)\\nTreatment. If no other cause for the symptoms exists\\n(an endometritis, for example), the stenosis should be re-\\nmoved by dilatation with metal sounds, laminaria tents, or\\niodoform-gauze tampons every few weeks. A more per-\\nmanent result is obtained by making, immediately after\\nthe period, bilateral transverse incisions, about one centi-\\nmeter deep, in the cervical commissures by means of\\nCooper s scissors. The mucous membrane of the cervical\\ncanal is then brought into apposition with that of the in-\\ntra vaginal cervix in such a manner that the two rows of\\nstitches pass from the anterior to the posterior cervical lip\\nand the uterine orifice gapes. The fresh surfaces are so\\nliable to form adhesions after this operation of Sims that it\\nis better to make four radiating incisions (Kehrer), or to\\ntransplant a flap, with a pedicle, from the cervix to the\\nincision. This is followed by a tamponade of ferripyrin\\ncotton, which is nonirritating. In stenosis of the entire\\ncervical canal faradization should be employed, with the\\nnegative pole in the cervix (fifty milliamperes for five\\nminutes, twice a week for two months).\\nThe anteflexion is treated by the introduction of a\\nstem-pessary made of silver. The stem should be from\\n2 to 3 mm. thick, the length from 1 to 1J cm. shorter\\nthan the uterine cavity, and the plate from 2 to 2J cm.\\nin diameter (v. Winckel). If the direct introduction of\\nthe stem is impossible, it may be introduced alongside of\\na sound. It is to be held in position for a few days by a\\ntampon, and the patient kept quiet. If an inflammatory\\nreaction occurs, the tampon is to be removed. This stem\\nseems not only to remove the flexion, but also to act favor-\\nably on the dysmenorrhea and sterility (v. Winckel). It\\n1 The normal cervical canal will accommodate a sound four milli-\\nmeters in diameter.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0035.jp2"}, "36": {"fulltext": "38 ANOMALIES OF MENSTRUATION.\\nstimulates and invigorates the organ. The vagina should\\nbe washed out daily, and the stem should be changed\\nevery few months. [The dangers involving the use of\\nintra-uterine stem-pessaries have caused them to be aban-\\ndoned by most practitioners. Forcible dilatation and\\noverstretching of the cervical canal by means of graduated\\nbougies or branched dilators are now usually employed.\\nThe endometritis resulting from the stenosis and aggra-\\nvating the symptoms renders a thorough curetment a neces-\\nsary part of the operation of dilating the cervical canal for\\nstenosis causing dysmenorrhea and sterility. Ed.]\\n5. Stenosis Vulvo vaginalis or Hymenalis. Inci-\\nsion is necessary only in a marked degree of vagina in-\\nfantilis, and then a flap should be transplanted. Should\\nthe hymen be too resistant and interfere with coitus, it\\nshould be incised and appropriately sutured, since forced\\nimmissio penis or the descending head has caused lateral\\nlacerations from which considerable hemorrhage has oc-\\ncurred. The more insignificant stenoses are to be dilated,\\neither quickly or slowly, with iodoform gauze. In neuro-\\npathic individuals simultaneous spasms of the constrictors\\noften occur. (See Vaginismus.)\\n4. ANOMALIES OF MENSTRUATION.\\nPhysiologic menstruation commonly appears first at\\npuberty (from the age of fourteen to sixteen years in our\\nclimate earlier in warmer countries in large cities\\nearlier than in the country), and is a sign of sexual\\nmaturity. It occurs as a hemorrhage, dependent upon a\\nregular monthly determination of blood to the genitalia,\\nin consequence of which the uterine mucous membrane\\nbecomes more vascular, spongy, and better fitted for the\\nreception and development of an impregnated ovum.\\nOvulation occurs at the same time, and is due to the es-\\ncape of a mature ovum from a ruptured Graafian follicle.\\nThe entire process (ovulation and menstruation) is regu-", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0036.jp2"}, "37": {"fulltext": "OLIGOMENORRHEA AND AMENORRHEA. 39\\nlated by a newous center, and goes hand in hand with\\nperiodic variations in the body-metabolism, which is least\\nactive at the time of the menstrual flow. The hemor-\\nrhage has its source in the mucous membrane of the\\nuterine cavity, and recurs periodically unless pregnancy\\nsupervenes. (See Atlas of Obstetric Diagnosis and\\nTreatment, second edition, 1.)\\nVarious disturbances may precede or accompany men-\\nstruation, and are to be looked upon as expressions of\\nfluctuations in the body-metabolism. These are Exan-\\nthemata (herpes labialis, acne), skin irritations, chilliness,\\nneuralgia, malaise, dizziness, borborygmus, diarrhea with\\nsuddenly appearing constipation, a preceding leukorrhea\\nfor several days, a more frequent desire to urinate, and a\\nurine loaded with urates.\\n6. Evolutio Praecox. In these cases menstruation may\\noccur during childhood, and the individual may present all\\nthe appearances of sexual maturity. 1 Should she become\\npregnant, delivery will usually take place without special\\ndifficulty.\\n7. Oligomenorrhea and Amenorrhea. Etiology,\\nIn 1-3 we have already found a series of causes for\\namenorrhea in the anomalies of development of the gen-\\nitalia. These can be divided into\\n(a) Permanent organic causes defects of the uterus,\\novaries, or Graafian follicles (either congenital or resulting\\nfrom an infantile oophoritis), with otherwise completely\\ndeveloped genitalia.\\n(b) Functional disturbances, which persist in some cases\\ninfantile genitalia (hypoplasia, anteflexion, stenosis, in-\\nsufficient development of the uterine mucosa), anemia,\\nespecially in neuropathic individuals (lack of determina-\\ntion of blood to the uterus).\\n(c) Mechanical obstructions atresias.\\n(d) Affections that cause a symptomatic amenorrhea\\n1 The not infrequent hemorrhages from the genitalia of the new-\\nborn should be excluded from this classification.", "height": "4592", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0037.jp2"}, "38": {"fulltext": "40 ANOMALIES OF MENSTRUATION.\\nmorphinism obesity severe acute diseases excessive\\ndisturbances of the circulation from catching cold or from\\nemotional excitement (fright, fear of pregnancy) diseases\\nof the genitalia, such as metritis (contraction of the mucous\\nmembrane), perimetritis (ovaries and tubal ostia embedded\\nin exudate), and oophoritis ovarian tumors puerperal\\nhyperinvolution (atrophy of the genitalia) and pregnancy.\\nThe latter causes a physiologic amenorrhea, but neverthe-\\nless it should be noted that ovulation and conception may\\noccur.\\nTreatment. It should first be determined whether the\\ncase is one of true amenorrhea or whether it is caused by\\nmechanical hindrances (congenital or acquired) to the exit\\nof blood. The treatment of the latter conditions (groups\\na and c), both curative and symptomatic, has been fully\\ndescribed in 1. (See Plate 38.)\\nGroup b (see 3) requires a tedious yet often a fruitful\\nline of treatment. The careful regulation of the manner\\nof living is of the utmost importance. Every injurious\\ninfluence should be removed, the more pernicious being\\noverexertion, especially that of a mental nature (hard study\\nconstant application to school-exercises, embroidery, or\\nsewing frequent visits to theaters, balls, etc.) too\\nmuch or too little sleep exhausting diarrhea or leukor-\\nrhea masturbation and the ingestion of improper food.\\nThe diet should at first be bland, nutritious, and of such\\na nature that constipation and tympanites are avoided\\nmeat diet later. The household duties are to be regularly\\narranged; if possible, daily walks of one or two hours in\\nthe country are to be recommended, taking care to avoid\\nfatigue the bowels must be regulated (fruit, abdominal\\nmassage, injections of lukewarm water with or without\\nsoap or oil, laxatives). Certain drugs stimulate the appe-\\ntite and are of value. Especially useful are blood tonics,\\nsuch as Hommel s hematogen (hemoglobinum liq.), Dah-\\nmen s hemalbumin powder, nutrol, wine with peptonate\\nof iron, or Blaud s pills with tincture of cinchona.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0038.jp2"}, "39": {"fulltext": "OLIG OMENORRHEA\u00e2\u0080\u0094 TEE A T3IEXT. 4 1\\nThe circulation should be encouraged by warm foot-\\nbaths (95\u00c2\u00b0 to 100\u00c2\u00b0 F., with a few teaspoonfuls of salt or\\nmustard, once or twice daily), warm sitz-baths or full\\nbaths, and the application of sinapisms to the thighs when\\ncongestion of the pelvic viscera and a mucous vaginal dis-\\ncharge point to a menstrual epoch. Cold baths should be\\nforbidden. The patient should be warmly clothed. Sea\\nair is beneficial, from its stimulating effect upon the appe-\\ntite. Nervous, chlorotic girls are benefited by the rest-cure\\n(Weir Mitchell-Playfair). For the local treatment see 3.\\nThe importance of massage should not be forgotten.\\nGroup d calls for treatment of the primary affection.\\nIt is in this class of cases alone that stimulating drugs are\\nto be used potassium permanganate, sodium salicylate,\\nsantonin, and aloes. Their use is by no means productive\\nof uniform success. Hyperin volution is treated by mas-\\nsage and electricity. (See 3, Stenosis.)\\nDependent upon the amenorrhea, the following secon-\\ndary conditions are observed\\na. Marked disturbances of metabolism, which lead to\\ndyspepsia of a severe type, tympanites, and secondary\\nanemia.\\n,5. Vicarious hemorrhages from other mucous mem-\\nbranes (renal, vesical, gastric, intestinal, nasal), and from the\\nskin, ears, or anterior chamber of the eye. It is difficult\\nto say whether these are results or causes of the amenorrhea,\\nas they do not appear at strictly periodic intervals.\\ny. Periodic exanthemata erythematous, impetiginous\\n(especially at the edge of the lip), and pustular (acne).\\nd. Periodic neuroses neuralgia, palpitation, cerebral\\ncongestion, dyspnea (asthma uterinum), cough (tussis\\nuterina), gastric colic, digestive disturbances, etc.\\nTreatment. For the vicarious hemorrhages hot irri-\\ngations, scarification of the vaginal cervix for the acne\\nLassar s paste, 1 sulphur ointment, pills of ichthyol (1J\\n1 See Therapeutic Table.", "height": "4606", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0039.jp2"}, "40": {"fulltext": "42 ANOMALIES OF MENSTRUATION.\\ngr. in lozenges) for the urticaria and erythema laxa-\\ntives, salicylated alcohol, five per cent, menthol spirit,\\natropin, sodium salicylate (1 J\u00e2\u0080\u0094 2 drams daily) for the\\nimpetiginous eczema (pustules with honey-yellow crusts)\\ndiachylon ointment 1 or bismuth salve for the herpes\\nzinc oxid ointment for the neuralgia and asthma caf-\\nfein, antipyrin, inhalations of chloroform, infus. digitalis,\\nand ice-bag over cardiac region. General nerve tonics\\nand hydrotherapy are indicated.\\n8. Dysmenorrhea is characterized by violent pains\\n(causing reflex hemicrania, nausea, vomiting, dizziness, and\\nhysteric symptoms), which emanate from the uterine and\\nparacervical ganglia, and are to be looked upon as symp-\\ntoms from the lumbar cord. Other diseased organs (liver,\\nheart, lung, stomach) participate in the disturbances.\\nFrom an etiologic standpoint seven forms may be\\ndifferentiated\\n(a) Reflex, from diseased ovaries, tubes, perimetrium,\\netc.\\n(6) In the initial stage of intramural myomata.\\n(c) So-called neuralgia uteri, with spasmodic flexion of\\nthe uterus (author) from fright, interrupted coitus, mas-\\nturbation, thermic and mechanical insults, acute colds.\\n(d) Congestive, with flexions of the uterus and all con-\\nditions that occasion a hyperemia of the organ and its\\nligaments. The pain precedes the flow r and ceases with\\nits onset, when the blood-vessels are relieved.\\n(e) Inflammatory, with endometritis, metritis, parametri-\\ntis, and perimetritis. The pain is most severe at the\\nbeginning of the period and gradually abates the uterus\\nis very sensitive, sometimes spasmodically contracted.\\nWhen the congestive (d) and inflammatory (e) dysmenor-\\nrheas have reached their height, shreds of mucous mem-\\nbrane, sometimes the entire mucosa, may be cast off\\n(decidua menstrualis). This condition is designated as\\ndysmenorrhoea membranacea with endometritis exfoliativa.\\nObstructive, often a result of c and d (see also \u00c2\u00a7\u00c2\u00a73", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0040.jp2"}, "41": {"fulltext": "DYSMENORRHEA. 43\\nand 4, amenorrhea), or arising from too rapid or too pro-\\nfuse a secretion of blood, stenosis or flexion of the cervix,\\nor swelling of the endometrium. The pains follow the\\nonset of the menses, and resemble those of labor. Large\\nclots or shreds of mucous membrane are sometimes dis-\\ncharged.\\n(a) Exfoliatio mucosae menstrualis or dysmenorrhea\\nmembranacea ivithout endometritis.\\nDiagnosis and Treatment. Indicated under the cor-\\nresponding letter.\\n(ci) In every case of dysmenorrhea the constitution of\\nthe patient should be considered, and the exact condition\\nof the entire genital apparatus should be determined by\\nbimanual palpation and, if necessary, by exploration with\\nthe sound.\\n(6) It is impossible to diagnose small intramural mvo-\\nmata before they cause a projection of the uterine wall or\\na change in its consistence. The characteristic symptoms\\nare violent, fixed, boring pains, without fever. These\\nare controlled by suppositories, vaginal or rectal injec-\\ntions, or pills of chloral, or by use of extract of bella-\\ndonna or hyoscyamin, tincture of opium, or antipyrin.\\nRubefacients (sinapisms, menthol, or spirits of camphor on\\ncompresses), ergotin, and salt baths are useful in the\\ntreatment of this condition. The patient should rest in\\nbed during the attack.\\n(c) Potassium bromid, caffein, sodium benzoate, phenac-\\netin, antipyrin (also as a wash), fluid extract of viburnum\\nprunifolium, potassium permanganate (to be taken one\\nweek before the period), and the pills and rubefacients\\npreviously mentioned. Diaphoresis should be encouraged.\\n(d) Rest in bed, warm clothing, especially over the\\nabdomen, hot sand-baths, rubefacients (see 6). Laxatives\\nand ipecac to prevent overfilling of the stomach, anti-\\nmonials and diaphoretics for the catarrh. Local depletion\\nof the blood-vessels by scarifications, two leeches to the\\ncervix, copious hot vaginal injections, or glycerin and", "height": "4605", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0041.jp2"}, "42": {"fulltext": "44 ANOMALIES OF MENSTRUATION.\\nastringent tampons. Any existing cause should be appro-\\npriately treated flexions, by pessaries, massage, etc.\\nstenosis, by dilatation.\\n(e) Removal of the inflammation. Treatment of attack\\nas in d above all, blood-letting (two leeches) and laxa-\\ntives, scarifications of the cervical mucosa, wedge-shaped\\nexcisions (see Metritis), atmocausis (vaporization, see\\nEndometritis).\\nSee treatment of stenosis and amenorrheas in\\n\u00c2\u00a7\u00c2\u00a73 and 4.\\n(g) According to v. AVinckel, the application of two\\nleeches to the cervix at repeated intervals prevents the\\ncasting off of the decidua menstrualis and allows concep-\\ntion and recovery to take place. Curetment and applica-\\ntion of zinc chlorid (chlorid of iron after the operation),\\natmocausis, or zestocausis (see Endometritis). Sympto-\\nmatic, as under b and d.\\nDiagnosis of Exfoliatio Mucosse 3Ienstrualis. The prodromes are\\nsensations of heat and cold, nausea, vomiting, dizziness, headache,\\nand unconsciousness, with or without hysteric convulsions. Circum-\\nscribed pain in the lower abdomen. The discharged blood may be\\nsmall in amount.\\nThe membrane is passed with or without pain. If complete, it\\nhas a triangular shape, showing the position of the three uterine ori-\\nfices (ostia tubarum, os internum). The outer surface is rough and\\ntattered, having been torn from the uterine wall the inner surface is\\nsmooth, offering for inspection furrows and minute glandular orifices.\\n3Iicroscopic Structure. The connective tissue is increased, and its\\ninterstices are filled with exudate and small round cells, which push\\napart the utricular glands. The latter are seen in cross-section, with\\ntheir cylindric epithelium and blood-vessels. Larger cells rarely ap-\\npear, and then are quite isolated. The picture is practically that of\\ninterstitial endometritis. Lohlein points out that pieces of mucous\\nmembrane obtained by curetment between two periods show none of\\nthe foregoing changes.\\nMembranes are sometimes cast off from the vagina in colpitis exfoli-\\nativa, consisting of polygonal squamous epithelial cells with relatively\\nlarge vesicular nuclei. Similar membranes may be exfoliated from a\\nchanged epithelial layer of the lower portion of the cervix. (See\\nPlates 28 to 31.)\\nMicroscopic Differential Diagnosis. The decidua vera graviditatis\\nconsists of a layer of large, irregular, roundish (decidual) cells pos-\\nsessing large nuclei (often multiple). These completely conceal the\\nscanty connective-tissue framework.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0042.jp2"}, "43": {"fulltext": "3IEX0BBHAGIA. 45\\ng. Menorrhagia. By this term we designate those\\nuterine hemorrhages that are so profuse in proportion to\\nthe general constitution of the individual that symptoms\\nof anemia appear, or, if already present, become exagger-\\nated. Its manifestations are dizziness, unconsciousness,\\nringing in the ears, flickering of objects before the eyes,\\nnausea, vomiting, constipation, a striking pallor of the\\nmucous membranes, lassitude, pain in the back, shortness\\nof breath, palpitation, etc. The monorrhagia may be\\nhabitual or temporary.\\nEtiology. (a) Diseases of the genitalia tumors, dis-\\nplacements and inflammations, swellings of the endo-\\nmetrium (b) diseases of other organs that cause circu-\\nlatory disturbances (heart, lungs, kidneys, spleen, liver)\\n(c) associated with intestinal diseases (dysentery, consti-\\npation) (c/) nervous hyperemia (emotion, hot drinks)\\n(e) associated with constitutional diseases (Werlhof s\\ndisease, excessive development of the panniculus adi-\\nposns).\\nTreatment. Symptomatic rest in the horizontal posi-\\ntion, a bland diet, soothing drinks (acids, effervescing\\npowders), hot fomentations of alcohol, sinapisms.\\nGroup a: See treatment of endometritis (especially\\nthe fungous and hemorrhagic forms), chronic metritis in\\nthe stage of engorgement, parametritis and perimetritis,\\nfibroid and mucous polyps of the uterus, sarcoma and\\ncarcinoma, ovarian tumors, flexion and prolapse of the\\nuterus.\\nIf radical treatment is not adopted, the hemorrhage is to\\nbe controlled by ergotin, cornutin, secale cornutum, or hv-\\ndrastis canadensis (hydrastin), stypticin, hot vaginal irriga-\\ntions (113\u00c2\u00b0 to 125\u00c2\u00b0 F.) at intervals of from three to six\\nhours, very firm tamponade of the vagina (iodoform gauze\\nor salicylated cotton), or even tamponade of the cavity of the\\nuterus with iodoform gauze or laminaria. The solution of\\nferric chlorid may be applied upon cotton, as a direct local\\nhemostatic, or the medicated sound (aluminum or wood)", "height": "4607", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0043.jp2"}, "44": {"fulltext": "46 ANOMALIES OF MENSTRUATION.\\nmay be introduced into the cervix and allowed to remain\\nthere for from two to three hours. Ferripyrin has proved\\nitself to be of value, controlling the hemorrhage and pro-\\nducing no irritation. It is used as a powder or, better, as\\nsterilized nondraining ferripyrin-nosophen gauze. x\\nInjections of gelatin solution and atmocausis (see treatment\\nof endometritis hemorrhagica) are to be recommended. 2\\nGroup b Digitalis, expectorants, and the waters of\\nKarlsbad, Franzensbad, Kissingen, Wildungen, Neu-\\nenahr, and Vichy have a specific action.\\nGroup c Laxatives (enemata of infusum sennge, strong\\ninfusions of rhubarb, 10 100, oleum ricini).\\nGroup d Arrest hemorrhage as in group a ergotin\\nreduction of obesity by the methods of Banting, Mendelsohn,\\nEpstein, or Oertel sojourn at Marienbad and vegetable\\ndiet. In hemophilia and scurvy, hydrotherapy and sub-\\ncutaneous injections of gelatin. Calcium hypophosphite\\nby the mouth or rectum.\\nI 5. STERILITY.\\nThe causes of sterility may be found in the physical or\\npsychic nature of the husband or wife, or in the habitual\\ndisease of the product. They may be divided into four\\ngroups\\n1. Impotentia coeundi from organic defects or from nervous or\\nps} r chic influences.\\nHusband. Wife.\\nEpispadias and hypospadias par- Atresia or stenosis of the hymen\\nesis and paralysis of the nervi or vagina vaginismus ob-\\nerigentes from psychic influence structing tumors or inflamma-\\nor nervous weakness (affections tions absence of sexual desire.\\nof the brain and spinal cord,\\nage, perverted habits, etc.)\\naspermatism from cicatricial\\nstenosis prostatic hypertrophy.\\n1 Prepared under the author s direction by Evens and Pistor, of\\nCassel.\\n2 A complete report of the indications for these new methods of\\nhemostasis and results of their application is to be found in the\\nauthor s article in the June number of Deutschen Praxis, 1899.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0044.jp2"}, "45": {"fulltext": "EXAMINA TION\u00e2\u0080\u0094TBEA TMENT. 4Ti\\n2. Azoospermism or arrested formation of the genital cell.\\nHusband. Wife.\\nAtrophy of the testicles (from The Graafian vesicles fail to rup-\\ngonorrhea, orchitis, trauma, ture, either from congenital or\\nand like causes) atresia of the inflammatory causes ovarian\\nejaculatory duct. tumors.\\n3. The spermatic filament is deposited in the female genitalia but\\nis unable to come in contact with the ovum.\\nAtresia or stenosis of the uterus\\nor tubes (flexions of both), cer-\\nvical plugs of tough mucus\\n(endometritis) uterine or tubal\\ntumors perioophoritic pseudo-\\nmembranes.\\n4. The ovum fails to lodge in the uterine mucosa.\\nEndometritis uterine tumors\\nweakness diseases of the ovum.\\nExamination.\\nHusband. Wife. (See 55 1 to 4.)\\nSince gonorrhea is a frequent cause Character of the menses presence\\nof azoospermism and cicatricial of fluor albus (genococci)\\nstenosis, the previous history is uterus, by speculum and sound\\nto be carefully considered and uterus and adnexa, bimanual,\\nthe number of well-formed sper-\\nmatic filaments in the semen is\\nto be determined.\\nThe treatment depends upon the cause demonstrated. If no reason\\ncan be found, advise the patient to hold the semen in the vagina as\\nlong as possible (with the knees together), as Marion Sims proved that\\nthe posterior vaginal vault acts as a seminal receptacle, the intra vaginal\\ncervix (in the normal position of the uterus) being here bathed in\\nthe spermatic fluid. In some cases coitus must be practised with the\\npelvis of the female elevated, or a posterioribus.", "height": "4612", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0045.jp2"}, "46": {"fulltext": "GROUP II.\\nCHANGES OF SHAPE AND POSITION.\\nCHAPTER I.\\nHERNIA.\\nThe abdominal organs may be invaginated into natural,\\npreformed canals, being covered by the enveloping soft\\nparts, and may present themselves in the abdominal\\nwall, in the gluteal region, in the course of the femoral\\nvessels, in the vagina, or in the labia. For vaginal hernia\\nsee also Inversion of the Vagina, 7.\\n6. HERNIA AND OTHER CHANGES OF SHAPE OF THE\\nVULVA.\\nThe hernial contents may consist of the uterus espe-\\ncially one horn of a uterus bicornis and its adnexa\\n(ovary, see 1, Pseudohermaphroditism), with or without\\nthe intestine and its appendages, or of the intestine alone.\\nThe more frequent path is through the inguinal canal\\n(Fig. 23) less often in front of the broad ligament and\\nalong the levator ani. In the first case we speak of a\\nhernia inguinalis labialis (anterior) in the latter, of a\\nhernia vaginalis labialis (posterior). The hernia may\\nattain the size of a melon.\\nDiagnosis. Varying changes of size of the tumor,\\nreduction of contained intestine (usually filled with gas\\nand fluids) with a gurgle/ the characteristic form and\\n48", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0046.jp2"}, "47": {"fulltext": "TREATMENT. 49\\nsensitiveness of the ovary, impulse on coughing, etc., all\\nestablish the nature of the swelling.\\nTreatment. Just as in other hernias taxis and\\nretention by a truss (Scarpa) or by a large, hollow, vagi-\\nnal ring (hard-rubber). If reduction is impossible, open\\nthe sac and replace, or an abdominal section may be per-\\nformed, the hernia reduced, held by fixation sutures, and\\nthe orifice closed.\\nOther changes of shape are seen in the duplication\\nand enlargement of individual parts the nymphae and\\nclitoris which may give rise to irritation, excoriation,\\nedema, etc.\\nTreatment. Frequent washings, using astringents if\\nnecessary, and applications of oak-bark decoctions or\\nlead water, constitute the preventive treatment. Boric\\nointment or bryolin, sitz-baths with bran, dermatol, bis-\\nmuth-talc, nosophen-starch, or applications of solutions\\nof cocain are to be used for their curative action.", "height": "4601", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0047.jp2"}, "48": {"fulltext": "CHAPTER II.\\nINVERSION AND PROLAPSUS.\\nThese conditions hold a certain mutual relation, inas-\\nmuch as the former is a weighty predisposing cause of the\\nlatter. The inverted vagina easily drags the uterus to\\nthe vulva, while in other cases the inversio vaginae and\\nthe prolapsus may be traced to a common cause. On the\\nother hand, the uterine prolapse, or apparent prolapse, due\\nto hypertrophy of the cervix, may lead to protrusions of\\nthe vaginal mucous membrane.\\ni 7. THE INVERSIONS OF THE VAGINA AND UTERUS.\\nInversions of the lower half of the vagina mostly lead\\nto the formation of hernias the most frequent are those\\nof the posterior wall of the bladder (Cystocele, Plate 5,\\nFig. 1) and of the anterior wall of the rectum (Rectocele,\\nPlate 5, Fig. 2). The upper half of the vagina is far\\nless often the seat of inversion, the other organs carrying\\nthe rectovesical or vesico-uterine folds of peritoneum\\nahead of them. In the Atlas of Obstetric Diagnosis\\nand Treatment (Figs. 102 to 105) cases of incarcerated\\nretroflexed gravid uteri and of extra-uterine pregnancy\\nare illustrated in which the gestation sac causes a protuber-\\nance of the vaginal wall.\\nAmong the rarer cases brought to our notice are ovario-\\ncolpocele, enterocolpocele (Plate 19, Fig. 1), hydrocolpo-\\ncele, pyocolpocele (Plate 58, Fig. 1, and Plate 59, Fig. 3),\\nand those bulgings of the vaginal wall that are brought\\nabout by tumors of Douglas pouch (Plates 58 and 59), or\\n50", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0048.jp2"}, "49": {"fulltext": "VAGINAL INVERSION.\\n51\\nof the rectovaginal or vaginovesical septa. (Plate 58,\\nFig. 3 Plate 88, Figs. 5 and 6.)\\nIf the ovary, intestine, or omentum becomes fixed in\\nthe pouch of Douglas, it may cause the vaginal wall to\\nbulge, so that in extreme cases it presents itself at the vul-\\nFig. 23. Inversion of both vaginal walls and inguinal hernia of\\nthe right labium in a case of lacerated perineum (photograph of an\\noriginal water-color). The two conditions are not infrequently associ-\\nated, as they have a common cause relaxation of the supporting\\ntissues.\\nvar opening. This is particularly true in cases of retro-\\nflexion or prolapse of the uterus. The simultaneous in-\\nversion of the anterior and posterior vaginal walls is rare,\\nbecause it could be caused only by an influence exerted at", "height": "4596", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0049.jp2"}, "50": {"fulltext": "52 VAGINAL AND UTERINE INVERSION.\\nthe same time on both recto-uterine and vesicouterine cul-\\ndesacs. It is rarely caused by ascites (with a retroflexed\\nor vertical uterus), more frequently by pus or an encap-\\nsulated peritoneal exudate (pyocolpocele).\\nDiagnosis. See scheme and differential diagnosis of\\ntumors of the recto-uterine pouch, 35.\\nIn ovariocele bimanual exploration reveals a charac-\\nteristic form, sensitiveness, and relation to the tube and\\nuterus. If the ovary is enlarged or embedded in exu-\\ndate, other differential points must be considered (explora-\\ntion per rectum).\\nEnterocele is recognized by the signs common to all\\nintestinal hernias, palpable and audible gurgling and\\nchanges in the tension of the tumor, with variations of\\nintra-abdominal pressure (impulse on coughing).\\nHydrocolpocele and pyocolpocele are to be suspected if\\nthe symptoms of ascites and peritonitis are present. (See\\nPeritonitis.) Carefully examine the previous history.\\nPrognosis and Treatment. An enterocele can be-\\ncome troublesome only during delivery. Reduction from\\nthe rectum if necessary colporrhaphy, in some cases\\nduring pregnancy.\\nA displaced ovary should be reposited, the patient be-\\ning in the lateral or knee-chest posture (narcosis if neces-\\nsary, finger in rectum). The difficulties encountered are\\ndependent entirely upon the number of adhesions. The\\nreposition of ovarian tumors during pregnancy or labor\\nmay lead to serious consequences. If it fails, the tumor\\nmust be tapped from the vagina.\\nThe prognosis and treatment of hydrocolpocele and\\npyocolpocele are the same as those of the causative disease.\\nPuncture from the vagina if condition is analogous to\\ncases just mentioned.\\nInversion of the posterior vaginal wall may lead to\\nrectocele. As the two organs are connected only by loose\\nconnective tissue, this displacement does not always", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0050.jp2"}, "51": {"fulltext": "UTERINE INVERSION. 53\\noccur indeed, the rectum generally induces it. As usual\\ncauses may be mentioned relaxed vaginal walls, gaping of\\nthe vulvar cleft, with or without perineal laceration, and\\nprolapse of the uterus. It presents itself to the examin-\\ning finger as a pocket, which causes constipation and\\ntenesmus. (Plate 4, Fig. 1 Plate 5, Fig. 1 Fig. 27.)\\nThe treatment consists in the repair of the perineum\\nand pelvic floor and in the shortening and narrowing of\\nthe vagina. (See operations described under Prolapse of\\nthe Uterus.) When the muscular coat of the vagina is re-\\nlaxed from colpitis astringents, either as injections (solu-\\ntions of aluminum acetate, 10 to 20^) or upon tampons\\n(glycerite of tannin). A pessary should be looked upon\\nas a temporary makeshift.\\nInversion of the anterior vaginal wall is more fre-\\nquently by far associated with cystocele, because the two\\norgans are firmly connected, and the intra-abdominal ten-\\nsion causes the bladder to follow the vaginal wall. The\\nbladder is divided into two pouches, one lying behind the\\npubic symphysis, the other in the cystocele. The latter\\ndraws the urethra down with it, causing it to assume an\\nS-shape. The greater concavity looks downward and\\nleads into the cystocele. (Plate 4, Figs. 2 and 3 Plate\\n3, Fig. 5 Plate 5, Figs. 2 and 4 Plates 8 and 9, Cath-\\neterization Plate 12; Plate 13, Condition in Artificial\\nProlapse.) The disturbances of the circulation in the\\ninverted parts sometimes cause dysuria, and, together with\\nthe inability completely to empty the bladder, may lead\\nto cystitis and to the formation of vesical calculi.\\nTreatment. Plastic operations to narrow the anterior\\nvaginal wall and to retain the bladder and the vaginal\\nwall in their proper places.\\nINVERSION OF THE UTERUS.\\nThis is an affection, severe in its nature, arising under\\nquite similar circumstances. The chief etiologic factor is", "height": "4604", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0051.jp2"}, "52": {"fulltext": "54 VAGINAL AND UTEEINE INVERSION.\\nPLATE 3.\\nFig. 1.\u00e2\u0080\u0094 Impressio fundi uteri as an initial stage of inversion of\\nthe uterus arises when the organ is relaxed, and Crede s method is too\\nforcibly exercised, or traction is made upon the cord.\\nFig. 2.\u00e2\u0080\u0094 Partial Inversion of the Uterus. A portion of the\\ncervix has not yet become invaginated. The inverted uterus already\\nforms a considerable peritoneal pocket this funnel is filled by the\\ntube and ovary.\\nFig. 3. The uterus has become invagiuated as far as the external\\nos the latter, however, has not descended.\\nFig. 4. The completely inverted uterus protrudes from the vulva\\nthe upper portion of the vagina has also become invagiuated as far as\\nthe constrictor cunni and levator ani.\\nFig. 5.\u00e2\u0080\u0094 Complete Prolapse of the Retroflexed Uterus and\\nof the Vagina with Laceration of the Perineum Cystocele.\\n(See Fig. 28 and Plates 8-10.) The apex of the bladder approaches\\nthe fundus the vesical diverticulum reaches to the internal os the\\npouch of Douglas lies in the prolapse, containing, however, no intestinal\\nloops (enterocele), as sometimes occurs in rare cases the intestines are\\nheld back by the retroflexed corpus uteri. The external os is everted\\nthe cervix is swollen.\\nThis illustration represents one of the extreme possibilities of pro-\\nlapse, and at the same time the most frequent manner of its develop-\\nment.\\na relaxation and dilatation of both the uterine and cervical\\nwalls. The direct cause is most frequently an acute one,\\noccurring in the puerperium (precipitate birth, forced\\nCrede s method, traction on the cord) or one chronic in\\nits nature, such as traction upon the fundus uteri from the\\nexpulsion of a fibroid polyp. If the tumor is submucous,\\nthe mucous membrane alone is drawn down if it is intra-\\nmural, the muscular coat, or even the serous covering, may\\nbe invaginated, so that a peritoneal funnel is formed in\\nwhich the adnexa or intestinal coils (only in puerperal\\ninversions) may lie (Kehrer). The latter may contract", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0052.jp2"}, "53": {"fulltext": "Tab. 3.\\nr\\nTigl.\\nFig. 2.\\nFig.J.\\nFig. 4\\nFig, o.\\nLith.Artst. F Reichhold. Munclien", "height": "4586", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0053.jp2"}, "54": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0054.jp2"}, "55": {"fulltext": "UTERINE INVERSION. 55\\ninflammatory adhesions in cases of lone standing. (Plate\\n3, Fig. 2; Fig. 24.)\\nDifferent degrees of inversion may be differentiated\\ncomplete, including the entire cervix complete, with in-\\nversion of the vagina (inversio uteri cum prolapsu) in-\\ncomplete, as far as the internal os. The slightest degree\\nis the impressio fundi uteri, (Plate 3.) The acute puerperal\\ninversion may become chronic.\\nSymptoms. The mucosa swells and proliferates from\\nthe constriction. It bleeds easily, and ulcers arise from\\nfriction. The ulcerated surfaces may grow fast to the\\nvaginal mucosa, or gangrene may appear. The acute\\npuerperal form occurs with violent symptoms resembling\\nshock.\\nThe chief symptoms are pain and hemorrhage, de-\\npendent upon the nature of the tumor. They render the\\npatient anemic and force her to stay in bed.\\nDiagnosis. An exact portrayal of the existing condi-\\ntions is demanded, as an inverted uterus has been repeat-\\nedly confounded with a polyp, and cut off.\\nIn complete inversion with prolapse we find a red, solid-\\nelastic tumor, which bleeds easily and is sensitive to pres-\\nsure. The uterine orifices of the Fallopian tubes may\\nprobably be recognized.\\nIn incomplete inversion the sound may be passed into\\nthe cervix, beside the tumor (corpus uteri), for quite a\\ndistance further in front than behind (from 3 to 4 cm.).\\nBimanual palpation is of importance it demonstrates the\\nabsence of the uterus from its usual position and the pres-\\nence of the peritoneal funnel.\\nTreatment. If due to a tumor, enucleation of the\\nsame, whereupon the uterus usually reinverts itself spon-\\ntaneously. If irreducible from proliferative thickening of\\nthe uterine wall, amputation of the organ close to the\\nexternal os, carefully closing the peritoneal funnel with\\nsutures. In acute puerperal inversion, manual reposition\\n(as in phimosis), trying to push back the portion in con-", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0055.jp2"}, "56": {"fulltext": "56 VAGINAL AND UTERINE INVERSION\\ntact with the external os first, and making counterpressure\\nfrom the abdomen to prevent elongation and possible\\nlaceration of the vagina.\\nThe earlier the attempt is made, the more likely is it to\\nbe crowned with success. If manual reposition fails, the\\nparts are to be carefully disinfected and pushed back by\\nFig. 24.\u00e2\u0080\u0094 Complete inversion of the uterus from a myoma of the\\nfundus. (See Plate 3.) (Original diagrammatic drawing.)\\nthe colpeurvnter (always to be filled after introduction) or\\nby means of astringent tampons. These are held in posi-\\ntion until the tumor is partly reduced, when the reinver-\\nsion is completed by cold-water injections. Massage of\\nthe uterus assists the action of the colpeurynter, and ergot", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0056.jp2"}, "57": {"fulltext": "VAGINAL AND UTERINE PROLAPSE. 57\\neffects the contraction of the organ. Elevations of tem-\\nperature give warning of the onset of pelvic peritonitis,\\nwhen all attempts at reduction must be discontinued.\\nCeliotomy is indicated only in extreme cases. A better\\nmethod is that of KiAstner, who makes an incision in the\\nposterior vaginal vault, which enables him to incise the\\nposterior uterine wall throughout its entire length, and to\\nrein vert the organ. Kehrer attacks the uterus through\\nthe anterior vaginal vault.\\n?8. PROLAPSE OF THE VAGINA AND UTERUS.\\nWhen the external os sinks below the interspinous\\nplane, we speak of descensus uteri. If in addition to\\nthe descent of the uterus the lower portion of the vagina\\nprotrudes at the vulva, the case is one of incomplete or\\npartial prolapse of the vagina if the vaginal vault also\\nprotrudes, complete prolapse.\\nIn incomplete prolapse of the uterus the cervix alone\\nprotrudes at the vulva in complete prolapse the en-\\ntire organ with the completely inverted vagina, and\\ncystocele or rectocele, or both lies outside of the introitus.\\nThe Normal Situation and Position of the Uterus.\\nThe normally situated uterus lies in the true pelvis in a position of\\nanteversion. The anterior surface is obliquely placed, lacing the\\nbladder the posterior surface is strongly convex, and is parallel to the\\nupper sacral curvature. The longitudinal axis of the organ passes\\nfrom above downward, and from before backward. If fixed points\\nare desired, the fundus marks the center of the conjugate vera, and\\nthe external is in the interspinous plane, being somewhat nearer to\\nthe sacrum than to the symphysis. (Plates 14 and 22.)\\nThis position is not a constant one, however the uterus is in a\\ncondition of unstable equilibrium, the fundus descending with every\\ninspiration. In the upright position the fundus is still lower, while\\nthe cervix becomes more elevated. It is balanced upon an axis of\\nfixation corresponding to the internal os, this portion of the neck\\nbeing suspended from the pelvis and sacrum by the supravaginal con-\\nnective tissue and the involuntary muscle-fibers of the uterosacral\\nligaments. In the dorsal position the fundus goes backward and the\\ncervix approaches the symphysis. The position is also dependent upon", "height": "4601", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0057.jp2"}, "58": {"fulltext": "58 VAGINAL AND UTERINE PROLAPSE.\\nPLATE 4.\\nFig. 1. Incomplete Prolapse of a Retro verted Uterus;\\nMarked Rectocele Vaginal Inversion.\\nFig. 2. Incomplete Prolapse of the Uterus, Due to Hyper=\\ntrophy of the Intermediate Portion of the Neck Inversion of\\nthe Vagina with Cystocele. (See Plate 12.) The fundus of the\\nuterus is nearly at its normal height. The sound shows the uterine\\ncanal to be longer than normal (longer than 5 or 6 cm.). The distance\\nfrom the internal to the external os demonstrates the elongation to be\\nin the intermediate portion of the cervix. The portion of the neck\\nthat is elongated is further shown by the relation of the anterior\\nand posterior vaginal fornices to the external os and to the internal os.\\nThe illustration shows the posterior vaginal vault at its usual\\nheight in the pelvis the anterior, however, is lower, and yet holds its\\nusual relation to the external os consequently, it is not the intra-\\nvaginal cervix that is hypertrophied, but the middle portion of the neck,\\nsituated between the anterior and posterior vaginal fornices and lying\\nhigher up.\\nFig. 3\u00e2\u0080\u0094 Total Prolapse of Anteflexed Uterus and of the\\nAnterior Vaginal Wall, with Cystocele Characteristic Flexion\\nof the Urethra. (See also Plates 8 and 9, Introduction of Catheter.)\\nFig. 4.\u00e2\u0080\u0094 Complete Prolapse of Retroflexed Uterus (First\\nDegree) and of Vagina. Small rectal and vesical diverticula.\\nPLATE 5.\\nFig. 1.\u00e2\u0080\u0094 Prolapse of Posterior Vaginal Wall; Rectocele;\\nDescent of Retroflexed Uterus (Second Degree). The posterior\\nvaginal wall seldom becomes inverted first a rectal diverticulum may\\nform in the pouch, demonstrable to the introduced finger.\\nFig. 2. Prolapse of the Anterior Vaginal Wall Extreme\\nGrade of Cystocele Anteflexion of the Uterus (First Degree);\\nDescent of the Uterus. Evidence of the existence of a cystocele\\nis obtained by the catheter. (See Plates 8 and 9.)\\nFig. 3. Reposition of Prolapsed Uterus by a Martin Stem=\\npessary. (Original diagrammatic drawing, modified according to\\nSchroder. This pessary is applicable when the genitalia are room} r or\\nrelaxed. The stem rests upon the levator ani, receiving lateral sup-", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0058.jp2"}, "59": {"fulltext": "*2", "height": "4590", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0059.jp2"}, "60": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0060.jp2"}, "61": {"fulltext": "*6\\nI", "height": "4584", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0061.jp2"}, "62": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0062.jp2"}, "63": {"fulltext": "UTERINE SUPPORTS. 59\\nport if it slips to one side. This case is one of pseudoprolapse,\\nbecause the reposition nuduly elevates the fundus, anteflexes the body,\\nand draws up a diverticulum from the bladder. The condition is\\nreally elongation of the neck, and amputation is indicated.\\nFig. 4.\u00e2\u0080\u0094 Hypertrophy of the Anterior Lip of the Uterus,\\nProducing Inversion of the Anterior Vaginal Wall and Cys=\\ntocele. (Original diagrammatic drawing modified according to\\nSchroder.)\\nthe degree of distention of the bladder and rectum. (See 10 and\\n11, Plate 17, Fig. 2 Plate 14, Figs. 1 and 4\\nThe uterus is not really suspended, but the ligaments limit the\\nexcursions of the organ beyond a certain point. It really rests indi-\\nrectly upon the floor of the pelvis, the external os pressing against the\\nposterior vaginal wall, and the cervix being grasped by the connective\\ntissue surrounding the vaginal vault. The latter is partly held up by\\nligaments, but more particularly by the vaginal walls themselves,\\nthese in turn deriving their support from the pelvic floor (con strict ores\\ncunni, levatores ani) and perineum. The integrity of the perineum\\nis consequently a most important factor in preventing the descent of\\nthe internal genitalia, the ligaments being a secondary consideration.\\nIt is not to be forgotten that the uterine supports may be insufficient\\nto withstand an increased pressure from above (tumors) or traction\\nfrom below. These structures are assisted by atmospheric pressure\\nwhen the patient is in the knee-elbow position, and Sims speculum\\nis introduced. The round ligaments resemble a bridle, having no\\nsupportive action.\\nThe size of the uterus also influences the existing conditions.\\nThe recto-uterine fold of peritoneum is normally 7 cm. above the\\nanus the vesico-uterine, lh cm. above the urethral orifice. Note the\\nfollowing measurements\\nLength of the uterus (external measurement)\\nIn virgins 6-8 cm. weight, 40 gm.\\nIn married women 8-10 u 100 u\\nWidth\\nf^ e 4/. f in virgins 4-5 cm.\\nOx the fundus te rl nl u\\ntin married women 5^-6^\\nOf the neck 2 -2|\\nThickness t^\u00e2\u0084\u00a2gms 2 -3\\n(in married women .3 -3 J\\nLength of uterine cavity\\nEntire.\\nIn the immature uterus 2.6\\nIn the mature virginal uterus .5.4\\nIn the uterus that has been gravid .5.9\\nThe corporeal secretion of the uterus is thick and oily the cervical,\\nalbuminoid or mucoid. Both are alkaline and contain mucin (coagu-\\nlated by acetic acid).\\nBody.\\nNeck.\\n0.8\\n1.8\\n3.2\\n2.2\\n3.3\\n2.6", "height": "4585", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0063.jp2"}, "64": {"fulltext": "60 VAGINAL AND UTERINE PROLAPSE.\\nThe prolapsed mucous membrane of the vagina and\\nvaginal cervix becomes either excoriated (Plates 8 and\\n10) or covered with a thickened layer of epithelium, the\\nsuperficial strata of which are horny in character. (Plate\\n28, Fig. 2.) The lips of the cervix are everted. (Plates\\n10 and 12, Figs. 28 and 29.) The introitus vaginae\\n(about 1 or 2 cm. of the vagina) maintains its normal\\nposition, even in extreme cases, forming a swollen ring\\nabout the prolapsed tumor. The latter consists of the\\nvagina and uterus, and contains diverticula from the\\nbladder and rectum. (Plates 10 and 13.) The urine\\n(or fecal matter) stagnates in these pouches, inducing\\ncatarrh and the formation of calculi especially as the\\nurethra is usually sharply bent upon itself. If the lower\\nand posterior half of the bladder forms the diverticulum,\\nthe ureters are likewise bent at an acute angle and may\\ngive rise to hydronephrosis. (Plate 4, Fig. 3 Plate 5,\\nFig. 2 Plate 12.) Retroversion of the uterus acts as a\\npredisposing cause for this condition of affairs (and for\\nprolapse generally), especially when it is combined with\\nlaceration of the perineum (loss of support for vaginal\\nwall) or descensus uteri. (Plate 4, Fig. 1 Plate 5,\\nFig. 1 Plate 13 Plate 19, Fig. 1.) Even the apex of\\nthe bladder and the vesico-uterine fold of peritoneum may\\nbe in the tumor. As the pouch of Douglas is in close\\ncontact with the posterior vaginal vault, it is likewise\\nwell down in the prolapse, and may accommodate a loop\\nof intestine. (Plate 4, Fig. 4 Plate 13.)\\nThe development of the prolapse is as follows\\nThe anterior vaginal wall loses its normal support, either\\nfrom perineal laceration (Plate 54) or from weakness of\\nthe pelvic floor. (Plates 6, 7, 25, 27.) The tuberculum\\nvaginae sinks down first, and remains between the nymphae.\\nThen the upper portion of the vagina begins not only to\\ndescend, but also to invaginate itself, as may be demon-\\nstrated every time the patient bears down. The cervix\\nof the still normally anteverted uterus is drawn downward", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0064.jp2"}, "65": {"fulltext": "BE VELOPMENT. 6 1\\nand forward. (Plate 54, Figs. 2 and 3.) By this time\\nthe posterior vaginal wall commences to prolapse, making\\ntraction upon the posterior vaginal vault and, through it,\\nupon the uterus. (Plate 54, 4.) This organ assumes\\nfirst a vertical position, and then one of retroversion, its\\nlong axis running parallel with that of the vagina, which\\nis now more vertical. At this time the slightest sudden\\npressure from above, a fall, or a series of similar factors\\nacting in a like manner is sufficient to effect prolapse of\\nthe uterus. (Fig. 26.) The same pressure from above,\\ntogether with the usually existing relaxed uterine wall,\\ncauses a bending of the body toward the cervix retro-\\nflexio uteri. The relations of the bladder and peritoneal\\nfolds are shown in plates 4 and 5, and in figures 27 and\\n28.\\nIf the prolapse is complete, the pressure acts still\\nfurther, everting the cervical mucosa (in extreme cases as\\nfar as the internal os), which swells and becomes eroded.\\n(Plates 8, 10 Fig. 28.) A lividity of the cervix results\\nfrom the circulatory disturbances. (Plate 10.) In chronic\\ncases this congestion leads to inflammation and prolifera-\\ntion giving rise not only to polyps of the mucous mem-\\nbrane, but also to secondary enlargements and elongations\\nof the uterine neck elongatio colli. (Plates 4, 5, and 12\\nFig. 25.)\\nThe body of the uterus takes little part in the process.\\nThe superficial epithelial layer becomes horny. (Plate 28,\\n2.) The muscular coat of the vagina becomes thickened,\\nand the adipose tissue disappears.\\nSymptoms. When the patient stands or walks, she\\nfeels as though the descending organ would fall out if the\\nprolapse is complete, it impedes her movements it be-\\ncomes ulcerated and painful from rubbing the same is\\ntrue of the thigh. The vaginal and cervical mucosae be-\\ncome inflamed, not only secreting mucopus, but causing\\nprofuse and painful menses. The prolapsed parts are\\nmuch enlarged at first from stasis, later from prolifera-", "height": "4601", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0065.jp2"}, "66": {"fulltext": "62 VAGINAL AND UTERINE PROLAPSE.\\nPLATE 6.\\nInversion of the Posterior Vaginal Wall. Leukorrhea in-\\ntact perineum. (Original water-color.)\\ntion of the connective tissue. (Chronic Metritis, Plates 28\\nand 32.) The dragging upon the adnexa calls forth ner-\\nvous and dyspeptic symptoms. Defecation and urination\\nare interfered with from secondary retention. Aside from\\nits subjective discomfort, secondary inflammation of the\\nperitoneum, by encapsulating the tubes and ovaries in\\nexudate, leads to sterility. Structural changes in the\\nuterine mucosa and the difficulties attendant upon cohabita-\\ntion and upon retention of the semen are productive of\\nthe same result. The organs become fixed in their abnor-\\nmal position.\\nEtiology. Congenital prolapse of the uterus is one of\\nthe greatest rarities. I found such a case in a child with\\nhydromeningocele at the Munich Frauenklinik (Fig. 25)\\nI saw a second in the Heidelberg Frauenklinik in 1894. 1\\nIt is also a rare condition in the virgin, being here caused\\nby heavy lifting. The most frequent causes are found in\\npuerperal injuries and too early attempts at straining, since\\nat this time the uterus already has a tendency to assume\\nor maintain a retrodeviation. Severe labors (forceps) lead\\nto perineal lacerations and to stretching and relaxation of\\nthe genital walls and suspensory apparatus. (See explana-\\ntions of Plates 13, 17, and 54 also p. 57.)\\nRetroversion of the uterus is easily produced by puer-\\nperal subinvolution with a relaxed vagina, chronic inflam-\\nmatory conditions, frequent labors in delicate women, and\\ntumors that force the uterus downward. Immediately\\nafter every normal labor the anterior lip of the cervix\\nmay be palpated, just within the introitus vaginae.\\n1 Described in Arch. f. Gyn. by Dr. Heil. At that time I knew\\nof only a third similar case (Qviesling, C.f. Gyn., 1890) since then\\nseveral have been published.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0066.jp2"}, "67": {"fulltext": "Tab. 6.", "height": "4585", "width": "3086", "jp2-path": "atlasepitomeofgy00scha_0067.jp2"}, "68": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0068.jp2"}, "69": {"fulltext": "PROGNOSIS. \u00e2\u0080\u0094DIA GNOSIS.\\n63\\nPrognosis. The danger of acute gangrene from con-\\nstriction is a remote one. The condition is weakening\\nfrom all the preceding manifestations. The excoriations\\npredispose to epithelioma (v. AVinckel).\\nDiagnosis. In many patients the prolapse recedes\\nwhen they lie down or remain quiet but any increase of\\nthe intra-abdominal tension (coughing, lifting, straining at\\nstool) causes it to descend, or to protrude from the vulva.\\nFig. 25. Congenital incomplete prolapse of the uterus from a\\nmature fetus with hydromeningocele (Munich Frauenklinik, 1889\\nArch. f. Gyn., 37, 2). Hypertrophy of the middle portion of the\\nneck inversion of the vaginal vault marked development of the\\novarian arteries, with iliac arteries of small lumen. The os is notched,\\nand a slight ectropion is present.\\nThe exact contents of the prolapse must be determined.\\nDoes it contain the uterus How much of the vagina\\nAre vesical or rectal diverticula present A number of\\nconclusions may be drawn from inspection. (Figs. 26 to\\n29 Plates 8 to 10.) The external os, the cervical canal,\\nand the length of the uninverted portion of the vagina\\nare recognized by exploration with the finger and sound.", "height": "4614", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0069.jp2"}, "70": {"fulltext": "6-1 VAGINAL AND VTERIXE PBOLAPSE.\\nPLATE 7.\\nFig. 1. Inversion of the vagina from a perineal tear of the\\nthird degree (into the rectum) the tuberculum vaginae has descended.\\n(Original water-color.)\\nFig. 2. View of the Cervix in a Case of Elevation of the\\nUterus. The cervix does not present itself as a free projection into\\nthe vagina, but forms the apex of the vaginal fannel. The oval ex-\\nternal os gapes slightly.\\nPalpation from the rectum demonstrates the existence of\\na proctocele and, in doubtful cases, the absence of the\\nuterus from its usual position. The direction taken by\\nthe vesical diverticulum is shown by the catheter.\\nIf the uterus is completely prolapsed, it may be grasped\\noutside of the vulva, and a retroflexed (common), ante-\\nflexed, or vertical position may be recognized. (Figs. 26 to\\n29.)\\nIn an incomplete prolapse the differential diagnosis\\nfrom cervical hypertrophy must be made. The dis-\\ntance from the external to the internal os is to be meas-\\nured with the graduated sound (the normal uterus has a\\ncervical canal 6 cm. long). The internal os is recognized\\nby the resistance that it offers to the passage of the\\nknobbed tip of the sound. The distance that the ante-\\nrior and posterior vaginal vaults extend above the exter-\\nnal os is also to be determined. (Plates 12 and 15.)\\nFinally, it must be ascertained whether the uterus is\\nfreely movable in its hernial sac, or adherent to its adnexa\\nand to the descended coils of intestine.\\nTreatment. Prophylactic. Perineal lacerations are\\nto be repaired at once. If the puerperal uterus is inclined\\nto retrodeviation, keep the patient on her side as much as\\npossible. She should never get up before from the tenth\\nto the fourteenth day, and if the foregoing predisposing\\ncauses of prolapse exist, she should be kept in bed for two\\nor three weeks, and then forbidden to lift or to do hard", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0070.jp2"}, "71": {"fulltext": "GROUP I.\\nANOMALIES OF FORMATION AND\\nARRESTED DEVELOPMENT.\\nCHAPTER I.\\nFETAL ANOMALIES OF FORMATION.\\nThe anomalies of formation of the female genitalia are,\\nalmost without exception, examples of arrested develop-\\nment. The differentiation of the Miillerian ducts is im-\\nperfect or does not occur the customary fusion fails to\\ntake place, or the ducts unite to form a single tube of\\nlimited extent. Defects of the entire genital tract or of\\nindividual organs are thus explained, as are also the con-\\ngenital atresias, fistulas, and partial or complete duplica-\\ntions of the genital tube (Kussmaul).\\nThe following forms are of clinical importance\\ni i. APLASIA AND HYPOPLASIA OF THE FETAL RUDI=\\nMENTS.\\n1. Absence of the uterine appendages.\\n2. Absence of the uterus.\\n3. Absence of the entire genital tract, with or with-\\nout\\n4. Pseudohermaphroditism.\\n5. Uterus unicornis i. e., absence of a portion of one\\nof the Miillerian ducts (Fallopian tube attached to the\\nuterine portion of one Miillerian duct),\\n2 17", "height": "4603", "width": "2785", "jp2-path": "atlasepitomeofgy00scha_0071.jp2"}, "72": {"fulltext": "18\\nAN03TALIES OF FORMATION.\\n6. Atresias which may be cord-like or diaphragmatic\\nin the cervix (corresponding to the internal or external\\nos) in the vagina, hymen, or vulva.\\n7. Congenital rectovaginal or recto vulvar fistulas (atre-\\nsia ani vaginalis or hymenalis, cloaca vaginalis, or fistula\\nrectovestibularis).\\n8. Feminine epispadias and hypospadias.\\ni and 2. Total absence of the uterus and its ap-\\npendages is very rare, and usually is first discovered at\\npuberty. Solid bundles of muscle-fibers pass up from\\nFig. 1. The fetal genitalia cut open in a median sagittal plane, so\\nthat the divided symphysis is thrown hack on either side. Absence\\nof the uterus (original drawing, from a preparation in the Munich\\nFrauenklinik).\\na rudimentary vagina and through the broad ligament,\\nwhich can be recognized as a small transverse partition in\\nthe pelvis. The vulva is well developed, as a rule, the\\nmost striking external defects being a stunted clitoris, ab-\\nsence of the pubic hair, and smallness of the breasts.\\nThe ovaries, on the contrary, are absent or but par-\\ntially developed. The Fallopian tubes are patulous only\\nin their ampullae. In one case I found at autopsy 1 a\\n1 In a fetus at the Munich Frauenklinik, Arch. f. Gym, 37, 2.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0072.jp2"}, "73": {"fulltext": "ABSENCE OF GENITAL TRACT. 19\\ntotal absence of the uterus and its appendages, with an\\nelongated vagina. One portion of the fetal rudiments had\\nformed this blind pouch, without any attempt at differen-\\ntiation of a cervix. (See Fig. 1.)\\nSymptoms. From the fact that the ovaries are absent\\nit follows that the sexual instinct is usually wanting,\\nalthough it may be present. The most striking symptom\\nof all nonappearance of the menses at puberty may go\\nhand in hand with the periodic appearance of the men-\\nstrual molimina.\\nShould such individuals indulge in sexual intercourse,\\nnew troubles arise from the forcible dilatation of the rudi-\\nmentary vagina, or frequently of the urethra (incontinence\\nof urine sometimes) (Plate 19, Fig. 2), especially since\\nthe latter often has a funnel shape, owing to a dropping\\nback of the posterior wall.\\nDiagnosis. Bimanual examination establishes the ab-\\nsence of the uterus. (Plate 19, Fig. 2 Plate 21, Fig. 2.)\\nThe finder is introduced into the rudimentary vagina or\\nrectum, and counterpressure is made either through the\\nabdominal Avail or by introducing a sound or the finger\\ninto the bladder after dilatation of the urethra, or by tam-\\nponade of the vagina. The uterus and adnexa are to be\\nsought for above the vaginal rudiment. Their recognition\\nis by no means easy.\\n3 and 4. Absence of the entire genital tract renders\\nthe individual sexless, and may exist without any other\\nmalformation sufficient to endanger life. The vulva may\\nbe entirely wanting or it may be well developed. In a\\ncase that I saw the latter condition obtained, together\\nwith a hymen so yielding that it could be pushed in for\\nseveral centimeters. The individual was subsequently\\nmarried to her lover, who was fully cognizant of her\\ngenital peculiarities.\\nThe clitoris may be robust the labia majora may be\\nfused, forming a median raphe the nymphse may be de-\\nformed and the genital fissure may be closed or so short-", "height": "4590", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0073.jp2"}, "74": {"fulltext": "20 ANOMALIES OF FORMATION.\\nened that the case assumes a pseudohermaphroditic char-\\nacter. In this event a careful examination will reveal\\ngenital glands in the labia majora in fact, the labia\\nmajora not only resemble the scrotum, but may contain\\ntesticles.\\nThis condition is known as pseudohermaphroditism. 1\\nIf testicles and ovaries are found in the same case, we call\\nthe individual a true hermaphrodite. No such case has\\nbeen established beyond a doubt. Most pseudohermaph-\\nrodites have proved themselves to be males, and some\\nof them are capable of procreation, the latter being espe-\\ncially true when the genital eminence is well developed\\nand the catheter demonstrates a culdesac in the posterior\\nurethral wall. Female pseudohermaphroditism is always\\nassociated with vaginal atresia.\\nTreatment. When the uterus does not exist, the\\nattempt to make an artificial vagina is aimless and futile.\\nIn such a case it is the duty of the physician to explain\\nthe condition of affairs to the patient and to treat the\\nmenstrual molimina symptomatically (narcotics and ex-\\nternal derivatives, oophorin tablets, castration). In cases\\nof hermaphroditism the predominant sexual type should\\nbe determined as accurately as possible, since it has fre-\\nquently happened that the conjugal relation has been\\nassumed and the individual has first become conscious of\\nhis or her true sex during married life.\\n5. Uterus Unicornis. It sometimes happens that one\\nMullerian duct remains rudimentary or imperfectly differ-\\nentiated into its corresponding half of the uterus and\\nappertinent tube. This half has a weaker muscular coat\\nand the uterus is narrower, pointed, and possesses a horn\\ncurving toward the better-developed side. (Fig. 2.) The\\nmildest degree of this condition is known as uterus inse-\\n1 The germinal glands are mostly rudimentary the other sexual\\nattributes are those of the opposite sex. Gynandres marked degree\\nof male hypospadias, including scrotum a stunted penis testicle\\nstill in the abominal cavity or inguinal canal. Viragines adhesion of\\nthe labia, enlarged clitoris menstrual hemorrhages.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0074.jp2"}, "75": {"fulltext": "UTERUS UNICORNIS.\\n21\\nqualis, and arises from arrested development of one side. 1\\nThe outcome of pregnancy and labor in such a case is\\nportrayed in the u Atlas of Obstetric Diagnosis and\\nTreatment (second edition, Munich). The tube and\\novary may be absent on the rudimentary side, or there\\nV:\\nv ^i^^SS-\\nI\\nI\\nj\\nX.,\\nFig. 2. Uterus unicornis dexter left half developed only as an\\nelongated tube. Hymen septus (prepared as in Fig. 1).\\nmay be a longer, undifferentiated tube, which is either\\nsolid or partly patulous. In such cases the extra-uterine\\n1 In two fetal cases I found that the round ligament was not\\ninserted into the angle between the uterus and the tube, but radiated\\ntoward the latter. The broad ligaments and tubes of the two sides\\nwere of unequal length.", "height": "4595", "width": "3071", "jp2-path": "atlasepitomeofgy00scha_0075.jp2"}, "76": {"fulltext": "22 ANOMALIES OF FORMATION.\\ntransmigration of spermatic filaments or ova has been\\nknown to occur.\\nThe early diagnosis of pregnancy is of great import-\\nance, because the rudimentary horn usually ruptures or a\\nfalse diagnosis of extra-uterine pregnancy may be made.\\n6, 7, and 8. Atresias may be found in any portion\\nof the genital apparatus. These may be explained in\\nvarious ways\\n(a) They represent an arrested development in early\\nembryonic life, when the Mullerian ducts are simply solid\\ncolumns of cells. Such atresias are usually cord-like and\\naffect a considerable portion of the duct. (See obliterated\\nvagina, Plate 19, Fig. 2.)\\n(b) The retarded develop-\\nment may occur a little later,\\nfrom the fourth to the sixth\\nweek, and certain invagina-\\ntions or openings of one hollow 7\\nviscus into another do not\\noccur, resulting in atresia\\nvulvse, atresia ani, or atre=\\nsia urethrse.\\nFig. 3. Atresia ani con- rrn -\\\\n\\ngenitfl rectovaginal fistula These malformations may\\n(above the hymen). occur alone or in combination\\nwith o t h e r d e velopm e n tal\\nerrors, such as a persistent cloaca L e\\\\, that embryonic\\ncavity that connects the bladder with the rectum and is\\nclosed externally. (Fig. 12.) The external opening first\\nappears when the rectovesical septum, containing the\\nMullerian ducts, grows down and forms the perineum.\\n(Figs. 12 to 16.) Certain atresias combined with con=\\ngenital fistulas may be traced back to this embryonic\\nperiod atresia ani with a rectovaginal fistula atresia\\nani vaginalis. (Fig. 3.)\\nImperfect closure of the primitive urethra toward the\\nvagina gives rise to the rare condition known as femi=\\nnine hypospadias (to be explained on etiologic and ana-", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0076.jp2"}, "77": {"fulltext": "ATRESIAS.\\n23\\ntomic grounds different from those of a similar condition\\nin the male). Imperfect closure toward the clitoris\\nfeminine epispadias is still rarer, and is usually asso-\\nciated with a fissured clitoris, a cleft symphysis (pelvis\\nfissa), and inversio (ectopia)\\nvesicae i. e., absence of the\\nanterior wall of the bladder,\\nthe posterior wall being\\nplainly visible.\\n(c) The fistula rectohy=\\nmenalis or rectovestibu=\\nlaris (Fig. 6) springs from\\na later period of the em-\\nbryonic cycle, and differs\\nfrom the rectovaginal fistula\\nin that the opening is in\\nthe vulva, outside of the hymen. It dates from the forma-\\ntion of the perineum (consequently, later than the cloaca),\\nwhich is formed by the union of the septum urogenito-\\nFig. 4. Hypospadias; posterior\\nwall of urethra is wanting.\\nFig. 5. Epispadias anterior\\nwall of urethra is wanting clit-\\noris nssa.\\nFig. 6. Recto vestibular or\\nrectohymenal fistula with con-\\ngenital atresia ani.\\nrectale with two lateral eminences, which have grown\\ndown and fused by a perineal raphe. (Figs. 1\u00c2\u00b1 to 16.)\\n(c?) A fourth group of atresias originates in this fetal\\nperiod, or at a much later one, in the shape of inflamma-", "height": "4597", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0077.jp2"}, "78": {"fulltext": "24\\nANOMALIES OF FORMATION.\\ntory adhesions. These are much more likely to assume a\\ndiaphragmatic character. Examples of these are seen in\\natresias of the vulva and of the hymen and in closure of\\nFig. 7. Atresia hymenalis,\\nhematocolpos, hematometra, an I\\nhematosalpinx (both the internal\\nand the external os may be rec-\\nognized).\\nFig. 8. A t r e s i a vaginalis\\nfrom a transverse membrane\\n(both the internal and the exter-\\nnal os may be recognized).\\nPartial hematocolpos, hemato-\\nmetra, partial hematosalpinx of\\nboth sides.\\nthe vagina, of the cervix, and of the uterine orifices by\\ntransverse bridges of mucous membrane. Atresias may\\nFig. 9. Atresia cervicalis\\nuteri. Hematometra, hemato-\\nsalpinx (internal os may be rec-\\nognized external os free).\\nFig. 10. Atresia vaginalis\\nwith uterus and vagina duplex\\nleft-sided partial hematocolpos,\\nhematometra, hematosalpinx\\n(both the internal and the exter-\\nnal os may be recognized).\\nalso be encountered in cases of uterus bicornis. (Figs.\\n7 to 11.)", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0078.jp2"}, "79": {"fulltext": "ATRESIAS.\\n25\\nFig. 11. Atresia of the ex-\\nternal orifice of a bicornate\\nuterus left-sided hernatometra,\\nhematosalpinx.\\nSymptoms. The symptoms of the genital atresias\\nvary, and appear at different periods of life, according to\\ntheir nature. Every new-\\nborn child should be care-\\nfully examined as to the per-\\nmeability of the urethra and\\nanus. This is frequently\\nneglected, and anal atresia,\\nor even complete closure of\\nthe urethra, is discovered\\nonly after days, either by\\naccident or through symp-\\ntoms of retention.\\nThe hymen also deserves\\nattention, for although atre-\\nsia in this situation is usually first discovered at puberty,\\nthere are recorded cases in which the menses had never\\nappeared, owing to the pres-\\nence of this anomaly, and\\nyet the condition remained\\nunrecognized until the\\npatient assumed the marital\\nrelation. The cardinal\\nsymptom of all genital atre-\\nsias, with the exception of\\nthose cases of uterus bi-\\ncornis in which one side\\nis patulous, is nonappear-\\nance of the menses. In-\\ncreasing distention of the\\ngenital tract by mucus and\\nby menstrual blood is the\\ncause of the earliest dis-\\nFig. 12. For the sake of\\nsimplicity, the two Miilleriau\\nducts are drawn one behind the\\nother, instead of side by side.\\nThey empty into the cloaca,\\nwhich connects the bladder\\n(allantois, V) and the rectum\\n(B), and which has no external\\nopening. A slight invagination\\nindicates the position of the\\nfuture anus, and a similar one,\\nthe urogenital sinus.\\nturbances. According to\\nthe location of the atresia, we have a hematocolpos, a\\nhernatometra, or a hematosalpinx.\\nThe symptoms are as follows Pain, at first periodic", "height": "4598", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0079.jp2"}, "80": {"fulltext": "26\\nANOMALIES OF FORMATION.\\nFig. 13.\u00e2\u0080\u0094 The Miillerian ducts\\nare of larger lumen, and have\\ndescended with the rectovesical\\nseptum to empty into the open\\ncloaca (P peritoneum).\\nand then continuous, with exacerbations similar to the\\npains of labor vesical and rectal disturbances indiges-\\ntion and vomiting, due to the\\npressure of the accumulated\\nblood. Hematosalpinx oc-\\ncurs in uterine atresias\\nearlier than in those of the\\nvagina. (Plate 40, Fig. 2.)\\nIt is dangerous on account\\nof the ease with which the\\ntubal wall may be torn,\\nand consequently the ex-\\namination should be con-\\nducted with great gentle-\\nness. The peritoneum is\\nfrequently subjected to inflammatory irritation by the\\nescape of small quantities of blood from the tubal ostia.\\nThe same dangers exist in\\ncollections of blood in closed\\nrudimentary cornua.\\nIn unilateral atresia of a\\ndouble genital canal (uterus\\nseptus cum vagina septa)\\nwe have less to fear, as the\\nhematoma is more likely to\\nrupture into the patulous\\nside. (Figs. 10 and 11.)\\nThe bloody tumor may\\nundergo putrefactive or sup-\\npurative changes. When\\nonly one genital canal exists,\\nrupture commonly occurs\\nthrough a thinned-out por-\\ntion of the cervix. The\\nFig. 14. The two Miillerian\\nducts have fused to form the\\nuterus U) a septum still exists\\nin the fundus. The sinus uro-\\ngeuitalis is longer (S. u.). G\\ngenital eminence future cli-\\ntoris Pe perineum. The ure-\\nthra opens high up, and is still\\nmore marked than the genital\\ncanal.\\nblood may escape into the\\nperitoneal cavity (peritonitis) or beneath the peritoneum,\\nextending down around the vagina to the floor of the\\npelvis hsematoma vulvae or vaginae.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0080.jp2"}, "81": {"fulltext": "ATRESIAS.\\n27\\nFig. 15. External genitalia\\nof figures 14 and 16. Behind the\\nrelatively important genital emi-\\nnence (clitoris) the opening of\\nthe sinus urogenitalis (G) is seen,\\nand posterior to this, the aims\\n(A).\\nIn atresia ani vaginalis the feces escape through the\\nvagina. (Fig- 3.) If the closure is sphincter-like, a\\nperiodic discharge of gas\\nand feces occurs. When\\nthe opening is high up in\\nthe vagina, retention is im-\\npossible despite the strictest\\ncleanliness. If the opening\\nis small or the intestine is\\nbent at an acute angle, in-\\nflammatory and obstructive\\nsymptoms may manifest\\nthemselves. The same is\\ntrue, mutatis mutandis, of\\natresia ani vestibularis (Fig.\\n6) and anus perinea lis.\\nComplete absence of peri-\\nneum may also be observed\\nfrom failure of fusion of\\nthe lateral eminences. Incontinence of urine exists with\\nthe more marked degrees of hypospadias, and especially\\nwith epispadias. (Figs. 4\\nand 5.)\\nDiagnosis. Persistent\\nnonappearance of the\\nmenses always demands an\\nocular inspection of the\\nparts. AY hen vaginal or\\nhymenal atresia exists, the\\nbluish prot r udi n g m e m-\\nbrane is seen, while cervi-\\ncal atresia renders the pas-\\nsage of the uterine sound\\nimpossible. Should the\\nclosure be at the internal os, the cervix alone is patulous\\nif at the external os, it is impervious. In unilateral\\natresia of duplicate genitalia one side will not permit the\\nintroduction of a sound.\\nFig. 16. Further descent of\\nthe urogenital septum, thereby\\nshortening the sinus nroueni talis", "height": "4593", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0081.jp2"}, "82": {"fulltext": "28\\nANOMALIES OF FORMATION.\\nPalpation completes the diagnosis. The finger is in-\\ntroduced into the rectum, and a firm elastic tumor is felt\\nanteriorly, above which the uterus is recognized as a small\\nhard body. If the distention is more marked, the uterus\\nassumes an hour-glass shape, in consequence of the resist-\\nance of the internal os. The tubes should be sought for,\\nexercising great care and gentleness. (Figs. 7 to 11.)\\nCord-like atresia of the vagina is recognized by bi-\\nmanual palpation through the rectum. (Plate 19, Fig. 2.)\\nFig. 17.\u00e2\u0080\u0094 During the fifth\\nfetal month the cervix (both\\nvagina] and supravaginal) is\\ndifferentiated from the vagina\\n(Vg.). The urethra is also\\nto be distinguished from the\\nbladder. The vesicovaginal\\nseptum assists in the formation\\nof the vestibule.\\nFig. 18. Scheme of the completed\\ngenitalia after the formation of the\\nhymen.\\nTreatment. The gynatretic membrane should be\\nincised without delay, and the blood should be shirty\\ndrained off. Collapse has followed when the latter caution\\nhas not been observed. If a tubal sac has ruptured,\\nimmediate celiotomy and removal of the blood are indi-\\ncated. Abdominal section is also demanded when the\\nhematometra is in a rudimentary accessory cornu. If\\nuterus bilocularis or vagina bilocularis (with a septum)", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0082.jp2"}, "83": {"fulltext": "DUPLICATION. 29\\nexists, it is better to excise the entire partition than simply\\nto incise it.\\nCases of pyocolpometra from secondary infection of the\\nretained blood are treated in a similar manner, a drainage-\\ntube being introduced and the cavity being washed out\\nseveral times daily.\\nIf there is a complete absence of the vagina (Plate 19,\\nFig. 2), its position being indicated by a fibrous cord, a\\nnew vagina must be made. Sounds are passed into the\\nbladder and rectum, and the operator cautiously dissects\\nup through the connective tissue. Skin-grafting should\\nbe employed to prevent a cicatricial closure of the newly\\nformed tube. If adhesions occur in spite of this, or if,\\nfrom the nature of the case, they are to be dreaded from\\nthe beginning, the ovaries should be removed by abdom-\\ninal section and the uterus should be sutured into the vulvar\\nwound, in order to prevent a subsequent hydrometra.\\nCongenital defects of the perineum and epispadias and\\nhypospadias are to be repaired by plastic operations. In\\natresia ani vaginalis the rectum is brought down through\\nthe perineum as far as possible, and is connected with an\\nartificial perineal anus. The fistula then closes either\\nspontaneously or after mild cauterizations.\\n2 2. HYPERPLASTIC ANOMALIES OF FORMATION.\\ni. Duplication of Entire Organs.\\n(a) Of the whole genital tract\\na. Uterus didelphys i. e., uterus and vagina grow as the two\\nMiilleriau ducts (Figs. 12 and 13), and remain without further\\ndifferentiation as two solid cords or as two tubes\\nUterus et vagina duplex i. e two genital tubes completely\\ndifferentiated into uteri and vaginae. These lie side by side\\nand each possesses a tube and an ovary.\\nBoth these malformations are seen only in those monsters incapable\\nof independent life. At the Munich Frauenklinik I observed two\\nexamples of type a, with ectopia viscerum, total absence of bladder\\nand kidneys, persistent cloaca, etc.; and one of type with eventra-\\ntion of all the intestines in an umbilical hernia and with atresia ani.\\nDuplication of the vulva is sometimes seen, but has no clinical\\nsignificance. Arch. f. Gyn., 37, 2.)", "height": "4608", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0083.jp2"}, "84": {"fulltext": "30\\nANOMALIES OF FORMATION.\\n(b) Of the uterine appendages ovaries, tubal ostia\\narising from a division of the Mullerian ducts.\\n(c) Of the uterus: bicornis. (Plate 2, Figs. 2 and 19.)\\nThose portions of the Mullerian ducts that should form\\nthe body of the uterus do not fuse, but develop sepa-\\nrately, remaining attached to a common neck. This mal-\\nformation may be associated with the one to be described\\npresently.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0084.jp2"}, "85": {"fulltext": "DUPLICATION.\\n31\\nIn the mildest degree of duplication of the uterus the\\nfundus simply shows a depression uterus introrsum arcu-\\natus.\\n2. Duplication by a Septum. The Mullerian ducts\\nfuse, but the partition dividing them does not disappear.\\nm\\nFig. 20. Vagina septa with atresia of one canal. Skene s glands\\nempty into the urethral orifice (Munich Frauenklinik. Arch. f.\\nGyn., 37, 2).\\n(Figs. 10, 13, 14.) This disappearance usually begins in\\nfrom the eighth to the twelfth week, commencing in that\\nportion of the tube that subsequently (from the twentieth\\nto the thirtieth week) forms the vaginal cervix, This", "height": "4598", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0085.jp2"}, "86": {"fulltext": "32 ANOMALIES OF FORMATION,\\nPLATE 1.\\nThe Vulva of a Nonpregnant Multipara (original water color\\nfrom a case at the Heidelberg Frauenklinik). The labia majora and\\nminora are separated. In addition to the remains of the hymen, there\\nis to be seen a congenital blind canal, about 1 cm. in depth, at the pos-\\nterior commissure. The author has repeatedly found analogous struc-\\ntures in the fetus (see Plate vn, Fig. 19, of the Arch. f. Gyn., 7\\n37, 2), as well as cysts of the hymen in the same situation. The\\nperineum is intact.\\nPLATE 2.\\nFig. 1.\u00e2\u0080\u0094 Intra vaginal Cervix of an Infantile Uterus. In\\nthese and the following analogous illustrations the parts are brought\\ninto view by Sims or Simon s specula, the patient being in the dorsal\\nposition. The labia are held apart, and the furrowed vaginal wall is\\nforced back, so that the cervix presents itself in the depth of the\\nvaginal funnel.\\nThe Sims position is the one best adapted for the physician without\\nassistance, because then it is necessary to introduce the posterior\\nspeculum only, the anterior vaginal wall falling back of its own\\naccord. The upper half of the body rests upon the left shoulder and\\nbreast the left arm lies upon the table, parallel to the body, and can\\nhold the speculum if necessary. The left thigh is almost completely\\nextended the right is strongly flexed on the abdomen. The physician\\nstands behind the patient.\\nThe illustration represents the pale, small cervix of a deficiently\\ndeveloped uterus, often combined with congenital stenosis of the cer-\\nvical canal and puerile anteflexion of the uterus. (See 3, 1-4, and\\nFig. 22 in text.)\\nFig. 2.\u00e2\u0080\u0094 Duplication of Cervix in a Case of Uterus Bicornis\\nSeptus with a Single Vagina. In the embryo the MLUlerian ducts\\ndo not lie quite symmetrically side by side, but the right one is nearer\\nto the symphysis. This asymmetry may be recognized in the illustra-\\ntion, from the relation of the two external orifices to each other.\\n(Figs. 10-21 in text and 2.) Where the uterus is duplicated, two\\ncervices may present themselves in the vagina, which is usually divided\\nby a septum. Uterus subseptus may exist with only a single ex-\\nternal OS.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0086.jp2"}, "87": {"fulltext": "1", "height": "4589", "width": "3216", "jp2-path": "atlasepitomeofgy00scha_0087.jp2"}, "88": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0088.jp2"}, "89": {"fulltext": "TREATMENT.\\n65\\nwork for some time. When the genitalia are relaxed and\\nthe vagina threatens to invert, support the perineum with\\na T-bandage on the eighth day of the puerperium a pes-\\nsary may be introduced. Catarrh, constipation, and\\ntumors are to be appropriately treated.\\nFig. 26. Incomplete prolapse of the uterus inversion of the\\nvagina from perineal tear of the third degree (into the rectum). The\\nos is notched (photograph from original water-color).\\nIf the prolapse is beyond the preventive stage, an ap-\\nparently rational therapy from our knowledge of the\\nsupports of the internal genitalia (based upon the author s\\nexperiments and those of Kimmel 1 would be the\\n1 Kimmel, Inaug. Dis., 1894, Heidelberg.", "height": "4593", "width": "3019", "jp2-path": "atlasepitomeofgy00scha_0089.jp2"}, "90": {"fulltext": "66\\nVAGINAL AND UTERINE PROLAPSE.\\nstrengthening of the muscles of the pelvic floor by mass-\\nage. This has, nevertheless, been followed by but few\\npermanent results. At the present time it is better to treat\\nthese cases with the pessary or by operation.\\nThe operative treatment is radical and sure. In retro-\\ndeviations the uterus is brought forward into its normal\\nFig. 27. Complete prolapse of a retroflexed uterus, with rectocele.\\nThe os is notched (photograph from original water-color).\\nposition by retrofixatio colli uteri, with or without open-\\ning of the recto-uterine pouch by shortening the round\\nligaments, either in the inguinal canal or after an anterior\\ncolpotomy. By the latter route the broad ligaments may\\nbe shortened or a thickened uterus may be anteflexed by", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0090.jp2"}, "91": {"fulltext": "TREATMENT.\\n67\\nexcision of a wedge-shaped piece from its anterior wall.\\nAfter the menopause the uterus may be separated from the\\nbladder and stitched to the vagina or bladder (vaginofixa-\\ntion or vesicofixation of Diihrssen, Mackenrodt). If the\\norgan is held by strong adhesions, or if the ligaments and\\nFig. 28. Complete prolapse of a retroflexed uterus simple erosion,\\nwithout rectoeele. (See Fig. 27.) (Photograph from original water-\\ncolor.\\nvaginal walls are greatly relaxed, ventrofixation should be\\nperformed the best method is that of Czerny-Leopolcl,\\nwhich consists in stitching the uterine serosa (Sanger\\nstitches the round or broad ligament) directly to the\\nparietal peritoneum of the abdominal wall.", "height": "4594", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0091.jp2"}, "92": {"fulltext": "68 VAGINAL AND UTERINE PROLAPSE.\\nPLATE 8.\\nComplete Prolapse of an Anteflexed Uterus Cystocele.\\nAscertained by the introduction of the sound into the diverticulum\\n(note direction of sound latter held like a pen). Excoriation of the\\ninverted mucous membrane. (Original water-color.)\\nRetention is secured by narrowing the vagina and re-\\npairing the perineum anterior colporrhaphy of Sims, in\\ncystocele, by excising a portion of the mucous membrane\\n(shaped like a myrtle leaf) and bringing the edges of the\\nwound together [An oval denudation (Martin), reaching\\nfrom the meatus urinarius to the cervix, and closed by tier\\nsutures of catgut, to narrow the vagina and to leave a firm\\nsupport for the bladder, is the most popular method in\\nAmerica for repairing the anterior vaginal wall. Except\\nwhere great elongation of the anterior vaginal wall has\\noccurred, the purse-string operation of Stoltz has been dis-\\ncarded, because it necessarily shortens the anterior vaginal\\nwall by approximating the meatus and cervix, and thus\\ntends to retrovert the uterus. Ed.] posterior colporrhaphy\\nof G. Simon, Hegar, Bischoff, Martin, v. Winckel, Fritsch,\\nXeugebauer, Kehrer, either by excising a triangular piece\\nof mucous membrane, the base corresponding to the peri-\\nneum, or by excising pieces of irregular outline and re-\\nmoving so much of the lateral wall that the posterior wall\\nis narrowed and the perineum raised. Posterior colpor-\\nrhaphy is also combined with plastic operations on the\\nperineum colpoperineauxesis (Hegar, Kaltenbach) or col-\\npoperineoplasty (Bischoff). [The anatomic and physio-\\nlogic principles embraced by Emmet s colpoperineorrhaphy\\nhave been so thoroughly appreciated by American sur-\\ngeons that Emmet s operation is usually chosen to the\\nexclusion of all others. Ed.] These operations should be\\nmost carefully planned and carried out. The portions to\\nbe excised are first outlined, then removed, the edges of the", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0092.jp2"}, "93": {"fulltext": "Tab. 8.\\nLUh Anst E Revchhold, Miinchen", "height": "4600", "width": "3140", "jp2-path": "atlasepitomeofgy00scha_0093.jp2"}, "94": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0094.jp2"}, "95": {"fulltext": "TREATMENT.\\n69\\nwound freely loosened up, and the sutures accurately\\nplaced.\\nConsiderable experience is necessary to enable the\\noperator to remove neither too much nor too little tissue.\\nWhen the operation is completed, the vulva should not\\ngape, and the vaginal walls should be well supported by\\nFig. 29. Complete prolapse of an anteflexed uterus simple erosion.\\n(See Plate 28.) (Photograph from original water-color.)\\nthe new perineum. Buried catgut or fine silk may be\\nused as suture material in the vagina in the perineum,\\nsilkworm gut or silver wire is to be employed.\\nIf an ectropion or an ulceration exists, the incision may\\nbe made to include this portion of the cervix. Not only", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0095.jp2"}, "96": {"fulltext": "70 VAGINAL AND UTERINE PROLAPSE.\\nPLATE 9.\\nExtreme Inversion of the Vagina, with Cystocele and\\nIncomplete Prolapse of the Retroverted Uterus. (Original\\nwater-color.) Density of the rnncous membrane. Thickening of the\\nvessels.\\nsuperficial parts of the mucous membrane, but also exten-\\nsive wedges of muscular tissue (see Metritis), or conic\\npieces of the hypertrophied cervix, may be excised, and\\ndeep sutures of silk or silkworm gut may then be inserted.\\nThe preparation of the patient and the after-treatment\\nmust receive as much care as the operation. Before the\\noperation, laxatives, vagina well scrubbed out with anti-\\nseptics (three times, including the cervical mucosa), and\\nthe prolapse returned, are measures to be employed because\\nthe parts are then less vascular. After the operation, three\\nweeks in bed in the first days, liquid diet and a few drops\\nof laudanum removal of the perineal stitches at the end of\\nthe first week if nonabsorbable sutures have been used in\\nthe vagina, they are taken out later. Vaginal irrigation, if\\ndischarge is fetid laxatives, to avoid tension on the sutures.\\nIf the uterus is so strongly adherent to the hernial sac\\nthat its reposition is impossible or can not be borne (in\\nspite of massage and stretching and tearing the pseudo-\\nligaments), and the subjective disturbances are great, noth-\\ning remains but total extirpation (Kehrer).\\nIf the operation is refused, pessaries and rings may\\nbe used for retentive purposes. Among these may be\\nmentioned\\n1. The round ring of Mayer (Plate 20, Fig. 3), when\\nthe lower part of the vagina is still narrow. It is harm-\\nPLATE 10.\\nIncomplete Prolapse of the Uterus Simple Erosion Cir=\\ncular Thickening of Cervix Rectocele. (Original water-color\\nfrom a case at the Heidelberg Frauenklinik.)", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0096.jp2"}, "97": {"fulltext": "H", "height": "4582", "width": "3237", "jp2-path": "atlasepitomeofgy00scha_0097.jp2"}, "98": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0098.jp2"}, "99": {"fulltext": "", "height": "4584", "width": "3189", "jp2-path": "atlasepitomeofgy00scha_0099.jp2"}, "100": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0100.jp2"}, "101": {"fulltext": "PESSARIES. 71\\nfill, inasmuch as it dilates the vagina. Those made of\\ncelluloid or hard rubber are better than the soft-rubber\\nvariety.\\n2. The B. S. Schultze sledge pessary (Figs. 32 and 33)\\ncorrects the retrodeviation of the uterus and allows a\\nnatural range of motion when the vagina is very large\\nand relaxed. It is better for prolapsus than\\n3. Schultze s 8-shaped pessary, which is so constructed\\nthat it is supported by the perineum. (Fig. 31.) It is of\\ngreatest utility when the introitus vaginae is intact.\\n4. Hodge s lever pessary, especially applicable in in-\\nversion of the anterior vaginal wall (Plate 20, Fig. 4\\nFig. 30), because it does not dilate the middle portion of\\nthe vagina, but puts it on the stretch.\\n5. The Zangerle-Martin stem-pessary (Plate 5, Fig. 3)\\nrests upon the levator ani and is applicable in obstinately\\nrecurring prolapse, and roomy, relaxed genitalia. The\\nold stemmed hysterophore is worthless, and is at best to\\nbe looked upon as a last resort, when the lower vagina is\\ndilated.\\nThe following two pessaries, on the contrary, are not\\nsufficiently appreciated in practice\\n6. Hewitt s cradle or clamp pessary (VJ-shaped, a\\nring bent upon itself), and\\n7. Breisky s egg-shaped pessary of hard rubber (espe-\\ncially Xos. 2 and 3), which are especially adapted to in-\\noperable cases beyond the menopause. It is held in posi-\\ntion by a T-bandage, and must be removed with forceps.\\nSee Directions for the Application of Pessaries, \u00c2\u00a711.\\nThe reposition of the prolapsed organ is accomplished\\nwith the patient in the dorsal position. The pressure\\nupon the cervix acts in the direction of the vaginal axis,\\nupward and backward, pushing back first the posterior\\nvaginal wall, then the uterus, and lastly the anterior vagi-\\nnal Avail. Tampons (saturated in glycerin, renewed twice\\ndaily) retain the prolapse temporarily, the dorsal position\\nbeing maintained. Breisky gave his patients a tampon-", "height": "4601", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0101.jp2"}, "102": {"fulltext": "72 ELEVATIO UTERI.\\nPLATE 11.\\nAnteflexion of the Uterus in a Child. View of Douglas\\npouch. (Origiual water-color, from cadaver.)\\ncarrier, enabling them to introduce the tampons them-\\nselves.\\nAs a supplement to the foregoing, elevatio uteri will\\nnow be considered. The uterus plays an entirely passive\\nrole in this change of position, as tumors of the organ\\nitself, or of adjacent organs, or peritoneal residues, and\\npseudoligaments lift it wholly or partly above the pelvic\\ninlet. (Plate 16, Fig. 1.)\\nThe diagnosis and the treatment are the same as\\nthose of the causal affection. The former is often difficult,\\nand as the condition is usually associated with structural\\nchanges, the organ becoming thinner and softer, the sound\\nis to be used with caution. The uterus may be joshed\\nup from below, or drawn up from above. The cervix\\noften projects into the vagina as a mere cone. (Plate 7,\\nFig. 2.)", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0102.jp2"}, "103": {"fulltext": "eg\\nI\\nI", "height": "4590", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0103.jp2"}, "104": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0104.jp2"}, "105": {"fulltext": "CHAPTER III.\\nTHE PATHOLOGIC POSITIONS, VERSIONS, AND\\nFLEXIONS OF THE UTERUS.\\nPathologic positions are displacements of the uterus\\nin toto y the individual portions of the same holding their\\nnormal mutual relations. They may be forward, back-\\nward, or to one side. Versions are turnings of the uterus,\\nas a whole, about an imaginary axis passing through the\\ninternal os. This axis may have a transverse or a sagit-\\ntal direction. In the condition known as a flexion, on\\nthe contrary, the body of the uterus forms an angle with\\nthe cervix. These three forms may be observed in com-\\nbination with one another or with a high position.\\n(Compare with Elevatio Uteri on p. 72.) Three degrees\\nare differentiated, dependent upon whether the fundus\\nis above, at the same level with, or below the external\\nos.\\ngp. THE PATHOLOGIC POSITIONS OF THE UTERUS\\nAND ITS ADNEXA.\\nThe uterus as a whole may be displaced fonvard, back-\\nward, or to one side antepositio, retropositio, and latero-\\npositio (dextropositio and sinistropositio).\\nThe displacement of the organ is a passive one, the\\nmost frequent cause being perimetritic or parametritic\\nexudates. These may be either recent, tumor-like masses\\nforcing the uterus away from them, or contracting bands\\nof scar-like adhesions pulling the organ toward them.\\n(Plates 44 and 45.) It can thus be seen that the uterus\\nmay be forced consecutivelv in two opposed directions at\\n73", "height": "4596", "width": "2796", "jp2-path": "atlasepitomeofgy00scha_0105.jp2"}, "106": {"fulltext": "74 PATHOLOGIC DISPLACEMENT.\\nPLATE 12.\\nIncomplete Prolapse of the Uterus Elongation of the Inter-\\nmediate Portion of the Neck with Circular Hypertrophy\\nof the Vaginal Portion; Inversion of the Anterior Vaginal\\nWall Cystocele. The posterior vaginal vault is almost at its normal\\nheight. (See Plate 4, Fig. 2. (Original water-color from a specimen\\nin the Munich Frauenklinik.)\\ndifferent stages of the disease. (Plate 16, Figs. 1 and 2\\nPlate 17, Fig. 1 Plate 58, Fig. 2.)\\nTumors act in the same manner. There may be tumors\\nof the uterus itself (antepositio from a myoma of the\\nposterior wall, Plate 58, 4), tumors of neighboring organs\\n(Plate 59, 2 and 4, Ovarian Cystomata), or tumors of\\nDouglas pouch, especially those of the rectum and sa-\\ncrum. Finally, excessive distention of adjacent organs\\nmay produce the same result. The bladder (Plate 17, 2,\\nand Plate 14, 4), the rectum in cases of chronic constipa-\\ntion, and a pyosalpinx (Plate 59, 3) furnish examples.\\nA special variety of lateroposition is of a congenital\\nand physiologic nature, brought about by unequal growth\\nof the Mullerian ducts and their adnexa (tubes, ligamen-\\ntum latum). 1 (See Fig. 2 in text.)\\nPLATE 13.\\nArtificial Prolapse for Operative Purposes, with the Arising\\nInversion of the Vagina and with Cystocele. The uterus first\\nassumes a position of retroversion. Further traction directs the organ\\ndownward in the direction of the vaginal axis (see the dotted lines,\\nwhich show the normal position of the uterus at the beginning and its\\nsubsequent stages of transition). The pathologic process proceeds in\\nthe same way. (Original diagrammatic sketch making partial use of a\\ndrawing of Beigel s.)\\n1 In 130 postmortem specimens of adult female genitalia, I found\\nthe adnexa of the right side longer in 31.5% of the left side, in\\n27%.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0106.jp2"}, "107": {"fulltext": "*M", "height": "4592", "width": "3182", "jp2-path": "atlasepitomeofgy00scha_0107.jp2"}, "108": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0108.jp2"}, "109": {"fulltext": "Tab. 13.\\nin lichen", "height": "4601", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0109.jp2"}, "110": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0110.jp2"}, "111": {"fulltext": "DIAGNOSIS. 75\\nDiagnosis. The presence or absence of a flexion is\\nfirst determined bimanually, and then the cause of the dis-\\nplacement is ascertained. The changed position of the\\nuterus is quite frequently combined with retroversion\\n(Plate 17, 2), elevation (Plate 14, 4), or both (Plate 16,\\n1). Extra-uterine pregnancy must be excluded if tumors\\nof the adnexa or of Douglas pouch are present. The\\nsound is to be employed only after the position of the\\nbody of the uterus has been accurately determined. It is\\nclear from the foregoing that an exact differential diag-\\nnosis, especially of the tumors of Douglas pouch (see p.\\n74), must be made. In uncomplicated changes of posi-\\ntion both vaginal vaults retain their normal form and\\nrelations the position of the vagina, on the contrary, is\\nchanged, its curve being lessened and its walls being\\nplaced under greater tension (anteriorly in antepositio).\\nThe treatment consists in the removal of tumors and\\nthe extension of cicatricial bands by massage.\\nThe tubes and ovaries are frequently displaced by\\ninflammatory processes or through relaxation and conges-\\ntion of their ligaments. The inflammatory virus (mostly\\ngonococci, staphylococci, and streptococci) escapes from the\\nabdominal ostium of the tube, and causes perimetritic,\\nperisalpingitic, and perioophoritic exudations. Its contrac-\\ntion dislocates the movable adnexa, and agglutinates them\\nwith the intestine and with the serosa of Douglas pouch.\\n(Plates 44 and 45.) The process may cause the tubes to\\nbe bent at an acute angle. Ovariocolpocele and pyocolpo-\\ncele have already been mentioned they can, with or with-\\nout the uterus, form the contents of almost any variety of\\nabdominal hernia. (See 6 7, Inversio Uteri Pro-\\nlapsi Plate 3, Fig. 2.)\\nThe ovaries usually change their position with the\\nuterus, and consequently displacements (one side or both)\\nin all directions are encountered. Descent of the ovary,\\ncombined with retroversion of the uterus, is the most fre-", "height": "4597", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0111.jp2"}, "112": {"fulltext": "76 ANTEVEESION AND ANTEFLEXION.\\nquent one (Plate 19, Fig 1) the ovary may be palpated\\nbeneath the uterus. They may also be displaced by tumors\\nthat proceed from the ovary itself (with or without adhe-\\nsion to adjacent viscera) or from neighboring organs. The\\nnormal position of the internal genitalia is described on\\npage 57.\\nThe symptoms, diagnosis, and treatment will be\\nfound in the chapter upon inflammation of these parts.\\nio. THE ANTEVERSIONS AND ANTEFLEXIONS OF THE\\nUTERUS.\\nEvery ante version or anteflexion is not pathologic. By\\npathologic anteflexions are meant only those that are per-\\nmanent, and that are commonly associated with a lessened\\nmobility of the corpus uteri. This lessened mobility may\\nrefer to its position in the pelvis or to the relation that it\\nholds to the cervix. The latter is designated as a rigid\\nangle of flexion if it has arisen from an inflammatory\\nproliferation of connective tissue in an abnormally flexible\\norgan. This variety of anteflexion was described in 3\\n(3 and 4) as that of infantile and puerile uteri.\\nEtiology. With the exception of the abnormally\\nflexible infantile form, there is always some cause for the\\ndisplacement outside of the uterus.\\n1. Cord-like residues of parametritic or perimetritic\\nexudates are most common causes. The latter may either\\nbind the corpus uteri down to the bladder or to the\\nanterior pelvic wall (Plate 14, Fig. 4), or may fix the neck\\nposteriorly (this being more frequent). Anteflexion results\\nif traction is made upon a still flexible uterus by an adhe-\\nsion of the posterior wall corresponding in position to that\\nof the internal os. (Plate 15, Fig. 1.) It also follows fixa-\\ntion of the neck anteriorly, as shown in plate 15, figure\\n2 this is a rare occurrence, however.\\n2. Tumors likewise produce anteversions and anteflex-\\nions in different ways either by the pressing downward", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0112.jp2"}, "113": {"fulltext": "DIAGNOSIS. 77\\nand forward of tumors of other organs (ovarian cysto-\\nmata), or by a myoma of the anterior uterine wall, which\\ncan simulate a flexion (determine course of uterine canal\\nwith sound, see Plate 14, Fig. 3), or by submucous\\npolyps, as shown in plate 15, figure 4. Anterior myo-\\nmata cause anteversion or anteflexion, according to their\\nsituation in the cervix or the corpus uteri.\\n3. The body of the uterus may likewise tip forward and\\nsink down, from an increase of its own weight (metritis,\\nhyperemia of menstruation, first weeks of pregnancy).\\n4. Ktistner found marked congenital anteflexion of the\\nuterus in strong, vigorous children my experience confirms\\nthis, and I have frequently been able to demonstrate, in\\naddition, a profuse secretion of glairy mucus in the cervical\\ncanal and follicular cysts in the ovary.\\nDiagnosis. Certain symptoms and objective signs,\\nmentioned in 3 (3 and 4), are to be emphasized Dys-\\nmenorrhea, sterility, constipation, and vesical disturbances\\nare not so frequently the result of mechanically changed\\nconditions (flexion at the internal os with stenosis, pressure\\nof the corpus uteri upon the bladder; Plate 14, Fig. 2\\nPlate 15, Fig. 3) as of endometritic and parametritic hy-\\nperemia and proliferation. Constipation, associated with\\nviolent pain and digestive disturbances, and due to the\\ncicatricial contraction of pararectal exudates, is one of the\\nmost constant concomitant phenomena. Catarrh of the\\nbladder is also quite frequent. Disturbances of innerva-\\ntion play a frequent and important role.\\nThe pathologic character of the anteversion or ante-\\nflexion must be established the lessened mobility of the\\nbody of the uterus the neck, usually higher and bound\\ndown posteriorly the cause of the fixation, commonly\\nparametritic masses of exudation about the cervix (Plate\\n59 Plate 61, Fig. 2), and its pararectal extensions. The\\nsound determines the direction of the cervical canal, and\\nthe relation that the fundus holds to the long axis of the\\nneck is revealed by bimanual palpation.", "height": "4601", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0113.jp2"}, "114": {"fulltext": "78 ANTEVERSION AND ANTEFLEXION.\\nPLATE 14.\\nFig. 1.\u00e2\u0080\u0094 Anteversion of the Uterus. Normal position, when the\\nbladder is empty and the uterus is not bound down. The vagina\\npasses in a normal manner from behind forward and from above down-\\nward.\\nFig. 2.\u00e2\u0080\u0094 Anteversion of the Uterus (pathologic, as the fundus is\\nlower than the cervix). The os looks backward and upward. Cervix\\nelevated. Bladder pressed upon.\\nFig. 3.\u00e2\u0080\u0094 Myoma of the Anterior Uterine Wall Simulating\\nan Anteflexion of the Second or Third Degree. Differential\\ndiagnosis by the sound. Pressure on the bladder.\\nFig. 4. Anteversion (or Anteflexion) of a Fixed Uterus (at\\nthe Same Time Retroposition from a Full Bladder). The corpus\\nuteri, bound down to the bladder, is elevated by the rilling of the\\nsame when the angle of flexion is not rigid, extension of the uterine\\naxis occurs.\\nTreatment. The cause must be removed as far as\\npossible. See sections on parametritis, perimetritis, me-\\ntritis, myomata, and 3 (3 and 4). The symptomatic\\ntreatment is that of the uterine catarrh (see endometritis),\\nthe pain (see parametritis and 4, 8), the vesical disturb-\\nance (see cystitis), and the constipation. The latter must\\nbe dealt with energetically tepid injections of water (J\u00e2\u0080\u0094 f\\nof a liter), oil, or occasionally infusion of senna abdom-\\ninal massage vegetable diet and medication by the\\nmouth, commencing with the milder drugs. (See thera-\\npeutic table.) The intestinal tenesmus is treated with the\\nsame narcotics as those used for the parametritic pains and\\ndysmenorrhea these are given in the form of supposi-\\ntories or intestinal injections. Hydrotherapy is of value.\\nDuring the inflammatory exacerbations and attacks of pain\\nthe patient must be kept in bed.\\nContracting scars in the vaginal vault must be excised.\\n(Plate 55, Fig. 1.) The treatment with the intra-uterine\\nstem-pessary has been portrayed in 3 (3 and 4). It is\\nfurthered by the introduction of the round ring of Mayer.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0114.jp2"}, "115": {"fulltext": "Tab. 14.\\nFig. 2.\\nFipJ.\\nFig. 4^.\\nLUh. Anst. F RewMwld, Miinchen.", "height": "4606", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0115.jp2"}, "116": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0116.jp2"}, "117": {"fulltext": "TEE ATM EXT. 79\\nCicatricial bands situated high up are to be stretched\\nor torn by massage. (Plate 23.)\\nii. THE RETROVERSIONS AND RETROFLEXIONS OF\\nTHE UTERUS.\\nWhen the fundus uteri is placed vertically above the\\nneck; or passes backward from it, and the condition is a\\npermanent one, we speak of retroversion. We consider\\nthat its different degrees, as well as those of retroflexion,\\nare independent of the absolute height of the fundus.\\nEtiology. Congenital retroversion, or a vertical posi-\\ntion of the corpus uteri, is found in feebly developed\\norgans. Congenital retroflexions are likewise described\\n(Saxtorph, C. Huge, v. Winckel), and puerile retroflexions\\nare more frequent than the later pathologic ones. Von\\nAVinckel and Kustner explain that some of the latter arise\\nfrom the former by the action of pernicious influences, as\\na habitually full bladder and premature excessive straining\\nThe puerperium may have a similar effect, from the dorsal\\nposition and the relaxed uterine walls.\\nThe puerperal process, however, operates in another man-\\nner, furnishing one of the most frequent causes namely,\\ninflammation in combination with injuries of the vaginal\\nvault, and stretching, tearing, and relaxation of the geni-\\ntalia. (Fig. 3 of Plates 16 and 17.)\\nWeakened conditions, either general or local (chronic\\ndiseases, dyscrasias, postpartum subinvolution, neurop-\\nathies, masturbation), are also predisposing causes of\\nrelaxation. In this group belong those cases of simple\\nretroversion in which spasmodic flexion has been observed\\nby the author.\\nThe neck may be drawn anteriorly by contracting scars\\n(Plate 15, Fig. 2 Plate 17, Fig. 4), pushed forward be-\\nneath the corpus uteri by tumors (chronic distention of the\\nrectum, etc.), or the organ may be bound down to the rec-\\ntum or posterior pelvic wall bv perimetritic adhesions.\\n(Plate 16, Figs. 1 and 2 Plate 38.)", "height": "4596", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0117.jp2"}, "118": {"fulltext": "80 RETROVERSION AXD RETROFLEXIOX.\\nPLATE 15.\\nFig. 1. Anteflexion of the uterus of the second degree\\n(fundus uteri at same height as vaginal cervix) from posterior peri-\\nmetritic adhesions or contracting parametritic exudates of Douglas\\nfolds at the level of the internal os. Gaping of external os. Pressure\\non the bladder. The pararectal adhesions produce pain and constipa-\\ntion.\\nFig. 2. Anteflexion of the uterus of the first degree with\\nthe neck lying horizontally (rare condition) the body drawn\\ntoward the bladder by parametritic adhesions a vesical diverticulum\\nis drawn toward the internal os. The corpus uteri is vertical. The\\nos looks forward and a trifle upward. The vaginal vault is drawn\\nanteriorly, so that the vaginal axis is vertical.\\nFig. 3. Anteflexion of the Infantile Uterus with Stenosis\\nof the Cervix and Internal Os Dysmenorrhea (more frequent\\ncondition, see 3, 3 and 4).\\nFig. 4. Anteflexion of the uterus of the third degree (fundus\\nlower than the vaginal cervix), caused by a submucous uterine polyp\\n(fibromyoma).\\nPLATE 16.\\nFig. 1. Retroversion of a Fixed Uterus. The uterus is verti-\\ncal and is fixed by sacro-uterine and recto-uterine adhesions the\\ncontracted and shortened uterine ligaments. Vagina put on the\\nstretch by the elevation of the uterus.\\nIn retroversions the chief causes for the deviation are changes in\\nthe ligaments in retroflexion, changes in the uterine parenchyma,\\ntogether with changes in the ligaments. Retroversion easily passes\\ninto retroflexion. If the adnexa are not bound down in Douglas\\npouch, they usually lie above the uterus and laterally.\\nFig. 2.\u00e2\u0080\u0094 Retroflexion of a fixed uterus (first degree, fundus\\nhigher than the cervix) uterus bound down throughout its entire\\nlength to serosa of Douglas pouch by perimetritic adhesions. Cervix\\nforced anteriorly, anterior lip thinned, the anterior cervical wall like-\\nwise posterior lip thickened. Vagina thrown into folds by the\\ndescensus. Pressure of the intestines upon the uterus.\\nFig. 3.\u00e2\u0080\u0094 Slight retroflexion and descent of the puerperal\\nuterus from relaxation of the genitalia (dorsal positipri, pressure", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0118.jp2"}, "119": {"fulltext": "Tab. 15.\\nFiff.l.\\nFfyg.\\nFig.3.\\nFi\\\\ 9 .4,\\nLWx. AnstF Retchhold. Miinchen", "height": "4601", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0119.jp2"}, "120": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0120.jp2"}, "121": {"fulltext": "Tab. 16.\\nFig.l.\\nFitf.2.\\nFi ff .3.\\nFig. 4-.\\nLith Anst F. Reichhold, ilimclien", "height": "4591", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0121.jp2"}, "122": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0122.jp2"}, "123": {"fulltext": "SYMPTOMS. 81\\nof the abdominal organs later, hard work, etc.). Puerperal metritis\\nis very often the cause of subinvolution.\\nFig. 4.\u00e2\u0080\u0094 Retroversion of the Uterus (Third Degree, Fundus\\nLower than the Cervix) from Pressure of an Ovarian Cyst.\\nThe os is directed forward and upward. The vagina is vertical and\\nextended. Pressure upon the rectum.\\nUterine myomata (Plate 18, Figs. 1 and 2) or tumors\\nof the vesico-uterine space pressing down from above may\\neffect retroversion and retroflexion. (Plate 16, Fig. 4.)\\nThe dorsal position, a heavy, relaxed, puerperal uterus,\\nand the weight of the intestines, usually combined with\\ndescensus uteri (Plate 16, Fig. 3), may bring about pro-\\nlapse of a retroflexed uterus. (Plate 4 Figs. 27 and 28.)\\nApart from primary inflammatory processes, secondary\\nadhesions of the posterior serosa of an already retroverted\\nuterus may also occur.\\nSymptoms. Menorrhagia from hyperemia of inflam-\\nmation or relaxation, and secondary proliferation of the\\nmucosa as a result of the latter dysmenorrhea, partly as\\na result of the proliferative changes, partly from the\\nmechanical obstruction of the flexion, and spasmodic\\nuterine contraction catarrhal secretion sterility, less\\ncommon than in anteflexion.\\nThe pressure of the vaginal cervix produces urinary\\ndisturbances from angulations of the urethra and the ure-\\nters (Plate 19, Fig. 1), and the displacement also inter-\\nferes with defecation (flattened, ribbon-like stools).\\nReflex nervous disturbances appear, not only those\\nof digestion (vomiting with migraine, dyspepsia), but also\\nthose of the respiratory and circulatory organs (tachycar-\\ndia, uterine cough, uterine asthma, neuralgia, etc.), as\\nwell as a host of hysteric symptoms convulsions, uncon-\\nsciousness, hystero-epilepsy, cardialgia, paraplegia, apho-\\nnia, spasmodic cough, globus and clavus hystericus, and\\nhypersensitiveness. Motor and sensory disturbances of\\nthe lower extremities (weakness, formication, cramps of\\n6", "height": "4593", "width": "2791", "jp2-path": "atlasepitomeofgy00scha_0123.jp2"}, "124": {"fulltext": "82 RETROVERSION AND RETROFLEXION\\nPLATE 17.\\nFig. 1. Encapsulated Peritoneal Exudate in Douglas Pouch.\\nDescent and Anterior Position of a Fixed Uterus (Furrowed,\\nCurved Vagina). A circumscribed peritonitis, or a gravitating peri-\\ntonitis from other abdominal organs, causes an accumulation of exudate\\nin the recto-uterine space the overlying intestines roof in the culdesac,\\nand by an adhesion of the serous surfaces an encapsulation of the\\npseudotumor is brought about. The uterus is adherent to the blad-\\nder as far as the fundus.\\nFig. 2.\u00e2\u0080\u0094 -Retroposition of the Uterus by a Full Bladder. From\\nits normal attachment to the bladder the uterus is at the same time\\nelevated and the vagina extended. The uterine body is directly over\\nthe vagina, and their longitudinal axes correspond. This position pre-\\ndisposes to prolapsus uteri consequently, the frequent habit of the\\nyoung of imperfectly emptying the bladder may help to bring about\\na descent of the uterus.\\nFig. 3. Descent and Retroflexion of the Uterus of the First\\nDegree, Brought About by Relaxation of the Folds of Doug=\\nlas. To be recognized by the low position of the vertically situated\\nvaginal cervix and by the curvature of the vagina. These symptoms\\nmake up the picture of relaxation of the genitalia and their support-\\ning apparatus (ligaments and pelvic floor), Avhich predisposes to pro-\\nlapse of the genitalia. The external os gapes ectropion of relaxation.\\nFig. 4. Retroflexion of the uterus of the first degree, with\\na normally directed neck, caused by the contraction of parametritic\\nadhesions that t ind the latter to the bladder (see 11, Etiology).\\nThe weight of the intestines, combined with relaxation of the uterine\\nwall, and the dorsal position (as in puerperium) force the body of the\\nuterus backward.\\ngastrocnemius) are also observed. They are due to reflex\\naction, pressure, or inflammation.\\nDiagnosis. By bimanual examination, after vaginal\\npalpation and inspection have shown the anterior cervical\\nlip to be thinned and shortened, the posterior lip thick-\\nened, and the os directed toward the symphysis. The\\nbody of the uterus is palpated either by allowing the ab-\\ndominal hand to sink into the pouch of Douglas or from", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0124.jp2"}, "125": {"fulltext": "Tab. 17.\\nFig.l.\\nFig.2,\\nFig.3.\\nFig.\\nLiXh. Anst F. Reiditwld, Minchen", "height": "4596", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0125.jp2"}, "126": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0126.jp2"}, "127": {"fulltext": "TREATMENT.\\n83\\nthe rectum. The presence or absence of adhesions must\\nbe determined.\\nTreatment. The manual treatment of the retrodevia-\\ntions is fully demonstrated in plates 21 and 22. By this\\nmethod a freely movable uterus may be replaced i. e., its\\nbody laid upon the anterior vaginal vault. Massage may\\nbe instituted if the organ is bound down by adhesions\\n(Thure Brandt, Plate 23), the latter being forcibly torn\\nif necessary or the contractile elements of the uterus, of\\nits ligaments, and of its vessels, may be stimulated.\\nFig. 30. Hodge s lever pes-\\nsary in retroflexion of the uterus,\\nfirst degree. It effects a normal\\nposition chiefly by causing tension\\nof the posterior vaginal vault.\\nFig. 31.\u00e2\u0080\u0094 Schultze s 8-shaped\\npessary fixes the cervix in normal\\nposition it is supported by the\\nvaginal wall and the pelvic floor.\\nIf the free uterus can not be replaced by this method,\\nthe bullet forceps of Kustner is used, or the sound is\\ncautiously employed. (See explanation to Figs. 1 and 2,\\nPlate 20*)\\nWhen the uterus is brought back into its normal posi-\\ntion, a lever-pessary is introduced as a retentive measure.\\n(See Figs. 30\u00e2\u0080\u009433.) Cold douches to the cervix and sacrum,\\nalternate hot and cold vaginal douches, ergotin subcutane-\\nously, and tamponade to stpengthen the uterine walls and\\ntheir ligaments are useful adjuvants.", "height": "4595", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0127.jp2"}, "128": {"fulltext": "84\\nRETROVERSION AND RETROFLEXION.\\nThe lever=pessaries are tried in the following order\\n1. The S-shaped Hodge pessary (rather sharply curved),\\nwhen the sacro-uterine ligaments are not sensitive.\\n2. The 8-shaped Schultze pessary, when the pelvic floor\\nis normal and the vagina is not too relaxed. Sometimes\\nthe instrument must be quite long.\\n3. The sledge-shaped pessary of Schultze, when the\\nvagina is relaxed or the pelvic floor is defective.\\n4. Hewitt s clamp pessary. (See p. 71.)\\nFig. 32. Rarer application of\\nSchultze s sledge-pessar y with\\nfirm pelvic floor.\\nFig. 33. Usual application of\\nSchultze s sledge-pessary. It is\\nsupported by the vaginal wall\\nand the symphysis. The cervix\\nis fixed between the anterior and\\nthe posterior bar. Employed in\\nretroflexed descended uterus.\\nDirections for the Application of Pessaries. The\\nappropriate pessary is to be introduced with the patient in\\nthe dorsal or knee-elbow position, and the vagina should\\nbe held open by a duck-bill speculum, allowing the uterus\\nand adnexa to fall forward.\\n1. The round, flexible caoutchouc ring of Mayer is\\ncompressed with the fingers or the Fritsch forceps (Plate\\n20, Fig. 2), introduced beyond the constrictor vaginae, and\\nplaced so that the cervix rests within its opening, which\\nshould not be too small. The ring should slightly dilate\\nthe vagina.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0128.jp2"}, "129": {"fulltext": "PESSARIES. 85\\n2. The S-shaped pessary of Hodge and the more curved\\none of Thomas with a bulbous enlargement of the upper\\nbar (made of hard rubber or celluloid, rendered flexible\\nby hot water, or of copper wire covered with caoutchouc)\\nare introduced into the vagina in the sagittal plane.\\n(Plate 20, Fig. 4.) When the pessary is above the con-\\nstrictor vaginae, it is rotated 90 degrees, so that the upper\\nand broader bar comes to lie in the posterior vaginal vault,\\nas shown in figure 30.\\nIt acts as follows The broad posterior bar lifts the\\nuterus and pries it anteriorly the cervix is drawn poste-\\nriorly by the longitudinal and transverse traction upon\\nthe vagina, and especially upon the uterosacral ligaments.\\nFrom the new position of the cervix and from the pressure\\nof the intestines upon the posterior uterine surface the\\nuterus rests firmly upon the posterior vaginal wall the\\ndescent of the organ and the accompanying disturbances\\nconsequently cease, even if the retrodeviation is not\\nwholly removed. The tension upon the sacro-uterine\\nligaments resulting from the descent is relieved by the\\ntransverse tension and elevation of the vaginal vault. In\\nmarried women the simple curved pessary, allowing of\\ncohabitation, is the more applicable, the lower bar resting\\nupon the pubic symphysis. Should this render the empty-\\ning of the bladder difficult, it may be provided with a\\ncurve (concave anteriorly). If the upper bar makes the\\nvaginal vault too tense, it should be bent backward.\\n3. The 8-shaped Schultze pessary is inserted with its\\nsmaller half about the cervix. (See Fig. 31.) It is made\\nof hard rubber or of copper wire covered with caoutchouc,\\nand rests upon the pelvic floor.\\n4. The sledge-shaped pessary of Schultze is so intro-\\nduced that the longer bar lies above and behind the cervix,\\nthe shorter bar being in front. (Fig. 33.) The shorter\\ncurvature rests against the pubic symphysis. This pessary\\nis used instead of the 8-shaped one when the pelvic floor\\nis relaxed. If the vagina is too roomy, the longer bar is", "height": "4604", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0129.jp2"}, "130": {"fulltext": "86 RETROVERSION AND RETROFLEXION.\\nPLATE 18.\\nFig. 1.\u00e2\u0080\u0094 Retroversion of the Uterus from Two Intramural\\nMyomata. By palpation, the condition simulates a retroflexion of\\nthe second degree. The sound demonstrates the course of the uterine\\ncanal, and consequently the true condition. External os directed an-\\nteriorly. Eectum pressed upon; constipation; Douglas pouch filled up.\\nUrinary disturbances also ensue.\\nFig. 2.\u00e2\u0080\u0094 Transition from Retroversion to Retroflexion of\\nthe Uterus from an Intramural Myoma of the Anterior\\nWall.\\nFig. 3. Retroflexion of the Uterus of the Third Degree\\n(Fundus at the Height of the Cervix). Descent of the uterus\\nrecognized by the folding of the vaginal wall (the os is below the\\ninterspinous plane also). Pressure upon the rectum. The os looks\\nanteriorly. The uterine body fills the pouch of Douglas. Thick-\\nening of the posterior uterine wall and lip thinning of the anterior\\none.\\nFig. 4. Retroflexion of the Uterus of the Third Degree\\n(Fundus Lower than the Cervix). Inveterate case os looks ante-\\nriorly, gapes widely (ectropion) anterior wall of the neck and lip of\\nthe os thinned. High position of the cervix extended, vertical\\nvagina. Douglas pouch filled by the uterine body.\\nPLATE 19.\\nFig. 1.\u00e2\u0080\u0094 Retroversion of the Uterus; Vaginal Ovariocele.\\nAngulation and dilatation of the ureters. Vertical position of the\\nvagina. (See \\\\\\\\1 and 11.)\\nFig. 2.\u00e2\u0080\u0094 Bimanual Examination from the Rectum of a Case\\nof Cord=like Total Atresia of the Vagina with a Rudimentary\\nSolid Uterus. During cohabitation the immissio penis has taken\\nplace into the urethra probably congenitally funnel-shaped and\\ndilated it as far as the internal sphincter. The palpating finger can be\\npushed into the bladder without difficulty, and its withdrawal is fol-\\nlowed by a quantity of urine. A slight incontinence exists. (Original\\ndiagrammatic drawing from a case.)", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0130.jp2"}, "131": {"fulltext": "Tab. 18.\\nFig.l.\\nFuj. 2.\\nFiff.J.\\nFig. A\\nLith. Aast. E Beichhold. Mimchen", "height": "4596", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0131.jp2"}, "132": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0132.jp2"}, "133": {"fulltext": "Tab. 19.\\nFial.\\nLith. Anst F. Reichhold, Miinchen.", "height": "4608", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0133.jp2"}, "134": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0134.jp2"}, "135": {"fulltext": "PESSARIES. 87\\nbrought forward and used as a support, while the smaller\\none holds the cervix in its concavity. Material same as\\npreceding the 8-shaped pessary is made of rings from 8 J\\nto 19 cm., the sledge-shaped of rings from 10J to 14 cm.,\\nin diameter (from 7 to 10 mm. thick).\\nA ring is in good position if its lower end is not visible\\nat the vulva if it does not threaten to fall out if it does\\nnot overdilate the vagina, but may be easily rotated on its\\nlongitudinal axis if the upper half of the vagina is ren-\\ndered moderately tense finally, if the fundus uteri is an-\\nterior and the cervix posterior, since otherwise the folds\\nof Douglas are not relaxed.\\nIf the foregoing conditions are complied with, the dis-\\nturbances soon disappear. In only one-fifth of the cases\\nis a really permanent cure obtained, so that the uterus\\nremains anteriorly without support.\\nDisadvantages. If the ring i improperly constructed\\n(uneven, too large, too thin, or made of wool, hair, leather),\\nor remains in position too long, it excites hypersecretion,\\nulcerations, and abscesses. Fistulous tracts communicat-\\ning with neighboring organs may result. Even with a pes-\\nsary made of good material, 1 have seen this occur after\\nthe menopause. If the ulcers cicatrize, embedding the\\nring, or if the latter becomes incrusted with phosphates\\nfrom the secretions or with dried masse- of mucus and\\nblood, it is difficult to remove the instrument. After re-\\nmoval of the wall of granulations the ring is to be seized\\nwith dressing forceps and extracted by rotatory move-\\nments. It is sometimes necessary first to break it in situ.\\nTo obviate these difficulties the ring should be removed\\nand cleaned after each period, although a pessary may\\nremain in. the healthy genitalia for two or three months\\nwithout harmful results. Repeated vaginal irrigations of\\nnonirritating fluids must be made daily, if leukorrhea\\nexists.\\nThe ring is to be immediately removed upon the ap-\\npearance of pain.", "height": "4609", "width": "2797", "jp2-path": "atlasepitomeofgy00scha_0135.jp2"}, "136": {"fulltext": "88 RETROVERSION AND RETROFLEXION.\\nPLATE 20.\\nFig. 1.\u00e2\u0080\u0094 Reposition of a Retroverted Uterus by Means of\\nKustner s Bullet Forceps. The uterus is first brought into the\\nvertical position by traction the cervix is then pushed backward, and\\nthe fundus uteri, if freely movable, comes forward.\\nYig 2.\u00e2\u0080\u0094 Reposition of a Retroverted Uterus by Means of\\nthe Sound. The latter is introduced with its concavity directed an-\\nteriorly, and is pushed in until its knobbed end has passed the internal\\nos. The concavity is now turned posteriorly, corresponding to the\\npathologic course of the uterine axis. If 5 or 6 cm. of the sound have\\npassed into the uterus, its knobbed end lies in the fundus. The curva-\\nture of the sound is now cautiously rotated anteriorly, the handle\\nof the sound being derjressed at the same time.\\nFig. 3.\u00e2\u0080\u0094 Introduction of the Elastic Ring of Mayer by Means\\nof Fritsch s Forceps. The ring should lie about the cervix.\\nFig. 4\u00e2\u0080\u0094 Introduction of Hodge s Pessary. This is bent into\\nthe shape of an S. as shown in the adjacent figure (Thomas pessary\\nis still more sharply bent at the upper bar). (See Fig. 30.)\\nIt is very important to determine whether the displace-\\nment or its complications cause the existing trouble, or\\nwhether hysteria alone exists.\\nThe inflammations of the bladder, endometrium, and\\nperimetrium are to be treated in the usual manner. If\\nadhesions render the reposition impossible, the condition\\nis made bearable by firm tamponade of the posterior vag-\\ninal vault with glycerin tampons.\\nIf pregnancy occurs, the pessary is allowed to remain\\nuntil the fifth month the retroflexed gravid uterus is to\\nbe similarly controlled in order to prevent incarceration\\nbeneath the sacral promontory.\\nOperative measures are adopted, partly to dispose of\\nvery resistant adhesions, which usually elevate the uterus\\nconsiderably, partly to fix the organ anteriorly, either by\\nceliotomy or per vaginam.\\nIf the uterus is freely movable [Alexander s operation.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0136.jp2"}, "137": {"fulltext": "Tab. 20.\\nFigl.\\nFig.*\\nFig.J.\\nFig. 4?.\\nLith. Anst.F.ReicMwld, Miiiidien.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0137.jp2"}, "138": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0138.jp2"}, "139": {"fulltext": "PESSARIES. 89\\nEd.] retrofixatio colli or vaginofixation is indicated if\\nit is markedly adherent, ventrofixation (suspensio uteri) is\\nto be performed. (See p. 67.)\\nThe Applicability of Pessaries with Respect to Certain\\nComplications of Retroversion.\\n1. Retro-uterine Adhesions. These are to be slowly\\nstretched by massage three or four times for at least twelve\\nsittings. First elevate in retroposition, to stretch or tear\\nthe adhesions, then anteflex the uterus, introduce a ring,\\nand keep the patient in bed with an ice-bag upon the\\nhypogastrium (remember the possible production of a\\nhematocele The tamponade of the posterior vaginal\\nvault is a palliative measure.\\n2. Chronic perimetritis furnishes a noli me tangere it\\nmust be cured first (absorption cure).\\n3. Parametritic bands and scars from lacerations (Plate\\n55, Fig. 1) are excised, the longer diameter of the denu-\\ndation being transverse, and the edges are so brought to-\\ngether that the row of sutures is in the longitudinal axis of\\nthe vagina, producing an elongation of the same (Martin).\\n4- Chronic Metritis. This is to be treated first by wedge-\\nshaped excisions, and then a pessary is to be applied if the\\npessary is not Avell borne, glycerin tampons. In acute me-\\ntritis antiphlogistic treatment until the pain has disap-\\npeared.\\n5. Endometritis. This will require astringent and anti-\\nseptic vaginal douches twice daily the pessary should be\\nfrequently removed treat the uterus by cauterization,\\nintra-uterine irrigation and medication, atmocausis, etc.\\nErosions of the os are to be cauterized or excised.\\n6. A stenosis of the cervix is to be dilated or incised.\\n7. If the cervix is too short, it exerts insufficient lever-\\nage upon the body, which becomes flexed, or the cervix\\nslips away from the ring and displacement occurs re-\\nversed introduction of the Hodge pessary with the upper\\nbar posterior is recommended.", "height": "4597", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0139.jp2"}, "140": {"fulltext": "90 RETROVERSION AND RETROFLEXION.\\nPLATES 21 AND 22.\\nManual Reposition of a Retroflexed Uterus (First and\\nSecond Degrees). First step: The body of the uterus is palpated\\nfrom the posterior vaginal vault by the index and middle fingers.\\nSecond step While these two fingers push the organ upward, the other\\nhand covers in the pelvic inlet, passes behind the uterus, and presses\\ndown along its posterior surface until (third step) it touches the fingers\\nin the vagina. In this manner the uterus is held from above, and is\\nhindered from slipping backward. Fourth step The fingers in the\\nvagina may now leave the posterior vaginal vault and push the cervix\\nupward, while the external hand presses the fundus toward the apex\\nof the bladder, thus forcing the uterus into its normal position. The\\nposition of the adnexa may be determined by analogous steps. The ab-\\ndominal walls should be relaxed (full bath if necessary), and the limbs\\nshould be flexed at an angle of 60 degrees. The tubes are felt as round\\ncords the ovaries (which can not be fixed) as bodies of the size of an\\nalmond. The ovaries lie 2 or 3 cm. laterally and behind the uterus,\\non the inner margins of the psoas muscles. The healthy ovaries\\nexhibit a characteristic sensitiveness to pressure.\\n8. The anterior vaginal wall being too short, it may he\\nlengthened by the operation mentioned under 3 (Skutsch).\\n9. The abnormally roomy, relaxed vagina is to be nar-\\nrowed by colporrhaphy if not permitted reversed applica-\\ntion of the sledge-pessary, as in figure 32.\\n10. The puerperium is an appropriate time for the treat-\\nment of the organs and ligaments, which at this period are\\ncapable of being modeled and stretched. Replace by the\\nmethod of Schultze pushing back the cervix, elevating\\nPLATE 23.\\nMassage (Thure Brandt). By steps similar to those shown in\\nplates 21 and 22 the finger-tips meet behind the retroverted uterus\\nand rub and stretch the adhesions between the latter and the rectum.\\nAt first the blood supply of the adhesions is increased they become\\nsofter and more easily stretched. The uterus is finally lifted (Fig.\\n2) in order to lengthen the parametritic bands.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0140.jp2"}, "141": {"fulltext": "M\\n4", "height": "4581", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0141.jp2"}, "142": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0142.jp2"}, "143": {"fulltext": "3\\nI?", "height": "4597", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0143.jp2"}, "144": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0144.jp2"}, "145": {"fulltext": "Tab. 23.\\nFig. 2.\\nLith. Anst E RetcMwld, Mime/ten", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0145.jp2"}, "146": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0146.jp2"}, "147": {"fulltext": "PESSARIES. 91\\nthe fundus, and thus causing the body to spring forward.\\nRetention is maintained by two glycerin tampons placed\\ntransversely in the anterior, or, at other times, the poste-\\nrior, vaginal vault. Enforced lateral position.\\nDuring pregnancy it is necessary for the ring to remain\\nonly until the fifth month, because the uterus then holds\\nitself in proper position from its increased size.\\n11. In narrowing of the introitus vagince (stenosis of the\\nhymen, vaginismus) operative measures are to be adopted\\nand a ring is to be introduced.\\n12. The combination of perineal defect with vaginal\\ninversions and prolapsed uterus is to be treated by opera-\\ntion otherwise, the sledge-pessary.\\n13. Tumors and senility are contraindications.\\n14. If the ring is in good position and the patient still\\ncomplains, it is to be removed and another cause for the\\ndisturbances (hysteria) sought.\\nTorsion of the uterus is a pathologic turning of the\\nuterus about its longitudinal axis, caused by tumors or\\nabnormal distention of neighboring organs, or by para-\\nmetritic or perimetritic fixations. (Plates 44 and 45.)\\nIt is usually combined with other displacements. The\\nvaginal cervix shows the effect of the torsion. (Plate 55.)\\nThere is a physiologic torsion (cause of the first vertex\\nposition), since the anterior surface of the uterus, usually\\nin dextropositio, is turned toward the right, and the left\\nmargin approaches the symphysis (the child consequently\\nhas more room for its back on the left side than on the\\nright, which is narrowed by the spinal column).", "height": "4580", "width": "2798", "jp2-path": "atlasepitomeofgy00scha_0147.jp2"}, "148": {"fulltext": "GROUP III.\\nINFLAMMATORY AND NUTRITIONAL DIS-\\nTURBANCES.\\nCHAPTER I.\\nINFLAMMATION AND ITS CONSEQUENCES: AC=\\nQUIRED STENOSES AND ATRESIAS, CONTRAC=\\nTIONS OF ORGANS, EXUDATIONS,\\nAND ADHESIONS.\\nInflammation in any portion of an organ affects either\\nthe parenchyma i. e., the epithelial and glandular tissue\\n[glandular inflammation) or the connective tissue (inter-\\nstitial inflammation). Both varieties may occur together.\\nThe inflammation may run an acute or a chronic course.\\nThe former variety proceeds with active proliferation\\n(hypertrophy and hyperplasia, small round-cell accumula-\\ntions); the latter with contraction, due to the transforma-\\ntion of the spindle cells into connective-tissue fibers. The\\ninflammation causes a more profuse secretion, which may\\nbe serous, mucous, or purulent, according to its severity\\nand the nature of the affected tissue.\\nIn the majority of cases the inflammation follows upon\\ninfection with bacteria, among which gonococci, staphylo-\\ncocci, and streptococci play by far the most important\\nrole.\\nThe nature of the infection will depend upon the inci-\\ndents of sexual life (cohabitation, puerperium) upon\\n92", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0148.jp2"}, "149": {"fulltext": "ETIOLOGY. 93\\noperations, or upon contiguity to diseased organs (tubercu-\\nlosis).\\nBacteria and yeast fungi found in the secretions of the\\nuterine cavity are not always to be considered the cause of\\ninflammation. They have entered and flourished either\\nbecause the secretion has become pathologic, or because\\nthe introitus vaginae and the cervical canal have become\\naffected and gape. The primary causes are the frequent\\nactive and passive hyperemias, resulting from disturbances\\nof innervation and atonic conditions of the pelvic and\\nabdominal organs.\\nThe cause of the latter may have originally been infec-\\ntious inflammations that have undergone resolution, but\\nthat have left behind them a diminished contractility of\\nall the elastic elements. Such infectious inflammations\\nmay have occurred in early life. Uterine inflammations\\nin virgins are usually of a noninfectious character, and\\nthe result of masturbation. They lead to a lessened\\ntonicity of the whole genital system hyperemia and\\nrelaxation of the ligaments, retroversion and retroflexion\\nof the descending uterus, swelling and gradual descent of\\nthe ovaries. In those who have borne children, failure to\\nnurse and general weakness play the most important role,\\nas well as injudicious conduct during the puerperium, caus-\\ning subinvolution and consequent chronic metritis. In one\\ngroup of such cases the primary cause may have been a\\nmild puerperal infection, which has been confined to the\\nmucosa.\\nTerminations. Rarely, spontaneous cure destruction\\nof the parenchyma from retention of secretion, abscess\\nformation, or cicatricial contraction in some cases the\\ngeneral health is affected.\\nI 12. GONORRHEA.\\nThe acute disease arises from infection with the pus of\\na florid urethral gonorrhea i. e., one rich in gonococci.", "height": "4596", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0149.jp2"}, "150": {"fulltext": "94 GONORRHEA.\\nPLATE 24.\\nFig. 1. Gonorrhea. Papilloma of the hyperemia cervix puru-\\nlent discharge (from Mracek).\\nFig. 2. Gonorrheal Cervicitis. Bloody discharge. Erosio\\nsimplex. (Original water-color.)\\nFig. 3. Gonococci and Pus=corpuscles.\\n(Plate 24, 3.) The vulva and the vestibule are covered\\nwith thick, yellow, creamy pus, which wells out of the\\nvagina upon separation of the labia. As the disease pro-\\ngresses the discharge becomes more fluid, but remains\\nyellow. (Plates 24 and 27.) The parts are swollen, strik-\\ningly red, and sensitive. If the finger is introduced into\\nthe vagina and stroking movements are made against the\\npubic symphysis, pus can be stripped from the urethra.\\n(Plate 25.) Urination causes marked ardor urinae fol-\\nlowed by vesical tenesmus every quarter or half hour\\nthe desire to urinate returns the emptying of the bladder\\nnever seems complete. The symptoms of vesical catarrh\\npresent themselves the urine becomes cloudy and has a\\npungent ammoniacal odor (neutral or even alkaline reac-\\ntion).\\nBartholin s glands do not become inflamed until a later\\nperiod (Plates 25 and 26), and in comparatively rare cases\\nproliferation of the papillae of the skin occurs (condylomata\\nacuminata). (Plate 24, Fig. 1.)\\nThe vaginal mucosa is likewise inflamed, sensitive, and\\ndotted with red points, corresponding to the hyperemia\\npapillae. The greater portion of the purulent secretion\\ndoes not come from the vagina (which has no glands), but\\nfrom the cervix, which becomes infected at the same time.\\n(Plate 24, 2.) The swollen cervical mucosa is deep red\\nand protrudes at the external os a cervical endometritis\\nconsequently exists. At first the process stops at the in-\\nternal os.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0150.jp2"}, "151": {"fulltext": "Tab. 24.\\nih. Arist E Reichfwkl, Muncheri", "height": "4579", "width": "3150", "jp2-path": "atlasepitomeofgy00scha_0151.jp2"}, "152": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0152.jp2"}, "153": {"fulltext": "CLINICAL COURSE. 95\\nGonorrheal vaginitis, properly speaking, is a more\\nchronic process and occurs only in children.\\nA different course is taken by infection from a latent\\ngonorrhea (gleet of the male, goutte militaire, consisting of\\na very short stricture of the pars membranacea with a\\npainless, scanty secretion, especially noticeable as the\\nmorning drop rarely, sensitiveness of the urethra and\\nepididymis during sexual excitement darting pains at\\nthe root of the penis). A creeping inflammation arises,\\nthe first symptoms of which (ardor urinse and discharge)\\nare usually overlooked. The disturbance becomes more\\nmarked as the process invades the mucous membrane of\\nthe body of the uterus.\\nIn this situation both forms of the disease pursue a\\nsimilar course.\\nEndometritis of the body of the uterus causes irregu-\\nlarities of menstruation, the various pathologic varieties\\nalternating (see \u00c2\u00a74) at the same time, as a result of the\\ninflammatory hyperemia of the uterus, a sensation of a\\nheavy body of a fullness in the pelvis presents itself;\\nlater, there is actual uterine pain. These pains, however,\\nmay also proceed from inflammations of the tubes, as the\\ncocci quickly invade the latter from the uterine cavity.\\nHere the process halts for a second time, and the latent\\ngonorrhea may remain stationary, just as the acute form\\ndoes at the internal os. The gonococci may, however,\\npenetrate into the myometrium, or may gain access to\\nthe blood and set up new areas of infection, especially in\\nthe joints. The gonorrhea becomes a lurking chronic\\ninflammation with a dubious prognosis. The discharge is\\nincreased and purulent.\\nFrequently the inflammation does not extend to the\\nperitoneum from the tube because the isthmus or the fim-\\nbriated extremity of the latter becomes agglutinated. In\\nthis way a closed sac is formed, which becomes filled with\\npus a pyosalpinx.", "height": "4611", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0153.jp2"}, "154": {"fulltext": "96 GONORRHEA.\\nPLATE 25.\\nBartholinitis Dextra Gonorrhoeica. Perforation of the abscess\\non the inner surface of the nymphse urethritis relaxation of the\\nvaginal walls. (Original water-color.)\\nIf the peritoneum is affected, it occurs in one of two\\nways either through the tissues of the tubal wall by\\nmeans of its lymphatic paths, or by continuity of structure,\\ncreeping out upon the peritoneum and ovary. The latter\\nmay likewise be infected by means of the lymphatics or\\nfrom the peritoneum.\\nPainful, chronic, circumscribed inflammations of the\\nserosa of Douglas pouch arise perimetrosalpingitis\\nand perimetro-OOphoritis. Interstitial inflammation of\\nthe ovary may terminate in abscess. These changes are\\naccompanied by attacks of fever and considerable pain,\\nand lead to serofibrinous exudates in the recto-uterine\\nspace, which subsequently form adhesions between the\\nserous surfaces of the pelvic organs. These are responsi-\\nble for the manifold displacements and anomalies of posi-\\ntion of the uterus, its adnexa, the intestinal coils, and the\\nrectum.\\nThe disease of the tubes (it is usually bilateral) is the\\ncause of a new symptom sterility (one-child marriages).\\nIt is worthy of note that the gonococci prepare the way\\nfor the pus cocci, so that in the later stages we have to do\\nwith a mixed infection.\\nSymptoms. Ardor urinse (finally vesical catarrh and\\nbartholinitis, the former being recognized by the cloudy,\\nalkaline urine containing crystals of triple phosphate and\\nacid urate of ammonium, numerous micrococci, and mucus-,\\npus-, and blood-corpuscles the latter, by the increased\\nPLATE 26.\\nBartholinitis Sinistra Gonorrhoeica. Abscess formation (from\\nMracek).", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0154.jp2"}, "155": {"fulltext": "Tab. 25.\\nI\\nLtth. Anst E Reichhold. Miinchen", "height": "4593", "width": "3142", "jp2-path": "atlasepitomeofgy00scha_0155.jp2"}, "156": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0156.jp2"}, "157": {"fulltext": "", "height": "4573", "width": "3255", "jp2-path": "atlasepitomeofgy00scha_0157.jp2"}, "158": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0158.jp2"}, "159": {"fulltext": "SYMPTOMS. TEE A TMENT. 9 7\\ntenderness, redness, swelling, and finally fluctuation at the\\nlower third of the labia rnajora, see Plates 25 and 26)\\npurulent discharge from the vagina, irregularities of men-\\nstruation, pain, and sterility.\\nDiagnosis. Demonstration of the gonococci (by stain-\\ning for half a minute in an -effective alcoholic solution of\\nmethylene-blue see Plate 24, Fig. 3 it is the only coc-\\ncus decolorized by Gram s method above all, it is found\\nwithin the pus-cells) a general or punctiform reddening\\nof the vagina the pus is seen to come from the cervix\\npain is localized in the uterus, adnexa, or peritoneum of\\nDouglas pouch.\\nTreatment. In fresh cases with colpitis alone Vag-\\ninal irrigations with a 5 solution of protargol (five times\\ndaily for two weeks, then twice daily with potassium per-\\nmanganate) keep the parts clean, especially the vulva\\n(cervicitis is usually present, however). Dilatation of the\\ncervical canal by means of metal dilators, after having\\ncarefully disinfected it and the vagina by means of anti-\\nseptic solutions intra-uterine irrigation with two liters of\\na 0.5^ to 2.o c /c (even 5^) solution of protargol (increase\\nthe strength gradually for two or three weeks). Follow-\\ning this, the introduction of h c c to 10^ protargol salve\\nor bougies, wiping out the vagina with a 10^ protargol\\nsolution and gauze tamponade with protargol salve or pro-\\ntargol glycerin. In the third week of this treatment the\\napplication of astringents to remove the remaining swell-\\ning of the mucous membrane mentioned on page 93\\nAluminum acetate solution (2 to oft), bismuth subnitrate\\n(2 to 3 ft This treatment is to be carried out with caution,\\nthe patient being kept at absolute rest in bed for the greater\\npart of its duration, to prevent the disease from spreading\\nto the adnexa. It is based upon Neisser s recommenda-\\ntion of the silver albuminates (especially protargol) as\\nspecifics.\\nIf for any reason this treatment can not be properly\\ncarried out, we must return to the earlier method of treat-\\n7", "height": "4619", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0159.jp2"}, "160": {"fulltext": "98 GONORRHEA.\\nPLATE 27.\\nGonorrheal Vulvitis and Vaginitis. Old perineal tear of first\\ndegree external hemorrhoids intertrigo. (Original water-color.)\\nPLATE 28.\\nFig. 1. The Microscopic Structure of the Parts of the\\nVulva. (1) Stratified squamous epithelium with the excretory ducts\\n(2) of the numerous sebaceous glands of the labium inajus, whose\\nconnective tissue (3) is sparingly supplied with blood-vessels. (4)\\nStratified squamous epithelium of the nymphae (still without se-\\nbaceous glands in the fetus), covering numerous connective-tissue\\npapillae the cavernous tissue is traversed by numerous capillaries,\\nwhich form a mass of erectile tissue at (6). This is surrounded by\\ndense bundles of fibers receiving their blood supply from (10) and\\npassing to the outer lamella (8) of the hymen, the squamous epithe-\\nlium (9) of which is likewise stratified. The inner lamella of the\\nhymen is composed of bundles of fibers and vessels, which come from\\nthe vagina (12). (Original drawing from a specimen obtained from a\\nnewly born girl.)\\nFig. 2. Longitudinal Section Through the Cervix in a Case\\nof Old Prolapse of the Uterus. The stratified squamous epithelium\\nof the cervix shows a superficial horny degeneration. The transition\\nfrom the squamous epithelium of the outer wall of the cervix to the\\ncylindric epithelium of the cervical canal is seen at (3). Its displace-\\nment inward is due to the slight ectropion of the lips of the os. The\\nstasis of the blood and lymph in prolapsed uteri is apparent from the\\ndilated vessels (4). (Original drawing.) (See Plates 10 and 12.)\\nFig. 3. Simple, Papillary, and Follicular Erosion of the\\nCervix. (Original drawing combined from different specimens.) At\\nthe left are seen the intact stratified squamous epithelium of the\\nvaginal cervix this is continuous with cylindric epithelium, which is\\nformed by the cuboid cells of the matrix after desquamation of the\\nsquamous epithelium has occurred (erosio simplex). Further to the\\nright are seen papillary elevations with cylindric epithelium (erosio\\npapilloides). Glandular follicles showing cystic dilatation from re-\\ntained mucus, or filled with exudation, are seen in the inflamed con-\\nnective tissue, which is traversed by dilated vessels with round cells\\n(erosio follicularis) Some muscle-fibers are above and to the left.\\n(See Plate 29, Fig. 4 Plates 33, 35, and 37 Plate 60, Fig. 2 and\\nPlate 90, Fig. 1.)", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0160.jp2"}, "161": {"fulltext": "j(\\\\ i\\nI\\nic0%W\\na\\nmm\\n\u00e2\u0096\u00a0St-/\\n1\\nMr-\\n*H\\n0\\nTab. 28.\\nFig.3.\\nLith. Anst. E Retdtkold, Miinchm.", "height": "4604", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0161.jp2"}, "162": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0162.jp2"}, "163": {"fulltext": "TREATMENT. 99\\nment let the cervix alone, wash away the secretions sev-\\neral times daily with 2 or 3 liters of solutions of silver\\nnitrate, potassium permanganate (bright red), bichlorid of\\nmercury (1 2000 to 1 4000), the patient being in the re-\\ncumbent posture wipe out the vagina several times a week\\nand pack with protargol gauze (10 finally, the patient\\nis allowed to introduce tampons of protargol glycerin.\\nThe husband must have his urethra appropriately\\ntreated.\\nArgonin also an albumin-silver combination contains\\nless silver than protargol. Argentamin, on account of its\\ngreater penetration and its ability to excite inflammation,\\nis adapted only to neglected cases, in which it is of con-\\nsiderable service. Nitrate of silver is of value in the\\nafter-treatment because of its astringent qualities. Largin\\ncontains 11.1 c /o silver in combination with nucleo-albumin,\\nand excels all others in its power of killing the gonococci\\nit is, however, inferior to them in rendering the soil unfit\\nfor the organism.\\nFor the urethritis (female) wipe out the urethra with a\\n5 f protargol solution, sublimate 1 5000, or a 2 f solu-\\ntion of silver nitrate, and introduce a bf protargol\\nbougie every day for a week the bladder may eventually\\nbe washed out with al^ to c /c protargol solution.\\nIf the bartholinitis goes on to abscess formation, incise\\nwhen fluctuation occurs and pack with iodoform gauze if\\nit recurs, excise it entire and bring the edges of the wound\\ntogether.\\nCondylomata are removed with scissors or cauterized w T ith\\n25 c /c chromic acid, concentrated carbolic acid, or nitric acid.\\nCystitis Wash out the bladder as previously directed\\nlater, with al^ or 2^ silver nitrate solution and a 2-J^\\nsolution of cocain (J to liter, lukewarm, using catheter\\nand Hegar s funnel, or Kiistner s urethral funnel).\\nInternally, diuretic drinks (milk, tea, juniper berries,\\netc.) and urotropin 0.5 three times daily.\\nIn the second group of cases the older ones only\\nL-ofCt", "height": "4610", "width": "2786", "jp2-path": "atlasepitomeofgy00scha_0163.jp2"}, "164": {"fulltext": "100 CHRONIC ENDOMETRITIS.\\nPLATE 29.\\nFig. 1. Elephantiasis Vulvas. (Original drawing.) (1) Strati-\\nfied squamous epithelium covering the connective-tissue papillae. Nu-\\nmerous lymph capillaries (3) are seen in the connective-tissue stroma\\n(2). Some round-cell deposits are present, due to the proliferation.\\n(See Plate 51, Fig. 1.)\\nFig. 2.\u00e2\u0080\u0094 Condyloma Acuminatum. (Original drawing.) (See\\nPlate 24, Fig. 1.) Fine dendritic proliferation of the connective-tissue\\npapillae (2), which are covered with a very thick layer of stratified\\nsquamous epithelium (1).\\nFig. 3. Vaginal Secretion. (1) Polygonal squamous epithelium\\n(seen from the side at 6) (2) red blood-corpuscles (3) leukocytes\\n(4) oidium albicans (5) staphylococci (7) bacilli (8) trichomonas\\nvaginalis.\\nFig. 4.\u00e2\u0080\u0094 Cross=section of an Ovule of Naboth Situated in\\nthe Wall of the External Os. (Original drawing from a speci-\\nmen.) (1) Simple cylindric epithelium of the cervical mucosa; (2)\\npartly desquamated cylindric epithelium from dilated cervical glands\\n(ovula Nabothi) (3) cervical glands (4) stratified squamous epithe-\\nlium of the vaginal cervix. (See Plate 37, Fig. 2 Plate 60, Fig. 2\\nPlate 90, Figs, land 3.)\\nafter the vagina has been washed out for weeks do we\\nproceed to treat the uterus on the principles laid down\\nunder endometritis and metritis. (See \u00c2\u00a713.) If affec-\\ntions of the adnexa are not rigidly excluded by careful\\nbimanual examination, every intra-uterine therapeutic\\nmeasure will be replied to by these organs with an exacer-\\nbation of the trouble. The salpingitis, etc., must be first\\ntreated. (See 16.)\\nIn commencing joint affections the temporary constric-\\ntion of the extremity is to be carried out according to the\\nmethod of Bier.\\n13. CHRONIC ENDOMETRITIS. EROSION AND\\nECTROPION OF THE EXTERNAL OS.\\nEndometritis is an affection of the uterine mucous mem-\\nbrane alone it may appear as a disease sui generis without", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0164.jp2"}, "165": {"fulltext": "Tab. 29.\\nM-i c\\n--Ax^W\\nFig.,\\nFig.3.\\nFig. 4-.\\nLith. Anst F. B,eichhold, Miindien", "height": "4595", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0165.jp2"}, "166": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0166.jp2"}, "167": {"fulltext": "CERVICAL ENDOMETRITIS. 101\\naffecting other organs, and causes little general disturb-\\nance.\\nAlthough gonorrhea plays the most important role in the\\netiology of the infectious uterine inflammations, there are,\\nnevertheless, an important class of cases in which we must\\nseek another cause. This is especially true when they\\noccur in the virgin. Pyogenic organisms, not infrequently\\nowing their introduction to the practice of masturbation,\\nare partly responsible for them.\\nAnother group of cases frequently leading to a general\\ndisease may be traced to a septic infection, whether it occur\\nin the puerperium, or as the result of operative measures\\nor of trauma.\\nClinically, we are able to differentiate\\n1 Catarrh (a) of the cervical mucosa of the cor-\\nporeal mucosa, usually of a nonbacterial nature.\\n2. Purulent inflammation (a) of the cervical mucosa\\n(6) of the corporeal mucosa, almost without exception of\\na bacterial nature.\\nFrom an anatomic standpoint the first form is synony-\\nmous with the pure glandular inflammation the second,\\nwith the interstitial inflammation accompanied by some\\nglandular change. (See explanation to Plates 30 and 31\\nand p. 107.)\\nThe affections of the cervix are the more frequent those\\nof the mucous membrane of the uterus, the more severe.\\n(a) Catarrh of the Cervix and Chronic Cervicitis and Their\\nConsequences Erosion and Ectropion.\\nThe acute inflammation of the mucous membrane and\\nwall of the cervix is, without exception, of an infectious\\nnature, and is due to the invasion of gonococci or strep-\\ntococci following puerperal lacerations, trauma, or oper-\\nations upon the cervix. In the latter case either the\\nulceration of the vaginal cervix or the inflammation of the\\nentire uterus and its surrounding connective tissue may\\nbe the more prominent manifestation.", "height": "4603", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0167.jp2"}, "168": {"fulltext": "102 CHRONIC ENDOMETRITIS.\\nPLATE 30.\\nFig. 1.\u00e2\u0080\u0094 Normal Uterine Mucosa. (Original diagrammatic\\ndrawing. The mucous membrane of the entire uterus is covered with\\na single layer of ciliated eylindric epithelium. In the cervix these\\ncells are club-shaped and considerably higher than in the corpus uteri.\\nBoth forms produce mucus, which ascends from the more easily stained\\nprotoplasm about the nucleus to the upper portion of the cell, from\\nwhich it is emptied. As this process goes on, the nucleus of the utric-\\nular cell ascends and descends, while the more actively secreting cer-\\nvical cell possesses two constituent parts a lower rounded portion,\\nalways containing the nucleus, and devoted to secretion; an upper\\nportion, connected with the former by a narrow isthmus, and devoted\\nto the storage of the secretion. This upper portion consequently does\\nnot take the nuclear stains. The nuclei of the cervical cells are neces-\\nsarily all at the same level, while in the utricular cells this is not the\\ncase. The cervical cells are fixed by means of processes that extend\\nunderneath the contiguous epithelium. In the intact healthy uterus\\nthe eylindric epithelium extends to the external os, where the squam-\\nous epithelium of the vagina commences.\\nThe uterus may be anatomically divided into two parts the body\\nand the neck. Corresponding to the utricular and cervical cells, we\\nalso have two specific forms of glands large, acinous glands in the cervix\\n(cervical glands); long, narrow, tubular glands, chiefly in the body\\n(utricular glands). These glands are distributed as follows:\\nIn the body of the uterus, only tubular utricular glands with low\\nepithelium, the nuclei being centrally situated. In the cervix above\\nthe plicae palmatae, both cervical and utricular glands, the former hav-\\ning unusually high epithelium. In the plicated region, simply folds\\nand recesses, no real glands; the plicae are studded with slender,\\nthread-like papillae, which are covered by a low, almost cuboid, eylin-\\ndric epithelium\\nIn the lowest portion of the cervix both acinous and tubular glands\\nare found; there is also another variety of papillae low, fungiform, and\\ncovered with large club-shaped cervical cells.\\nThe secretion of the healthy uterus is scanty. The vagina contains\\nno glands, or only a few (glandula aberr antes) at its junctions with the\\nuterus and with the vulva.\\nThe mucous and submucous connective-tissue stroma is richly sup-\\nplied with round cells and vessels, which allow of considerable varia-", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0168.jp2"}, "169": {"fulltext": "Iig.1.\\nFig.Z.\\nFiffJ.\\n\u00e2\u0096\u00a0M:^+\\nFig \\\\4r.\\nlith. Anst. F. RetcMwUL, Miinchen", "height": "4596", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0169.jp2"}, "170": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0170.jp2"}, "171": {"fulltext": "CERVICAL ENDOMETRITIS. 103\\ntion in the degree of swelling of the mncons membrane, whether it be\\nmomentary or corresponding to the periodic congestions. This also\\nexplains its rapid regeneration. The muscularis is situated beneath\\nthe submncosa.\\nFig. 2. Hyperplastic Glandular Endometritis. (Original\\ndrawing from a specimen. The individual glands are more numerous\\nand are increased in extent by lateral pouchings (Ruge) the walls are\\nenveloped in a connective-tissue capsule, which is richly infiltrated\\nwith leukocytes and round cells the remaining stroma shows practi-\\ncally no inflammatory or proliferative process. If the stroma gave\\nevidences of the latter, the condition would be known as endometritis\\nfungosa (Olshausen), the mucous membrane being considerably thick-\\nened. If the proliferation of glandular and interstitial tissue is cir-\\ncumscribed, the condition is known as endometritis polyposa.\\nFig. 3. Malignant adenoma (glandular cancer) (original\\ndrawing from a specimen differentiates itself from hyperplastic endo-\\nmetritis by the fact that the glandular epithelial proliferation exceeds\\nthat of the connective-tissue stroma the relative proportion between\\nthe two differs from the normal. The glandular tissue eats up the\\nstroma, so to speak, destroys the muscularis, and finally invades other\\norgans or gives rise to metastases along the lymphatic channels. The\\nstroma always shows marked round-cell infiltration; the glandular\\nspaces are lined with stratified squamous epithelium an evidence of\\nthe active proliferation. There is a striking irregularity in the form\\nof the glands and in the picture as a whole.\\nFig. 4. Hypertrophic Glandular and Interstitial Endome-\\ntritis. (Original drawing from a specimen.) The glandular hyper-\\ntrophic form rarely occurs alone, and consists of an enlargement (no\\nincrease or marked pouching) of the glands (Ruge); they become\\ncoiled like a corkscrew, showing, at most, a serrated pouching. In\\nthis specimen the interglandular tissue shows proliferative round-cell\\ninfiltration hemorrhages have occurred in both glandular and connec-\\ntive tissues. The superficial epithelium has undergone partial desqua-\\nmation.\\nChronic cervicitis arises as a sequel to such an in-\\nflammation, especially if the external os has been lacer-\\nated and gapes.\\nThe noninfectious inflammations of the cervix present", "height": "4601", "width": "2789", "jp2-path": "atlasepitomeofgy00scha_0171.jp2"}, "172": {"fulltext": "104 CHRONIC ENDOMETRITIS.\\nPLATE 31.\\nFig. 1. Acute Interstitial Endometritis. The interglancliilar\\nconnective tissue is in active proliferation, and consists of densely\\npacked round cells. The glands are partly pressed aside and partly\\nconverted into retention cysts (ovula Nabotlii) by distortion of their\\nexcretory ducts. Hemorrhage into the stroma. Epithelial desquama-\\ntion. (Original drawing from a specimen.\\nFig. 2 Chronic interstitial endometritis is the continuation\\nof the former, the round cells becoming changed into rigid connective\\ntissue. The glands atrophy. The vessels become thick-walled. The\\nsuperficial epithelium is absent or almost squamous (the squamous epi-\\nthelium of the external os can be seen at the left of the illustration).\\nFig. 3.\u00e2\u0080\u0094 Postabortive Endometritis. An island of decidual\\ncells may be seen under the partly regenerated superficial epithelium.\\nFew glands, many round cells, strongly dilated capillary blood-vessels.\\nthe same clinical picture. A condition of relaxation is\\nthe primary cause it may lead to ectropion even though\\nno laceration exists. If the inflammation is limited to\\nthe mucous membrane, we speak of catarrh of the cervix.\\nSymptoms. The discharge is the first and most con-\\nstant symptom. In uncomplicated catarrh it is mucoid\\nin purulent cases (mixed infection) it is mucopurulent as\\na result of the admixture of pus-corpuscles. This dis-\\ncharge in time weakens the individual and hinders con-\\nception by the formation of a cervical plug of tough\\nmucus. The blood-vessels are overfilled and are easily\\ntorn on account of the inflammatory proliferation of the\\nmucous membrane. (Plate 30.) Reflex menorrhagia\\nand dysmenorrhea occur, as well as slight hemorrhages\\nfrom contact. Pain is present, however, in the intervals\\nbetween the periods, if the swollen mucous membrane\\nprotrudes from the external os ectropion. (Plate 28,\\nFig. 3 Plates 35 and 56.)\\nEctropion usually occurs when the commissures of the\\nos uteri have been lacerated. I have repeatedly seen it", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0172.jp2"}, "173": {"fulltext": "Tab 31.\\nJ\\n;L\\ni\\nJ^l.\\nu^-\\nWai/8.\\nv-I^ -5-t-vSaojv\\n/Ygf.J.\\nZrt/z Anst F. Rekhhold. Mimchen", "height": "4603", "width": "3106", "jp2-path": "atlasepitomeofgy00scha_0173.jp2"}, "174": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0174.jp2"}, "175": {"fulltext": "DIAGNOSIS. 105\\narise in the intact uterus if pessaries were introduced when\\nthe organ was relaxed and in a lower position than usual.\\nDiagnosis. Palpation discloses the thickening of the\\ncervix, and the examining finger is covered with mucus or\\npus. Changes of structure can be felt only in the older\\nectropions, and such a condition should always lead one\\nto suspect a beginning cancer.\\nInspection (Speculum). In a multipara with ectro-\\npion the examination of the mucous membrane is easy\\nin the closed orifice of the nullipara we discover, at most,\\nretention cvsts of the cervical glands ovula Xabothi.\\n(Plate 29, Fig. 4; Plate 56, Fig. 1 Plate 69, Figs. 1\\nand 3.) In these cases we must draw the os well down\\nby means of forceps, evert the lips with tenacula, or dilate\\nthe external os.\\nThe cervical cavity is distended by the profuse, tena-\\ncious secretion this may be demonstrated by the sound.\\n(Plates 47 and 67.)\\nThe secretion also causes a desquamation of the super-\\nficial layers of the squamous epithelium about the os uteri,\\nand erosio simplex is produced. (Plate 28, Fig. 3 Plate\\n33, Fig. 1.) If the cells of the matrix become cylindric\\nand arrange themselves in glandular formations, we have\\nto do with an erosio papilloides. (Plate 90, Fig. 1.) If\\neither one is combined with the formation of ovula Xabothi,\\nwe speak of erosio follicularis. (Plate 37, Fig. 2.)\\nDifferential Diagnosis. Between erosion and ectro-\\npion In the former the external os is centrally situated\\nwithin the erosion in the latter it is outside of, and\\npressed away by, the ectropion. (Plates 33, 37, and 56.)\\nDifferentiation between erosio papilloides and epithelio-\\nmatous papilloma is best made bv the microscope. (Plate\\n28, Fig. 3 Plate 79, Figs. 1 to* 3.) The follicular form\\nmay produce polypoid excrescences by a circumscribed\\nelevation of portions of the mucous membrane. (Plate\\n90, Fig 3.)\\nBetween ectropion (Plates 34, 35, and 56) and incipient", "height": "4599", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0175.jp2"}, "176": {"fulltext": "106 CHRONIC ENDOMETRITIS.\\nPLATE 32.\\nFig. 1. Marked Congestion and Beginning Simple Erosion\\nof the Posterior Lip of the Os, as a Sign of Uterine Inflam\\nmation Endometritis and Metritis. The simple erosion (see\\nPlate 33 also consists of a casting-off of all the epithelial cells above\\nthe cuboid layer, allowing the cutaneous capillaries to shine through\\nmore distinctly. The constant irritation of the uterine secretion is the\\ncause of the desquamation.\\nFig. 2. Slight Congestion of the Cervix of a Multipara\\nwith a Characteristic, Broad, Fissured External Orifice.\\ncancer Touch is not to be depended upon, since both con-\\nditions offer the sensation of hard, solitary nodules. (Plates\\n81, 83, 84, and 90.) Inspection shows ovula Nabothi\\nin ectropion nodules with destructive ulceration in carci-\\nnoma. If ulceration does not exist, all that remains is\\nthe microscopic examination of an excised piece.\\nPrognosis. It is of importance to remember that\\ncatarrh of the cervix is cured with difficulty, and that the\\ninveterate forms have a tendency to malignant degenera-\\ntion.\\nTreatment. The local treatment of the cervical mu-\\ncosa is exactly the same as that of the uterine mucous mem-\\nbrane. (See p. 109.) The swelling of the vaginal cervix\\nand of the ovules of Naboth is greatly lessened by multi-\\nple punctures and scarifications. If the external os is\\nnarrow, lateral incisions are to be made to the vaginal\\nvault, if necessary.\\nErosions are to be treated by cauterization Acetic acid,\\nto which 4 fo carbolic acid has been added, is poured into the\\nPLATE 33.\\nFig. 1.\u00e2\u0080\u0094 Congenital Simple Erosion of the Cervix of a\\nVirgin. (Original water-color from a case.\\nFig. 2. Leukorrhea and Simple Erosion. (Original water-\\ncolor from a case.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0176.jp2"}, "177": {"fulltext": "A\\n^\u00e2\u0096\u00a0p", "height": "4603", "width": "3125", "jp2-path": "atlasepitomeofgy00scha_0177.jp2"}, "178": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0178.jp2"}, "179": {"fulltext": "CO\\nOS\\nH\\nSI", "height": "4590", "width": "3124", "jp2-path": "atlasepitomeofgy00scha_0179.jp2"}, "180": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0180.jp2"}, "181": {"fulltext": "CORPOREAL ENDOMETRITIS. 107\\nspeculum and allowed to act for several minutes (daily, for\\na few weeks). The reddened ulcerated patches gradually\\ndisappear as the pathologic cylindric epithelium is replaced\\nby epidermoid cells. Weak solutions of cupric sulphate\\nor zinc chlorid act more quickly. If the epithelial cov-\\nering is cast off in deeper ulcerations, cauterize with one\\ndrop of fuming nitric acid, afterward washing out with\\nwarm water otherwise, excise. Above all, remove the\\ncause the discharge.\\nEctropion and follicular hypertrophy of the mucous\\nmembrane, if present in but a slight degree, vanish when\\nthe catarrh is treated Avith caustics. The severe forms are\\ntreated by operative measures by removal of the swollen\\nmucous membrane by means of a wedge-shaped excision\\nfrom the entire thickness of the cervical wall (see Metritis\\nunder 14) by excision of the connective-tissue commis-\\nsures of the gaping os uteri followed by suture. In other\\ncases the pessary should be removed and an operation for\\nprolapse should be performed.\\n(b) Endometritis Corporis Uteri.\\nAny endometritis, whether it be cervical or corporeal,\\nmay appear as an acute or a chronic process, or in milder\\nor severer forms.\\nThe latter division denotes not only difference of grade,\\nbut also qualitative change\\nThe milder forms produce no structural change the\\nsecretion is more profuse and is mucoid and glairy hem-\\norrhages occur.\\nThe severer forms lead to proliferation and to a puru-\\nlent discharge.\\nThere are certain histologic peculiarities that explain\\nthese differences (see Plates 30 and 31) these are as fol-\\nlows (Ruge, Veit)\\nI. Endometritis glandularis: (1) Hypertrophic e., the glands\\nproliferate in length only, becoming rolled up between the surface of\\nthe mucosa and the muscularis. Their longitudinal section resembles", "height": "4605", "width": "2781", "jp2-path": "atlasepitomeofgy00scha_0181.jp2"}, "182": {"fulltext": "108 CHRONIC ENDOMETRITIS.\\nPLATE 34.\\nEctropion with Extreme Relaxation of the Cervical Wall\\nand Intact Commissures of the External Os. Anemic cervix fol-\\nlowing climacteric menorrhagias from myomata. (Original water-\\ncolor from actual case.\\na corkscrew. (2) Hyperplastic the glands proliferate in length and\\nbreadth, forming lateral pockets.\\nII. Endometritis interstitialis (1) Acnte ronnd-cell proliferation\\nleads to purulent secretion 2 chronic or cirrhotic connective-tissue\\nformation, contraction, leading at last to atrophic endometritis.\\nThe glandular forms occur as mixed forms, especially with acute\\ninterstitial endometritis if the hyperplasia and proliferation are pro-\\nnounced, we have:\\nIII. Endometritis fungosa (mixed form), if the proliferation is\\ndiffuse or\\nTV. Endometritis polyposa (mixed form) and endometritis follicu-\\nlaris (Plate 90, 3), if it is circumscribed.\\nFrom groups II and III the following varieties may be separated,\\ntheir most striking symptom being either hemorrhage or a casting-off\\nof the mucosa\\nY Endometritis exfoliativa dysmenorrhea membranacea, see 3\\nVI. Endometritis dissecans with phlegmon.\\nVII. Endometritis hemorrhagica scanty secretion; fungous mu-\\ncosa after abortion in acute infectious diseases.\\nIf the endometritis is the result of an abortion, we designate it as\\nVIII. Endometritis post abortum, to be recognized by the large\\ndecidual cells.\\nThe ovules of Xaboth arise (Plate 29, Fig. 4 56, Fig. 1 69, Figs,\\nland 3):\\n1. From excessive proliferation and secretion in I (2).\\n2. From a too narrow excretory duct in I (1).\\n3. From occlusion of duct by angulation in I (1).\\n4. From compression of duct by inflamed connective tissue in II (1).\\n5. From cicatricial closure in II (2).\\nThe symptoms of chronic endometritis corporis uteri\\nare the same in infectious and noninfectious cases\\n1. Pain, at the time of the menses (dysmenorrhea),\\nPLATE 35.\\nMucous Polyp and Ectropion of the Anterior Lip of the\\nUterus. The cervical walls are relaxed and anemic the commis-\\nsure of the os uteri is intact. (Original water-color from actual case.)", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0182.jp2"}, "183": {"fulltext": "Tab. 34\\nLUfCAnst F RsLchhvld, Munthai.", "height": "4593", "width": "3109", "jp2-path": "atlasepitomeofgy00scha_0183.jp2"}, "184": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0184.jp2"}, "185": {"fulltext": "Tab. 35.\\nLiih Anst K Reichtwld, Muncheii", "height": "4604", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0185.jp2"}, "186": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0186.jp2"}, "187": {"fulltext": "DIA GNOSIS.\u00e2\u0080\u0094 TEE A TMENT. 109\\nwith or without casting-off a decidua menstrualis or,\\nrarely, in the interval (intermenstrual pain) or permanent,\\nceasing with the beginning of the flow, so that the men-\\nstrual period is the only time at which there is no pain\\nor permanent, with exacerbations at the menstrual epoch.\\n(See 17.)\\n2. Discharge, mostly bloody, serous, mucoid (Kiistner,\\nSchroder) and purulent (B. S. Schultze). Determined by\\nmeans of tampons.\\n3. Changed character of menstruation menorrhagia\\nand dysmenorrhea.\\n4. Sterility.\\n5. Reflex nervous disturbances pains in the umbilical\\nregion, dyspepsia, all varieties of hysteric troubles.\\nAs the myometrium is usually involved, the symptoms\\nof myometritis may complicate the clinical picture.\\nDiagnosis. 1. The sound causes characteristic pain as\\nit passes the internal os the entire uterine mucosa is hyper-\\nsensitive. The sound also reveals the size of the uterine\\ncavity and any roughenings or fungosities that may be\\npresent.\\n2. Abrasio mucosae (curetment, raclage, excochleation)\\nthe tissue is removed and its structure examined with\\nthe microscope.\\n3. In doubtful cases the cervical canal is dilated (metal\\ndilator of Fritsch, Kustner s adjustable dilator, lamin-\\naria well sterilized) and the entire uterine cavity is\\npalpated.\\nPrognosis. Serious results follow from the hemor-\\nrhage and from the discharge, as well as from the occur-\\nrence of malignant degeneration.\\nTreatment. Above all, provide for a regular and\\nsufficient discharge of the secretions. The external os,\\nand especially the internal os (normally 4 mm. in diam-\\neter), are usually constricted frtfm the inflammatory swell-\\ning of the mucosa, and may require mechanical dilatation.\\nTo aid in removing the secretions, vaginal irrigations", "height": "4619", "width": "2788", "jp2-path": "atlasepitomeofgy00scha_0187.jp2"}, "188": {"fulltext": "110 CHRONIC EXDOJIETBITIS.\\nPLATE 36.\\nFigs. 1 a, 1 1 e. Different Molds of the Uterocervical\\nCanal as Shown by Swollen Laminaria. The end to which the\\nsilk thread is attached lay in the external os. (Original water-color\\nfrom actual cases.\\nFig. 2. Curetment in Fungous Endometritis. Relaxed,\\nanemic cervix sharp, although irregular limitation of the squamous\\nepithelium at the external os. (Original water-color from actual\\ncase.\\nwith astringents (alum, tannin, bismuth subnitrate, zinc\\nsulphate) or antiseptics (potassium permanganate, solu-\\ntion of aluminum acetate, 1 formalin, 1 4000 to 1 2000\\ncorrosive sublimate), exciting the uterus to contraction\\nand washing the cervical mucosa.\\nThe character of the diseased mucous membrane must\\nbe changed by using astringents or caustics. The stronger\\ncaustics (10 zinc chlorid, for example) should not be\\nused, as they may produce strictures, stenoses, and patho-\\nlogic adhesions. These substances are best applied in\\nliquid form (sesquichlorid of iron in 50^ solution or\\npure, 2 c c solution of silver nitrate, 5 c solution of zinc\\nchlorid, fuming nitric acid) by means of cotton and the\\naluminum sound.\\nAt the same time the infectious virus must be removed,\\neither by the foregoing caustics or by antiseptics. In\\naddition to intra-uterine irrigation (Fritsch s two-way\\ncatheter), pencils of itrol or iodoform may be introduced.\\nThe cervix may be dilated and the uterine cavity may\\nbe disinfected at the same time by packing the uterus with\\nitrol or iodoform gauze (following Abel, to be removed\\ndaily). Landau introduces yeast cultures.\\nThe changed and infected mucous membrane may be\\nremoved by radical methods abrasion, curetment (rac-\\nlage, excochleation).\\n1 See Therapeutic Table.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0188.jp2"}, "189": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0189.jp2"}, "190": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0190.jp2"}, "191": {"fulltext": "TREATMENT. Ill\\nAfter careful disinfection and dilatation the cervix is\\nfixed with bullet-forceps and the uterine walls are care-\\nfully and evenly scraped. Simon s sharp spoon or the\\ndull wire curet may be used. [The dull wire curet is\\npractically useless. Ed.] The various portions of the\\ncavity should be cureted in some definite order. The\\ncureting is to be immediately followed by packing with\\nantiseptic gauze (itrol, iodoform) or with gauze saturated\\nwith some caustic (solution of ferric chlorid, formalin).\\nThis controls the hemorrhage, acts as a disinfectant, and\\nbrings the medicament in contact with the remaining\\ndiseased mucous membrane. It is still better to follow\\nup the curetment with atmocausis or zestocausis. (See\\nTreatment of Chronic Metritis.)\\nNarcosis is necessary in the majority of cases. The\\nintra-uterine irrigations may sometimes cause colic.\\nFor three or four days after the curetment daily intra-\\nuterine douches of 2 c c carbolic acid act favorably in the\\nmarked cases of proliferative fungous endometritis the pro-\\ncess is kept within bounds by washing out the uterine\\ncavity twice daily, and then applying astringents (solution\\nof sesquichlorid of iron, tincture of iodin) by means of\\nthe sound.\\nAccording to my experience, atmocausis and zestocausis\\n(vaporization, vapocauterization) are productive of better\\nand more permanent results than these scraping and cau-\\nterizing methods.\\nI 14. CHRONIC METRITIS.\\nThe clinical picture of chronic metritis consists of inflam-\\nmatory hyperemia and swelling and sensitiveness of the\\nentire organ. It leads to a connective-tissue hyperplasia\\nrather than to a proliferation of the muscle-cells. The\\ninflammation progresses slowly, with acute and subacute\\nexacerbations, and in some cases ends in cirrhosis. The\\nendometrium is nearly always diseased, and consequently", "height": "4611", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0191.jp2"}, "192": {"fulltext": "112 CHRONIC METRITIS.\\nPLATE 37.\\nFig. 1. Chronic Metritis with Ovula Nabothi. Metritis is\\nan inflaniniation of the uterine muscular is. If the process is of long\\nduration, the muscle-cells are partly replaced by scar-tissue (see Plate\\n31, Fig. 2), which in our illustration retracts the cervical mucosa and\\ncauses a visible wrinkling. The ovula Nabothi are retention cysts,\\nresulting from distortion of the ducts by contracting connective tissue.\\n(Plate 29, Fig. 4.)\\nFig. 2. Gonorrheal Endometritis with Simple Erosion and\\nOvules of Naboth; Inflammatory Hyperemia. (Plates 29, 30,\\nand 31. Thick, yellow, creamy pus flows from the os and fills the\\nvagina. The ovula Nabothi are also filled with pus. The erosion is\\nthe result of the endometritis. The simple infection with gonococci\\nsoon gives place to a mixed infection with staphylococci and strep-\\ntococci, the former organisms having prepared the soil for the latter.\\nThe process creeps up the tubes and then progresses to the nearest peri-\\ntoneal surface (metritis, oophoritis, perisalpingitis), at first producing\\nexudations, then adhesions and cicatricial bands. (Plates 44 and 45,\\nFig. 36. The gonococci, as a rule, invade only the supe icial layers\\nof those membranes covered with cylindric epithelium.\\nThe adhesions of the tubes and ovaries lead to the fori. \u00c2\u00bbn of ab-\\nscesses Pyosalpinx, Plate 42 and sterility. The perimetritic process\\ncauses displacements of the uterus and its adiiexa.\\nthe symptoms of myometritis and endometritis are insepa-\\nrably associated.\\nThere are two stages a The stage of hyperemia and round-cell\\ninfiltration the uterus is soft and easily torn, as a result of the edema\\nand fatty degeneration of the muscularis. (b) The stage of cirrhotic\\ninduration the uterus is tough, anemic, or livid from venous stasis\\nPLATE 38.\\nRetroversion of the Fixed Uterus (First Degree) and Ag=\\nglutination of the Cervix (Acquired). A peritoneal pseudoliga-\\nment holds the uterine fundus in retroversion. Caustics or senile\\nprocesses cause adhesions and, later, atresia of the cervix. Changed\\ndirection of the vagina in retroversion of the uterus. (Original water-\\ncolor from a specimen in the Munich Frauenklinik.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0192.jp2"}, "193": {"fulltext": "", "height": "4585", "width": "3287", "jp2-path": "atlasepitomeofgy00scha_0193.jp2"}, "194": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0194.jp2"}, "195": {"fulltext": "", "height": "4577", "width": "3239", "jp2-path": "atlasepitomeofgy00scha_0195.jp2"}, "196": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0196.jp2"}, "197": {"fulltext": "ETIOLOG Y. \u00e2\u0080\u0094DIA GNOSIS. 113\\n(arterial walls thickened, their lumen narrowed, muscularis partly\\nreplaced by connective tissue).\\nEtiology. (1) From puerperal subinvolution; (2)\\nfrom the irritation of a chronic endometritis (3) from\\nthe penetration of infectious germs (especially gonococci)\\n(4) from other hyperemic irritations, such as masturba-\\ntion (5) from venous stasis in flexions, prolapse, or other\\ndisplacements accompanied by engorgements (habitually\\nfull bladder, chronic constipation, or secondary stasis from\\ncirculatory disturbances in other organs) (6) rarely, from\\nan acute metritis.\\nPrognosis. Although the disease does not cease at the\\nmenopause, but usually several years later, this time is the\\nbest for effective treatment. The prognosis is more favor-\\nable if the second stage appears early, as the disturbances\\nthen disappear.\\nSymptoms. A sensation of fullness (as if a heavy\\nbody were in the abdomen), pains in the side and sacral\\nregion, discharge, menorrhagia, dysmenorrhea, dysuria,\\nand constipation. The symptoms are more pronounced\\nat the menstrual epoch or when obstinate constipation\\nexists. They are favorably influenced by rest in the dor-\\nsal position.\\nDiagnosis. The cervix is soft, thickened, and hyper-\\nemic, with swollen lips, from the accompanying endo-\\nmetritis ectropion, erosion, ovula Nabothi. (Plates 32\\nand 56.) In the second stage the cervix is livid, hard,\\nand wrinkled. (Plate 37, Fig. 1.)\\nHypersensitiveness is not always present, but a peculiar\\nsoftening and enlargement of the organ occur, causing\\nit to resemble a gravid uterus at the second and third\\nmonths. The sound reveals the elongation of the uterine\\ncavity and a thickening of its wall.\\nAny variety of inflammation of the surrounding tissues\\nand organs may occur. Conception takes place with diffi-\\nculty, and leads to abortion or to premature delivery.\\nDifferential Diagnosis. In the first months it is dif-", "height": "4597", "width": "2795", "jp2-path": "atlasepitomeofgy00scha_0197.jp2"}, "198": {"fulltext": "114 CHRONIC METRITIS.\\nPLATE 39.\\nAcute Purulent Pelvic Peritonitis (Peritonitis of Perfora=\\ntion). View of pouch of Douglas and the posterior wall of the uterus\\nand left broad ligament with its tube and ovary. The pus has been\\nwiped off of the uterus but allowed to remain on the serosa of Doug-\\nlas pouch. (Original water-color from a specimen at the Heidelberg\\nPathologic Institute.\\nficult to differentiate a gravid uterus from an inflamed\\norgan the former is softer, especially at the cervix and\\ninternal os (bimanual from the rectum), and rests upon\\nthe cervix like a round, thickened body the latter is more\\nsensitive. Pregnancy must always be thought of, espe-\\ncially if intra-uterine treatment is under consideration.\\nIntra-uterine tumors may be palpated with the sound,\\nor directly with the finger after dilatation of the cervix.\\nThe inflamed uterus is elongated, especially the cervix,\\nwhich is contracted in virgins and everted in multipara.\\nIn cancer small pieces may be removed and examined\\nmicroscopically.\\nIf the case is simply one of endometritis, the increase\\nin volume and the hypersensitiveness of the entire organ\\nare not marked.\\nTreatment. Prophylactic. During menstruation\\nrest in bed (not all the time) avoid everything inducing\\ncongestion (excitement, especially sexual heating drinks\\nconstipation colds). During the puerperium Ergotin,\\nwarm or cold applications, abdominal massage hot vag-\\ninal irrigations (117\u00c2\u00b0 to 127\u00c2\u00b0 F.) or warm general baths\\n(95\u00c2\u00b0 to 100\u00c2\u00b0 F.) in the second w^eek.\\nSpecial treatment of the hyperemic stage absorptive\\nhot injections and baths, with or without salt or lye.\\nThe hyperemia is controlled by constricting the vessels\\nErgot or ergotin, hyclrastis, stypticin hot vaginal injec-\\ntions scarifications of the cervix (every three or four\\ndays, J to 2 fluidrams, especially before the period) relieve", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0198.jp2"}, "199": {"fulltext": "Tab. 39.\\nlith.An.st F. ReicMiold.Uihuhai.", "height": "4583", "width": "3171", "jp2-path": "atlasepitomeofgy00scha_0199.jp2"}, "200": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0200.jp2"}, "201": {"fulltext": "TREATMENT. 115\\ncongestion and pain. Compression by means of vaginal\\ntamponade and sand-bags or shot-bags laid upon the ab-\\ndomen.\\nGlycerin tampons are used as derivatives, and the secre-\\ntion is further stimulated by astringents and caustics.\\nThe applications are to be repeated every week, but only\\nin the first stage. Curetment, followed by chlorid of iron\\nor iodin (Playfair s aluminum sound).\\nThe application of steam to control hemorrhage (nienor-\\nrhagia) is, according to the author s experience with atmo-\\ncausis, a most valuable addition to our therapeutic measures.\\nIt was first employed by Snegirew, the instrumentarium\\nbeing perfected by Pinkus. My own observations show\\nthat it is as effective in obstinate endometritis as it is in\\ninflammations of the myometrium. It is not advisable\\nfor one unskilled in gynecologic practice to make use of\\nthis method, especially if he is without assistance. It is\\nas little adapted for ambulatory treatment as is curet-\\nment.\\nThe instrumentarium is as follows A tested boiler with\\nsafety-valve and thermometer a rubber tube (tightly\\nscrewed to the boiler), rather thick and well wrapped and\\na two-way intra-uterine catheter with a discharge-tube for\\nthe steam returning from the uterine cavity. The catheter\\nis covered with gauze or celluloid to protect the cervix\\nfrom injury and subsequent stenosis. The pressure and\\ntemperature of the steam and the duration of its action\\nmust be gaged to suit the individual case. A cureted\\nuterus or one having a small cavity must be treated more\\nmildly, probably using only the zestocautery i. e., the\\nclosed catheter, 105\u00c2\u00b0 to 112\u00c2\u00b0 C, for from ten to twenty\\nseconds with a large cavity and a thickened endometrium,\\n110\u00c2\u00b0 to 115\u00c2\u00b0 C, for fifteen seconds. If obliteration is\\ndesired, steam at 1 15\u00c2\u00b0 to 120\u00c2\u00b0 C. for from one-half to two\\nminutes is to be employed. This may be repeated, whereas\\nordinarily the application should not be renewed until the\\nnext menstrual period has passed. Narcosis is not neces-", "height": "4596", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0201.jp2"}, "202": {"fulltext": "116 CHRONIC 3IETBITIS.\\nsary, but is usually desirable the same is true of assistance.\\nThe cervix must be dilated.\\nThe methods of treatment just named are symptomatic\\nand palliative. If pain and a sensation of fullness are\\npresent frequent scarifications and glycerin tampons\\nabdominal belt and pessary to remove tension from the\\nuterine ligaments.\\nFor the menstrual disturbances Previous scarifications,\\nwarm sand-bags upon the abdomen or warm alcoholic\\nfomentations (narcotics). In menorrhagia ergotin, tam-\\nponade, application of ferripyrin or introduction of ferri-\\npyrin-gauze tampons, gelatin injections, atmocausis.\\nOperations for the Purpose of Reducing the Size of the Collum\\nUteri and Removing the Diseased Mucous Membrane.\\nThese results, together with the removal of scars from\\nlacerations, are best accomplished by means of wedge-\\nshaped excisions (or amputation of the cervix, removal of\\nconic pieces of tissue operations of Sims, Hegar, Simon,\\nSchroder). The following operations are to be particu-\\nlarly recommended\\nSchroder s Operation. The inner circumference of the\\nos with its diseased mucous membrane is completely\\nexcised. The remaining outer half of the cervical wall is\\nturned in and sewed to the remains of the cervical mucosa.\\nA. Martin s Operation. The entire vaginal cervix is\\nexcised in the shape of a cone. The cervical mucosa is\\nthen drawn down and stitched to that of the vagina.\\nKehrer s Operation. AYedge-shaped pieces are excised\\nfrom both lips of the os uteri. Their base is formed by\\nthe cervical mucosa, and they extend through the entire\\ncervical wall.\\nAfter the Operation. Glycerin or iodoform-gauze tam-\\nponade (one day) then vaginal irrigations for secondary\\nhemorrhage firm gauze tamponade with ferripyrin, solution\\nof sesquichlorid of iron, or suture if catgut has not been\\nemployed, removal of sutures in eight days.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0202.jp2"}, "203": {"fulltext": "VUL VITIS.\u00e2\u0080\u0094 COLPITIS. 117\\nI 15. SEPSIS.\\n(Acute Vulvitis, Vaginitis, Endometritis, Myometritis, Sal=\\npingitis, Parametritis and Perimetritis, Peritonitis.)\\nThe acute inflammations of the endometrium and myo-\\nmetrium present practically the same clinical pictures.\\nThey are due to the invasion either of gonococci or of\\nseptic germs. It is to the inflammations caused by the\\nlatter that attention is now directed.\\nEtiology and Clinical Aspect. Invading pyogenic\\norganisms (streptococcus pyogenes staphylococcus aureus,\\nalbus, citreus, etc.) excite septic inflammations the ave-\\nnues of infection are either the skin or mucous membrane\\nof the genitalia, or the peritoneal covering.\\nThe opportunity for invasion through the lining mucous\\nmembrane is given by trauma, by faulty technic in opera-\\ntions and examinations (sounds, dilators), or by the puer-\\nperal process.\\nBy virtue of the peculiar quality of the secretion and\\nof the wound surface, which is particularly adapted for\\nthe multiplication of invading organisms, the puerperal\\ninfections are of the greatest importance. The secretions\\nmay stagnate in closed spaces, at body-temperature, and in\\ndirect communication with numerous lymphatic channels.\\nThe gynecologic infections take the following courses,\\naccording to their point of introduction, the infection de-\\npending not only upon the place of entrance, but also upon\\nthe virulence of the germ and upon the general and local\\npower of resistance of the individual.\\nVulva (Phlegmone Vulvce). The infection usually re-\\nmains local and leads to abscess formation. The perineal\\ninfections, especially when near the rectum, lead to throm-\\nbophlebitis and general infection.\\nVagina {Colpitis Crouposa et Diphtheritica, Phlegmone\\nVagince, Abscesses, Paracolpitis, Paraproctitis), The in-\\nfection remains local, at most spreading to the adjoining", "height": "4596", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0203.jp2"}, "204": {"fulltext": "118 SEPSIS.\\nPLATE 40.\\nFig. 1. Acute Catarrhal Parenchymatous Salpingitis (Due\\nto Gonococci and Streptococci). The tubal catarrh is the first\\nconsequence of the invasion of the cocci in the endosalpinx, and it\\nproduces a hypersecretion of mucus. The endosalpinx commences to\\nproliferate the connective-tissue papillae 1 covered with columnar\\nciliated epithelium, form dendritic ramifications that fill the lumen\\nof the tube (2). The stroma of the papilla is infiltrated with young\\nround cells 6 The submucosa 4 and the muscularis 5 are still\\nhealthy, but there is a commencing perivascular (3) round-cell infil-\\ntration. (Original drawing from a specimen.\\nFig. 2. Hematosalpinx. In gynatresias (see Figs. 7-11 in text)\\nthe menstrual blood remains in the uterus and finally dilates the tube\\n(2); the epithelium (1) desquamates after the papillae (3) have been\\nflattened by pressure the vessels 5 of the submucosa 4 are dilated\\nfrom stasis there is a reactionary round-cell accumulation (7) about\\nthe blood-vessels in the muscularis (6). Tubal hemorrhages occur\\nduring the periods, in heart disease and kidney disease, in cases of\\nmyomata and ovarian cystomata, and in extra-uterine pregnancy.\\n(Original drawing from a specimen.)\\nFig. 3.\u00e2\u0080\u0094 Pyosalpinx. The ostia being closed, the pus distends\\nthe tube. The epithelium (1) is completely destroyed the papillae (2)\\nare flattened the stroma (3), rich in round cells, is bathed in pus;\\nand the elasticity of the tubal wall is destroyed because the muscle-\\nfibers (4) are separated and replaced by connective tissue (6). The\\nsubmucous capillaries are dilated from stasis; the vessels of the mus-\\ncular layer show a chronic inflammatory thickening. Such pus sacs\\ncontain different varieties of microbes, the virulence of which depends\\nupon the age of the abscess at the time of its rupture. (Original draw-\\ning from a specimen.)\\nconnective tissue. Contrary to what is the rule in puer-\\nperal cases, the process very rarely extends to the uterus.\\nUterus (Endometritis et Metritis Acuta). The course is\\ndoubtful, and if progressive, it may be a very chronic\\nafYection.\\nSymptoms. Bloody and mucopurulent discharge;\\nenlargement and hypersensitiveness of the uterus (expe-", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0204.jp2"}, "205": {"fulltext": "o\\nas\\n.OS\\n\u00e2\u0096\u00a03", "height": "4594", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0205.jp2"}, "206": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0206.jp2"}, "207": {"fulltext": "SYMPTOMS. 119\\nrienced by the patient as a dull pain in the pelvis, in-\\ncreased by movement, coughing, straining, etc.) stran-\\ngury diarrhea with violent tenesmus fever (rarely, ab-\\nscess formation).\\nThe patients soon show evidences of a severe infec-\\ntion. They are pale and hollow-eyed no appetite\\nmeteorismus pulse-rate and temperature increase the\\nabdomen becomes sensitive. These are all symptoms of\\nbeginning parametritis and perimetritis.\\nVaginal examination (to be most gently carried out)\\nreveals hypersensitiveness of the vaginal vault and re-\\nsistance behind the uterus. Rectal examination shows a\\ntumor behind or beside the uterus, the differentiation of\\nthe two being impossible by palpation. Anatomically, it\\nmay be a pyosalpinx, oophoritis, perimetrosalpingitis, peri-\\noophoritis, or parametritis.\\nThe process may remain stationary at this point. The\\nintestinal coils, which roof in the pouch of Douglas, be-\\ncome adherent and wall off the exudate from the general\\nperitoneal cavity peritonitis exsudativa saccata. The\\ninflammatory products may undergo absorption, may per-\\nforate into the rectum, or, rarely, may perforate into the\\nvagina. Chills are present. Permanent resistance beside\\nthe uterus may be demonstrated.\\nAs sequels may be mentioned dysmenorrhea, sterility,\\nand deviations of the uterus, the intra-uterine treatment\\nof which, as well as the periodic congestions, may produce\\nfebrile exacerbations.\\nIf the inflammation proceeds, a general peritonitis\\noccurs with marked meteorismus, great abdominal pain\\n(which may be absent or intense only at times), compres-\\nsion of the rectum, hindered passage of flatus, threatening\\nsymptoms of obstruction, vomiting (even fecal), and some-\\ntimes profuse fetid diarrheas. The pulse is rapid, small,\\nand irregular.\\nThe patient may die, the fever being no more pro-\\nnounced than the anatomic changes. The patient may", "height": "4593", "width": "2795", "jp2-path": "atlasepitomeofgy00scha_0207.jp2"}, "208": {"fulltext": "120 SEPSIS.\\nrecover slowly, the pus being absorbed or rapidly, the\\npus emptying externally or into some hollow viscus.\\nDiagnosis. Ulcers of the vulva, vagina, and cervix\\nare seen most frequently in the puerperium, occurring\\nelsewhere only in children and in severe acute infectious\\ndiseases, such as croupous diphtheria and gangrenous\\nvulvitis. The diagnosis is made by the fetid discharge,\\npain, slight elevation of temperature, and the gray, green,\\nor yellowish covering of the. wound. Ulcers situated near\\nthe perineum may be due to injuries or ulcerative pro-\\ncesses of the rectum or to inflammations of the glands of\\nBartholin, which in rare cases are not of a gonorrheal\\nnature.\\nAcute colpitis and endometritis, with their concomi-\\ntants, myocolpitis and myometritis, may be brought about\\nnot only by gonorrhea and puerperal infection, but also\\nby a cold followed by menstrual suppression, by septic\\noperative measures, or by acute infectious diseases (influ-\\nenza and others).\\nThe main symptoms are fever, purulent secretion, hem-\\norrhages, and pain in the interior of the uterus. The\\ncervix is swollen, and the external os is ulcerated, eroded,\\nand covered with purulent ovula Nabothi. (Plate 37,\\nFig. 2.)\\nThe deeper the process penetrates into the perivascular\\nand interstitial connective tissue of the muscularis, the\\nmore violent will be the febrile invasion. This is accom-\\npanied by chills, by hypersensitiveness of the enlarged,\\nhyperemic, softened uterus, by dull pelvic pain, and by\\nvesical and rectal pain and tenesmus. If abscesses form\\nlater, their presence is detected by fluctuation.\\nParametritis seems, to the touch, like a lateral extension\\nof the uterus. In the beginning it has a doughy consistency.\\nThe inflammation has invaded the connective tissue sur-\\nrounding the uterus, and may spread anteriorly alongside\\nof the bladder to the extraperitoneal connective tissue, and\\neven to the connective tissue of the thigh. It may extend", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0208.jp2"}, "209": {"fulltext": "DIAGNOSIS. 121\\nlaterally between the layers of the broad ligament to the\\nhollow of the sacrum or it may go posteriorly, pushing\\nup the serosa of Douglas pouch and ascending behind the\\nperitoneum, on the iliopsoas muscles, to the renal region.\\nThe tumor is found in some one of the foregoing posi-\\ntions. It is an exudate in the pelvic connective tissue\\n(phlegmon of the pelvis, pelvicellulitis, parametritis of\\nVirchow), and consists of a mucoid swelling and round-\\ncell infiltration of the connective tissue. (Plate 59, Fig.\\n1 61,2; 41, 2.) The exudate is usually absorbed, but\\nscar tissue is left behind, which later binds down and\\ndisplaces the uterus.\\nIf abscesses form, the pus may burrow its way into the\\nrectum, into the vagina, into the bladder, through the sci-\\natic foramen, along the inguinal canal, or, lastly, through\\nthe abdominal wall, pointing above Poupart s ligament.\\nThe overlying peritoneum is usually in a condition of\\nirritation, as is indicated by greater pain, meteorism, diar-\\nrhea, and vomiting. The consequent adhesions of the\\npelvic organs cause sterility. If the peritoneum allows\\nthe exudate to escape, a fatal perforative peritonitis will\\nfollow. (Plate 39.)\\nIn circumscribed parametritis there may be localized\\nabdominal pain (from the irritation of the serosa), but the\\nviolent general pains, the tympanites, and the intraperi-\\ntoneal exudate are absent. The space of Douglas also\\nremains free. Alongside of the uterus there is at first a\\nhypersensitiveness, then increased resistance, and finally a\\nparametritic tumor of doughy consistency.\\nFor the differential diagnosis from tumors of the pouch\\nof Douglas see 35.\\nThe diagnosis of peritonitis is based upon the demon-\\nstration of an exudate. (Plate 58, Fig. 1.) As long as\\nthe process is limited to the pouch of Douglas and is\\nwalled off by adhesions at the pelvic inlet (a pelveoperi-\\ntonitis), the prognosis is far more favorable than when the\\nentire peritoneal cavity is involved.", "height": "4598", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0209.jp2"}, "210": {"fulltext": "122 SEPSIS.\\nPLATE 41.\\nFig. 1. Acute Purulent Parenchymatous and Interstitial\\nSalpingitis. Not only the papillae are proliferated, but also their\\nstroma (1) and the connective tissue of the subniucosa (3), and the\\nmuscularis (4 and 5) is infiltrated with round cells. The epithelium\\nis partly swollen and partly cast off, the excoriated papillae adhering\\nand forming small cysts (2). (Original drawing from a specimen.\\nFig. 2. Parametritis Acuta of the Broad Ligament. Both\\nthe connective-tissue fibers and the areolar tissue are infiltrated with\\nround cells. This first stage of swelling and suppuration passes later\\ninto the second stage the transformation into scar tissue. Contrac-\\ntion occurs. (Original drawing from a specimen.\\nFig. 3. Chronic Oophoritis with Oligocystic Degeneration.\\n(See Plate 45 and Fig. 35. The inflammatory disturbances lead to a\\nthickening of the tunica albuginea, producing a cystic swelling of the\\nfollicles 1 and 2 the follicular epithelial cells desquamate 10 and\\nthe ova die. The older corpora lutea become transformed into corpora\\nfibrosa (8) (or candicantia). Eecent hemorrhages and older ones\\nwith blood pigment (9) are found in the stroma (13). The tortuosity\\n(5) of the vessels (4) is a physiologic peculiarity of the ovary; in\\nplaces perivascular round-cell accumulations can be seen (6). The\\nfollicles are surrounded by the tunica fibrosa (7); the surface of the\\novary is covered with cuboid germinal epithelium (3). (Original\\ndrawing from a specimen.\\nAs an intermediate stage we sometimes observe acute\\noophoritis or salpingitis in the shape of swollen, exquisitely\\nsensitive adnexa, in the bimanual palpation of which the\\ngreatest gentleness must be exercised in order to avoid the\\nrupture of an abscess or the destruction of an existing\\nencapsulation. (Plates 39, 44, 59, Fig. 3.)\\nGeneral peritonitis may follow an acute or a chronic\\ncourse the latter is designated as peritonitis pyofibrinosa,\\nand has a more favorable prognosis.\\nThe onset of the inflammation is marked by a pro-\\ntracted chill, and is followed by diffuse abdominal pain.\\nThe abdomen may be so tympanitic and distended that", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0210.jp2"}, "211": {"fulltext": "c?-\\nOr-\\n6^\\nu", "height": "4593", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0211.jp2"}, "212": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0212.jp2"}, "213": {"fulltext": "TREATMENT. 123\\ndyspnea is caused by the pushing-up of the diaphragm.\\nVomiting and constipation are present, giving place to a\\nprofuse fetid diarrhea, Euphoria, together with a rapid\\nrise of the respiratory and pulse-rates (not always of the\\ntemperature, however), is always suspicious.\\nTreatment. All disturbances of menstruation are to\\nbe avoided. Absolute asepsis is to be observed in all\\noperative measures therapeutic manipulations (sounds)\\nand in the care of pessaries. The lighting-up of old\\ninflammatory residues by exploratory procedures is par-\\nticularly to be avoided.\\nUlcers of the vulva are to be cauterized (formalin) and\\ntreated with iodoform, airol, nosophen, or iodoformogen,\\nor protected by compresses soaked in oil of turpentine.\\nThe inflammatory edema is to be treated by moist appli-\\ncations (solution of aluminum acetate).\\nUlcerations of the cervix are to be cauterized with for-\\nmalin and treated with irrigations of aluminum acetate, cor-\\nrosive sublimate, or lysol. Dry powders may be employed\\nto disinfect the parts, although this method is more trouble-\\nsome, because of the necessity of daily repetition.\\nIn acute endometritis and myometritis the patients, and\\nespecially the genital organs, should not be disturbed.\\nThe treatment consists of rest in bed, mild laxatives,\\nw r arm fomentations, warm vaginal irrigations with potas-\\nsium permanganate, weak solutions of lysol (0.25^),\\nnormal saline solution, or mucilaginous decoctions, using\\nabout a liter of fluid, carrying the tube high up (gently),\\nand not elevating the douche bag very much.\\nIf the inflammation increases, the fomentations are to\\nbe replaced by frequently repeated cold applications or by\\nthe ice-bag or ice-coil.\\nAbscesses should be opened only wdien they are easily\\naccessible. They are usually situated in the parametritic\\ntissues.\\nAcute parametritis is to be treated with the ice-bag,\\ncalomel, and blue ointment (1.0 applied every two hours", "height": "4591", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0213.jp2"}, "214": {"fulltext": "124 CHRONIC SALPINGITIS.\\nPLATE 42.\\nDouble Pyohydrosalpinx, Chronic Adhesive Perimetritis\\nand Oophoritis. Both tubes are almost filled with pus; the fimbri-\\nated ends, walled off: both from the isthmus and from the peritoneal\\ncavity, are transformed into cysts. (Original drawing from a specimen\\nof Professor Beck s.\\nto the point of salivation), followed by warm fomentations\\nand enemata.\\nIn acute peritonitis several ice-bags upon the abdomen\\nand laxatives in the stage of constipation (infusion of\\nsenna; calomel at first 0.2 to 0.5, later 0.05 to 0.1,\\nat a dose). The diet should be liquid and nutritious.\\nStimulants, which should contain more alcohol when the\\npatients are accustomed to wine or beer. As soon as free\\nevacuations occur opium is given, or inunctions of blue\\nointment together with calomel in small doses. Free-\\ndiaphoresis is excited, and the activity of the skin is in-\\ncreased by cool sponging. [Cases of acute peritonitis\\nshould be carefully watched in order not to neglect opera-\\ntive measures. Localized peritonitis with abscess forma-\\ntion always indicates, and promptly responds to, surgical\\ntreatment. Acute diffuse peritonitis, however, will usually\\nprove fatal, but that fact warrants early surgical treat-\\nment, although most cases succumb. Ed.]\\n16. CHRONIC SALPINGITIS.\\nEtiology. For definition and anatomv see explanations\\nto Plates 40-43, 44, 46, 59 (Fig. 3), and 74. The most\\nfrequent causes are puerperal and gonorrheal inflamma-\\ntions in every case of endometritis the tubes are not\\nnecessarily involved.\\n(a) Parenchymatous Catarrh of the Tubes (Plate 40, Fig. 1),\\nwith Atresia of the Ostia Hydrosalpinx.\\nThe secretion accumulates in the abdominal portion, flattens the\\npapillae of the mucous membrane and their cylindric epithelium, sepa-", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0214.jp2"}, "215": {"fulltext": "", "height": "4596", "width": "3136", "jp2-path": "atlasepitomeofgy00scha_0215.jp2"}, "216": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0216.jp2"}, "217": {"fulltext": "DIA GNOSIS.\u00e2\u0080\u0094 TEE A T3IEXT. 125\\nrates the muscle-fibers, and in this way thins and stretches the tubal\\nwall. The tube is held by the serous duplicature of the broad liga-\\nment, and presents a spiral appearance with multiple constrictions, as\\nshown in plates 42 and 44. Sometimes the hydrops tubse (profLuens)\\nempties itself periodically into the uterus.\\nSymptoms. There are no characteristic symptoms\\nworthy of mention, except anomalies of menstruation,\\nsterility (since the disease is usually bilateral), pressure\\neffects, and perisalpingitic pain.\\nDiagnosis. As long as pelvic exudates are absent,\\nbimanual palpation reveals a round, fluctuating, trumpet-\\nshaped tumor, peripherally swollen, extending from an\\nangle of the uterus, and not rarely lying in the vesico-\\nuterine space. The exclusion of a tumor of the ovary is\\nimportant. (Plate 74.)\\nTreatment. In an extreme degree of swelling, celio-\\nsalpingotomy, for the purpose of removing the tubal sac\\nor salpingostomy i. e., restoration of the lumen of the\\ntube by opening the ostium abdominale and stitching the\\nserosa to the mucosa.\\n(b) Parenchymatous and Interstitial Purulent Inflamma=\\ntion of the Tubes (Plate 41, Fig.l), with Atresia of the Ostia\\nPyosalpinx. (Plate 40, Fig. 3 Plates 42 and 44 Plate 59, Fig. 3\\nPlate 74.\\nThe tube is bluish-red and thickened, not only from a\\npassive dilatation, but also not rarely from proliferation of\\nthe muscularis. The inflammatory process passes either\\nthrough the abdominal ostium or through the tubal wall to\\nthe peritoneal covering, and thence to the pelvic peritoneum\\nand ovary. It always remains circumscribed, the organs\\ncontracting adhesions that often contain purulent deposits.\\nThe gonorrheal inflammation is usually bilateral.\\nWe differentiate histologically\\n1. Acute catarrhal parenchymatous salpingitis with pro-\\nliferation of the epithelium.\\n2. Acute purulent parenchymatous and interstitial salpin-\\ngitis with partial desquamation of the epithelium and in-\\nflammatory infiltration of the stroma.", "height": "4597", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0217.jp2"}, "218": {"fulltext": "126 CHROXIC OOPHORITIS.\\nPLATE 43.\\nChronic Adhesive Perimetritis and Salpingitis with Uterine\\nMyomata. A cross-section shows the marked thickening of the tubal\\nwall and exposes to view the unopened ovarian abscess, which is adher-\\nent to the tube. (Original water-color.\\n3. Chronic interstitial salpingitis, contraction from the\\nconnective tissue that replaces the muscularis. The tube\\nloses its elasticity.\\nFrom agglutination of the tubal ostia the first class\\nof cases gives rise to hydrosalpinx the second and third,\\nto hematosalpinx and pyosalpinx.\\nSymptoms. Pain at the side of the uterus, becoming\\nworse at the menstrual epoch and when the intra-abdomi-\\nnal tension is increased. Sterility, from the usual combi-\\nnation with oophoritis. Fever (in gonorrhea, only after\\nexertion or excitement).\\nPrognosis. Conception is impossible. The patient is\\nalways threatened with peritonitis from perforation. Gon-\\norrheal pyosalpinx does not rupture easily the septic form\\ndoes.\\nDiagnosis, By bimanual palpation. (See the differen-\\ntial diagnosis of the retro-uterine tumors under Ovarian\\nCystomata, and Plate 74, Figs. 1 and 2, and Plate 59,\\nTreatment. Celiosalpingectomy, stitching the pus sac\\nto the abdominal wall (Hegar, Kaltenbach) and pressing\\nup the uterus from the vagina (Gusserow) are indicated. If\\nthe pyosalpinx is not adherent, its rapture can usually be\\navoided.\\nIf there is distinct fluctuation in the vagina or abdominal\\nwall, free incisions should be made and iodoform gauze\\ndrainage established. (See Chronic Pelviperitonitis.)\\n17. CHRONIC OOPHORITIS.\\nEtiology. Suppurative oophoritis, due to lymphatic", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0218.jp2"}, "219": {"fulltext": "Tab. 43.\\nLUh. Anst E Reichiuild, Miuichm.", "height": "4601", "width": "3115", "jp2-path": "atlasepitomeofgy00scha_0219.jp2"}, "220": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0220.jp2"}, "221": {"fulltext": "ETIOLOGY.\\n127\\nabsorption from the uterus and tubes, and caused by trau-\\nmatic or operative septic infection, has been mentioned in\\nconnection with peritonitis in a preceding section.\\nOvarian abscesses, however, usually follow purulent\\nFig. 34. Senile cirrhotic atrophy of the ovary.\\nFig. 35. Oligocystic degeneration of the ovary.\\ninflammations of the tubes. (Fig. 36.) This oophoro-\\nsalpingitis is combined with perimetrosalpingitis, peri-\\nmetro-oophoritis, and pyosalpinx, forming, together with\\nencapsulated ovarian and peritoneal pus sacs, a large ag-", "height": "4595", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0221.jp2"}, "222": {"fulltext": "128 CHRONIC OOPHORITIS.\\nPLATE 44.\\nPelvic Peritonitis, Perioophoritis, Perisalpingitis and Right=\\nsided Pyosalpinx. View of the pouch of Douglas. Pseudoliga-\\ninents fix the uterus aud its aduexa to the sigmoid flexure. The left\\ntube is beut at an angle, the right tube shows inflammatory redness,\\nand is transformed into a pyosalpinx by the agglutination of the ab-\\ndominal ostium. The globular divisions of the tumor are character-\\nistic. (See Plates 40, 42, 59, 74.) (Original water-color.)\\nglutinated tumor (pyo-oophorosalpinx). As in purulent\\nsalpingitis, the cause is to be found in a septic or gonor-\\nrheal mixed infection.\\nSclerotic oligocystic ovarian degeneration (Plate 45\\nPlate 41, Fig. 3 and Fig. 35), may occur alone, leading\\nto destruction of all the follicles, so that the organ becomes\\nhypertrophic, cicatrized, and dense from the formation of\\nchronic inflammatory connective tissue. (Plate 44 and\\nFig. 34.)\\nSymptoms. These are clue partly to the uterine phe-\\nnomena of dysmenorrhea and partly to hysteria.\\nThe predominant symptom is pain, felt in the lumbar\\nand pelvic regions and radiating to the groins and thighs.\\nThis pain increases at the menstrual periods, which are\\nvery irregular, sometimes oligomenorrhea or amenorrhea,\\nsometimes menorrhagia, being present. It occurs far less\\noften as intermenstrual pain. It is increased by exertion\\nand constipation, and may present itself as a tubal colic.\\nDiagnosis. A hypersensitiveness of the adnexa may\\nbe found by bimanual examination the tube is swollen,\\nand the ovary is enlarged. These organs should be care-\\nfully palpated by the methods demonstrated in Plates 21-\\n23. The ovary is frequently dislocated and bound down\\nbehind and below the uterus. (Plate 19, Fig. 1.)\\nOne must not be misled by tenderness of the overlying\\nparts. In lumbo-abdominal neuralgias the belly wall is\\nhypersensitive certain hysteric affections ovarie of", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0222.jp2"}, "223": {"fulltext": "", "height": "4595", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0223.jp2"}, "224": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0224.jp2"}, "225": {"fulltext": "SYMPTOMS.\u00e2\u0080\u0094 TREATMENT.\\n129\\nCharcot) may give rise to pain in a healthy ovary, or in the\\nneighboring portions of the broad ligament or vaginal vault.\\nIn perimetrosalpingitic processes the individual organs\\ncan not be differentiated.\\nFig. 36. Adhesive perioophorometrosalpingitis. The entire poste-\\nrior peritoneal surface of the uterus and the broad ligaments is covered\\nby adhesions. They form a pocket in which the ovary was completely\\nconcealed. It was only by holding up the ovary by means of a thread\\nthat it was rendered visible in the illustration. The fimbriated end\\nof the tube is completely occluded and destroyed by the flap-shaped\\nadhesions. An analogous case is described in the Mon. f. Geb.,\\n1898, in which the ovary was still more freely movable, and could be\\ndistinctly palpated as it slipped in and out of a similar pocket.\\n(Photograph from an autopsy at the Heidelberg Path. Inst.)\\nTreatment. Avoid injurious congestions by abso-\\nlute rest in bed, by sexual continence, and by securing\\nregular evacuations of the bowels and bladder.\\n9", "height": "4599", "width": "3122", "jp2-path": "atlasepitomeofgy00scha_0225.jp2"}, "226": {"fulltext": "130 CHROXIC OOPHORITIS,\\nPLATE 45.\\nFig. 1. Pelvic Peritonitis. The uterus is displaced anteriorly\\nand to the left. Adhesions bind it to the bladder and intestine and\\nfix the tubes and ovaries. The left ovary is enlarged, and shows\\noligocystic degeneration i. e. all the follicles become cystic, with des-\\nquamation of the germinal epithelium and destruction of the ova.\\n(See Plate 41, Fig. 3, and Fig. 35.) The other ovary is not enlarged,\\nand has a scarred surface from frequent ovulation. (Fig. 34.) These\\nplastic inflammations are due to gonorrheal salpingitis, or to metritis\\nor parametritis from puerperal or operative lesions of the genital mu-\\ncous membrane. They may start in other organs and sink down into\\nthe pouch of Douglas, which is the lowest space in the abdomen.\\nFig. 2. Left=sided Dermoid Cyst Perforating into the\\nRectum. (Original drawing made from the data obtained in palpat-\\ning a case in the Munich Frauenklinik.) The hair contained in the\\ntumor passes into the rectum through the perforation. Dermoid cysts\\noccur most frequently in the ovary, and contain sebaceous matter, hair,\\nteeth, or even complicated organic structures (brain and nerve masses,\\nportions of the eye, mandible with teeth, etc). (See Plate 79, Fig. 4.)\\nRemoval of the original cause Treatment of the uter-\\nine inflammation, vaginal irrigations, but no intra-uterine\\ntreatment.\\nFor the pain Rest in bed the ice-bag, which may be\\nsubsequently replaced by warm fomentations and baths.\\nIn certain cases hot vaginal irrigations (117\u00c2\u00b0 to 122\u00c2\u00b0 F.)\\nor hot sand-baths are of value. If the patient is up\\nand about, the organs are to be supported by Mayer s\\nring (the lever-pessaries press upon the diseased adnexa),\\nor vaginal tamponade (the fornix especially) with iodoform\\ngauze, or depletives, such as potassium iodid, ichthyol, or\\nglycerin, in vaginal suppositories or upon tampons,\\nIf the pain is unbearable or if frequent elevations of\\ntemperature occur Removal of one or both ovaries,\\nusually with the corresponding tube. When the pelvic\\norgans are completely agglutinated, the adhesions con-\\nsisting of rigid scar tissue, the uterus also is to be re-", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0226.jp2"}, "227": {"fulltext": "Tab. 45.\\nV", "height": "4598", "width": "3107", "jp2-path": "atlasepitomeofgy00scha_0227.jp2"}, "228": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0228.jp2"}, "229": {"fulltext": "CHRONIC PELVIC PERITONITIS. 131\\nmoved. Ovariotomy is indicated only when persistent\\ntreatment for years has failed.\\nIf all the subacute phenomena have disappeared (occa-\\nsional chilliness, great pain), massage and compression are\\nuseful.\\n1 18. CHRONIC PERIMETRITIS, OOPHORITIS, AND SAL=\\nPINGITIS. CHRONIC PELVIC PERITONITIS.\\nAnatomy. See explanations to Plates 40-45 59,\\nFig. 3 74, and Diagnosis of Pyosalpinx.\\nEtiology. In chronic pelveoperitonitis the tube is by\\nfar the most frequent avenue of infection (mostly gonor-\\nrheal) small quantities of serum, mucus, or pus escape\\nfrom the ostium abdominale. The infection may also\\noccur through the lymphatics. Genital tuberculosis is a\\nnot infrequent cause.\\nCatarrhal salpingitis gives rise to perimetrosalpingitis\\nserosa purulent salpingitis, to purulent pelveoperitonitis\\nsaccata. Suppurating tumors (dermoids) furnish an occa-\\nsional source of infection.\\nSymptoms and Prognosis. Sudden violent pelvic\\npain (from the escape of pus into the abdominal cavity),\\nwith chill, vomiting, tympanites, small pulse, and drawn\\nfeatures. The temperature rises and assumes a remittent\\ncharacter. There are rectal and vesical disturbances,\\npericystitis, and periproctitis. If an abscess breaks\\nthrough into the bladder, sharp pain and purulent cystitis\\nresult.\\nThe fever declines as the exudate becomes encapsu-\\nlated the chills reappear, however, as soon as the per-\\nforation of a hollow viscus is threatened.\\nThe premonitory symptoms are intestinal tenesmus,\\nvesical pain, and foul-smelling feces and urine.\\nWhen perforation has occurred, the process has by no\\nmeans terminated from now on there are periods of\\neuphoria, alternating with chills and purulent discharges,\\nthe patient becoming gradually weaker hectic fever.", "height": "4594", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0229.jp2"}, "230": {"fulltext": "132 CHRONIC PELVIC PERITONITIS.\\nPLATE 46.\\nGenital Tuberculosis of Both Tubes (the Right One Cut\\nOpen), of Both Ovaries, and of the Pouch of Douglas. (Orig-\\ninal water-color from a specimen.\\nPerforation into the peritoneal cavity is rarely followed\\nby immediate death.\\nIn relatively favorable cases the encapsulated exudate\\nbecomes absorbed (peritonitis indurata), but from the\\nnumerous adhesions, and consequent organic displace-\\nments and irritations, there remain serious permanent\\ndisturbances of health sterility (abortion, extra-uterine\\npregnancy), hysteria, menstrual colic, menorrhagia, and\\nprofuse discharge. The gonorrheal inflammation is espe-\\ncially liable to recur.\\nDiagnosis. In addition to the hypersensitiveness of\\nthe abdomen and of the vaginal vault, bimanual examina-\\ntion causes marked pain, especially on moving the uterus.\\nThe adhesions are recognized from the fact that the\\nuterus has lost its range of motion, being bound down in\\nsome pathologic position. (See Displacements of the\\nUterus and accompanying plates.)\\nExudates never exist without peritoneal pain, fever, etc.\\nThey are usually found in the pouch of Douglas, and may\\nbe palpated from the rectum or from the posterior vaginal\\nvault. The adnexa are embedded in the exudate. (See\\nEetro-uterine Tumors under Ovarian Cystomata.) If the\\npouch of Douglas is obliterated, the exudate occurs above\\nthe pelvic inlet in the iliac fossae. In other cases the\\nmass may reach as high as the umbilicus.\\nTreatment. The acute form is discussed in 16. In\\nthe chronic form every therapeutic manipulation of the\\ngenitalia is contraindicated. This includes the introduc-\\ntion of pessaries and of the mtra-uterine sound, scarifica-\\ntion of the cervix, prolonged bimanual examination, etc.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0230.jp2"}, "231": {"fulltext": "CO\\nOS", "height": "4594", "width": "3094", "jp2-path": "atlasepitomeofgy00scha_0231.jp2"}, "232": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0232.jp2"}, "233": {"fulltext": "TREATMENT, 133\\nUterine catarrh is to be disregarded abscesses are to be\\nopened only when perforation is threatened.\\nFrequent rest, sexual abstinence, and rather liquid\\nstools are to be secured. For the pain and fever hori-\\nzontal position, warm fomentations, lukewarm vaginal in-\\njections of mucilaginous or narcotic solutions, introduction\\nof vaginal suppositories containing anodynes (cocain,\\nextract of belladonna, morphia). Later, warm sitz-baths\\n(99\u00c2\u00b0 F. and gradually cooler).\\nTo stimulate absorption Compression, hot vaginal in-\\njections (117\u00c2\u00b0 to 126\u00c2\u00b0 F.). Absorbents, such as potas-\\nsium iodid, ichthyol, iodoform, glycerin tampons, mud\\nbaths, salt baths (Kreuznach, Xauheim, Oeyuhausen,\\nTolz). Adhesions may be stretched at first by rectal in-\\njections (as recommended by Hegar, gradually increasing\\namount and decreasing temperature) later, if the parts\\nare absolutely painless, massage. (See Plates 21\u00e2\u0080\u009423.)\\nIn tubercular peritonitis Simple celiotomy, with or\\nwithout applying iodoform to the serosa. The opening of\\nthe abdominal cavity by posterior colpotomy has proved\\nof value (Lohlein).\\nIn gonorrheal peritonitis Removal of pyosalpinx and\\ndiseased ovaries, as far as enucleation is possible. If pelvic\\nabscesses cause an increasing impairment of the general\\nhealth, they must be enucleated or freely drained.\\nThe parts may be best surveyed after a celiotomy. A\\nconclusion may then be drawn as to whether it is better to\\nopen and drain the abscess from the vagina, or through the\\nabdominal wall.\\nThe posterior vaginal vault may be directly incised, and\\nthe thickened peritoneum stitched to the vaginal mucosa.\\nThere is danger of infection from putrefactive organisms\\nfrom the rectum.\\nIf perforation into the bladder occurs, it may be neces-\\nsary to establish a vesical fistula, either suprapubic or\\nvaginal.\\nIf the abscess, with or without vaginal fistula, has old,", "height": "4596", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0233.jp2"}, "234": {"fulltext": "134 CHRONIC PARAMETRITIS.\\nPLATE 47.\\nCystitis; Ureteritis (Pyonephrosis) as a Result of Lithi=\\nasis; Metritis with Endometritis Fungosa; Cervicitis with\\nMarked Dilatation of the Cervical Canal Vaginitis. The\\nbladder is dissected away and displaced to the left; its hyperemia\\nmucous membrane and thickened walls are exposed to view. On the\\nright may be seen the ureter, cut across near its insertion into the\\nbladder. It shows inflammatory redness at this point, while just\\nabove there is an ulceration from which an impacted phosphatic calcu-\\nlus (depicted below) was removed at autopsy. The ureter was mark-\\nedly dilated above this point, as a result of the obstruction and of the\\ncongestive narrowing of the canal at its entrance into the bladder.\\nThe endometrium shows marked proliferation and edema; the mucous\\nglands and the uterine cavity are filled with mucus. In the cervical\\ncanal a tough mucous plug has been left in position, covering the nar-\\nrow external os. The internal os is also quite narrow. The vaginal\\nmucous membrane is inflamed. (Original water-color from a specimen\\nat the Heidelberg Path. Inst.\\nhardened walls difficult of removal through an abdominal\\nwound, vaginal hysterectomy (Landau, Pean) drainage.\\n19. CHRONIC PARAMETRITIS (PHLEGMON OF THE\\nBROAD LIGAMENTS) AND PARACOLPITIS.\\nThere are two forms\\n(a) A chronic process, arising from the acute parametritis\\njust described.\\n(6) Atrophic chronic parametritis (Freund).\\nEtiology. (a) See 15. (b) Overstimulation of the\\ngenital nerves by prolonged and profuse secretion (fre-\\nquently repeated pregnancies, with lactation during the\\nintervals, sexual excesses). Following upon periphlebitic\\nprocesses, a connective-tissue change resembling cicatricial\\natrophy commences in the base of the broad ligament and\\ngradually involves the entire genital tract.\\nSymptoms and Diagnosis. (a) An acute parametritis", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0234.jp2"}, "235": {"fulltext": "I\\nmpmtft pjoyi/mx jsvyynj\\nIt\\nX.\\nif q^x", "height": "4590", "width": "3086", "jp2-path": "atlasepitomeofgy00scha_0235.jp2"}, "236": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0236.jp2"}, "237": {"fulltext": "SYMPTOMS.\u00e2\u0080\u0094 TREATMENT. 135\\nthat has become chronic may take one of the following\\ncourses The exudate may become thick, remaining for\\nmonths or years it may perforate, and, as it has not\\nentirely undergone suppuration, it may discharge from\\ntime to time or, more frequently, it may undergo absorp-\\ntion and cicatricial contraction. These contractions may\\nalso follow scars from noninfected interstitial lesions\\nduring delivery. They result in displacements and dis-\\ntortions of the uterus and its adnexa. (See 9 to 1 1 and\\nPlates 23 41, 2 55, 1 59 62.) These masses of scar\\ntissue are less sensitive than those due to perimetritis.\\nThey may be found about the vaginal fornices or alongside\\nof the uterus the sacro-uterine ligaments may be shortened,\\nlimiting range of motion of the uterus.\\n(6) Symptoms of parametritis chronica atrophicans Spon-\\ntaneous pelvic pain and tenderness of the bladder and\\nrectum if their surrounding connective tissue is involved\\nin the process. Abrogation of the sexual functions\\noligomenorrhea and dysmenorrhea. Nervous irritability,\\ndepression, hysteria, and disturbances of general nutrition.\\nIt is difficult to move the organs about in the sensitive\\nand firm connective tissue.\\nTreatment. (a) Chronic septic parametritis Abscesses\\nare to be incised only when they give rise to fluctuation\\nbeneath the skin or mucous membrane, as in chronic pel-\\nveoperitonitis. Absorption is to be stimulated by potas-\\nsium iodid, glycerin, ichthyol, iodoform, hot vaginal\\ninjections, Hegar s enemata, mud-baths, and hot sand-baths.\\nMassage is indicated in some cases. Elastic traction on\\nthe cervix by means of a bullet-forceps is occasionally\\nof some benefit. No intra-uterine operations should be\\nperformed. Secure easy and regular evacuations of the\\nbowels.\\n(6) Parametritis atrophicans Hot vaginal douches and\\nsitz-baths massage repeated mechanical intra-uterine\\nstimulation and mild intra-uterine irrigations (soda,\\nFritsch) are measures to be employed,", "height": "4607", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0237.jp2"}, "238": {"fulltext": "136 GENITAL TUBERCULOSIS.\\nPLATE 48.\\nChronic Cystitis with Acute Exacerbations. Mucous mem-\\nbrane atrophic, partly necrotic, and thrown into plump, rigid folds by\\nthe marked thickening of the bladder- wall. (Original water-color\\nfrom an autopsy at the Heidelberg Path. Inst.\\ni 20. GENITAL TUBERCULOSIS.\\nDefinition and Etiology. The infection with the\\ntubercle bacillus may be primary or secondary the latter\\nis the more frequent. On the whole, genital tuberculosis\\nis rare. Gonorrheal, septic, and mixed infections favor its\\ndevelopment.\\nPrimary infection may result from cohabitation with a\\nman who has genital tuberculosis, from an infecting digital\\nexamination, from infected linen, etc.\\nSecondary infection may occur by metastasis from the\\nintestines or from the lung, by infection of the tube from\\nthe peritoneum (the most frequent cause), or from the ad-\\nhesion of a tubercular loop of intestine.\\nThe mucous membrane of the tube is by far the most\\neasily infected the process readily extends from here to\\nthe ovaries (by way of the peritoneum, according to\\nSchottlander), or, less rarely, to the uterine mucous mem-\\nbrane, the menstrual changes evidently interfering with\\nthe deposit of the bacilli. The cervical and the vaginal\\nmucosa are very rarely affected, the former being protected\\nby its secretion, the latter by its dense epithelium. Here,\\nas in the vulva, fissures form the sole avenues of entrance\\nfor the primary invasion of the bacilli.\\nTuberculosis of the vesical mucosa, following a general\\nor a genital tuberculosis, is not of more frequent occur-\\nrence.\\nAnatomy. (1) General peritoneal tuberculosis, which also affects\\nthe genital serosa; (2) tuberculosis of the tubes, ovaries, or corpus\\nuteri; (3) the very rare affections of the cervical and vaginal mucosa;\\n(4) the lupous forms seen on the vulva.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0238.jp2"}, "239": {"fulltext": "Tab. 48.\\nLith.Anst EReichhold, Miinchen.", "height": "4593", "width": "3078", "jp2-path": "atlasepitomeofgy00scha_0239.jp2"}, "240": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0240.jp2"}, "241": {"fulltext": "PATHOLOGY.\u00e2\u0080\u0094 DIAGNOSIS. 137\\nSubacute aud chronic inflammatory phenomena (ascites, serofibrin-\\nous exudate, formation of pseudoligaments occur, and the peritoneum\\nbecomes covered with tubercles. The tubes are fixed in the pouch of\\nDouglas and their ostia are agglutinated. As the caseous secretion\\ncan not be discharged, a pyosalpinx is formed. The walls are red-\\ndened, thickened, and infiltrated with yellow tubercular granulations.\\nCaseous areas, very rarely miliary tubercles, are found in the ovaries;\\nthey seem to arise most frequently in the stroma. Schottlander also\\nfound follicular tuberculosis experimentally he further found micro-\\nscopic tubercular changes in the apparently healthy ovaries of tuber-\\ncular women.\\nThe cylindric epithelium is at first well preserved, only a few cells\\nshowing mucoid and granular degeneration. The epithelial layer,\\nhowever, is finally replaced by a caseous coating, and the muscular is is\\ninfiltrated with granulation tissue containing giant cells. The vessels\\nshow chronic inflammatory and hyaline changes. Koch s bacilli may\\nbe demonstrated, although sparingly present.\\nIn uterine tuberculosis the wall is thickened by the edema of the\\nmuscularis; the mucous membrane is totally destroyed and is trans-\\nformed into a caseous mass; scattered tubercles may be seen. The\\nulcerative process is sharply limited at the internal os.\\nTuberculosis of the vagina and cervix likewise presents irregular\\nulcerations surrounded by tubercles and a dirty yellow exudate.\\nLupus vulvae usually commences on the labia as small, flat, reddish\\ntumors, which ulcerate. Although they infiltrate more diffusely, they\\ndo not extend so rapidly nor secrete so profusely as do syphilitic ulcers.\\nThe scars are reddish-violet. The microscope shows no hypertrophy\\nof the papillse and skin, but a small-cell infiltration about the vessels.\\nTuberculosis of the bladder occurs as tubercular infiltration or in\\nthe form of ulceration.\\nThe symptoms and diagnosis of the tubal affections\\nare the same as those of salpingitis or pyosalpinx.\\nUterine tuberculosis produces the same phenomena as\\nordinary metritis, but the organ enlarges more quickly and\\nto a greater degree. The discharge is caseous. The dif-\\nferential diagnosis, from corporeal carcinoma especially,\\nmay be aided by curetment, but it is by no means easy\\ngiant cells, tubercles, demonstration of bacilli, or inocula-\\ntion of the peritoneal cavity of a rabbit with the uterine\\nsecretion. An accompanying tubal affection is strong cor-\\nroborative evidence.\\nIn the beginning of the disease there is amenorrhea,\\ninterrupted by blood-tinged or mucopurulent discharges,\\nand a sensation of weight and pressure in the pelvis.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0241.jp2"}, "242": {"fulltext": "138 GENITAL TUBERCULOSIS.\\nPLATE 49.\\nFig. 1. Syphilitic Ulcer of the Vaginal Cervix. Lardaceous\\nexudate swollen, markedly and sharply cut edges. General inflam-\\nmatory hyperemia of the cervix. (From Mracek.\\nFig. 2.\u00e2\u0080\u0094 Syphilitic Ulcers of the Vaginal Mucosa. Typical\\n|-form, the vaginal walls coming in contact. (From Mracek.)\\nIii vulvar, vaginal^ and cervical tuberculosis the bacilli\\nare to be demonstrated, the microscopic changes in ex-\\ncised pieces studied, and the general condition of the\\npatient taken into consideration.\\nPeritonitis. Ascitic fluid of a high specific gravity, straw-yellow\\ncolor exploratory laparotomy shows confluent tubercles. It must,\\nnevertheless, be remembered that some forms of chronic peritonitis\\nof nontubercular origin show confluent nodules.\\nPrognosis. Grave, just as in tuberculosis of the uro-\\npoietic apparatus. If an organ is primarily affected, it\\nmay be extirpated. We are not yet sufficiently acquainted\\nwith the ultimate results from these operations.\\nTreatment. Extirpation with a good result is possible\\n(Hegar, AVerth, Pean) if the disease is limited to the\\ntubes and uterus if there are no tubercular peritoneal\\npseudomembranes and if the general condition, of the\\nlungs especially, will allow of the operation.\\nIf only the tubes are diseased, they are to be removed,\\ntogether with the ovaries, by celiotomy. The peritoneal\\ncavity is protected from infection by bringing the tumor\\noutside of the abdominal wound and using elastic ligatures.\\nIf the hemorrhage is uncontrollable, incise the posterior\\nvaginal vault and pack Douglas pouch w T ith iodoform\\ngauze (Wiedow).\\nIf the uterus is affected as well, and is not too volumi-\\nnous, removal per vaginam should be practised.\\nIf contraindications exist, the pyosalpinx is to be\\nopened from the vagina and drained with iodoform gauze;", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0242.jp2"}, "243": {"fulltext": "ICj", "height": "4580", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0243.jp2"}, "244": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0244.jp2"}, "245": {"fulltext": "TREATMENT.\u00e2\u0080\u0094 VENEREAL DISEASES. 139\\nthe uterus is to be cureted and the raw surface covered\\nwith iodoform (iocloform-blower).\\nVaginal ulcers and vulvar lupus are to be excised or\\ncauterized with the hot iron, fuming nitric acid, or caustic\\npotash, and dusted with iodoform.\\nTuberculosis of the peritoneum is treated by celiotomy.\\nUlcers of the bladder First determine the condition\\nof the kidneys. A suprapubic cystotomy is performed,\\nthe ulcers are excised, and the wound is packed with iodo-\\nform gauze until it closes spontaneously. [The facility\\nwith which circumscribed areas of ulceration may be\\ntreated through the endoscope renders cystotomy less fre-\\nquently necessary. Ed.]\\ng 21. VENEREAL DISEASES.\\ni. Ulcus Molle (Soft Chancre).\\nDiagnosis. These round, multiple, sharply circumscribed ulcers\\noccur in from one to four days after exposure, and usually affect the\\nvulva, occurring at the position of a small tear or herpetic ulceration.\\nThey are rare in the vagina and upon the cervix. The ulcer is bathed\\nin pus; its edges are undermined, soft, and reddened. It may be the\\nseat of diphtheric inflammation or of a rapid destructive ulceration\\nulcus gangramosum. It may heal at the point of infection (as usual\\nwith a scar), yet spread further by serpiginous ulceration.\\nThe infection is a local one, stopping at the inguinal glands, which\\nundergo suppuration (chancroidal bubo) and are very sensitive.\\nTreatment. Cauterize the ulcer with fuming nitric acid or chromic\\nacid and treat it antiseptically. Buboes are either to be freely incised\\nor enucleated, and dusted with iodoform.\\n2. Ulcus Durum (Hard Chancre) Syphilis.\\nDiagnosis. The first lesion is a small, single ulcer, in which a\\npapule develops three or four weeks after exposure. Its characteristic\\npeculiarity is that it neither heals nor grows larger, but becomes sur-\\nrounded by a hard infiltration. Its most frequent situation is upon\\nthe posterior commissure, and, next in order, upon the cervix, but it\\nalso occurs in the vagina. (Plate 49.)\\nAs a secondary affection, multiple, indolent, inguinal buboes ap-\\npear, which do not suppurate (differential point from the nonsyphilitic\\nbuboes). The infection spreads from here to the abdominal glands.\\nFlat condylomata appear on and about the vulva, extending to the", "height": "4584", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0245.jp2"}, "246": {"fulltext": "140 CYSTITIS.\\nPLATE 50.\\nPapular Gummata of the Vulva, of the Anus, and of the\\nInner Side of the Thigh. Some of them show areas of central\\nnecrosis. (From Mracek.\\nthighs and anus. These are secondary proliferations (Plate 50), having\\nthe same structure as the primary papule (dense alveolar infiltration\\nof the cutis with cells rich in nuclei chronic inflammatory thickening\\nof the vessel-wall, with narrowing of the lumen).\\nTertiary syphilides rarely occur; gummata are usually situated\\nin the vagina and beside the cervix. They disintegrate rapidly,\\nand strongly resemble the flat ulcerating vaginal epithelioma. (Plate\\n50.)\\nThe differential diagnosis has been given to insure clinical recog-\\nnition. The treatment properly belongs to the domain of syphilog-\\nraphy.\\n22. CATARRH OF THE BLADDER AND CYSTITIS.\\nAnatomy. Vesical catarrh occurs in an acute and in a chronic\\nform. The latter arises either from the former or from a chronic\\nhyperemia, which produces ecchymosis in the mucous membrane or\\nhemorrhages into the bladder.\\nIn acute catarrh the organ is contracted; the mucosa is reddened,\\nand shows areas that have lost their epithelium. Epithelial debris\\nand emigrated red and white blood-corpuscles may be found between\\nthe folds of the wrinkled mucous membrane.\\nIf the inflammation has become chronic, there is a reddening of the\\nentire mucous membrane, or an insular hyperemia (often about the\\ninternal urethral orifice, associated with small eechymoses). Great\\nnumbers of leukocytes pass out through the dilated vessels; the\\nmucosa secretes quantities of mucus and casts off its superficial\\nsquamous epithelium\\nIf the catarrh decreases, the leukocytes continue to migrate for a\\nlong time in other cases permanent excoriations are established, which\\nare converted into ulcers most frequently in the trigonum or at the\\nurethral orifice) by the action of bacteria. The muscularis is finally\\naffected.\\nThe original infiltration of the muscularis leads either to an acute\\nextension of the inflammation, to cystitis, and even pericystitis e.,\\ninflammation of the vesical subserosa and serosa), or to a chronic\\nparenchymatous hypertrophy of the muscularis. The entire bladder-\\nwall is thick and rigid. Plate 48.\\nThe serosa reacts in a like manner and protects the peritoneal cavity\\nfrom the urine; if it does not, the most acute peritonitis sets in and", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0246.jp2"}, "247": {"fulltext": "t\\nfa", "height": "4595", "width": "3146", "jp2-path": "atlasepitomeofgy00scha_0247.jp2"}, "248": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0248.jp2"}, "249": {"fulltext": "ETIOLOGY. 141\\ndeath follows. Such pernicious extension is brought about by pro-\\ngressive gangrene. If the necrosis is limited to the mucous membrane,\\nit leads to casting-oS of the same in toto or in shreds cystitis diph-\\ntheritica.\\nEtiology. The manner of origin differs in many re-\\nspects from that in the male. The shortness of the\\nurethra allows the infective material to penetrate into the\\nbladder more easily, and yet the same peculiarity prevents\\nthe urethritis from becoming chronic and going on to the\\nformation of strictures. Concretions as large as a cherry\\nmay pass the urethra, and still larger ones may be removed\\nthrough it by operative means. The female has no pros-\\ntate, the hypertrophy of which leads to stasis and decom-\\nposition of the urine. The puerperal process gives rise\\nto a series of injurious influences, partly direct pressure\\neffects and partly inflammations. The latter are due either\\nto direct extension from a parametritis or perimetritis, or\\nto the perforation of an exudate or an extra-uterine gesta-\\ntion sac. An analogous predisposition is seen in perforat-\\ning tumors of the female genitalia (carcinoma, see Plates\\n85, 86, 88, 89 dermoid cysts).\\nRetention of urine is another cause of catarrh of the\\nbladder. It may be due to incarceration of a retroflexed\\ngravid uterus, to an impacted retro-uterine tumor, or to an\\ninversion of the vagina, with cystocele. The cause may be\\nfound in the bladder itself tumors of the wall or vesical\\ntuberculosis.\\nThe two most frequent causes, however, are direct\\ninfection from a dirty catheter and gonorrheal urethritis.\\nBacteria are concerned in all vesical catarrhs they in-\\njure the bladder-wall and cause decomposition of the urine,\\nwhich irritates the mucous membrane. The catarrh is\\nmaintained by irritating urinary ingredients, such as alco-\\nhol and cantharides.\\nSymptoms and Diagnosis. Increased frequency of\\nmicturition, ardor urinse, vesical tenesmus the urine is\\nsometimes bloody and always contains more or less mucus", "height": "4589", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0249.jp2"}, "250": {"fulltext": "142 CYSTITIS.\\n(marked nubecula) or mucopus (thick, white sediment). It\\nis cloudy and has a pungent ammoniacal odor. Slight\\nfever is present.\\nThe microscope shows red and white blood-corpuscles,\\ndesquamated epithelium, and, if alkaline fermentation\\nexists, crystals of triple phosphate and acid urate of am-\\nmonium.\\nDiphtheric cystitis is recognized by the great vesical\\npain, the fever, and the shedding of membranes or shreds.\\nThe last-named symptom may render catheterization diffi-\\ncult. If these membranes produce marked ischuria,\\nsymptoms of urinary retention (beginning uremia) appear\\ndyspepsia, nausea, vomiting, alternating constipation and\\ndiarrhea, and cerebral congestion.\\nHypertrophy of the bladder gradually leads to consider-\\nable vesical dilatation from the rigidity of the walls\\neven the empty bladder may be felt above the symphysis.\\nAfter the muscular hypertrophy disappears the walls of\\nthe senile bladder may become almost as thin as paper\\natrophy of the bladder. Both forms may be demonstrated\\nby the catheter.\\nThe presence of a cystitis being established, its cause\\nmust be diagnosed. The vesical causes are ulcers, tumors\\n(see under Tumors), concretions, and foreign bodies.\\nVice versa a whole series of troubles spring from inflam-\\nmatory irritation, especially of the urethra. The same\\nis true of ulcers (tubercular and others) and fissures at\\nthe neck of the bladder, especially those situated at the\\ninternal orifice of the urethra and in the urethra itself.\\nThese are extremely sensitive, and often arise from cathe-\\nterization (even with the elastic catheter). These fissures\\nand the catarrh and many of its causes lead to the", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0250.jp2"}, "251": {"fulltext": "SYMPTOMS. \u00e2\u0080\u0094DIA GNOSIS. 1 43\\nSequels of Cystitis.\\n1. Vesical spasm.\\n2. Paralysis of the bladder paralysis vesicae (ischuria,\\nincontinence, ischuria paradoxa, incontinence of reten-\\ntion).\\nI. Vesical Spasm is a neuralgia, and occurs in nervous\\nwomen, either as a result of vesical catarrh, pericystitis,\\nand all irritations of the bladder (foreign bodies concre-\\ntions hemorrhoids ulcerations and fissures, especially at\\nthe vesical neck and in the urethra tumors), or as a\\nprimary neuralgia from the influence of severe irritations\\nupon an easily excited nervous system. It reminds one\\nof vaginismus, and the two conditions may be associated.\\nIt is possible that irritations of the internal genitalia may\\nact as causal factors. Such irritations are overindulgence\\nin sexual intercourse, onanism, interrupted coitus, strong\\nemotions, probably, and colds with subsequent chronic\\nhyperemia. When such primary conditions exist, irritat-\\ning foods and drinks may bring on an attack. Hysteria\\nalso plays its role.\\nSymptoms and Diagnosis. Violent attacks of pain,\\nlasting from a few minutes to several hours, which radiate\\nfrom the neck of the bladder, and sometimes assume an\\nextremely painful spasmodic character, especially at the\\nbeginning of urination. This spasm may be so violent\\nthat the urine can not be voided (ischuria spastica).\\nIf a complicating vesical catarrh exists, the urine is\\ncloudy, containing red and white blood-corpuscles, and\\nmucus. In a pure neurosis it is as clear as water (urina\\nspastica), but is frequently rich in urates and of such a\\npeculiar offensive odor that some abnormal metabolic pro-\\ncess (autointoxication) must be considered. The urine is\\nsometimes passed in drops, sometimes in large amounts.\\nThe act excites radiating pain in all directions, as well\\nas intestinal tenesmus, nausea, subsequent dyspepsia, ill\\nhumor, and sleeplessness, so that the general condition", "height": "4590", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0251.jp2"}, "252": {"fulltext": "144 CYSTITIS.\\nfinally suffers. The paroxysms frequently appear irregu-\\nlarly the affection may persist for years.\\nDiagnosis. All causes must be excluded. Bimanual\\nexploration (palpation between the vagina and the sym-\\nphysis) reveals the presence of calculi, tumors, and vesical\\nhypertrophy. The sound, combined with the palpating\\nvaginal finger, demonstrates sensitive areas (fissures) or\\nsmall diverticula, the sacculations of which can not be\\nemptied by the catheter, and thus continually reinfect the\\nurine. The interior of the bladder may be digitally ex-\\nplored. Cystoscopy (with or without dilatation of the\\nurethra by means of Simon s specula) allows of inspection\\nof the parts, showing the presence of tumors, ulcers, cir-\\ncumscribed ecchymoses, small foreign bodies, and encysted\\ncalculi, and renders catheterization of the ureters possible.\\nThe latter procedure is of value in determining the source\\nof pus that does not come from the bladder.\\nCystoscopy, as it has been perfected by the instruments\\nof Casper, Nitze, Pawlick-Kelly, and Rose, is the newest\\naid to diagnosis. In difficult cases it is indispensable. The\\nvarious methods of its application must be practically\\nlearned. The pelvis of the patient is elevated, the urethra\\nis somewhat dilated (previous injection of a few centimeters\\nof a 5^ solution of cocain), and a speculum with a\\nbeveled end is introduced. The bladder fills with air, and\\nits walls, together with the urethral orifices, may be seen.\\nIn another method of cystoscopy at least 50 c.c. of a\\nboric acid solution are injected into the bladder, and a\\ncatheter (not exceeding J of a cm. in diameter), armed\\nwith a small incandescent lamp, is introduced. By moving\\nthe instrument about, the numerous recesses of the female\\nbladder, the interureteric fold, and the trigonum are ex-\\nposed to view. By means of the operative cystoscope\\nminor operations, such as catheterization of the ureters,\\nmay be performed. This method is particularly applicable\\nto determine definitely the source of pus in unilateral\\npyonephrosis.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0252.jp2"}, "253": {"fulltext": "VESICAL PARALYSIS. 145\\nIt should be mentioned that it is also possible, in the\\nfemale, to separate the urines from the ureters by means\\nof a double catheter, the dividing partition of which ex-\\ntends to a position between the two ureteral orifices, and is\\npressed firmly against the bladder-wall.\\nThe ureteral orifices are seen as fine linear fissures,\\neither upon the apex or at the sides of small elevations of\\nthe mucosa.\\nTubercular ulcers, developing tumors, threatened rup-\\nture of a parametritic or pericystic abscess, and encysted\\nforeign bodies (vesical calculi) may be surely diagnosed,\\nand to a certain extent treated, by means of the cystoscope.\\n2. Paralysis of the bladder may be of a twofold char-\\nacter paralysis of the longitudinal and oblique muscular\\nfibers ischuria, retention of urine or paralysis of the\\ncircular fibers (sphincter vesicae) incontinentia paralytica.\\nBoth forms may be combined i. e., the urine dribbles and\\ncan not be retained (incontinence) after the desire to uri-\\nnate has already been lost (ischuria).\\nIf paralysis of the sphincter is not present, in addition\\nto the retention the bladder becomes immoderately dis-\\ntended (without strangury), gradually overcoming the re-\\nsistance of the sphincter and emptying its urine drop by\\ndrop. The bladder suffers no decrease in size, however,\\nand the patient has no suspicion of its dilated condition\\n(ischuria paradoxa, incontinence of retention).\\nAll these conditions (ischuria and incontinence) may\\nfollow the puerperal process, from displacements of the\\nbladder, angulation of the urethra, swellings in the ureth-\\nral region after delivery, or from inflammation of any por-\\ntion of the genital tract or its serous covering. They may\\nbe due to changes in the elasticity of the muscularis (fatty\\ndegeneration, atrophy) from cystitis, habitual overdistention\\nof the bladder, advanced age, and acute infectious diseases.\\nThey are caused by decreased innervation, as seen in dis-\\neases of the spinal cord and other central disturbances,\\nsuch as apoplexy, neurasthenia, and hysteria (after easy\\n10", "height": "4601", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0253.jp2"}, "254": {"fulltext": "144 CYSTITIS.\\nfinally suffers. The paroxysms frequently appear irregu-\\nlarly the affection may persist for years.\\nDiagnosis. All causes must be excluded. Bimanual\\nexploration (palpation between the vagina and the sym-\\nphysis) reveals the presence of calculi, tumors, and vesical\\nhypertrophy. The sound, combined with the palpating\\nvaginal finger, demonstrates sensitive areas (fissures) or\\nsmall diverticula, the sacculations of which can not be\\nemptied by the catheter, and thus continually reinfect the\\nurine. The interior of the bladder may be digitally ex-\\nplored. Cystoscopy (with or without dilatation of the\\nurethra by means of Simon s specula) allows of inspection\\nof the parts, showing the presence of tumors, ulcers, cir-\\ncumscribed ecchymoses, small foreign bodies, and encysted\\ncalculi, and renders catheterization of the ureters possible.\\nThe latter procedure is of value in determining the source\\nof pus that does not come from the bladder.\\nCystoscopy, as it has been perfected by the instruments\\nof Casper, Nitze, Pawlick-Kelly, and Rose, is the newest\\naid to diagnosis. In difficult cases it is indispensable. The\\nvarious methods of its application must be practically\\nlearned. The pelvis of the patient is elevated, the urethra\\nis somewhat dilated (previous injection of a few centimeters\\nof a 5^ solution of cocain), and a speculum with a\\nbeveled end is introduced. The bladder fills with air, and\\nits walls, together with the urethral orifices, may be seen.\\nIn another method of cystoscopy at least 50 c.c. of a\\nboric acid solution are injected into the bladder, and a\\ncatheter (not exceeding J of a cm. in diameter), armed\\nwith a small incandescent lamp, is introduced. By moving\\nthe instrument about, the numerous recesses of the female\\nbladder, the interureteric fold, and the trigonum are ex-\\nposed to view. By means of the operative cystoscope\\nminor operations, such as catheterization of the ureters,\\nmay be performed. This method is particularly applicable\\nto determine definitely the source of pus in unilateral\\npyonephrosis.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0254.jp2"}, "255": {"fulltext": "VESICAL PARALYSIS. 145\\nIt should be mentioned that it is also possible, in the\\nfemale, to separate the urines from the ureters by means\\nof a double catheter, the dividing partition of which ex-\\ntends to a position between the two ureteral orifices, and is\\npressed firmly against the bladder-wall.\\nThe ureteral orifices are seen as fine linear fissures,\\neither upon the apex or at the sides of small elevations of\\nthe mucosa.\\nTubercular ulcers, developing tumors, threatened rup-\\nture of a parametritic or pericystic abscess, and encysted\\nforeign bodies (vesical calculi) may be surely diagnosed,\\nand to a certain extent treated, by means of the cystoscopy\\n2. Paralysis of the bladder may be of a twofold char-\\nacter paralysis of the longitudinal and oblique muscular\\nfibers ischuria, retention of urine or paralysis of the\\ncircular fibers (sphincter vesicae) incontinentia paralytica.\\nBoth forms may be combined i. e., the urine dribbles and\\ncan not be retained (incontinence) after the desire to uri-\\nnate has already been lost (ischuria).\\nIf paralysis of the sphincter is not present, in addition\\nto the retention the bladder becomes immoderately dis-\\ntended (without strangury), gradually overcoming the re-\\nsistance of the sphincter and emptying its urine drop by\\ndrop. The bladder suffers no decrease in size, however,\\nand the patient has no suspicion of its dilated condition\\n(ischuria paradoxa, incontinence of retention).\\nAll these conditions (ischuria and incontinence) may\\nfollow the puerperal process, from displacements of the\\nbladder, angulation of the urethra, swellings in the ureth-\\nral region after delivery, or from inflammation of any por-\\ntion of the genital tract or its serous covering. They may\\nbe due to changes in the elasticity of the muscularis (fatty\\ndegeneration, atrophy) from cystitis, habitual overdistention\\nof the bladder, advanced age, and acute infectious diseases.\\nThey are caused by decreased innervation, as seen in dis-\\neases of the spinal cord and other central disturbances,\\nsuch as apoplexy, neurasthenia, and hysteria (after easy\\n10", "height": "4603", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0255.jp2"}, "256": {"fulltext": "146 CYSTITIS.\\nlabors, simple operations that do not even involve the\\nvesical region or anterior vaginal wall, emotion, ingestion\\nof irritating foods, new wine and beer, asparagus, strong\\ntea, etc.). Finally, they are seen in weak individuals, in\\nthe form of enuresis nocturna, and associated with intoxi-\\ncations.\\nSymptoms and Diagnosis. Ischuria paralytica mani-\\nfests itself by the difficulty of urination, excessive demands\\nbeing made upon the abdominal muscles to aid in the ex-\\npulsion of the urine. The cause must, nevertheless, be\\naccurately determined, and the possible existence of ureth-\\nral tumors especially should be considered. When drib-\\nbling is present, the catheter is to be employed in order to\\nexclude ischuria paradoxa and foreign bodies.\\nTreatment of Cystitis.\\nRecent gonorrheal urethritis and cystitis are treated as\\nindicated in \u00c2\u00a712.\\nIn simple acute vesical catarrh (without fever) the blad-\\nder is not to be disturbed the urine is to be rendered mild\\nand unirritating above all, an abundance of tea and milk\\n(add 25.0 of lime-water to J of a liter of milk if it is\\nnot well borne). Abstinence from all irritating foods, es-\\npecially alcohol. The diet should be bland, including egg-\\nalbumen, milk of almonds, bouillon, and rare meat. The\\nbowels should be regulated by injections and mild laxa-\\ntives.\\nInstead of prescribing balsams, as was formerly the\\ncustom, urotropin (0.5, three times daily), potassium chlo-\\nrate, or a solution of sodium salicylate (5 150) are given.\\nThe tenesmus is best controlled by rest in bed, warm\\nfomentations, narcotics in vaginal or rectal suppositories\\n(chloral, tincture of opium, morphin, extract of bella-\\ndonna), or chloral or opium by the mouth. The vesical\\nmucous membrane itself absorbs nothing. Warm baths.\\nIn chronic cystitis due to infection irrigation of the\\nbladder is to be added to the foregoing measures physio-", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0256.jp2"}, "257": {"fulltext": "TREATMENT. 147\\nlogic JSaCl solution, 1-2 boric acid, c f c salicylic acid,\\n0.5-1 1000 nitrate of silver. To alleviate the irritation\\nof the stronger solution, subsequent irrigations of 0.25^\\ncocain are employed. After solutions of nitrate of silver\\nstronger than 6 1000, NaCl solution to precipitate the\\nsilver. If the mucous membrane is very sensitive, JSaCl\\nor mucilaginous solutions (starch, oatmeal).\\nThe irrigations are carried out with a catheter, or with\\nKiistner s funnel (which I prefer to use, because of the\\neasy formation of a fissure by the catheter) to which a\\ntube and a glass funnel (Hegar^s) are attached. The\\nlatter should hold from to of a liter. The apparatus\\nmust be rigidly aseptic, and no air-bubbles are to enter the\\nbladder. The funnel is to be filled several times in suc-\\ncession. The temperature should be from 95\u00c2\u00b0 to 100\u00c2\u00b0 F.\\nThe pressure should not be too great, especially with a\\nparalyzed detrusor urinse. The irrigations are made from\\none to four times daily if high fever is present, every\\ntwo hours.\\nThe quickest results are obtained by permanent drain-\\nage of the bladder, which is always to be employed if\\nfissures and severe cystitis are present. As recommended\\nby Fritsch, a rubber tube, 15 cm. long and 0.6 or 0.7 cm.\\nin diameter, is introduced and is held in position by adhe-\\nsive plaster (or Unna s zinc plaster) or by a suture through\\nthe nymphse. The tube should only be introduced far\\nenough to allow the urine to flow out. The instrument\\nmust be changed every three days on account of the\\nincrustation.\\nDiphtheric membranes must be removed their pres-\\nence may be diagnosed from the numerous small incrusted\\nshreds and from the bloody, decomposing urine. The\\nurethra must be dilated by means of Simon s specula.\\nThe first three numbers are to be successively introduced,\\nand the irrigation is to be carried out with j^o. 3. If\\nhemorrhage occurs Ferripyrin solution (1 5), solution\\nof sesquichlorid of iron (1 800), or iodoform-ferripyrin-", "height": "4593", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0257.jp2"}, "258": {"fulltext": "148 CYSTITIS.\\ngauze tamponade through the speculum. The after-treat-\\nment consists of a bland diet and carbonated waters (such\\nas Wildunger, Vichy) or mild infusions.\\nHypertrophy and contraction of the bladder are treated\\nby regular catheterization and lukewarm irrigations, the\\namount being increased daily (to distend the bladder),\\ncold baths, douches, and vaginal irrigations.\\nFor spasm of the bladder Removal of the cause (for-\\neign bodies, etc.), bearing in mind fissures at the neck of\\nthe bladder or in the urethra if these are present, Fritsch s\\npermanent catheter or dilatation of the urethra. Avoid all\\ncongestions injections and mild cathartics forbid sexual\\nintercourse hot foot-baths bland diet without alcohol.\\nFor the nervous excitability Potassium bromid, mild\\nhydrotherapy. During the attack Chloral internally, by\\nthe vagina or rectum injections of morphin directly into\\nthe bladder, or irrigation with a cocain solution or the\\nmeasures employed for tenesmus.\\nIn paralysis of the bladder the exercise of the will\\nplays an important role as far as the sphincter is con-\\ncerned enuresis nocturna, for example (wake the patient\\nseveral times during the night and have her empty her\\nbladder) hydrotherapy roborants.\\nIschuria (detrusor paralysis) is treated by frequent\\ncatheterization, cool applications, and abdominal massage.\\nIf the muscularis is already paretic or paralytic (incon-\\ntinentia paradoxa paralytica), electricity is to be employed.\\nIt is also of value in uncontrollable enuresis nocturna.\\nOne well-insulated pole is introduced into the bladder,\\nwhich has been filled with water, and the other pole is\\napplied to the symphysis, lumbar region, or perineum.\\nErgot is also employed. The treatment of the catarrh\\ncatheterization and lukewarm irrigations is usually of\\nvalue in alleyiating this condition.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0258.jp2"}, "259": {"fulltext": "CHAPTER II.\\nDISTURBANCES OF NUTRITION AND CIRCULATION.\\n(Exanthemata, Phlebectasia, Neuroses.)\\nSince the female genitalia, and particularly the vulva,\\nare unusually rich in nerves, glands, blood-vessels, and\\nlymphatics in the shape of cavernous tissue, the affections\\nof one set of structures easily spread to the others, and\\ncause the most varied changes, which usually give rise to\\na typical symptom-complex pruritus vulvae, vaginismus,\\ndysmenorrhea, hysteria.\\n?23- DISTURBANCES OF NUTRITION AND CIRCULATION.\\n(a) Of the External Genitalia.\\nBy vulvitis pruriginosa we understand an inflammation\\nof the external genitalia, associated with intense itching\\n(pruritus). The parts are dry, fissured, and slate-gray in\\ncolor.\\nThere are different varieties of vulvitis simple redden-\\ning dermatitis simplex if the corium and subcutaneous\\ntissue are diffusely involved phlegmone vulvae with\\nabscess formation if partial furunculosis if the sebace-\\nous glands are inflamed (small yellowish projections like\\nacne) folliculitis if an inflammation of the connective-\\ntissue papillae (small red prominences) also exists papil-\\nlary vulvitis. There is a vulvitis diabetica. Bartholin-\\nitis has been mentioned in \u00c2\u00a712.\\nCutaneous exanthemata (eczema, herpes, prurigo, mili-\\naria) rarely occur.\\nTreatment. Simple inflammation Washings with warm soda\\nsolutions and the subsequent application of lead-water, solution of\\n149", "height": "4591", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0259.jp2"}, "260": {"fulltext": "1 50 NUTRITIONAL AXD CIBCULA TOE Y DISTURBANCES.\\naluminum acetate, zinc ointment. 20 boric-vaselin, 10 c c carbolized\\noil. sitz-batlis, dusting-powders i bisniuth-talcmn\\nSeverer inflammation Soda solutions, then apply 5-10 -V solution of\\nsilver nitrate, and lead-water compresses.\\nAbscesses: Incision. In furunculosis Shave off the pubic hair;\\nUnna s mercurial plaster in the beginning later, warm sitz-baths.\\nsoap plaster, emollient cataplasms.\\nDiabetic vulvitis: Constitutional treatment, meat diet, laxatives\\nsal carolinum\\nFolliculitis Eemove the grease from the skin by means of solutions\\nof potassium carbonate a piece the size of a walnut is dissolved in the\\nwash-water I and immediate application of 5-10 c c solution of nitrate\\nof silver. If pruritus is present, excision of the part, 5-V- menthol-\\nalcohol, or menthol-lanolin.\\nPruritus: Washings with soda solution; application of 10 fr solution\\nof nitrate of silver and subsequent 10 V carbolic acid compresses: appli-\\ncations of ice-water, compresses of 6 V menthol-alcohol, or J-l 1000 cor-\\nrosive sublimate, or salicylic acid: warm sitz-baths with J of a pound of\\nwheat bran, oak-bark decoctions, or other astringents (alum, formalin,\\ntannin Anodynes cocain expensive i. eucain B. chloroform, nior-\\nphin. and belladonna act temporarily in cases having a neurasthenic\\nbasis and not rarely appearing after some acute exciting cause i fright i\\n(b) Of the Internal Genitalia.\\nBy vaginismus we understand a reflex spasmodic con-\\ntraction of the introitus vaginae from contact with the\\nmarked hyperesthetic. usually thickened and chronically\\ninflamed, hymen, or carunculae myrtiformes. It is a\\nsymptom-complex similar to pruritus, but it also affects\\nthe motor elements. The two affections may coexist. Cen-\\ntral or hysteric processes are also responsible, as is demon-\\nstrated by the fact that the lightest touch with a smooth\\ninstrument-handle produces the same result as the impetus\\ncceundi or the introduction of a speculum.\\nI had a patient in whom the introduction of an irriga-\\ntion tube was easy and painless when carried out by her-\\nself, but accompanied by intense pain when done by any\\none else. If her attention was engaged, a tampon could\\nbe introduced. The thought of a remarriage, with subse-\\nquent coitus, also brought on an attack.\\nThere is one form of vaginismus, however, without\\npain, as is shown by the symptom of the penis captivus.\\nThere are also neuroses of the vagina situated higher up", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0260.jp2"}, "261": {"fulltext": "IXTEEXAL GEXITALLL 151\\npainful area?, especially in the posterior vaginal vault and\\nnot associated with parametritic processes.\\nTreatment. Careful excision of the entire hymen, in-\\ncluding the urethral orifice with its caruncles. In the\\nease mentioned the nymphae i folliculitis i were also re-\\nmoved, on account of pruritus. The patient married.\\nconceived, had an easy delivery, and has now been a\\nmother and wife for four years in her first marriage.\\nlasting for some years, she was an unhappy, and finally a\\ndivorced, woman.\\nIf the hypersensitiveness -till remains, the sphincter\\nvaginae should be forcibly stretched. The actual anes-\\nthesia of the part- is now demonstrated to the patient by\\npalpation. Regular coitus and the speedy occurrence of\\nimpregnation remove the last vestiges of the trouble.\\nIn other cases conditions of pronounced nervous irrita-\\ntion, and finally nervous depression, or even psychoses,\\noccur.\\nMasturbation is a frequent cause, hi such cases the\\ntime of the patient shouM be completely occupied by\\nabsorbing and fatiguing duties, and all irritations of the\\nsenses should be removed lectures, balls, theater, etc.\\nOther causes are fissures, arising from a re-i-tent hymen,\\nand impotentia cceundi on the parr of the male. See I 5.\\nA disturbance of nut agt I itis vetnlarum Paige\\nleads, as colpitis ulcerosa adhaesiva irregular areas of round-cell intil-\\nd with desquamated epithelium to adhesions, sears, and bridges\\nof new tissue.\\nExamples of vasomotor anomalies of innervation are\\nfurnished by phlebectasia of the vulva (Plate 51) and\\nvaricocele parovarialis i Plate 53 the latter may give\\nrise to intraperitoneal hematocele or hematoma of the\\nbroad li ^ament.\\nThe disturbance- of innervation of the arterial system\\nare usually associated with similar affections of all the\\ncontractile elements of the genitalia and their supporting\\nligaments. This deficient tonus is a frequent occur-", "height": "4598", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0261.jp2"}, "262": {"fulltext": "152 NUTRITIONAL AND CIRCULATORY DISTURBANCES.\\nPLATE 51.\\nFig. 1. Elephantiasis Vulvae Originating in the Labium\\nMajus Dextrum and Polypoid Excrescences of the Mucous\\nMembrane at the Urethral Orifice. The elephantiasis starts in\\nthe deeper connective tissue and consists of proliferated lymph-capil-\\nlaries (see Plate 29, Fig. 1), partly neuromatous (Czerny) and partly\\nfrom stasis. The tumors may resemble external papillomata, but their\\nexcrescences are usually larger and flatter. (See Plate 24.) Some-\\ntimes the tumors grow out from the entire vulva. Their growth is\\nalways slow and is characterized by great variations in size.\\nPolyps of the urethral mucous membrane are seen at the external\\norifice or at the neck of the bladder. They consist of connective tissue,\\nand rarely contain small retention cysts, arising from atresia of the\\nexcretory ducts of Skene s glands (in Fig. 20 the fine orifices of these\\nglands are seen in the urethral wall). Other urethral tumors arise as\\nvarices, as vascular proliferations (angioma), as sarcoma and epithe-\\nlioma. (Original water-color case in Munich Frauenklinik.)\\nFig. 2. Phlebectasia of the Labia Majora, of the Clitoris,\\nand of the Nymphse the Right Labium Majus Contains a\\nHematoma (Thrombus Vulvae) and Hemorrhoids. This con-\\ndition is most frequently found in parturient or puerperal women, the\\nvarices being due to venous stasis the extravasation, to subcutaneous\\ninjuries of the vessels during delivery. Hematoma may also occur in\\nnonpregnant women as a result of trauma.\\nrence, and leads to descent and prolapse of the uterus, of\\nthe vaginal walls with the bladder and the rectum, and to\\nretroversion and retroflexion of the uterus. It produces\\na chronic hyperemia of these organs, which becomes the\\nnoninfectious starting-point of an inflammation.\\nThese affections have been considered in 7\u00e2\u0080\u009411 and\\nin 13, 14, and 17. The foregoing common etiologic\\nfactor must be borne in mind, as it is of far-reaching im-\\nportance.\\nThe partly uterine, partly ovarian symptom-complex of dysmenor-\\nrhea is described in 4, under 8.\\nThe hysteric symptom-complex (see 11, under Symptoms, and\\n17, under Diagnosis) represents a disease of the entire nervous sys-", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0262.jp2"}, "263": {"fulltext": "", "height": "4589", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0263.jp2"}, "264": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0264.jp2"}, "265": {"fulltext": "SY31PT0MS. \u00e2\u0080\u0094TEE A TMENT. 153\\ntern, with a cerebral origin, and the evolution of certain phenomena,\\nA predisposition either may preexist or may be induced by a too indul-\\ngent education. This disease arises from marked sensual or emotional\\nexcitement, which individuals with healthy nerves bear without injury,\\nor from a permanent feeling of self -dissatisfaction.\\nIn addition to congenital traits, a general predisposition is fur-\\nnished by our city life, with its early manifold sensory impressions, its\\ndisproportionate mental activity, its luxuries and pleasures, and with\\nits absence of actual invigorating labor, and of precise duties and cor-\\nresponding strengthening of the will. These pernicious factors must\\nbe excluded in youth amends must be made for them in later years.\\nDiseases of the genitalia may bring on the disease, but they do not\\nalways produce hysteria, nor are they the only exciting causes. As\\nsuch may be mentioned puerperal diseases, with their infectious irrita-\\ntions and weakening hemorrhages chronic painful oophoritis and sal-\\npingitis; pelveoperitonitic adhesions; retro flexio uteri fixati; spas-\\nmodic angulation of a retroverted uterus; inflammations of the uterus;\\nintramural myomata projecting from the os uteri; traction from polyps,\\netc.\\nSymptoms. 111 humor, hypersensitiveness, weakness of will.\\nEpileptiform spasms and contractions, usually clonic, sometimes\\ntonic, with perfect consciousness and reflex excitability (pupils) of\\nthe muscles of the extremities and trunk (Charcot s arch), with accel-\\nerated respiration, and, according to the state of mind, paroxysms of\\nshrieking, crying, laughing of the laryngeal and esophageal muscu-\\nlaris, spasm of the glottis (barking cough), spasm of the esophagus\\n(globus hystericus). Singultus hystericus.\\nParalyses of the extremities, unilateral and bilateral of the\\nvocal cords, hysteric hoarseness and aphonia (as in a case with retro-\\nflexion of the uterus at the Heidelberg clinic).\\nGeneral and partial hyperesthesias and anesthesias Tussis uterina,\\nemesis et vomitus, clavus hystericus, spinal irritation, ovarie (Char\\ncot).\\nVasomotor and trophic symptoms Palpitation, stenocardia, ner-\\nvous dyspepsia, meteorismus anomalies of secretion of the skin\\n(hyperidrosis, anhidrosis), of the kidneys (polyuria, oliguria or tem-\\nporary anuria, ischuria) nervous diarrhea, etc.\\nDiagnosis is made from the rapidly changing character of the\\nsymptoms. These do not form a clinical picture corresponding to\\npathologic changes in any definite organ.\\nTreatment. Prophylactic see Treatment of Vaginismus Psychic\\ninfluence and education above all, never criticize the patient s view\\nof her ailment, but demonstrate to her its general nervous character,\\nand change the manner of living, the diet, etc. Eegulate the func-\\ntions as indicated in 4, under 7. Eestricted and bland diet or a more\\nliberal one, as the case may be. Treatment of a genital disease, if\\npresent.\\nLukewarm baths to render the patient more hardy gradually lower\\nthe temperature from 88\u00c2\u00b0 to 72\u00c2\u00b0 F., fifteen minutest Electric baths.\\nSymptomatic. Potassium bromid (with heart disease, sodium", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0265.jp2"}, "266": {"fulltext": "154 NUTRITIONAL AND CIRCULATORY DISTURBANCES.\\nPLATE 52.\\nEdema of the Nymphae from a Moribund Patient with a\\nCardiac Lesion. (Original water-color from nature.)\\nbromid) and monobromated camphor for the excitement, irritation,\\nand palpitation phenacetin, lactophenin, heroin, sulphonal, trional,\\nmenthol, valerian. Chloroform, morphin, atropin, chloral, and ex-\\ntract of belladonna (by the mouth, by the rectum, or hypodermically\\nare all used for the neuralgias and as sedatives or hypnotics. They\\nusually do more harm than good. For the paralyses, faradization or\\nmassage for the sj)asins and convulsions, cold water in every form\\nknown to hydrotherapy.\\nCharcot s so-called Ovarie has been mentioned in 17, under\\nDiagnosis. In the great majority of cases it has nothing to do with\\nthe ovaries or even with the adjacent nerve plexuses. It is generally\\neither a neuralgia of the nerves passing through the abdominal recti\\nmuscles toward the hypogastrium, or neuralgia of the posterior vaginal\\nvault, of the pouch of Douglas, and of the contiguous portion of the\\nrectum. The latter cases are usually associated with vasomotor and\\nmotor disturbances of innervation of the parts. (See the author s\\npaper in the u Mon. f. Geb., January, 1898.)\\nCoccygodynia is a local hyperesthesia of the plexus coccygeus.\\nTreatment. Hydrotherapy, or, in extreme cases, extirpation of\\nthe os coccygeus.\\nSometimes confusion may arise from a pain, which is experienced\\nin the coccygeo-anal region, but the location of which may be shown\\nto be considerably higher in the posterior vaginal fornix or about the\\npouch of Douglas; not rarely varicoceles in the broad ligament and\\nhemorrhoids high up in the rectum may be demonstrated. In the\\npuerperium, immediately after delivery, and sometimes even occasion-\\nally during pregnancy, an analogous pain is experienced, which is\\nfalsely ascribed to the coccyx, to pressure on its plexus, to periosteitis,\\nto luxations, etc. Careful palpation from the rectum and externally\\nexcludes these conditions.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0266.jp2"}, "267": {"fulltext": "1", "height": "4595", "width": "3119", "jp2-path": "atlasepitomeofgy00scha_0267.jp2"}, "268": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0268.jp2"}, "269": {"fulltext": "GROUP IV.\\nINJURIES AND THEIR CONSEQUENCES.\\nCHAPTER I.\\nDEFECTS WITH CICATRICIAL CHANGES.\\nAll varieties of genital lesions arise by far most fre-\\nquently during delivery. The effect they produce is\\ndependent upon their location. Cicatrices in the vulva\\nrarely cause atresia on the contrary, they produce a gap-\\ning. Lacerations of the external os may heal with ectro-\\npion nevertheless, here, as in the vagina and cervix,\\nstenosis and atresias are more likely to occur.\\ni 24. INJURIES OF THE VULVA (INCLUDING FISSURES)\\nAND PERINEAL DEFECTS, INCONTINENTIA VULV/E.\\nDefinition. The solutions of continuity, which are\\nnow to be considered, have the character of incised, of\\nlacerated, and of lacerated and contused wounds. A\\nnatural division, based upon the depth of the injury, is as\\nfollows\\n1. Fissures: Slight linear solutions of continuity of\\nthe surface, occurring at the frenulum perinsei and pro-\\nductive of specific results when involving the hymen, the\\nneck of the bladder, or the urethra. (See \u00c2\u00a7\u00c2\u00a722 and 23.)\\n2. Lacerations of the perineum of the first degree\\nTears of the frenulum perinsei and of the mucous mem-\\nbrane of the vestibule.\\n155", "height": "4592", "width": "2796", "jp2-path": "atlasepitomeofgy00scha_0269.jp2"}, "270": {"fulltext": "156 VULVAE AND PERINEAL INJURIES.\\nPLATE 53.\\nPhlebectasia with Phleboliths of the Ligmenta Lata Cor=\\nresponding to the Ovarian Vessels and the Pampiniform\\nPlexus. The venous stasis in the remaining portions of the broad liga-\\nments is also apparent. (Original water-color from an autopsy at the\\nHeidelberg Path. Inst.\\n3. Tears of the mucosa of the fossa navicularis, the\\nskin surface of the perineum being intact, but under-\\nmined. This important and easily overlooked variety is\\nnot rarely produced by the posterior shoulder.\\n4. Lacerations of the perineum of the second degree\\nTears extending to the sphincter ani.\\n5. Perforations of the perineum (rare) Canal-like\\nlacerations, which pass from the vagina through the\\nmiddle of the perineum, sometimes involving the anus,\\nthe anterior portion of the frsenulum perinsei being left\\nintact.\\n6. Lacerations of the perineum of the third degree, or\\ncomplete lacerations the tear extends into the rectum.\\nWhile all these tears are brought about, almost without\\nexception, by incidents of the sexual life (cohabitation,\\ndelivery, and the puerperium urethral fissures from cathe-\\nterization), the parts of the vulva are also exposed to other\\ntraumatisms. These are followed by serious results, espe-\\ncially if occurring during pregnancy, when the parts are\\nvery vascular. The region of the clitoris is the most\\nexposed to wounds, which are usually caused by falling\\nastride of some object. It is also the most dangerous\\nregion, as patients have bled to death in a short time from\\nhemorrhage from the corpus cavernosum.\\nHemorrhages and injuries of this character must be\\ntreated immediately by suture.\\nLacerations and perforations of the nymphse are not\\nproductive of further consequences.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0270.jp2"}, "271": {"fulltext": "CO\\n^v", "height": "4597", "width": "3103", "jp2-path": "atlasepitomeofgy00scha_0271.jp2"}, "272": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0272.jp2"}, "273": {"fulltext": "SY3IPT0MS. \u00e2\u0080\u0094SEQ UELS. 157\\nSymptoms and Consequences of Perineal Lacera-\\ntions. If primary union is not obtained by immediate\\nsuture after delivery, these wounds heal by granulation, the\\nlower portions of the labia being drawn apart and dis-\\ntorted.\\nFissures cause only a burning, and may induce infectious\\n/ulceration they may nevertheless be produced in a peri-\\nneal cicatrix as rhagades (after coitus, difficult defecation).\\nIn perineal lacerations of the first degree (Plate 54,\\nFig. 3) the tuberculum vaginae loses the covering and sup-\\nport of the frenulum perinsei. This portion of the anterior\\nvaginal wall prolapses the urethral orifice gapes x there\\nis a predisposition to urethritis and vesical catarrh.\\nIn perineal lacerations of the second degree the posterior\\nvaginal wall prolapses from above the scar (see Plate 27)\\nand if the entire pelvic suspensory apparatus, including\\nthe pelvic fascia and the levatores ani muscles, has lost its\\ntonus/ all those downward displacements described in\\n7 and 8 and their appurtenant plates may occur. In\\naddition, uterine and vaginal catarrh, cystocele, and recto-\\ncele, and their sequels, are produced.\\nIn perineal lacerations of the third degree the complete\\nvariety (Plates 7, 1 54, 2 and 4 Fig. 26) fecal inconti-\\nnence is present, because the voluntary external sphincter\\nmuscle is torn. In extreme cases the internal sphincter is\\nalso involved.\\nAs is shown in the sagittal section of the perineum (Plate 54,\\nFig. 1), the transversely striated external sphincter forms a rounded\\nbody about the anal pouch (see the corresponding outline of the shad-\\ning), while the internal sphincter passes vertically upward from it as\\nan elongated mass of fibers. Both sphincters are absent in figures 2\\nand 4; in figure 3 they are both present. The whole perineum may\\nbe destroyed, and yet a portion of the external sphincter may remain\\nintact.\\n1 In Heidelberg I saw such a case in a peasant s wife. The impetus\\ncoeundi had been directed against the prolapsed tuberculum vaginae\\nand, in this manner, had so dilated the urethra that the finger could be\\nreadily introduced. (Plate 19, 2.)", "height": "4602", "width": "2792", "jp2-path": "atlasepitomeofgy00scha_0273.jp2"}, "274": {"fulltext": "158 VULVAE AND PERINEAL INJURIES.\\nPLATE 54.\\nFig. 1. The normal perineum is a physiologic support for the vagi-\\nnal walls, and indirectly for the uterus. The intact perineum forms\\nthe lowest part of the vulva, being at a lower level than the end of\\nthe anterior vaginal wall. It resembles a triangle placed beneath the\\nvaginal ostium and supporting the tuberculum vaginae. It also sup-\\nports the entire posterior vaginal wall, which, in its turn, holds up the\\nupper half of the anterior one. The normal cervix looks backward,\\nresting against the posterior vaginal fornix, and the corpus uteri de-\\nrives its support from the anterior vaginal wall.\\nFig. 2. Perineal Laceration of the Third Degree (into the\\nRectum). Inversion of the anterior vaginal wall with beginning\\ncystocele descensus uteri from flattening of the anterior vaginal vault.\\nFig. 3. Perineal Laceration of the Second Degree. The\\nloss of support of the anterior vaginal wall is clearly shown.\\nFig. 4. Perineal Laceration of the Third Degree. Inver-\\nsion and prolapse of the posterior vaginal wall beginning retroversion\\nof the uterus.\\nThere are cases, however, in which solid, and even\\nliquid, stools can be voluntarily controlled. This is due\\neither to an intact portion of the external sphincter, the\\ntear not extending 1| cm. into the rectum, or to the fact\\nthat the lowest portion of the rectum has undergone cica-\\ntricial contraction. Such cases are not easy to diagnose,\\nbecause these rectal scars become pigmented and covered\\nwith epidermoid tissue.\\nThe scars may be the seat of neuralgias or pruritus. If\\nfissures form, burning and tenesmus are present. The\\ncontinual moisture of the prolapsed vaginal walls, with or\\nwithout discharge or intertrigo, is a constant source of an-\\nnoyance there arises a dragging sensation, as if the inter-\\nnal organs would fall out. The deficient closure of the\\nvulva, which increases with the senile atrophy of fatty\\ntissues, allows air to enter the vagina any increase of the\\nabdominal tension will force this air out in an audible\\nmanner garrulitas vulvae.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0274.jp2"}, "275": {"fulltext": "", "height": "4595", "width": "2787", "jp2-path": "atlasepitomeofgy00scha_0275.jp2"}, "276": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0276.jp2"}, "277": {"fulltext": "TREATMENT. 159\\nTreatment. These serious symptoms are best treated\\nby plastic operations, as mentioned in 8. The success\\nof the operation depends partly upon the preparation of\\nthe patient disinfection of the vagina and cervix by\\nsponging and irrigation, emptying of the bladder, and\\nespecially of the rectum (two or three days before the\\noperation). Narcosis. Cotton tampon in the rectum.\\nThe operation may be performed soon after the comple-\\ntion of the puerperium. Not only must the cutaneous\\nbridge between the lower ends of the labia be restored,\\nbut the new septum, with its anterior edge (corresponding\\nto the frenulum), must also cover the tuberculum vagina?\\nand support the anterior vaginal wall.\\nThis new perineal septum must, further, have the same\\nsize and shape (triangular in sagittal section) as the normal\\nperineal body, so that a new fossa navicularis will be\\nformed.\\nThe outline of the denudation will vary according to the\\nnature of the defect if the vagina is injured and deeper,\\nit is hat-shaped (Hildebrandt and Freund) if the chief\\nlacerations are in the lateral portions of the vagina, it is\\nshaped like the wings of a butterfly (Simon and Hegar). In\\nthe latter case the area is denuded in that manner so as to\\nform a perineal body resembling the original one. Fritsch\\npursues the same course, excising the scars in the vagina,\\nwith their lateral extensions, and inserting stitches toward\\nthe vagina, toward the perineum, and toward the rectum.\\nHildebrandt, Freund, and Martin cut one or two or more\\ntriangular flaps from the vagina i. e., either avoid or\\nremove the columna rugarum posterior.\\nBischoff, v. AVinckel, and Kiistner (episioplasty) procure\\na median vaginal flap or two lateral vulvar flaps of corre-\\nsponding shape to the outline of the scar, the principal\\nportions of which are rarely in the middle line. This is\\nknown as flap-perineorrhaphy.\\nSimpson, Lawson Tait, Sanger, Zweifel, and v. Winckel\\nperform perineoplasty in as conservative a manner as pos-", "height": "4589", "width": "2783", "jp2-path": "atlasepitomeofgy00scha_0277.jp2"}, "278": {"fulltext": "160 VAGINAL AND CERVICAL LACERATIONS.\\nsible i. e., without the removal of tissue. This method has\\nbeen improperly denned as flap-perineorrhaphy. A trans-\\nverse incision is made in the rectovaginal septum, and its\\nedges are drawn upward and downward by means of\\ntenacula. The original transverse wound is now closed by\\na vertical row of sutures (deep and superficial), drawing\\nthe tissues together in the median line. [In America the\\nimportance of repairing ruptures of the pelvic fascia and\\nof the levatores ani muscles is so thoroughly appreciated\\nthat Emmet s plan of operating for so-called perineal\\nlacerations has largely superseded all others. Ed.]\\nThe complete perineal lacerations (third degree) are\\noperated upon according to the same principles here the\\nedges of the rectal tear must also be freshened and must\\nbe united by sutures.\\nAfter=treatment It is best to leave the wound un-\\ncovered it should be frequently irrigated, and the most\\nrigid cleanliness should be maintained. The knees are to\\nbe bandaged together. The sutures are allowed to remain\\nas long as possible (from ten to twenty days) the best\\nmaterials are silver wire and silkworm-gut.\\nOn the third day, or soon thereafter, the bowels should\\nbe moved by castor oil in capsules high injections may be\\nused, if necessary. In most cases opium is unnecessary\\nfor the production of an artificial coprostasis if the intes-\\ntinal tract has been previously thoroughly evacuated and\\nthe patient is kept upon a nutritious liquid diet. If indi-\\nvidual sutures cut through, they are to be removed.\\nShould a rectovaginal fistula occur, the entire septum is to\\nbe divided, all granulation tissue removed, and the wound\\nsurfaces united as before.\\nThe patient is to be kept in bed for two or three weeks.\\n1 25. LACERATIONS OF THE VAGINA AND CERVIX.\\n(a) Simple injuries of the vagina (t. e., without opening neigh-\\nboring organs) occur most frequently during delivery. They are also\\nthe result of accidental trauma or of unskilled or rough manipulations,", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0278.jp2"}, "279": {"fulltext": "CERVICAL TEARS. 161\\nsuch as forced coitus, especially in elderly women or where the dispro-\\nportion between the size of the genitals is great rape clumsy opera-\\ntive procedures or examinations the introduction of specula that are\\ntoo large attempts at abortion and cauterizations.\\nSymptoms. Often union per primam sometimes severe hemor-\\nrhages or septic infection. The author observed, two hours after a tear\\nof the fornix with most profuse hemorrhage (illegitimate coitus of an\\nEnglish woman forty-nine years of age, who had had a child twelve\\nyears before, and who suffered from vaginismus), a temperature of\\n101.3\u00c2\u00b0 F., a pulse of 120, and an acute urticaria covering the entire\\nbody, which lasted twelve hours.\\nTreatment. Disinfection, removal of necrotic shreds, ligation or\\nsuture of vessels, coaptation of fresh wounds, tamponade with ferri-\\npyrin, alum-iron chlorid, iodoform, nosophen, or itrol gauze. Old\\nvaginal scars producing stenosis or atresia are to be excised, stretched\\n(manually or by tamponade), or treated by plastic operations. This\\nwill make the treatment tedious, and if conception has already occurred,\\ncomplicated methods of delivery may be necessary.\\n(b) Tears of the cervix lead to commissural or to star-\\nshaped defects (Plate 55), to scars of the os uteri, and,\\nsecondarily, to ectropion. 13 and Plate 56.) If they\\nextend into the vaginal vault and the paracervical connec-\\ntive tissue, they produce torsions and fixed displacements\\nof the neck of the uterus. (See 11 and Plate 55.)\\nThese lacerations, instead of undergoing simple cicatriza-\\ntion, many persist for a considerable time as yellowish-\\ngray, fissured ulcers with reddened edges. Both processes\\noccur most frequently at the commissures of the os uteri,\\nbecause these portions of the tissues heal poorly. The\\nulcers are immediately followed (even in the puerperium,\\nsee 15) by endometritis, metritis and parametritis, and\\nsecondary ectropion the scars cause direct ectropion and\\na secondary uterine catarrh.\\nThe distortions produced by the scar tissue cause radiat-\\ning pains in the lower extremities and nervous reflexes\\nsimilar to the epileptic and epileptiform attacks associated\\nwith scars elsewhere.\\nTreatment. Emmet first directed attention to these\\nfissured ulcers and their consequences, and recommended\\ntheir treatment by the following procedure The lips of\\nthe ectropion are fixed with tenacula the commissural scar\\n11", "height": "4596", "width": "2777", "jp2-path": "atlasepitomeofgy00scha_0279.jp2"}, "280": {"fulltext": "162 TRAUMATIC STENOSES AND ATRESIAS.\\nPLATE 55.\\nFig. 1. Torsion of the Cervix Produced by Scar Tissue. It\\nextends posteriorly from the commissure of the os uteri into the base\\nof the left broad ligament.\\nj? IG 2. Star=shaped laceration of the external os, resulting\\nfrom difficult labor with a rigid cervix, or from an operative delivery\\nbefore the external os is sufficiently dilated. Tears occur in the lips\\nof the os uteri just as frequently as in their lateral commissures\\nwhile the former usually heal well, the cicatrization of the latter is\\naffected by the poorer vascular supply of the sides of the cervix, and\\nresults in a greater degree of contraction. The lips of the os gape and\\nthe cervical mucosa gradually protrudes (ectropion).\\ntissue is excised, going into the vaginal vault if neces-\\nsary (not too deeply, however, on account of the large\\nvessels), and the surfaces of the wound are united.\\nThe Martin-Skutsch modification is described on page 89,\\nand the excision of the proliferated mucous membrane in\\n14. Sanger designed a hysterotrachelorrhaphy. By\\nthese methods the normal shape and size of the cervix are\\nrestored.\\n26. TRAUMATIC STENOSES AND ATRESIAS OF THE\\nVULVA, OF THE VAGINA, AND OF THE UTERUS.\\nThe congenital stenoses and atresias are described on\\npages 22 to 29, 33, and 36 to 38.\\nPLATE 56.\\nFig. 1.\u00e2\u0080\u0094 Laceration of the Left Commissure of the Os Uteri,\\nwith Marked Ectropion and Ovules of Naboth on the Project=\\ning Hypertrophied Cervical Mucosa. (See Plates 28; 29, 4; 30;\\n90, 3.)\\nFig. 2. Old Ectropion and Congestion of the Cervix. The\\nmucosa becomes wrinkled from the minute cicatricial contractions of\\nthe newly formed connective-tissue fibers (endometritis interstitialis\\nchronica, see Plate 31, Fig. 2).", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0280.jp2"}, "281": {"fulltext": "", "height": "4596", "width": "3151", "jp2-path": "atlasepitomeofgy00scha_0281.jp2"}, "282": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0282.jp2"}, "283": {"fulltext": "", "height": "4603", "width": "3103", "jp2-path": "atlasepitomeofgy00scha_0283.jp2"}, "284": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0284.jp2"}, "285": {"fulltext": "ETIOLOGY.\u00e2\u0080\u0094 SYMPTOMS, 1 63\\nAnatomy and Etiology. Xarrowings, and even cica-\\ntricial adhesions, are brought about by chronic inflamma-\\ntory processes, circumscribing ulcers with marked con-\\ntraction, too severe cauterizations, and injuries. They are\\nseen in advanced life and in connection with acute infec-\\ntious diseases.\\nThe ulcerated labia become adherent the urethral\\norifice even may be temporarily occluded. There is a\\nretention of blood and of the secretions of the entire\\ngenital canal.\\nActual obliteration occurs in the vagina, chiefly from\\ncauterization and in advanced age.\\nThe external os is the most frequent location for these\\nagglutinations. It is either contracted to a small, round,\\ncicatricial opening, or subdivided by a bridge of tissue, or\\nretracted by scars into a funnel of mucous membrane. The\\nstenosis may be short and circumscribed or long and tubu-\\nlar, leading, correspondingly, to a membranous or to a cord-\\nlike atresia. Atresias of the internal os from too severe\\ncauterizations are rarer those of the ostium tubse are still\\nmore infrequent. For the anatomic changes see \u00c2\u00a71 (6).\\nSymptoms and Diagnosis. Stenosis results in dys-\\nmenorrhea and sterility (see 3), with primary or second-\\nary inflammation. The stasis produces either tension and\\nnausea or colic.\\nIn atresias the more pronounced phenomena first be-\\ncome apparent at puberty (see 1, 6-8 (c?)). The diagnosis\\nis made by examination with speculum and sound in\\nhematometra, hydrometra, pyometra, and lochiometra bi-\\nmanual examination demonstrates a tense elastic tumor\\noccupying the position of the uterus. In time, perimetritic\\nchanges take place.\\nTreatment. To the operative enlargements by forced\\ndilatation, and by incision of the commissures of the os\\nuteri, described in 3 (3, 4), may be added a variation of\\nv. AVinckel s, which is employed if thickening of the\\ncervix is present. If the cervix is thickened and elon-", "height": "4591", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0285.jp2"}, "286": {"fulltext": "164 TRAUMATIC STENOSES AND ATRESIAS.\\ngated, it is removed by the elastic ligature if it is, how-\\never, only thickened and the os narrowed, the operation\\nof Sims (p. 37) is performed, and then small wedges are\\ncut out of the four wound surfaces produced by the com-\\nmissural incisions. The wedge-shaped defects are sutured\\nas in Sims method. Lastly, excision of the cervix, ac-\\ncording to Kaltenbach, may be performed.\\nThe acquired atresia with hematometra is naturally\\nmuch more dangerous (from septicemia) than the con-\\ngenital form. A free incision must consequently be made\\nas early as possible, the uterine cavity carefully washed\\nout with a 2 ft carbolic solution, and drained by iodoform\\ngauze or by a tube. (See p. 29.)\\nHematosalpinx and hematometra with a uterus bicornis\\nare to be removed by celiotomy.\\nAcquired atresia of the vulva is treated by dividing the\\nadhesions and packing with iodoform gauze, or the raw\\nsurfaces may be separately sutured.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0286.jp2"}, "287": {"fulltext": "CHAPTER II.\\nFISTULAS.\\nFistulas are most frequently the result of trauma\\nduring delivery. They may be the immediate result of\\nlacerations, or they may arise secondarily from the slough-\\ning of contused parts. Other fistulas are due to pessaries\\n(especially the winged pessary of Zwanck), operations,\\nforeign bodies, accidental traumatism, and perforating\\nulcerative processes such as occur in malignant tumors\\n(see Plates 85, 86, 88, 89), diphtheric inflammations of\\nthe puerperium, syphilis, vesical calculi, and to the perfor-\\nation of a perimetritic or parametritic abscess, of a\\nhematocele, or of an extra-uterine gestation sac.\\nSeveral fistulas may exist in the same case, as is shown\\nin figures 40, 42, 43, and 48 to 51.\\n27. CLASSIFICATION OF FISTULAS.\\nFor a more exact study of the more recent works see the classic\\ndissertation of Fritsch in Vert s Handbook.\\nA. Fistulas of the Urinary Organs.\\nAnatomy. According to the location of their orifices, these fis-\\ntnlas may be divided as follows\\n1. Urethrovaginal fistulas (Fig. 37), opening below the tnbercnlnm\\nvaginae.\\n2. Vesicovaginal fistulas (Fig. 39), the most frequent. Every portion of\\nthe posterior x bladder- wall, as high up as the vertex, may be in-\\nvolved they are more frequent as the vaginal vault is approached.\\nIf the fistula extends to the edge of the external os, it is designated\\nas a\\n3. Superficial vesicocervicovaginal fistula. (Fig. 38.) This form is\\nof especial importance, because its cicatricial dragging upon the lips\\n1 The original reads anterior. Tbaxslatob.\\n165", "height": "4589", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0287.jp2"}, "288": {"fulltext": "166\\nFISTULAS.\\nof the os uteri gives it a particular influence upon the uterocervical\\ncanal. If the os uteri is also torn, we have a\\n4. Beep vesicocervieovaginal fistula with destruction of the anterior\\nlip. (Fig. 40. Both 3 and 4 are small, and are found in the median\\nline, because they arise in contracted pelves, from contusion against\\nthe symphysis.\\nFig. 37. Urethrovaginal fistula. Fig.\\n38. Superficial vesicocer-\\nvieovaginal fistula.\\n5. Vesicocervical fistulas. (Fig. 41.) They represent narrow canals\\nwhich, from the peculiar anatomic relations of the cervix and vaginal\\nvault, may be combined with vesicovaginal fistulas, since the vesical\\nend may fork (Fig. 42) or two fistulas may coexist.\\nThe tear may be laterally placed, involving the vesical orifice of\\nthe ureter. If the other opening is in the vaginal wall, we have a:\\n39. Vesicovaginal fistula.\\nFig. 40. Deep vesicoeervieo-\\nvaginal fistula with a defect of the\\nanterior lip of the os uteri.\\n6. Vesico-ureterovaginal fistula. (Fig. 43.) Such a fistula will be\\nfound laterally along the course of the ureter or posteriorly in the\\nvaginal vault.\\nSimple ureteral fistulas arise when the injuries are situated high\\nup; even then they may pass to the vaginal vault as:\\n7. Ureterovaginal fistulas. (Fig. 44.) As in all ureteral fistulas,\\nthe orifice is so minute that its recognition is difficult. Its position is", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0288.jp2"}, "289": {"fulltext": "URINARY FISTULAS.\\n167\\nthe same as in 6; they frequently empty, as does the urethra, upon a\\nreddened prominence.\\n8. Ureterocervical fistulas. (Fig. 45.\\nThere are also uretero-intestinal and uretero-abdominal fistulas.\\n9. Vest co-abdominal fistulas. (Fig. 46. These urinary fistulas are\\npeculiar in their origin. They include different degrees and locations\\nFig. 41. Vesicocervical fistula.\\nFig. 4*2. Vesicocervi co vaginal\\nfistula with eolpocleisis.\\nof the defect. Their occurrence is very rare; they are usually of a\\ncongenital nature, rarely the result of perforation into an inflamed\\nadherent bladder.\\nWe designate as fissures:\\nFig. 43.\\n-Vesi co-u ret ero vaginal\\nfistula.\\nFig. 44. Ureterovaginal fis-\\ntula bilateral (inflammatory\\nadhesions). Bl, bladder.\\n{a) The fissura vesicae inferior a cleft beneath the united sym-\\nphysis, often combined with a fissured clitoris.\\n(6) The fissura vesicse superior a cleft above the normal symphysis.\\n(c) The fistula vesico-umbiUcalis i. e., the persistent urachus. This\\nis an actual fistulous tract.\\n(d) Eversio (exstrophia, ectopia) vesicse clefts of the bladder, with", "height": "4599", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0289.jp2"}, "290": {"fulltext": "168\\nFISTULAS.\\nor without a fissured symphysis. (See 1.) These are extreme con-\\ngenital defects.\\n10. lleovesical or ileo-ureterovesical fistulas. (Fig. 51.) Of the com-\\nmunications between the bladder and intestine due to trauma and\\nulcerative perforations, that with the small intestine is the more fre-\\nFig. 45. Right-sided uretero- Fig. 46. Vesi co-abdominal fistula\\ncervical fistula R, rectum Bl, (persistent urachus).\\nbladder.\\nquent. There are also fistulas connecting the bladder with the\\nstomach.\\n11. Rectovesical or recto-ureterovesieal fistulas (Fig. 50) arise from\\nperforating pelvic abscesses.\\nFig. 47.\u00e2\u0080\u0094 Central perforation of Fig. 48. Ileovaginal fistula.\\nthe perineum. Rectovaginal fistula (most fre-\\nquent variety).\\nB. Intestinal Fistulas.\\n1. Rectovaginal fistulas (Figs. 48 and 49), or rectovestibular fistulas\\n(when outside of the hymen).\\n2. Ileovaginal fistulas (Fig. 48) an opening in the small intestine", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0290.jp2"}, "291": {"fulltext": "INTESTINAL FISTULAS.\\n169\\nempties (usually) iuto the vaginal vault in such a manner that the\\ngreater portion of the feces passes on through the intestinal canal. If\\nthe upper end of the ruptured bowel is united with the vagina through-\\nout, complete defecation occurs through this canal. This communica-\\ntion is designated as an\\nFig. 49. Ileovaginal preter-\\nnatural anus. Kectovagiual fis-\\ntula.\\nFig. 50. Vesico-ureterorectal\\nfistula. Siuistropositio uteri. i?,\\nRectum.\\n3. Ileovaginal preternatural anus. (Fig. 49.) Both varieties are very\\nrare, occurring in both the anterior and posterior peritoneal pockets.\\nFistulas vary greatly in shape and size. At first they\\nare usually wide later, they undergo cicatricial contrac-\\ntion they may pursue a\\ndirect or a tortuous course.\\nVesicovaginal and recto-\\nvaginal fistulas are the\\nlargest. The length is de-\\npendent upon the mode of\\norigin they may be long\\nand multiple, for example,\\nwhen they follow the per-\\nforation of an abscess into\\ntwo hollow viscera. If the\\ntissue has undergone necro-\\nsis from contusion, the surrounding scar tissue is quite\\nextensive a clean-cut fistula is surrounded by much\\nhealthier walls. In the beginning every fistula is char-\\nacterized by secretion, and forms granulations.\\nFig. 51 Ileo-ureterovesical\\nfistula D, Ileum in the vesico-\\nuterine pouch.", "height": "4601", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0291.jp2"}, "292": {"fulltext": "170 FISTULAS.\\nThe concomitant injuries may be so great that it is im-\\npossible to find the uterus in the cicatricial mass.\\nIf the urine is constantly emptied through the fistulous\\ntract, the normal passage becomes contracted or even\\nobliterated, in the case of the ureters and the urethra. In\\nthe larger vesicovaginal fistulas the bladder-wall be-\\ncomes invaginated into the vaginal lumen, giving rise\\nto slight catarrhal inflammations and polypoid prolifera-\\ntions, which may lead to dangerous inflammations of\\nthe kidneys. Further results are pericystic irritations\\nand adhesions.\\nThe genital mucous membranes and the vulva become\\ninflamed and incrusted from the constant dribbling of the\\ndecomposing urine.\\nInflammations of the rectum develop in a similar man-\\nner. In perforating ulcerations the fistula pursues an\\noblique course, the larger primary orifice being the higher.\\n(Fig. 49.)\\nSymptoms. Incontinence of urine, varying according\\nto the nature of the fistula and the position of the patient\\nif the vulva is swollen, the urine may be retained in the\\nvagina in the recumbent posture. This incontinence does\\nnot come on immediately after the injury, but follows the\\nsloughing of the tissues from pressure necrosis.\\n1. In urethrovaginal fistulas the sphincter, and conse-\\nquently the voluntary closure, may be maintained, but the\\ndirection taken by the stream of urine is different.\\n2. In vesicovaginal fistulas (with large orifices not\\noccluded by cicatricial membranes or temporarily blocked\\nby calculi, etc.) permanent incontinence is present.\\n3. In vesicovaginal fistulas emptying into the fornix\\nand in vesico-uterine fistulas the patient, when erect, can\\nhold her urine until the lower portion of the bladder has\\nbecome filled the uterus, in addition, may act as a lever\\nor as a valve the body drops forward, distorting and dis-\\nplacing the fistulous tract and the cervix may directly\\nocclude it (in vesico-uretero-uterine or vesico-ureterovag-", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0292.jp2"}, "293": {"fulltext": "SYMPTOMS. 171\\ninal fistulas). In the recumbent posture the urine trickles\\ndirectly into the vagina.\\n4. In fistulas of the ureter the emptying of the bladder\\nis voluntary, as only a small amount of urine can escape\\nthrough the narrow canal the lesion may be unilateral,\\nonly affecting the urine from one kidney. Some of the\\nurine passes through the vagina during urination.\\n5. In the smaller rectovaginal fistulas only flatus and\\nliquid stools escape involuntarily in the larger ones there\\nis incontinence of well-formed fecal masses.\\nThe maceration of the tissues by the urine gives rise to\\na penetrating odor and to catarrhs of the genitalia with\\nulcerations of the vulva; sleeplessness and loss of appe-\\ntite occur the patient feels that her presence is annoying\\nshe isolates herself, becomes unable to work, and falls into\\na melancholic state. The same is true of fecal fistulas.\\nThe general condition passes from bad to worse, and\\nthe patient finally succumbs after years of discomfort.\\nDiagnosis. Fistulas situated in the anterior vaginal\\nwall are the easiest to recognize. If they are as large as\\nthe finger-tip, simple digital examination may suffice. A\\nsound or catheter may be passed through them from the\\nbladder.\\nSmall fistulas especially lateral ones or those empty-\\ning into the cervical canal may be demonstrated by the\\ninjection of colored liquids (milk, solution of potassium\\npermanganate) into the bladder and careful inspection of\\nthe suspected location through the speculum. The suspi-\\ncious area is fixed by tenacula and the course of the canal\\nis determined by fine sounds. In vesico-uterine fistulas\\nthe external os must be everted, dilated, or incised ste-\\nnoses must also be previously removed.\\nIf urine, but not the colored liquid, flows through the\\ngenitalia, we have to do with a fistula of the ureter. The\\nuretero-uterine fistula is differentiated from the corre-\\nsponding vaginal one by the vagina remaining dry after\\nfirm tamponade of the os uteri. The exit of the fistula", "height": "4610", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0293.jp2"}, "294": {"fulltext": "172 FISTULAS.\\nmay be more definitely fixed by giving the patient methy-\\nlene-blue (0.1) several hours before the examination, and\\nthus coloring the urine.\\nIf doubt exists, the cystoscope may be employed or the\\nurethra may be dilated with Simon s specula and the in-\\nterior of the bladder palpated. This procedure also gives\\na clue to the existence of other varieties of vesical fistula\\n(ileovesical, etc.). As a last resort, Trendelenburg per-\\nforms a suprapubic cystotomy.\\nIn intestinal fistulas conclusions may be drawn from the\\nnature of the fecal mass (ileum or colon-rectum).\\nTreatment. Operative closure of the fistula is made\\npossible by modern advanced technic. Minute exactness\\nis of even more importance than in colporrhaphy or perin-\\neoplasty.\\nIf stenosis of the urethra exists, it must be dilated\\nbefore the fistula is closed.\\nCervical fistulas are operated upon after incising the lips\\nof the os uteri. Ureteral fistulas are closed by means of oval\\nflaps, which are sutured over a catheter introduced into the\\nureter (after an artificial vaginal fistula has been made\\ncolpocystotomy, to allow of the introduction of the ureteral\\ncatheter) (Simon, Schede). The free ureteral end with its\\nsurrounding mucous membrane may be excised and im-\\nplanted into the bladder (Mackenrodt). If the operation\\nis not possible through the vagina, a lateral abdominal sec-\\ntion may be made, the peritoneum stripped up, the ureter\\ndissected out along the linea terminalis and sutured into\\nthe bladder. The intraperitoneal operation is hazardous.\\nIf the typical operations fail to close the fistula, trans-\\nverse obliteration of the vagina (colpocleisis, Simon) may\\nbe performed i. e., the vaginal cavity is converted into a\\nreservoir connected with the bladder, an artificial atresia\\nbeing produced in its upper portion the lips of the os\\nuteri may be freshened and united by suture (hysterocleisis).\\nVesicocervicovaginal fistulas may be closed in an analogous\\nway, either by the lips of the os or by the body of the", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0294.jp2"}, "295": {"fulltext": "TREATMENT. 173\\nextremely anteflexecl uterus. The condition brought about\\nby colpocleisis is not very promising in some cases\\ncatarrhs, incrustations, and the like demand the removal\\nof the obliteration. In such a case, nevertheless, the\\nfistula was subsequently permanently closed by v. Winckel.\\nAfter=treatment. Antiseptic irrigation of the bladder\\nimmediately after the operation (test the completeness of\\nthe closure by milk or potassium permanganate). Later,\\nit is necessary to catheterize only if voluntary urination is\\nimpossible. A catheter may be introduced and per-\\nmanently retained. Rest in bed for several days only.\\nSilk sutures are removed on the fifth, silkworm-gut on the\\neighth, day. Vaginal irrigation only when a fetid dis-\\ncharge exists. If subsequent operations are necessary,\\nthey may be performed four weeks later.\\nRectovaginal fistulas are in most cases also to be operated\\nupon either by circumscribing them by an oval incision,\\nand uniting their edges by deep sutures, or by the use of\\nvaginal flaps. Very small fistulas, or those combined with\\nanal defects or following perineoplasty, are closed by means\\nof division of the entire rectovaginal septum. Laxatives\\nare previously given for several days both organs are\\nthoroughly irrigated with antiseptic solutions. During the\\noperation the upper margin of the fistula is drawn down\\nby tenacula and the upper portion of the rectum is plugged\\nwith cotton. Subsequent liquid diet and mild cathartics\\non the third or fifth day are indicated.\\nIn an ileovaginal fistula the spur must first be destroyed\\nby clamp-forceps, so that the fecal contents may pursue\\ntheir normal course after the plastic closure of the fistulous\\ntract.\\nCauterizations by means of fuming nitric or sulphuric\\nacids, chlorid of zinc, Vienna paste, caustic potash, nitrate\\nof silver, the hot iron, or zestocausis are uncertain they\\nare slow in producing results, and as they render the edges\\nof the fistula hard and nonvascular, the tissues are in an\\nunfavorable condition for later operations. They are of", "height": "4605", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0295.jp2"}, "296": {"fulltext": "174 FISTULAS.\\nPLATE 57.\\nRectouterine Hematocele in Combination with an Extra=\\nuterine Gestation Sac. In this mass I found an embryo of three\\nweeks (above and to the left, near to the tube). (Original water-color\\nfrom a specimen removed at the Heidelberg Frauenklinik.\\nvalue in long, narrow fistulas with healthy granulations.\\nTheir use may be combined with the retained catheter of\\nFritsch. (See 22.)", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0296.jp2"}, "297": {"fulltext": "Tab 57.\\nS\\nhold, Miincheti", "height": "4606", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0297.jp2"}, "298": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0298.jp2"}, "299": {"fulltext": "CHAPTER III.\\nTRAUMATIC EFFUSIONS OF BLOOD.\\nTraumatic effusions of blood may take place in the\\nconnective tissue surrounding the genitalia (hematoma) or\\ninto the peritoneal cavity (intraperitoneal hematocele).\\n\u00c2\u00a728. HEMATOMA: (a) VULVAR; (b) EXTRAPERITONEAL\\nHEMATOMA (RETROUTERINE, PERIUTERINE,\\nOR ANTE=UTERINE).\\n(a) Vulvar hematoma (see Plate 51, Fig. 1) arises\\nsuddenly, with irritation and pain, and forms a tense,\\nelastic, fluctuating, bluish tumor in the labia.\\nTreatment. Ice-bag and compression; if the skin\\nshows a tendency to break down, incise and pack with\\niodoform gauze recovery is slow.\\n(b) Extraperitoneal, retro-uterine, peri-uterine,\\nand ante-uterine hematoma (Plate 58, Fig. 3), espe-\\ncially in the broad ligament and gravitating alongside of\\nthe vagina to the pelvic floor. These come on after\\ntrauma (such as a fall), with signs of concealed hemor-\\nrhage, violent pelvic pain, and disturbances of the blad-\\nder and rectum. Fever and peritoneal irritation are\\nabsent, unless the broad ligament ruptures and an intra-\\nperitoneal hematocele of Douglas 3 pouch is secondarily\\nformed.\\nBimanual palpation shows the pouch of Douglas to be\\nempty the posterior vaginal vault is pushed down, or a\\ntense elastic tumor may be felt at the side of the uterus.\\nThe internal ligaments may be so slightly lacerated\\nthat the effusion of blood can not be discovered by palpa-\\ntion it may, nevertheless, lead to retroversion and pro-\\nlapse of the internal genitalia as a result of the acute\\n175", "height": "4595", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0299.jp2"}, "300": {"fulltext": "176 HEMATOCELE.\\nstretching of the suspensory apparatus. I have frequently\\nobserved such cases in weak individuals after very heavy\\nlifting and falling backward. The first symptoms are\\npain (lasting for days or weeks), discharge, and menstrual\\ndisturbances they may vanish, if the individual takes\\nproper care of herself, to recur during the menses or after\\ncolds. Such cases offer a point of diminished resistance\\nfor puerperal or operative infections.\\nTreatment. The treatment consists of rest in the hori-\\nzontal position with the head low. Restoratives (ammonia,\\nether) should be administered. Vaginal tamponade and a\\nsand-bag upon the abdomen are recommended. Incision\\nmay be necessary.\\n?2p. INTRAPERITONEAL RETROUTERINE\\nHEMATOCELE.\\nDefinition and Etiology. Intraperitoneal retro-uter-\\nine hematocele conies on suddenly without fever, usually\\nfollowing nonappearance of the menses, as a tense, elastic\\ntumor, which bulges the recto-uterine pouch into the\\nvagina and lies in close contact with the uterus. Eleva-\\ntions of temperature may occur later, and brownish\\nmasses of blood are sometimes discharged from the uterus.\\nThe abdominal end of the tube not rarely projects into\\nthe effusion. The mass of blood is surrounded by layers\\nof fibrin, probably the result of successive hemorrhages,\\nand is walled off from the intestines by pseudomem-\\nbranes. Extra-uterine pregnancy is the usual, if not the\\nonly, cause (J. Veit) not rarely villi, or even an embryo,\\nmay be demonstrated. In a specimen extirpated at the\\nHeidelberg Frauenklinik I was fortunate to find an\\nembryo at most only three weeks old. (See Plate 57.)\\nThe uterus is displaced anteriorly.\\nThe hemorrhage is rarely profuse enough to pass over\\nthe broad ligaments into the vesico-uterine pouch.\\nOther causes are hematosalpinx (in hematoraetra from", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0300.jp2"}, "301": {"fulltext": "SYMPT03IS.\u00e2\u0080\u0094 DIAGNOSIS. 177\\natresia), ruptured varicocele or phlebectasia of the uterine\\nadnexa, rupture of abdominal organs, and hemorrhagic\\npelvic pachyperitonitis (perimetritis).\\nSymptoms. Sudden appearance of symptoms of con-\\ncealed hemorrhage, and pain, resulting from the peritoneal\\nirritation. If the extra vasted blood is not infected from\\nthe bowel, from the tube, or from the parametrium, ab-\\nsorption proceeds, with apyrexia infection produces vio-\\nlent peritoneal pain and fever.\\nFrom the uterus continued discharge of changed blood\\n(conducted to the uterus through the tube, according to v.\\nWinckel).\\nFrom pressure upon neighboring organs neuralgia and\\ndysmenorrhea (ovaries, see 23 from the sciatic plexus\\ninto the thigh), disturbances of bladder and rectum.\\nFrom further hemorrhage (as is especially the case after\\na previous perimetritis) repeated sudden changes for the\\nworse, until absorption occurs or rupture takes place into\\none of the hollow viscera (most frequently the rectum)\\nwith danger of septic infection. After absorption takes\\nplace a scar remains.\\nDiagnosis. Bimanual palpation should be most cau-\\ntious, in order to avoid exciting further hemorrhage, rup-\\nturing the fibrin capsule, or pressing infectious material\\nout of the tubes. The posterior vaginal vault is very sen-\\nsitive to the touch. All manipulations involving the use\\nof the sound or calling for incision are to be avoided.\\nThe uterus is displaced anteriorly the posterior vaginal\\nvault is pushed down by a tense elastic tumor. The space\\nof Douglas is filled out in such a manner that the contour\\nof the tumor is continuous with the uterine fundus con-\\nsequently, confusion with a retroflexed gravid uterus may\\noccur, especially if perimetritis coexists. (For differential\\ndiagnosis see Ovarian Cystomata.) The anamnesis and the\\nforegoing symptoms are also to be borne in mind. If the\\ntumor becomes smaller and nodular, with apyrexia, it\\nspeaks for hematocele.\\n12", "height": "4601", "width": "2788", "jp2-path": "atlasepitomeofgy00scha_0301.jp2"}, "302": {"fulltext": "178 HEMATOCELE.\\nPLATE 58.\\nFig. 1.\u00e2\u0080\u0094 Free Ascites in the Upright Position. In the dorsal\\nposition the fluid (serous or bloody) gravitates toward the spinal col-\\numn. The anterior border of the dullness on percussion is consequently\\nlower. The border passes back in a line concave toward the chest\\n(while tumors have an almost constant area of dullness, which is con-\\nvex above). In the lateral position the border again shifts; the fluid\\nseeks the lowest side, and the highest portion of the abdomen is tym-\\npanitic (where dullness formerly existed). A wave of fluctuation\\nmay be obtained.\\nAscites occurs in malignant tumors (malignant papillary ovarian\\ncystomata, cancer of the ovary, of the intestine, etc. peritoneal tuber-\\nculosis, and exudative peritonitis (in addition to the obstructive dis-\\neases of the heart, lungs, kidneys, liver, portal circulation, etc.).\\nIf the fluid is an exudate (from an inflammatory process tuber-\\nculosis, for example), it contains red and white blood-corpuscles, cells\\nof various sizes with fatty granules (individual cholesterin crystals),\\nmuch fibrin and albumin, 1 and coagulates quickly; the specific gravity 2\\nmay exceed 1018 a sign of its inflammatory nature. If the fluid is a\\ntransudate from stasis, it contains a few blood-corpuscles, flat endo-\\nthelium from the serosa, no fibrin, and does not coagulate.\\nFig. 2.\u00e2\u0080\u0094 Intraperitoneal Retrouterine Hematocele. (See\\nPlate 57.)\\nFig. 3. Extraperitoneal Retro= uterine Hematoma. Uterus\\nretroverted and retroflexed. Douglas pouch is free, but, like the\\nvagina and rectum, it is bulged out by a fluctuating tumor, which\\ncan also be designated as a subperitoneal pelvic hematoma. This\\ntumor is due to the tearing of vessels or organs or to the rupture of a\\nphlebectasia.\\nFig. 4. Large Subserous Posterior Myoma of the Uterus\\nSimulating a Retroflexion. (Diagnosis made by sound! This is\\ngiven for comparison with the other three retro-uterine tumors occupy-\\n1 Determination of the amount of albumin From 10 to 50 c.c. of\\nfluid are diluted with ten volumes of water: heat to the boiling-point\\nand add diluted acetic acid until reaction is slightly acid the precipi-\\ntate is washed with water, ether, and alcohol it is then dried and\\nweighed.\\n2 The specific gravity is to be measured at room -temperature. If\\nover 1018, inflammatory exudate, because it contains more albumin.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0302.jp2"}, "303": {"fulltext": "Tab. 58.\\nFiff.l.\\nFig. 2.\\nFig,3.\\nFig A.\\nlith. Anst. F. Reichfwld, Miinchen.", "height": "4599", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0303.jp2"}, "304": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0304.jp2"}, "305": {"fulltext": "TREATMENT. 179\\ning the pouch of Douglas. Anterior position of the uterus. Bulging\\nof the vaginal vault into the rectum by a firm tumor, which grew\\ngradually without fever. The tumor moves with the uterus: bi-\\nmanual examination demonstrates the connection.\\nTreatment. Absolute rest in bed and the avoidance\\nof all internal therapeutic examinations and procedures.\\nIce-bag; enemata of opium, morphia, or chloral (to de-\\ncrease the heart s action). If the collapse continues and\\nthere are sufficient grounds for the supposition of an extra-\\nuterine pregnancy (see Atlas of Obstetric Diagnosis and\\nTreatment celiotomy.\\nIf perforation threatens, or if violent pain- and eleva-\\ntions of temperature are present, and the tumor remains\\nthe same, the most prominent portion is incised through\\nthe vagina the sac is drained and i- irrigated daily under\\nlow pressure. Ice-hag. bland diet, enemata. mild laxa-\\ntives. If perforation into the rectum occur.-, no exami-\\nnation should be made, on account of the danger of septic\\ninfection.\\nAbsorption is to be aided by the measures indicated in\\n\u00c2\u00a718. Rest during subsequent menstruations, when fresh\\nhemorrhages easily occur.\\nPrognosis. The earlier and more appropriate the treat-\\nment, the more favorable will be the prognosis for a com-\\nplete absorption in several weeks or months. In perfora-\\ntion it is dependent upon the degree of antisepsis that can\\nbe maintained rupture into the rectum is the most\\nfavorable.", "height": "4583", "width": "2786", "jp2-path": "atlasepitomeofgy00scha_0305.jp2"}, "306": {"fulltext": "CHAPTER IV.\\nFOREIGN BODIES IN THE GENITAL CANAL AND\\nIN THE BLADDER.\\nForeign bodies in these organs may exert an injurious influence\\neither from the injury attendant upon their entrance or from the in-\\nflammation produced by their retention in the viscera.\\nI 30. FOREIGN BODIES\\nowe their introduction into the bladder, vagina, or uterus to a great\\nvariety of causes.\\n(a) Retained instruments pieces of vaginal nozles, glass specula,\\nincrusted pessaries, needles, tampons, laminaria, retained silk sutures,\\nincrusted pieces of catheter (especially the elastic ones).\\n(b) Masturbation, perverse or criminal manipulations hair-pins,\\nneedle-cases, candles, lead-pencils, fir cones, pomade boxes, spools\\ntampons, sponges, and occlusive pessaries (to avoid conception) knit-\\nting-needles and other pointed instruments (to produce abortion).\\nTc) Falls upon a pointed fence, for example.\\n(d) Causes originating in the body perforating tumors, such as\\ndermoid cysts (teeth, hair, analogous to Plate 45, 2, into the rectum),\\nextra-uterine gestation sacs, echinococcus-cysts, fistulas from other\\nhollow viscera. Portions of the ovum remaining in the uterus are also\\nto be classed under this heading. Vesical calculi.\\nThe consequences are depicted in 22, 24, and 25 they are mostly\\ninflammations, ulcerations, and fistulas.\\nTreatment. The removal of incrusted pessaries is described on\\npage 87.\\nThe genital canal should always be disinfected by irrigation before\\nany foreign body is removed (partly on account of the existing inflam-\\nmation and fetid discharge, partly on account of the ease with which\\nthe mucosa may be injured).\\nForeign bodies are to be cautiously extracted with the fingers. If\\nthis is not successful, instruments (bullet-forceps or polyp-forceps,\\ntenacula) are to be employed, carefully protecting the vagina from any\\nsharp points. If the foreign body is a long one, it is to be grasped at\\none end. If this also fails, the object must be made smaller or the\\nparts must be incised. In such cases deep narcosis is necessary.\\nForeign bodies in the bladder are diagnosed by the metal catheter,\\nby bimanual palpation, by the cystoscope, or after urethral dilatation.\\n180", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0306.jp2"}, "307": {"fulltext": "VESICAL CALCULI. 181\\n(See 22. The latter procedure is also necessary for their removal\\nbullet-forceps are introduced alongside of the palpating finger, and the\\nforeign body is seized by one end, if possible, in order to prevent its\\nbecoming wedged transversely during extraction. The foreign body\\nmay be directly viewed through the speculum. It is sometimes ad-\\nvantageous to fill the bladder with a boric acid solution. If the object\\nis too large, it must be made smaller otherwise, colpocystotomy in\\nchildren, suprapubic cystotomy.\\nFrom an etiologic, symptomatic, and therapeutic stand-\\npoint vesical calculi differentiate themselves not only from\\nother foreign bodies, but also from the same affection in\\nthe male. This difference is shown even in childhood.\\nThe shortness and the greater width of the female urethra\\nallow concretions the size of a cherry-stone to pass, so that\\nthey are rarely able to become calculi by the continued\\naccumulation of uric acid salts.\\nEtiology and Symptoms. All foreign bodies, includ-\\ning tumors and particles of mucus and pus in vesical\\ncatarrh, become incrusted with deposits of salts of uric,\\nphosphoric, and oxalic acids as well as with cystin. All\\nvesical catarrhs and other affections producing complete or\\npartial retention of urine (vesical paralysis, cystocele,\\ndiverticula) are also causes of the formation of calculi.\\nCalculi produce vesical catarrh, so that the symptoms of\\nthe latter are components of the clinical picture.\\nThe stone irritates the bladder hyperemia, hyper-\\nsecretion, hemorrhages, pain (local and radiating into the\\ngenitalia, sacrolumbar region, lower extremities), spasm.\\nThe local rubbing leads to ulceration, to perforating\\nabscesses, and to the formation of fistulas. The urine\\ncontains clouds of mucus, pus, blood, ard squamous epi-\\nthelium.\\nDiagnosis. This is made by bimanual examination,\\nintroduction of the catheter, cystoscopy, or direct inspec-\\ntion through the speculum, the urethra being more or less\\ndilated and the pelvis raised (Rose s procedure). (See\\n22.) The presence of a stone in a cystocele or in a\\ndiverticulum may be demonstrated by the cystoscope, or", "height": "4574", "width": "2779", "jp2-path": "atlasepitomeofgy00scha_0307.jp2"}, "308": {"fulltext": "182 VESICAL CALCULI.\\nPLATE 59.\\nFig. 1.\u00e2\u0080\u0094 Left=sided and Posterior Parametritis. An inflam-\\nmation of the parametrium (or paravaginal tissues paracolpitis) arises\\nfrom puerperal or operative infection (laminaria, intra-uterine pessa-\\nries), and extends into the broad and sacro-uterine ligaments. A yel-\\nlowish, doughy, inflammatory exudate is formed (see Plate 61, 2, and\\nPlate 40, 2), which displaces the uterus. Later, cicatricial contraction\\noccurs, causing further displacement and angulation of the uterus as\\nend-results of the process. Contraction of the sacro-uterine ligaments\\nleads to anteflexion of the uterus of the septum between the blad-\\nder and uterine neck, to retroversion or retroflexion. Other devia-\\ntions arise if perimetritic adhesions are associated with the parame-\\ntritis.\\nAnother termination may occur The inflammation spreads behind\\nthe uterus into the pelvic connective tissue and beside the bladder.\\nAbscesses are formed, which rupture into the vagina, rectum, or blad-\\nder. They may perforate the abdominal wall above Poupart s liga-\\nment or gravitate to the thigh, to the pelvic floor, or through the sci-\\natic foramen, appearing beneath the gluteal muscles.\\nThe acute wound infection may have a fatal termination from severe\\nsepticemia.\\nFig. 2. Intraligamentous and Retroperitoneal Multilocular\\nGlandular Mucoid Cyst of the Left Ovary. This consists of a\\nproliferation of the germinal epithelium of the Graafian follicle 1 or of\\nthe superficial cuboid epithelium of the ovary, together with prolifera-\\ntion of the vascular and supporting connective tissue (see Plate 72)\\ncysto-adenoma.\\nFig. 3 Left=sided Pyosalpinx. (See Plates 18, 19, and 39.\\nFig. 4. Carcinomatous Cystadenoma of the Ovary. (Dia-\\ngrammatic drawing from a case in the Heidelberg Frauenklinik.\\nThe uterus is anteflexed and displaced anteriorly by a myxocystoma.\\nThe tumor has become malignant solid masses have grown into the\\nfloor of the recto-uterine pouch and have so surrounded the rectum\\nthat a rigid impermeable stricture exists. Ascites, numerous adhe-\\nsions, and metastases to all organs are seen in such cases. In this case\\nit was necessary to make an artificial anus.\\n1 Stefleck demonstrated ovula in the young cysts of cystadenomata.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0308.jp2"}, "309": {"fulltext": "Tab. 59.\\nFig 1\\nFig: 2.\\nFig.J.\\nFig.\\nLith. Anst. F. Retihtwld, Miinchen", "height": "4590", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0309.jp2"}, "310": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0310.jp2"}, "311": {"fulltext": "TREATMENT. 183\\nby means of catheters, after the bladder has been filled\\nwith 2 f boric acid solution.\\nTreatment. (a) Prophylactic: removal of causes,\\nsuch as vesical catarrh, cystocele, foreign bodies, fistula.\\n(b) Radical removal of the stones\\n1. Through the urethra, after dilatation of the same.\\n(See 22.)\\n2. By colpocystotomy opening the bladder by a T-\\nshaped incision in the vagina, the upper transverse arm\\nbeing situated in the vaginal vault close to the anterior lip\\nof the os uteri. If the stone is too large or the genitalia\\ntoo small\\n3. Suprapubic cystotomy (sectio alta) is to be per-\\nformed. The intestines are thoroughly evacuated, and\\n350 gm. of a warm 2 f boric acid solution are introduced\\ninto the bladder in order to elevate it and its peritoneum\\nabove the symphysis. The incision commences at the\\nsymphysis and is from 5 to 7 cm. long, directly in the\\nlinea alba (or a transverse incision may be made Tren-\\ndelenburg). The fascia transversalis is to be divided for\\n1 or 2 cm. just above the symphysis. The catheter,\\nalready introduced into the bladder, is pressed toward the\\nwound and the bladder-wall is incised. The edges of the\\nvesical wound are to be firmly held.\\nIn this manner the anthor removed a stone larger than a man s\\nthnmb, and bent npon itself at right angles, from a girl fourteen\\nyears of age. She had suffered from incontinence of nrine for five\\nyears, and was not more developed than a child of ten. The inconti-\\nnence originally was due to prolonged chilling of the lower extremi-\\nties. The stone was adherent in a right-sided diverticulum. There\\nwas vesical catarrh, which caused a slight evening elevation of tem-\\nperature and an increased pulse-rate. Several months after recovery\\nthe child had gained twelve pounds and presented a healthy appear-", "height": "4579", "width": "2786", "jp2-path": "atlasepitomeofgy00scha_0311.jp2"}, "312": {"fulltext": "GROUP V.\\nNEW GROWTHS.\\nEtiology. The origin of tumors of the female geni-\\ntalia, like that of tumors in general, is shrouded in dark-\\nness. It is nevertheless striking that organs which undergo\\nsuch active and variable changes in form, structure, and\\nmetabolism, and which are exposed to so many mechanical\\ninjuries, bacterial invasions, and nervous irritations, can\\nconsequently easily lose their equilibrium of structure L e.\\nthe normal quantitative relation of the individual tissues.\\nWe observe proliferations in specific infectious inflam-\\nmations (see 12, 20, and 21) and in chronic congestive\\ninflammations in general. (See Group III, chap. I and 22.)\\nWe are able, further, to observe that in such inflammatory\\nproliferations the normal relation of the epithelial to the\\nconnective tissues is gradually lost the new formation\\nbecomes atypical, and assumes a malignant character.\\n(See Endometritis Fungosa and Erosio Papilloides, 13\\nand Plate 30.) In the same manner benign proliferations\\nmyxofibromata, for example may become sarcomatous\\npigmented nevi of the vulva have a great inclination to\\nbe suddenly transformed into the most malignant melano-\\nsarcomata. Repeated cauterizations, excochleations, and\\nunfortunate subsequent infections have without doubt not\\ninfrequently furnished the starting-point for a malignant\\nmetamorphosis. As in other epitheliomata, the malignant\\ntendency is particularly liable to appear at the time of the\\nmenopause.\\nA connection evidently exists between the origin of\\nmalignant epitheliomata and the liability of certain parts\\n184", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0312.jp2"}, "313": {"fulltext": "ETIOLOGY. 185\\nto injury, as is shown both by the predilection of these\\ntumors for the vulva and cervix uteri and by the frequency\\nof their occurrence in multipara. This is analogous to\\nthe predisposition to mammary carcinoma furnished by the\\nscars of mastitis whether we suppose the cause to be in\\nthe scar itself or in the original infection.\\nThe etiologies of the sarcomata and of the malignant\\ncystomata are unknown the former are even relatively\\nfrequent in childhood or occur congenitally. Dermoid\\ncysts seem to represent a variety of intrafetation.\\nWhile the polyps of the mucous membrane are most\\nfrequently to be looked upon as circumscribed inflamma-\\ntory proliferations (endometritis polyposa), there is no\\netiologic explanation for the proliferation of the muscularis\\nuteri for the myomata and fibromyomata indeed, their\\noccurrence is far more common in women who have borne\\nfew or no children. Sterility (in spite of regular sexual\\nintercourse) or the causes of sterility are, perhaps, re-\\nsponsible for the tendency of the muscularis to proliferate\\nsecondary proliferation of the mucosa exists often enough,\\nand this may be the cause of the sterility.\\nIt must be remembered that Ribbert and AVeigert, and\\nrecently Lubarsch also, consider the cause of the prolif-\\neration to be a decreased resistance to growth in the sur-\\nrounding tissues.", "height": "4595", "width": "2780", "jp2-path": "atlasepitomeofgy00scha_0313.jp2"}, "314": {"fulltext": "CHAPTER I.\\nBENIGN TUMORS.\\nBy benign tumors, from an anatomic standpoint, we\\nunderstand those that retain the typical structure of the\\ntissue from which they arise, and that do not eat up\\nall the surrounding tissues by a predominant proliferation,\\nnor produce further destruction by metastasis. From a\\nclinical standpoint, certain anatomically benign tumors\\nmay, nevertheless, be productive of pernicious results to\\nthe organism. This chapter treats only of the absolutely\\nbenign tumors.\\n31. BENIGN TUMORS OF THE MUCOUS MEMBRANES\\nCOVERED WITH SQUAMOUS EPITHELIUM (EPITHE=\\nLIAL TUMORS OF THE BLADDER, VULVA, AND VA=\\nGINA, AND TUMORS OF THE STRUCTURES EMBEDDED\\nIN THEM).\\nThe mucous membrane, covered with squamous epithelium, lines\\nthe vagina, the vestibule, the bladder and urethra, and, in an ex-\\ntended sense, the vulva. It consists of stratified squamous epithelium\\nresting upon a matrix of cuboid cells, of the connective tissue of the\\ncutis, which forms variously shaped papillae, and of adipose tissue.\\nThe embedded tissues are the lymph-vessels and lymph follicles\\nblood-vessels, which in the clitoris, the nymphae, and in the neighbor-\\nhood of the urethra form erectile cavernous bodies sebaceous glands\\nthe two glands of Bartholin, lined with cylindric epithelium (see\\nPlates 25 and 26) the similarly clothed small glands and ducts of the\\nurethra (Skene s glands, see Fig. 20) and of the bladder (exceptionally,\\nthe vagina has glandulae aberrantes) and, lastly, muscle-fibers and\\nnerves. The tumors now to be considered may arise in any one of\\nthese tissues. We accordingly differentiate\\n1. PapiUomata and condylomata, such as lupus of the vulva (see 12\\nand 20 Plates 29 and 50) and, rarely, of the vagina.\\n2. Condylomata {caruncle) of the urethra. (See Plate 51.)\\n3. PapiUomata of the bladder.\\n4. Fibromata, myxofibromata and fibromyomata of the vulva.\\n186", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0314.jp2"}, "315": {"fulltext": "VAGINAL TU310RS. 187\\n5. Fibromata, myxofibromala and fibromyomata of the vagina.\\n6. Polyps of the mucous membrane or papillary polypoid angiomata,\\nfibromata,, fibromyomata of the urethra.\\n7. Polyps of the mucous membrane, fibromata, fibromyomata of the\\nbladder.\\n8. Lipomata of the vulva (usually with a pedicle) and of the vagina.\\n9. Elephantiasis lymphangiectatica vulvae. (See Plates 29 and 51.)\\n10. Cysts of the vulva of the glands of Bartholin of the glands about\\nthe clitoris and urethra occluded sebaceous glands of the nyniphse\\nhydrocele of the inguinal canal) and cysts of the vagina (which in-\\ncludes the trimethylamin forming colpohyperplasia cystica).\\n11. Cystic myxo-adenomata of the urethra.\\n12. Cysts of the vesical mucous membrane I found them once in the\\nfetus, see v. Winckel s Ber. u. Stud., Munich).\\nDiagnosis and Treatment. The new growths of the\\nvulva usually become polypoid, and are consequently\\neasily removed with scissors, the knife, or the galvano-\\ncautery (or Paquelhr s cautery) the latter is particularly\\nadapted for the removal of sessile or very vascular tumors.\\nFibromyomata of the vagina are rare; they may\\nbecome so large that they lift the uterus up above the\\npelvic inlet and disturb the sexual functions as much as\\nsimilar tumors of the bladder and intestine. If they have\\na broad base, they are to be shelled out from the surround-\\ning tissues. They sometimes show myxomatous degenera-\\ntion. In every case it is to be carefully determined\\nwhether the tumor is really a vaginal one, or a myoma of\\nthe uterus which has been delivered into the vagina.\\nThe latter tumor may grow fast to the vaginal wall, lose\\nits pedicle, and become a secondary vaginal myoma,\\nVaginal cysts vary in size and constitution according\\nto their place of origin. They may be the remains of a\\nduct of Gartner, having cylindric ciliated epithelium and\\nserous contents of a vagina septa (see Fig. 20) or of a\\nhematoma which has undergone partial absorption leaving\\nbehind a more or less blood-stained fluid.\\nTreatment. Enucleation. When that is impossible, a\\nbroad piece of the cyst-wall is excised and the cavity is\\npacked.\\nThe tumors of the urethra are very sensitive and", "height": "4584", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0315.jp2"}, "316": {"fulltext": "188 BENIGN TU3I0BS OF MUCOUS 3IEMBRANES.\\nPLATE 60.\\nFig. 1. Polyps of the mucous membrane are circumscribed prolif-\\nerations of the endometrium, both of the body of the uterus and also\\nof the cervical canal they consist of connective tissue containing nu-\\nmerous glands, partly cystic, and dilated, thin- walled capillaries. (See\\nPlate 71, 1.) They form a pedicle by traction (see Fig. 52) and bleed\\neasily on account of their structure. In contrast to polypoid rlbro-\\nmyomata, they are soft. They are livid from the constriction of the\\nos uteri.\\nFig. 2. Simple Erosion with Ovules of Naboth. Uterine\\nfibroid on the point of dilating the os uteri i. e. about to be\\ndelivered. (See Plate 62, 2 Plate 90, 4 Fig. 55.)\\nbleed easily. The pain is often associated with itching,\\ntroublesome sexual excitement, or dysuria it radiates to\\nthe surrounding tissues, and may bring on convulsive\\nattacks. Urination is painful, infrequent, or interrupted.\\nIf the tumors become larger, they project from the urethral\\norifice in other cases they may be drawn out with ten-\\nacula, after incision or dilatation of the urethra.\\nTreatment. The latter procedures must be carried out\\npreparatory to the removal of the tumors by ligation and\\nPaquelin s cautery or the ecrasear (wire snare).\\nPapillomata of the bladder first make themselves\\nPLATE 61.\\nFig. 1. Subserous Polypoid Fibromyoma of the Uterus.\\n(Original drawing from a specimen in the Munich Frauenklinik.\\nThe tumor is composed of masses of concentrically arranged lamellae.\\nFig. 2. Myomatosis Uteri. Parametritic swelling about the\\nneck of the uterus and vaginal vault. Intramural myomata of the\\nfundus submucous myoma of the fundus submucous polypoid fibro-\\nmyomata of the body of the uterus. The pedicle is elongated and\\ntwisted the tumors have dilated the os and have a dark bluish-red\\ncolor from the constriction. (Original drawing from a specimen in the\\nMunich Frauenklinik.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0316.jp2"}, "317": {"fulltext": "", "height": "4592", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0317.jp2"}, "318": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0318.jp2"}, "319": {"fulltext": "Tab. 61.", "height": "4589", "width": "3158", "jp2-path": "atlasepitomeofgy00scha_0319.jp2"}, "320": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0320.jp2"}, "321": {"fulltext": "DIAGNOSIS.\u00e2\u0080\u0094 TREATMENT. 189\\nknown by an indefinite feeling of pressure in the vesical\\nregion and by early disturbances of urination (increased\\nfrequency, tenesmus, ischuria). Violent radiating pains\\nsubsequently appear. From the ease with which the sur-\\nface of the tumor may be injured, frequent hemorrhages\\noccur, producing a particularly striking symptom, hema-\\nturia, which may lead to a blocking of the urethra during\\nurination by a mass of fibrin. The urine then undergoes\\ndecomposition and all the symptoms of vesical catarrh\\npresent themselves. Particles of the new growth may also\\nocclude the urethra or cause the formation of calculi.\\nDiagnosis. When such symptoms are present, cystos-\\ncopy or dilatation of the urethra and palpation of the in-\\nterior of the bladder. Microscopic examination of particles\\nremoved by means of the cystoscope. If the tumor is in-\\ntact, not disintegrated, it is probably a benign growth.\\nPerforating tumors, such as dermoid cysts and extra-uterine\\ngestation sacs, are to be considered.\\nTreatment. The urethra is to be dilated the left in-\\ndex-finger is then introduced into the bladder, and the\\ntumor is removed by the wire ecraseur. If the tumor is\\nsessile or too large, it is either to be incised or crushed\\nbimanually. The hemorrhage is to be controlled by appli-\\ncations of a solution of sesquichlorid of iron or of ferri-\\npyrin, by injections of ice-water, by an ice-bag upon the\\nhypogastrium, and by firm tamponade of the vagina. If\\nthese methods are inapplicable, colpocystotomy or supra-\\npubic section. (See 30.)\\nPrognosis. The removal of tumors by modern methods\\nis sure, without danger to life, and without permanent in-\\ncontinence the new growth easily returns, however, with-\\nout showing a malignant structure, evidently because the\\nbed of the tumor has not also been removed.\\nS 32. BENIGN TUMORS OF THE UTERUS.\\nAs far as their consequences and removal are concerned,\\nthe only absolutely benign tumors are the mucous polyps", "height": "4597", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0321.jp2"}, "322": {"fulltext": "190\\nBENIGN TUMORS OF THE UTERUS,\\nPLATE 62.\\nSeveral Polypoid Myomata of the Fundus, Which Produced\\nUncontrollable Hemorrhage at the Time of the Menopause.\\nChronic metritis. Congestive swelling of the ovaries. (Original water-\\ncolor from a case of total extirpation.\\n(i. e., the smaller circumscribed proliferations of the\\nmucous membrane) and the stationary subserous, the\\nsmaller intramural, and the small slender pedunculated\\nfibromyomata. Of the remaining varieties of myomata, at\\nleast 10 ^S of the doubtful, often dangerous tumors are made\\nup of the flat proliferating polyps of\\nthe mucous membrane (molluscum),\\nand the large and broad-based fibro-\\nmyomata, especially the intramural\\nand submucous varieties.\\nThe following are consequently\\nbenign\\ni. Mucous polyps (benign\\nadenomata) (a) of the lips of\\nthe os uteri (b) of the cervical\\nand corporeal mucosa. (For\\nAnatomy and Histology see Plates\\n60,1; 67; 71, 1 90 Fig. 52.)\\nThey are frequent, usually multiple,\\noften combined with fibromyomata\\nand projecting from them they usually remain small.\\nSymptoms and Diagnosis.\u00e2\u0080\u0094 Slight hemorrhages are\\nfrequent. Since many of these adenomata owe their\\norigin to an endometritis fungosa or decidualis (decid-\\nuoma, Ktistner), with or without the formation of cysts\\n(ovules of Xaboth) (see Plate 90), we have a combination\\nwith the symptoms of this disease above all, anomalies\\nof menstruation.\\nThe adenomata of the lips of the os uteri represent\\nglandular hypertrophies of these tissues, while those\\nspringing from the mucous membrane higher up hang\\nFig. 52.\u00e2\u0080\u0094 Polyp of\\nthe mucous membrane\\nof the fundus uteri.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0322.jp2"}, "323": {"fulltext": "i\\nI\\nV\\nN", "height": "4591", "width": "3092", "jp2-path": "atlasepitomeofgy00scha_0323.jp2"}, "324": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0324.jp2"}, "325": {"fulltext": "DIAGNOSIS.\u00e2\u0080\u0094 TEE A TMENT.\\n191\\nfrom the latter by a pedicle. Upon this is based the diag-\\nnosis by inspection. They are dark red, usually soft,\\nand bleed very easily. As they are forced down against\\nthe os they produce a corresponding feeling of pressure\\nand a reflex nausea. Frequently enough, however, such\\nphenomena may be quite overlooked.\\nFig. 53. Intramural myo-\\nmata. The myomata of the\\nnterns arise (according to v.\\nWinckel) without exception\\nin the muscularis of the\\ncorpus uteri and grow in\\nvarious directions. (See Fig.\\n54.) Cysts are seen in the\\nproliferated cervical mucosa.\\nFig. 54. Intramural myomata\\narising in the corpus uteri grow out\\nof the wall in different directions\\nsubserous, submucous, and down-\\nward into the wall of the cervix.\\nThey are all still inserted by a broad\\nbase and surrounded by circularly\\narranged fibrous tissue with widely\\ngaping vessels. The mucosa is\\nthickened.\\nTreatment. The easily accessible tumors with a ped-\\nicle are to be removed by the wire snare, or they may be\\nligated and then removed by means of scissors.\\nIf the pedicle of the tumor is difficult of access (Fig. 52),", "height": "4608", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0325.jp2"}, "326": {"fulltext": "192 BENIGN TUMORS OF THE UTERUS.\\nPLATE 63.\\nIntraperitoneal Surface of an Amputated Myomatous\\nUterus (Submucous Myoma). (See Plate 66.) The two surfaces of\\nthe incised uterus are drawn apart by the strong elastic retraction of\\nthe tumor. The cut surface of the tumors projects above the surround-\\ning tissues on all sides. The ovaries and tubes are covered with\\nsmall cysts. (Original water-color from a specimen removed by celiot-\\nomy at the Heidelberg Frauenklinik.\\ndilate the os uteri with well-sterilized laminaria or incise\\nthe commissures and enlarge the internal os with metal\\ndilators then hold the lips of the os open with tenacula\\nprofuse hemorrhage is controlled by suture, Paquelin cau-\\ntery, or applications of solution of sesquichlorid of iron\\nfirm tamponade with ferripyrin-nosophen gauze from\\ntwenty-four to forty-eight hours.\\nFlat tumors are to be cureted (see 13 (b)) then the\\ngauze tamponade, as previously cysts are to be punctured.\\n(Plate 90, 3.)\\nAll these tumors must be carefully removed with\\ntheir pedicles, or they will recur. If the inclination to\\nreturn is great, the parts are cauterized repeatedly with\\nchlorid of zinc or solution of sesquichlorid of iron after\\nthe removal of the tumor.\\n2. Fibromyomata with an Absolutely Benign\\nCourse. Stationary intramural (parietal) myomata,\\nsmall submucous or polypoid submucous fibromyomata,\\nnot causing marked hemorrhage, and small subserous or\\npolypoid subserous fibromyomata. (See Fig. 53, and Plates\\n14; 15, 4; 18, 1 and 2 67 90, 4.)\\nAnatomy and Histology. We differentiate histoid\\nand organoid myomata. The histoid fibromyomata con-\\nsist of nonstriated muscle-cells and of partly dense, partly\\nareolar, connective tissue. (See Plate 71, 2.) They arise\\nin the muscularis of the body of the uterus. They are at\\nfirst intramural (intraparietal), and grow out in various", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0326.jp2"}, "327": {"fulltext": "Tab. 63.", "height": "4589", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0327.jp2"}, "328": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0328.jp2"}, "329": {"fulltext": "HISTOLOGY.\u00e2\u0080\u0094 ETIOLOGY.\\n193\\ndirections. (See Figs. 53-55.) They commence in the\\nneighborhood of vessels, and their origin probably has\\nsome connection with vasomotor disturbances of growth.\\nThe organoid myomata are the adenomyomata (v. Reck-\\nlinghausen, 1896): i. e. y myomata with glandular and\\ncystic inclusions, which v. Recklinghausen demonstrated\\nFig. 55. The tumors commence to become pedunculated as poly-\\npoid subserous and submucous fibromyomata. The myoma of the\\ncervix, arising from gravitation, begins to shell itself out from its\\nsurroundings. Circular arrangement of fibers within the tumors.\\nto be partly postfetal from the epithelium of the uterine\\nmucosa, consequently derived from the epithelium of the\\nMullerian ducts (adenomyomata of the mucous mem-\\nbrane), and partly remains of the Wolffian body (paro-\\nophoritic adenomyomata). The adenomyomata are most\\n13", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0329.jp2"}, "330": {"fulltext": "194 BENIGN TUMORS OF THE UTERUS.\\nPLATE 64.\\nSeveral Bleeding Myomatous Polyps of the Fundus.\\n(Original water-color from a specimen in the Path. Inst, at Munich\\nBollinger.\\nintimately connected and interwoven with the muscularis\\nthey are not encapsulated, as are the histoid myomata.\\nThe adenomyomata of the mucous membrane may also\\nbe due either to a general or local penetration of the\\nmucosa into the uterine wall, or to isolated, misplaced,\\nfetal rudiments of the uterine mucosa (Landau), in which\\ncase the presence of a cytogenetic connective-tissue cap-\\nsule speaks for their origin from the Mullerian ducts.\\nAccording to location we differentiate\\n1. Intramural fibromyomata. (Figs. 53, 57 to 59, and Plate 61, 2.)\\n2. Submucous fibromyomata. (Figs. 54, 55; Plates 63 and 66.) The\\ntumor has a broad base and is still partly in the uterine wall.\\n3. Polypoid submucous fibromyomata. (Fig. 55 and Plates 61, 2; 62,\\n64.) The tumor has a pedicle and projects into the uterine lumen.\\n4. Cervical fibromyomata. (Figs. 54 and 55 and Plate 65.) The\\ntumor (intraparietal) has gravitated into the cervical wall.\\n5. Subserous fibromyomata (Figs. 54 and 55 and Plates 43 and 65.)\\nThe tumor causes a projection of the peritoneum.\\n6. Polypoid subserous fibromyomata. (Fig. 55 and Plates 61, 1;\\n67.) The tumor is connected to the uterus by a pedicle and projects\\ninto the peritoneal cavity. It may form adhesions with neighboring\\norgans and thus have two pedicles if the primary pedicle becomes\\nobliterated, the new growth seems to spring from the other viscus.\\n7. Intraligamentous fibromyomata. The tumor grows in between the\\nlayers of the broad ligament.\\n8. Intercorporeal fibromyomata in a double uterus. The tumor forms\\nthe septum.\\nPLATE 65.\\nCompletely Extirpated Myomatous Uterus. The posterior\\nlip of the os uteri (very anemic from profuse hemorrhages), as well as\\nits appurtenant cervical wall, is transformed into a myoma larger than\\na man s fist. Adenomyomata at the insertions of the tubes. (Original\\nwater-color from an operative specimen at the Heidelberg Frauen-\\nklinik.)", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0330.jp2"}, "331": {"fulltext": "", "height": "4595", "width": "3143", "jp2-path": "atlasepitomeofgy00scha_0331.jp2"}, "332": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0332.jp2"}, "333": {"fulltext": "Tab. 65,\\nLith.Anst F. Reichtwld, Miiiichen", "height": "4584", "width": "3218", "jp2-path": "atlasepitomeofgy00scha_0333.jp2"}, "334": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0334.jp2"}, "335": {"fulltext": "SY3IPT0MS. 195\\nA special group of the paroophoritic aclenomyomata is\\nmade up of the voluminous juxta-uterine and subserous\\nvarieties for both, although they pass diffusely into the\\nuterine muscularis, may be isolated from it (Landau)\\nthey may separate themselves spontaneously and be found\\nas solitary tumors in the broad ligaments.\\nIsolated glandular and cystic deposits are found in his-\\ntoid myomata as accidental embryonic displacements of the\\nepithelium, or analogous to the frequent combination of\\nsubmucous myomata and mollusca of the neighboring\\nendometrium Virchow), since the enveloping endometrium\\nof submucous and polypoid myomata sometimes passes\\ninto the muscular tissue in a striated manner.\\nSymptoms.\u00e2\u0080\u0094 As can be deduced from the foregoing\\nstatements, these tumors throughout can be looked upon\\nas absolutely benign only as long as they are small.\\nTheir earliest possible diagnosis and removal is conse-\\nquently of the greatest importance.\\nInitial Symptoms. All the phenomena are independent\\nof the size of the tumors. The most violent boring pains,\\nproduced by the tension, are particularly characteristic of\\nthe small intramural new growths. These pains are exag-\\ngerated by all congestive conditions (menses, cohabitation,\\nconstipation) and by exploratory palpation of the uterus,\\nwhich is neither necessarily enlarged nor displaced. These\\npains radiate into the surrounding tissues, and cause reflex\\nneuralgias in the sacral and lumbar regions, in the face,\\netc. they make up a large part of the hysteric symptom-\\ncomplex which is present in patients otherwise apparently\\nin good general condition.\\nHemorrhage first appears as a menorrhagia later, as\\nan irregular metrorrhagia.\\nCause. Partly glandular endometritis over the tumor as soon as\\nthe last muscle-fibers between the new growth and the mucosa have\\ndisappeared, however, the proliferation of the interstitial tissue causes\\na fungous endometritis, or multiple adenomatous new growths (Wyder).\\nIn other cases the uterus is unable to contract sufficiently to close the", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0335.jp2"}, "336": {"fulltext": "196 BENIGN TUMORS OF THE UTERUS.\\nPLATE 66.\\nInner Surface of a Uterus with an Incised Intramural Sub=\\nmucous Hemorrhagic Myoma of the Posterior Wall. (See\\nPlate 63. Original water-color from an operative specimen at the\\nHeidelberg Frauenklinik. The anterior wall of the supra vaginally\\namputated uterus is opened, and the entire uterine cavity is filled by a\\nround, tense, elastic tumor, which has been divided into two halves\\nand thrown to each side. By bimanual palpation a deceptive fluctua-\\ntion was apparent, due to the fact that the muscular tissue was com-\\npletely saturated with blood.\\nvessels of the myoma (Landau). The contractility of these vessels\\nthemselves is evidently insufficient.\\nThese hemorrhages appear early, and, corresponding to\\ntheir cause of origin, almost without exception in intra-\\nparietal and submucous myomata. They frequently con-\\ntinue after the menopause.\\nIf the tumor grows out of the uterine wall, escaping its\\ntension, and is small and of the subserous variety, the ini-\\ntial pains cease and there are no further pressure phe-\\nnomena if it becomes submucous, distending the uterine\\ncavity (Fig. 54), new labor-like pains appear and the leu-\\nkorrhea and hemorrhage become more profuse. These\\npains bring about a dilatation of the os uteri. (Plate 60.)\\nIf the tumor-tissue yields, the pedicle becoming long-\\ndrawn-out, the complete delivery of the mass occurs.\\nDiagnosis. Small intraparietal myomata, as well as\\ndiffuse homogeneous substitutions of the endometrium by\\nadenomyomata, are not to be recognized by bimanual pal-\\npation. TTe suspect their presence from the apyrexia,\\nwith initial violent boring pains, and, later, monorrhagia\\nand metrorrhagia. These symptoms demand the palpa-\\ntion of the uterine cavity (after dilatation, with or without\\nincision of the commissures of the os), which reveals sub-\\nmucous or polypoid prominences, or different degrees of\\ndensity of the uterine wall.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0336.jp2"}, "337": {"fulltext": "H", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0337.jp2"}, "338": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0338.jp2"}, "339": {"fulltext": "DIA GNOSIS. TEE A T3TEXT. 197\\nLater, the obliteration of the os uteri (Plates 60, 61,\\nand Fig. 55) may be recognized by inspection.\\nFor differential diagnosis see page 219. Above all,\\npregnancy must be excluded before dilatation of the os\\nuteri (menstruation is not absent, cervix is not so livid\\nnor so soft).\\nTreatment. Prophylactic ergotin subcutaneously\\n(0.05 gm. daily, for months and years) to cause the tumor\\nto contract and disappear. Ergotin also checks the hem-\\norrhage, as does stypticin and hydrastin the former by\\nexciting the involuntary muscle-fibers in the vessel-wall\\nto contraction, the latter two through the vasomotor\\nnerves.\\nThese measures are rendered more effective by hot vag-\\ninal irrigations (117\u00c2\u00b0 to 127\u00c2\u00b0 F., one or more liters several\\ntimes daily or every two hours), and, further, by depletives,\\nespecially before the period mild laxatives, salt baths,\\nsalt inunctions, applications of alcohol.\\nIf the hemorrhages do not cease, the vagina is to be\\nfirmly packed with iodoform gauze or cotton tampons if\\nthis is without avail, cotton is wrapped about Playfair s\\naluminum sound, soaked in ferripyrin or chlorid of iron\\nsolution, and applied to the uterine cavity, or even left\\nthere for several hours. Ergotin subcutaneously and by\\nmouth (as extractum secale cornutum 1 The author uses\\ntampons the size of the finger, saturated with ferripyrin\\nor gelatin emulsion. These are left until extruded by the\\nuterus.\\nIf the uterine cavity is dilated and its walls are relaxed,\\nferripyrin, solution of sesquichlorid of iron, or gelatin\\nshould be injected by Braun s syringe. Great caution must\\nbe exercised the syringe should not contain over two cubic\\ncentimeters of fluid the syringe is to be withdrawn as\\nthe injection is made it is better to inject into gauze\\n(previously introduced) than against the mucous membrane.\\n1 See Therapeutic Table.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0339.jp2"}, "340": {"fulltext": "198\\nBENIGN TUMORS OF THE UTERUS.\\nAnemia resulting from hemorrhage is to be treated\\nsymptomatically, see 4, under 7 for the dysmenorrhea\\nand neuralgia see 4, under 8, and, in addition, salt or\\nbrine baths (Kreuznach, Tolz) and applications of mud,\\nbrine, or hot alcohol to the abdomen.\\nFibroid and mucous polyps are to be removed by opera-\\ntion. If the tumors are large, their size is to be decreased\\nby longitudinal or spiral incisions or by the excision of\\nFig. 56. Myxofibroma of the ovary with a long pedicle (rare).\\n(Specimen at the Munich Frauenklinik.\\npieces, until the enucleation of the pedicle is possible.\\nThe uterine cavity is then to be disinfected and packed\\nwith iodoform gauze.\\nSmall submucous tumors are removed after dilatation of\\nthe cervix the overlying mucous membrane is incised, and\\nthe tumor is seized by the vulsella forceps of Muzeux and\\nis shelled out of its bed. If the dilatation is insufficient,", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0340.jp2"}, "341": {"fulltext": "BENIGN TUMORS OF ADNEXA. 199\\nthe bladder is dissected free and the anterior cervical wall\\nis divided to a point above the internal os.\\nCervical myomata that have grown into the parametritic\\nconnective tissue are removed after incision of the vaginal\\nmucous membrane (Czerny). Vaginal tamponade.\\n\u00c2\u00a733. BENIGN TUMORS OF THE UTERINE ADNEXA.\\nThe new growths proceed from the visceral serosa of the adnexa,\\nwith its subserous connective tissue, and the involuntary muscle-fibers\\nof the broad and round ligaments; from the mucous membrane and\\nmuscularis of the tube; from the cuboid germinal epithelium of the\\novary; and from the ovarian connective-tissue stroma.\\nWe have the following\\n1. Papillary proliferations of the tube: circumscribed or diffuse, with\\nor without cyst formation in the tubal mucosa of an infectious nature.\\n2. Fibromata and fibro myomata, including paroophoritic adenomyomata\\nand adenomyomata of the mucous membrane (Plate 60) of the tube: soli-\\ntary, from the size of a pea to that of a child s head; multiple, as a\\nresult of inflammatory proliferation (salpingitis nodosa, combined with\\nhyperplasia of the mucosa and cyst formation) in the uterine isthmus\\nof the tube, which is rich in muscle-fibers.\\n3. Small fibromata and fibromyomata of the ovary may develop from\\nthe corpora candicantia or fibrosa. (Plate 40, 3.) Under certain con-\\nditions they may become very large they then lose their benign char-\\nacter, partly because they show a tendency to malignant degeneration,\\npartly because they act as an obstacle to delivery. They may have a\\ncystic or cavernous structure.\\n4. Fibromyomata and adenomyomata of the round ligament are very\\nrarely intraperitoneal 1 they are more f recjuent in the inguinal canal.\\n5. Fibromy.vomata and fibromyomata of the broad ligament may grow\\nto the pelvic outlet and simulate hernias. The latter must not be\\nconfused with intraligamentous uterine myomata and adenomyomata.\\n6. Lipomata of the tubes and of the broad ligament are rare; the former\\nare only the size of a bean, the latter may weigh fifteen kilograms\\nthirty -three pounds\\n7. Cysts of the tubes and of the broad ligament, of serous origin (with\\nthe exception of the mucous cysts mentioned under 1 and 2), are small\\nand only occasionally of importance, inasmuch as they may become\\npedunculated (hydatids, 2 such as Morgagni s) and contract adhesions\\n1 I found such a tumor at autopsy. It was round, as large as a\\nsmall potato, and in the middle of the broad ligament. This position\\nis very rare Samml. d. Munch. Frauenklinik v. Winckel s Ber.\\nu. Stud., 1884- 90).\\n2 This formation of hydatids is a frequent occurrence. I found\\nthem 45 times in 130 autopsies; in 8 of these several hydatids coex-\\nisted in 3 cases 2 vesicles had the same pedicle. Several were calci-\\nfied. Small cysts of the broad ligament were found 15 times 5 of\\nthese were calcified. I have seen them repeatedly in the fetus.", "height": "4596", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0341.jp2"}, "342": {"fulltext": "200 BENIGN TUMORS OF ADXEXA.\\nwith the intestinal coils. Those cysts situated in the anterior layer of\\nthe broad ligament are to be considered as remains of the canals of\\nthe Wolffian body; the others, however, are to be looked upon as\\npedunculated fimbria with epithelial inclosures.\\n8. Unilocular cysts of the ovary are dne to dropsy of the follicles.\\n(Plate 68, 1.) The multil ocular cysts of the ovary are without sig-\\nnificance only as long as they are small.\\n9. Parovarian cysts arise from the remains of the Wolffian duct\\n(probably also from the remains of the Wolffian bod} between the\\nparovarium and the uterus). These growths commonly remain small,\\nbut they may attain the size of a walnut or an apple and cause\\ntrouble. They are located between the ovary and the tube, and may\\nbe multiple. The cyst is always unilocular; the Avail is thin and\\nconsists of endothelium and subserous connective tissue with elastic\\nand involuntary muscle-fibers; it is lined with either ciliated or non-\\nciliated cylindric epithelium.\\nThe contents are clear and are poor in albumin and consequently\\nwatery (of diagnostic importance regarding tapping). The fluid con-\\ntains cylindric cells and has a specific gravity of 1005.\\nParoophoritic cysts are found in the course of the uterus as far as\\nthe upper portion of the vagina (Gartner s duct has been demonstrated\\nup to this point in the fetus Klein). Yeit includes in this classifica-\\ntion the large vaginal cysts, which extend into the broad ligament.\\nSymptoms and Diagnosis. Ovarian fibromata, see\\nOvarian Cvstomata and the following section.\\nOvarian cysts (unilocular), see Ovarian Cvstomata also\\nOligocystic Degeneration, 17. An ovary may show\\ncystic changes without being enlarged. Nevertheless,\\npains exist, especially at the menstrual epoch, during\\npalpation, or during defecation, which is usually difficult.\\nThese pains are referred to the sacrum, sometimes as the\\nso-called intermenstrual pain. (See 17.) Dysmen-\\norrhea follows, or, if the disease is bilateral, amenorrhea\\nand sterility.\\nThis painful affection, usually of an inflammatory\\nnature, gradually stamps itself on the features of the pa-\\ntient -fades ovarica (lips pressed together, angles of the\\nmouth drawn down and the surrounding skin correspond-\\ningly furrowed, wrinkled and furrowed forehead, sunken\\ncheeks, prominent cheek-bones, and pointed nose).\\nIf the tumor attains the size of a child s head, symp-\\ntoms arise from the displacement of the uterus and from", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0342.jp2"}, "343": {"fulltext": "VIA GNOSIS. TEE A TMENT 201\\npressure upon the rectum, bladder, vessels, and nerves\\n(desire to urinate, constipation, hemorrhoids, phlebectasia,\\nneuralgias in the lower extremities, etc.). It is at this\\npoint that the ovarian cysts cease to be unimportant.\\nThe diagnosis of ovarian cysts is made by bimanual\\npalpation (also through the rectum). A pedunculated\\ntumor is found beside the uterus the tumor replaces the\\novary of this side.\\nParovarian cysts first give rise to symptoms when they\\nreach to the pelvic inlet. They produce disturbances of the\\ncirculation in the broad ligament, and consequently inter-\\nfere with the nutrition of the ovary. This results in\\nanomalies of menstruation.\\nThey may be recognized as fluctuating tumors at the\\nside of the uterus, distinctly differentiated from it, and\\nupon puncture yield a fluid with the previously described\\ncharacteristics. They rarely return after being tapped.\\nTreatment. Parovarian cysts may be tapped.\\nThose containing a fluid richer in albumin are to be\\nremoved by celiotomy. If the tumor has a pedicle, the\\noperation is a simple one. If strong adhesions exist, re-\\nmove as much as possible and unite by suture. [Celi-\\notomy and complete removal should take the place of\\ntapping. Ed.]\\nIntraligamentous cysts are to be dissected out from the\\nsurrounding connective tissue, or the corresponding portion\\nof the broad ligament is to be excised.\\nOvarian cysts not larger than an apple are to be removed\\nonly when the disturbances they produce are unbearable.\\nIodid of potassium is to be given in solution or in vaginal\\nsuppositories (as an absorbent) until iodism is produced.\\nTo alleviate the disturbances warm fomentations to the\\nabdomen and applications of iodin rest during the\\nperiods. If pelvic peritonitis appears, rest in bed and\\nthe ice-bag are indicated. Regular movements of the\\nbowels are to be secured. (See also 35.) [Ovarian\\ncysts presenting symptoms should be removed. Ed.]", "height": "4606", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0343.jp2"}, "344": {"fulltext": "CHAPTER II.\\nTUMORS OF BENIGN STRUCTURE THAT MAY\\nBECOME DANGEROUS UNDER CERTAIN\\nCONDITIONS.\\n\u00c2\u00a734. THE FIBROMYOMATA.\\nAll the large, progressively increasing myomata of the\\nvagina, uterus, and ovary that are not polypoid (intraliga-\\nmentous and intraparietal growths, and those with broad\\nbases) belong to the group of fibromyomata that are fol-\\nlowed by serious consequences (mortality, 10^).\\nThe dangerous results of these tumors are\\n1. Extreme anemia and secondary cardiac disease, pro-\\nduced by the continued hemorrhage (later, the dilated,\\nthin- walled vessels may rupture).\\n2. Hemorrhages may also occur into the substance of\\nthe tumor. (Plate 66.) The cause is usually a distur-\\nbance of the circulation with thrombosis (this sometimes\\nleads to fatal emboli after operation). These extravasa-\\ntions suppurate easily, and thus cause sepsis.\\n3. Torsion of the pedicle 1 in large subserous polyps\\nleads to necrosis and inflammation in the submucous\\npolyps, to ulceration and putrefactive gangrene.\\n4. Inflammatory adhesions are formed with the intes-\\ntines.\\n5. Submucous polyps may lead to inversion of the\\nuterus (Figs. 24 and 57-59) if they proceed from the fun-\\ndus and if the formation of a pedicle is made difficult by\\n1 There are cases in which the uterus itself, instead of the pedicle,\\nis twisted about its axis, or even torn open at the internal os. The\\ntumor may become separated from the uterus, and obtain its nourish-\\nment through previously existing intestinal and omental adhesions.\\n202", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0344.jp2"}, "345": {"fulltext": "FIBE0JIY03IA TA.\\n203\\nFig. 57. Intramural nbromyoma of the uterine fundus, projecting\\ninto the vagina. Mm, Os uteri.\\nFig. 58. Multiple intramural myomata of the fundus. Submucous\\nmyoma of the fundus projecting into the vagina. Mm, Os uteri.", "height": "4601", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0345.jp2"}, "346": {"fulltext": "204 FIBEOMYOMA TA\\nPLATE 67.\\nPolypoid Subserous Fibromyoma Polyps of the Mucous\\nMembrane in the Dilated Cervical Canal. (Original water-color\\nfrom a specimen at the Path. Inst, at Heidelberg.\\nnumerous strong muscle-fibers from the uterine muscularis\\nextending into the tumor. Further consequences pres-\\nsure necrosis, gangrene.\\n6. The large size of the tumor (some of them may weigh\\neighty-five pounds, especially if they are the seat of cystic\\ndegeneration) may cause obstruction or distortion of the\\npelvic organs, 1 or may interfere with delivery. They are\\nparticularly dangerous when they are calcified.\\nCysts arise from myxomatous degeneration, from absorbed extrava-\\nsations, or from the edematous softening of muscle-fibers (due to com-\\npression or infectious thrombosis of the vessels).\\n7. Intramural tumors may undergo fatty or calcareous\\nchanges, remaining stationary or becoming smaller. They\\nmay be the seat of myxomatous degeneration they then\\nshow an inclination to be transformed into myxosarcomata\\n(Plate 87, 2 73, 1), sometimes with intermuscular pseudo-\\ncysts (Plate 73, 3), which arise from the destruction of\\nround cells or from blood extravasations.\\n8. The central portions of the tumor may undergo\\nprimary metamorphosis into a fibrosarcoma. Primary\\ncarcinomatous degeneration of the tumor itself or of the\\nproliferated uterine mucosa may take place. Malignant\\ndegenerations occur at the menopause in 4| f of all cases\\n(Fehling).\\n9. The dangers of operative removal are hemorrhage\\nand suppuration. If the tumors are sessile or are located\\ndeep in the uterine wall, necessitating the opening of the\\nuterine cavity, peritonitis may occur, either from primary\\n1 Occlusions of the intestines, bladder, and ureters, which lead to\\nintestinal obstruction, absolute retention of urine, uremia, inconti-\\nnence with secondary cystitis, pyelonephrosis, etc.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0346.jp2"}, "347": {"fulltext": "Tab. 67.\\nLith.An.st tl ReidihoUl, Miinchen.", "height": "4599", "width": "3205", "jp2-path": "atlasepitomeofgy00scha_0347.jp2"}, "348": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0348.jp2"}, "349": {"fulltext": "DA NGEES. \u00e2\u0080\u0094S YMPTOMS.\\n205\\ninfection or from the later rupture of an abscess of the\\nstump.\\nFinally, lung emboli are more common than in opera-\\ntions upon other large genital tumors. All these dangers\\nare more pronounced when the patient is profoundly\\nanemic.\\nSymptoms.\u00e2\u0080\u0094 Vaginal myomata only pressure symp-\\ntoms.\\nLarge uterine myomata (for initial symptoms see 31).\\nIf intramural, monorrhagia, and, in addition, pressure\\nFig. 59. Intramural fibroin voma of the fundus uteri producing an\\ninversion of the uterus. Jim. Os uteri.\\nsymptoms, as in all these larger tumors. (Plates 63\\nand 66.)\\nIf submucous, menorrhagia and metrorrhagia with vio-\\nlent colicky pains, as the tumors twist the uterus and often\\nocclude the outlet for the discharge. Slight perimetritic\\npains are present. Sterility or abortion is frequent. The\\ntumors easily undergo suppuration during the puerperium.\\nIf submucous and polypoid, all the symptoms of the\\nsimple submucous variety, and, in addition, labor-like", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0349.jp2"}, "350": {"fulltext": "206 FIBBOMYOMATA.\\npains, since the uterus tries to expel the pendulous myoma.\\nWhen the polyp lies in the vagina, it becomes edematous\\nand the seat of a foul ulceration. A constant, nonremit-\\ntent fever exists even when a fetid discharge is not pres-\\nent. This is due to interstitial infection of the tumor.\\n(Plate 61, 2.) Catarrhal discharge is profuse because the\\nirritation of the fibroid polyp causes the mucous mem-\\nbrane to proliferate in toto. Multiple mucoid polyps may\\nconsequently arise.\\nIf subserous, the symptoms are few, often not more\\nmarked than the pressure symptoms of the pregnant\\nuterus (dyspnea reflex irritation of the breasts is not\\noften absent). The tumor may irritate the peritoneum or\\nmay produce reflex neuralgias from pressure.\\nIn cervical myomata, menorrhagia and profuse leukor-\\nrhea. (Plate 65.)\\nWith very rare exceptions the tumors contract during\\nthe menopause the climacterium is, nevertheless, not\\nrarely prolonged by marked hemorrhages. The author\\nsaw regular periods from this cause in an American\\nwoman, fifty-seven years of age.\\nIn ovarian fibromyomata the symptoms are very uncer-\\ntain sometimes absence of the menses or ascites.\\nDiagnosis. Vaginal Myomata. It must be deter-\\nmined whether the tumor actually springs from the vag-\\ninal wall, or is simply adherent to it, as uterine polyps\\nmay contract secondary adhesions with the vagina.\\nIntramural Uterine Myomata. The wall of the organ\\nis hypertrophied and the uterine cavity is elongated.\\nMetritis and pregnancy must be excluded. In the former\\nthe wall is not so dense and the sound is not made to\\ndeviate from the straight line by the presence of a tumor.\\nIn the latter the cervix is livid and the entire organ is\\nstrikingly soft the increase in size occurs in a typical\\nway the menses are absent.\\nIf one suspects submucous or polypoid myomata, the\\nuterine cavity is to be palpated after dilatation of the cer-", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0350.jp2"}, "351": {"fulltext": "DIAGNOSIS. 207\\nvix. The sound is to be passed first the cavity is en-\\nlarged, but the sound passes around the tumor or can not\\neffect an entrance. At the menstrual epoch the tumor\\nseparates the lips of the os (Plate 60, 2; 61); traction\\nwith the bullet-forceps gives information as to whether the\\ntumor has a long pedicle or a broad-based insertion.\\nIf such tumors are very large (Fig. 57), and if they\\nproject far into the vagina, it is often difficult to determine\\ntheir true origin without bimanual examination through\\nthe rectum and the employment of the sound.\\nCervical myomata, especially if they have undergone\\nsuppuration, must be distinguished from epitheliomata of\\nthe cervix. The former have a pedicle leading into the os\\nuteri when broken down, they have a loose fibrous\\nstructure and a brownish-red or pale rose color. The epi-\\ntheliomatous nodules are softer they crumble and bleed\\neasily they are always outside of the external os they\\nundergo ulceration without the production of polypoid\\nexcrescences. The microscope shows fibrous tissue in the\\none case, epitheliomatous plugs of cells in the other. (Plate\\n71, 2 79.) Fibromyoma differentiates itself from sarcoma\\nby its greater density, slower growth, painlessness, and\\nabsence of foul discharge with particles of tissue. The\\ntransition from myoma to sarcoma is consequently char-\\nacterized by the appearance of these symptoms and by\\nascites. Fibromyomata have been mistaken for placental\\npolyps, and also for inversion of the uterus. .(For diagnosis\\nof the latter see 7.) Placental polyps, like polyps of the\\nmucous membrane, are softer. They contain decidual\\ncells, glandular epithelium, and chorionic villi.\\nIt is often difficult to diagnose subserous eincl intraliga-\\nmentous uterine myomata from tumors of the adnexa and\\nfrom tumors of the pouch of Douglas. This is partly\\nowing to the fact that they completely fill the rectovaginal\\nculdesac, and partly because they may be embedded in the\\nexudate of a pelvic peritonitis. (For differential diagnosis\\nsee following section, under Ovarian Cystomata.) The", "height": "4606", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0351.jp2"}, "352": {"fulltext": "208 FIBROMYOMATA.\\nsound demonstrates the course of the uterine canal, so that\\nwe know where to look for the tumor and where to look for\\nthe uterus. (Plate 58, 4.)\\nBimanual examination is employed to determine\\nwhether the uterus moves with the tumor. This method\\nof examination is of especial importance if the tumor is a\\nsubserous polyp with a long pedicle. (Plates 61 and 67.)\\nThe density of such tumors is also to be observed. Fi-\\nbroid cysts or very edematous tumors may show fluctuation,\\nthus resembling ovarian cysts.\\nThe diagnosis is made by tapping. The fluid from the\\ncystic myoma is lymph it coagulates and contains only\\nlymph-corpuscles. In simple myomata nothing is ob-\\ntained but blood. The differential diagnosis from ovarian\\nfibromata is sometimes impossible.\\nA vascular bruit may be heard upon auscultation in\\n66^ of all myomata; rare in cystomata.\\nIf a myoma undergoes suppuration, it becomes intensely\\npainful and fluctuates. Septic jaundice and fever make\\ntheir appearance.\\nOvarian Fibromata. The chief point is the ovarian\\norigin of the tumor. The further diagnosis is made by\\nthe density of the new growth.\\nTreatment. Operative interference is indicated if the\\ntreatment with ergotin (Hildebrandt), as given in the\\nprevious section, is fruitless and the tumor continues to\\ngrow and to produce threatening symptoms. This treat-\\nment is to be considered useless if the menorrhagia is not\\ndecreased by the daily injection of 0.2 gm. of ergotin for\\ntwo months (i. e., after at least from sixty to eighty injec-\\ntions).\\nThe larger submucous tumors are to be removed piece-\\nmeal through the vagina (fifty-two pieces in one of v.\\nWinckel s cases) suppurating tumors are to be cautiously\\nremoved by means of the polypus-forceps under contin-\\nuous irrigation colpomyotomy.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0352.jp2"}, "353": {"fulltext": "TREATMENT. 209\\nEnucleation, in the true sense of the word, is often impossible, as\\nthe intramural and submucous myomata are rarely, the adenomyo-\\nmata never, encapsulated. It is difficult to remove the tumor, as\\nthe finger works in the uterine wall in the dark. Hemorrhage is\\ncontrolled by injections of hot water and by tamponade. Sepsis occurs\\nonly too easily.\\nIf such a case is foreseen, it is better to incise the overlying mucous\\nmembrane, to administer ergot, and to allow the uterus to expel the\\ntumor. The tumor may be made smaller by morcellement (Pean)\\nand the uterus removed. Ligation of both uterine arteries is recom-\\nmended as a palliative measure.\\nThere are three methods for the removal of the tumor by celiotomy\\nI. Myomotomy i. e., removal of the tumor from the uterus, which is\\nleft uninjured.\\nII. Supravaginal amputation of the uterus i. e., removal of the uterine\\nbody, together with its myoma, from the cervix.\\nIII. Total extirpation of the uterus (Fritsch, Kiistner, Martin, Mack-\\nenrodt).\\nIV. Castration: i. e., the removal of both ovaries. A premature\\nmenopause is produced, since experience teaches that myomata fre-\\nquently grow smaller at this time. This measure is not absolutely\\ncertain in its results.\\nIt must be carefully determined whether the disturbances and dan-\\ngers due to the tumor are greater than those of the operation (embol-\\nism fatal hemorrhage sepsis, especially from the opened uterine\\ncavity, see foregoing).\\nIndications for the operations\\n1. Severe exhausting hemorrhages.\\n2. Inability to work.\\n3. Such rapid growth that life is apparently threatened, especially\\nin cystic degeneration.\\n4. Abscess formation in the tumor.\\n5. Torsion of the pedicle with symptoms threatening the life of the\\npatient.\\nI. Myomotomy is applicable to subserous polyps and to those sub-\\nserous and intramural myomata that may be shelled out of the uterine\\nwall. (Plate 61, 1; 67.)\\nIf the uterine cavity is opened, or if only the mucous membrane\\nremains as a thin layer\\nII. Supravaginal amputation is to be performed.\\nThe question of the necessity for and of the manner of amputation\\nfrequently remains undecided until the abdominal cavity is opened.\\nIt is indicated in the broad-based subserous tumors, in the large or\\nmultiple intramural growths, and in intraligamentous or degenerated\\n(cystic, cavernous, carcinomatous, supjmrating) myomata that do\\nnot project into the uterine cavity. (Plates 63, 66.)\\nAn elastic tube is applied about the uterus and adnexa (laterally\\nfrom the ovaries). The broad ligament is then ligated close to the\\nuterus Z weif el in three portions, from the suspensory ligament of the\\novary inf undibulopelvic ligament) to a point as low down as possible,\\n14", "height": "4590", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0353.jp2"}, "354": {"fulltext": "210 FIBROMYOMATA.\\nPLATE 68.\\nFig. 1. Unilocular Ovarian Cysts. Two cysts were situated\\nin such a manner that one of them forced its way into the other.\\n(Original water-color from an autopsy at the Heidelberg Path. Inst.\\nFig. 2. Thin=walled Multilocular Glandular Mucoid Cyst.\\nThe pedicle, together with the tube and a hydatid, lies upon the tumor.\\nThe furrow is due to the impression of the iliopectineal line, as the\\nsmaller portion of the cyst was in the pelvis and filled the pouch of\\nDouglas. (Original water-color from an operative specimen.)\\nand the uterus, with tumors and adnexa, is removed. If intraliga-\\nmentous tumors are present, the broad ligament is incised and ligated\\non both sides in three portions.\\nThe stump may be treated according to various methods\\n1. Schroder s Intra peritoneal Method. Wedge-shaped excision (cau-\\nterizing the stump with concentrated liquid carbolic acid, zinc chlorid,\\nor Paquelin s cautery). The mucosa, the muscularis, and the serosa\\nare sutured separately etage suture with catgut.\\nThere is danger of secondary infection i. e., of abscess formation\\nin the stump and. rupture of the united serosa. A large stump should\\nconsequently be avoided, as portions of it may undergo necrosis.\\n2. Pean-Hegars Extraperitoneal Method. Long needles are passed\\nthrough the stamp at right angles, fixing it in the lower angle of the\\nabdominal wound outside of the peritoneum. The serosa of the stump\\nis sutured to that of the abdominal wall. The stump is covered only\\nby the abdominal muscles.\\nIt undergoes necrosis and is cast off, together with the elastic tube,\\nafter two or three weeks.\\nThe disadvantage of this method consists in the permanent traction\\nupon the bladder.\\nFritsch unites the stump as does Schroder, using- sagittal instead of\\ntransverse sutures, and sews it into the lower angle of the abdominal\\nincision. On the ninth day he removes the coaptation sutures of the\\nstump from the bottom of the wound.\\n3. Chrobak fixes the stump behind the peritoneum (consequently\\nan extraperitoneal method) by covering it with a peritoneal flap pre-\\nviously excised either from the tumor or from the uterus.\\nIII. Total extirpation guarantees the greatest security against sec-\\nondary infection of the peritoneal cavity from the secreting or partly\\nnecrotic stump obtained by the supravaginal method l it is. however,\\na more radical operation. In certain cases it is absolutely indicated,\\n1 At the Heidelberg Frauenklinik. in 1896, thirty myomotomies were\\nperformed (the stump being treated by the retroperitoneal method)\\nwith two deaths, one from pulmonary embolism, one from severe\\nanemia.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0354.jp2"}, "355": {"fulltext": "00", "height": "4601", "width": "3105", "jp2-path": "atlasepitomeofgy00scha_0355.jp2"}, "356": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0356.jp2"}, "357": {"fulltext": "TREATMENT. 211\\nas in pyosalpinx (Plate 42) and cervical myomata (Plate 65). The\\novarian arteries are ligated, transverse incisions are made in the vesico-\\nuterine and recto-uterine excavations, and the ligaments are successively\\nligated and divided. The neck is amputated in such a manner that a\\nvery small portion remains behind with the external os (the orifice\\nmay be cauterized This wound is to be united by some nondraining\\nsuture material (silkworm-gut). Catgut ligatures are used in the\\nparametritic cellular tissues and in the serosa.\\nIV. Hegar s castration is only a makeshift. It is to be performed\\nonly when the removal of the myomata must be looked upon as\\ndangerous to life (very large myomata with multiple subserous nod-\\nules preventing their removal from the pelvic cavity). The operation\\nhas a mortality of 16 because the ovaries are frequently so close to\\nthe tumor that the ligation of the vessels is very difficult. In many\\ncases the looked-for result has failed to appear. The ligation of the\\nuterine arteries from the vagina is a better operation Gottschalk\\nThe operative removal of ovarian fibromata is indi-\\ncated, even if they are of only moderate size and station-\\nary, on account of the danger of malignant degeneration.\\nHemorrhage, especially from the adhesions, is the chief\\ndanger of the operation. The elastic rubber tube is used,\\nand the pedicle is tied off with broad, strong ligatures\\nbefore the removal of the tumor.\\nThe preparatory treatment and after-treatment in all\\nthese celiotomies are the same as in the removal of ovarian\\ncystomata.\\n35- THE OVARIAN CYSTOMATA.\\nDefinition, Anatomy, and Histology. The multi-\\nlocular glandular mucoid cyst arises from a proliferation\\nof the germinal epithelium of the Graafian follicle, 1\\ntogether with a supporting and vascular proliferation of\\nthe connective tissues (see Plate 72) cystadenoma.\\nFive varieties of ovarian cysts may be differentiated\\n1. Unilocular cysts (Plate 68, 1) hypertrophic ovarian follicles\\nhydrops f olliculomm\\n2. The multilocular glandular mucoid cyst a nodular complex of\\nmany smaller cysts, filled with viscid mucus (greenish-yellow to\\ngrayish-black according to the admixture of blood) and surrounded\\nby a single outer wall. (Plate 72.)\\n1 Steffeck demonstrated ovula in the young cysts of cystadenomata.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0357.jp2"}, "358": {"fulltext": "212 OVARIAN CYSTOMATA.\\nPLATE 69.\\nMultilocular Glandular Mucoid Cyst. As a result of torsion\\nof the pedicle, hemorrhages have occurred in individual cysts dark-\\nbluish color) and portions of the wall have become necrotic and adher-\\nent to the omentum. Subperitoneal disturbances of the circulation\\nhave formed cystic spaces (on the left) in the latter. (Original water-\\ncolor from a case at the Heidelberg Frauenklinik.\\nThe tumors show a more or less rapid, progressive,\\nand almost unlimited growth. They become dangerous\\nwhen they grow larger than a man s head their weight\\nmay exceed that of the patient herself. (Fig. 62.) AVhen\\nthe tumor has involved the entire ovary, it is fixed to the\\nuterus and nourished by a pedicle, which consists of the\\nbroad ligament, tube, and ovarian ligament. The pedicle\\nis absent in intraligamentous tumors (Plate 59, 2) because\\nthe entire growth develops outside of the peritoneum in\\nthe subserous connective tissue of the broad ligament.\\nThe anterior surface of the ovary is embedded in the\\nbroad ligament (by the mesovarium), while the posterior\\nsurface, directed toward the pouch of Douglas, is uncov-\\nered. If an ovarian cyst develops from the anterior\\nsurface, it grows into the connective tissue between the\\ntwo layers of the broad ligament it is intraligamen-\\ntous if the tumor becomes larger, it strips up the pos-\\nterior lamella, elevates the serosa of Douglas pouch, and\\nreaches the spinal column it becomes retroperitoneal/\\nThe pedicle previously mentioned is pathognomonic of\\novarian tumors, and may be demonstrated by the method\\nillustrated in Plate 74. It is usually twisted in a spiral\\nmanner in the larger tumors. This torsion of the pedicle\\nis due to intestinal peristalsis, to the variable emptying and\\nfilling of the abdominal organs, and to the movements of\\nthe body. In left-sided tumors the pedicle is more\\nfrequently twisted from 90 to 180 degrees to the right.\\nIf it is twisted more than 360 degrees, disturbances of the", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0358.jp2"}, "359": {"fulltext": "", "height": "4590", "width": "3078", "jp2-path": "atlasepitomeofgy00scha_0359.jp2"}, "360": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0360.jp2"}, "361": {"fulltext": "SEQ UELS. \u00e2\u0080\u0094SYMPTOMS. 213\\ncirculation and extravasation occur in the tumor, and\\nhematomata are formed in the pedicle secondary dis-\\nturbances of nutrition lead to retrograde metamorphoses\\nboth results are serious in proportion to the rapidity of\\nthe compression (necrosis rupture of the mucoid degen-\\nerated wall, Plate 72 decomposition peritonitis). If\\ncolloid masses reach the peritoneal cavity, they become\\norganized upon the serosa, constituting peritoneal myx-\\nedema (pseudomyxoma peritonei, Werth).\\nThe larger tumors always cause fibrinous deposits and\\nadhesions, because the changed superficial epithelium be-\\ncomes desquamated. In a beginning cystoma the fim-\\nbriated end of the tube sometimes becomes agglutinated\\nif the dividing wall disappears, a tubo-ovarian cyst re-\\nsults.\\n3. Papillary proliferating cysts. (See explanation to Fig. 61.)\\n4. Racemose cysts (Olshausen) differentiate themselves from the\\ncystadenomata by the fact that several vesicles are attached to one\\npedicle even if they have broad bases, they do not present a smooth\\nglobular surface, but look like a mass of small vesicles (resembling a\\nhydatid mole). The vesicles contain a fluid that is not colloid; it is\\nrich in albumin.\\n5. Dermoid Cysts. (Plates 45 and 79.)\\nCystomata may lead to serious consequences\\n1. From their increase in size larger than a man s\\nhead.\\n2. From strangulation as a result of torsion of the\\npedicle, with hemorrhages, inflammation, suppuration, in-\\nfection (they may, it is true, undergo absorption and nat-\\nural cure), septicemia.\\n3. From intestinal adhesions and the subsequent pro-\\nduction of intestinal obstruction.\\n4. From rupture of the tumor and consequent pseudo-\\nmyxoma peritonei (Werth).\\n5. From carcinomatous degeneration.\\n6. Death from cardiac weakness, uremia.\\nSymptoms. (See initial symptoms in 32.) Pressure\\nsymptoms first occur when the tumor reaches the size of", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0361.jp2"}, "362": {"fulltext": "214 OVARIAN CYSTOMATA.\\nPLATE 70.\\nMultilocular Glandular Mucoid Cyst. The middle of the tumor\\nis laid open by an incision. Original water-color from an operative\\nspecimen from the Heidelberg Frauenklinik.\\nPLATE 71.\\nFig. 1.\u00e2\u0080\u0094 Histologic Structure of a Uterine Mucous Polyp.\\nOriginal drawing from a specimen from the Munich Frauenklinik.)\\nCircumscribed proliferation of the uterine mucosa (proceeding from the\\nbody as well as from the cervix consisting of glandular and connective\\ntissue in their normal structure and relations in contrast to the atypi-\\ncal proliferation of malignant adenoma, as seen in Plate 30, Fig. 2).\\nThe glandular spaces (1) are lined with ciliated columnar epithelium.\\nNumerous thin-walled, dilated vessels (2 and 4) are seen in the con-\\nnective tissue (3), and are responsible for the hemorrhage that is so\\neasily produced.\\nFig. 2. Microscopic Section through the Transition Zone\\nof a Minute Myoma That is Becoming Encapsulated into\\nthe Surrounding Normal Uterine Muscularis. (Original draw-\\ning from a specimen from the Munich Frauenklinik.) The tumor\\ntissue to the left (1) consists of densely packed and interlaced non-\\nstriated muscle-fibers alone, without the admixture of connective-tissue\\nfibers that occurs without exception in the large tumors (consequently\\ncalled fibromyomata, which always originate in such pure intramural\\nmy omata The border-line 2 of the normal muscular tissue consists\\nof concentrically arranged parallel lamellae, which are evidently com-\\npressed by the new growth. To the right, markedly dilated vessels\\n(4) are seen in the muscularis (3), which shows a less parallel arrang-\\nment.\\nFig. 3.\u00e2\u0080\u0094 Vaginitis (Colpitis). (Original drawing from a speci-\\nmen from the Munich Frauenklinik. Eound-cell infiltration of the\\nsubmucous connective tissue, especially in the neighborhood of the\\nnumerous normal lymph-follicles (3\u00e2\u0080\u0094 surrounded by round cells and\\nlymph-channels). (1) Normal vaginal tissue (2) normal connective\\ntissue.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0362.jp2"}, "363": {"fulltext": "", "height": "4603", "width": "3066", "jp2-path": "atlasepitomeofgy00scha_0363.jp2"}, "364": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0364.jp2"}, "365": {"fulltext": "Tab. 71.\\nFig.l.\\ni\\nK hl--u? $$M In- .Mt\\n-U\\nX\\nm\\nFig.Z.\\nFiff.3.\\nLith.Anst.F. Reiehhold Munrhen", "height": "4594", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0365.jp2"}, "366": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0366.jp2"}, "367": {"fulltext": "Fig. 60. Multilocular glandular mucoid cyst of the ovary, v\\ntorsion of the pedicle. (Specimen at the Munich Frauenklinik.\\n215\\nwith", "height": "4607", "width": "3091", "jp2-path": "atlasepitomeofgy00scha_0367.jp2"}, "368": {"fulltext": "216\\nOVARIAN CYST03IATA.\\na child s head and remains wedged in the pelvic cavity\\n(constipation, urinary disturbances, neuralgias). Intes-\\ntinal perforation may occur. (See Plate 45, 2, represent-\\ning a case treated in the dispensary at the Munich Frau-\\nenklinik.) Dyspnea, swelling of the thoracico-abdominal\\nveins, edema, and pressure upon the ureters are observed.\\nThe patient is finally confined to bed.\\nFig. 61.\u00e2\u0080\u0094 Papillary proliferating cyst (specimen from the Munich\\nFrauenklinik), characterized by the fact that the epithelium produces\\nnot only glandular\u00e2\u0080\u0094 i. c, follicular and cystic\u00e2\u0080\u0094 formations, but also\\nconglomerations of papillary formations upon the walls of the cysts.\\n(See also Plate 72, Figs. 1 and 2. These dendritic proliferations are\\nfound either only upon the inner surface of the cysts, or also upon the\\nouter surface; in the latter case they not rarely grow through the wall.\\nThey give metastasis to the serosa of the entire peritoneal cavity and\\nproduce ascites. Macroscopically, they are not to be differentiated\\nfrom the similar, somewhat firmer, carcinomatous growths.\\nThe diagnosis is made by the demonstration of a\\npedicle and the separation of the tumor from the uterus,\\nthe method of Schultze being employed. (Plate 74,\\nFig. 3.) Fluctuation is a further aid. In contrast to\\nascites, percussion demonstrates an area of dullness which", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0368.jp2"}, "369": {"fulltext": "Q\\n217", "height": "4609", "width": "3049", "jp2-path": "atlasepitomeofgy00scha_0369.jp2"}, "370": {"fulltext": "218\\nOVARIAN CYSTOMATA.\\nhas an upper convex border above and at the sides an\\nintestinal tympanitic note may be obtained. Ascites may\\ncoexist. Vascular murmurs are much rarer than over\\nmyomata.\\nThe uterus is usually found in front of and beneath the\\ntumor (Plate 59) it is rarely retroverted (Plate 16, 4)\\nif pregnancy occurs, total prolapse may take place. The\\nuterus does not move with the tumor. The pedicle arises\\nfrom one corner of the uterus (Plate 74, 3) and may be\\nbest palpated through the rectum. Dermoid cysts usually\\nlie in front of the uterus in the vesico-uterine excavation.\\nThe fluid obtained by tapping has the following char-\\nacteristics\\n(a) Microscopic. (See Plate 72, Fig. 5.)\\n(6) Chemic Golden yellow to dark brown (blood) in\\ncolor; specific gravity, from 1010 to 1024 (1005 to\\n1055) colloid from pseudomucin (metalbumin). The\\ndemonstration of the latter is important. The albumi-\\nnous substances pass through a process analogous to diges-\\ntion until they become soluble in water (the older the\\ntumor, the more soluble the substance Eichwald). The\\nchemic differentiation of the mucous and albuminous sub-\\nstances found together in cystomata is as follows\\nMucous Series.\\n1. The substance of\\nthe colloid globules\\ntransformed cel-\\nlular parenchyma.\\n2. Mucin.\\n3. Colloid substance\\n(soluble in water).\\n4. Mucopeptone.\\nAlbuminous Series.\\n(a) Albumin.\\n1. i (b) Albuminate\\nof soda.\\n2. Paralbumin (pro-\\npeptone).\\n3. Jletalbinnin (pseu-\\ndomucin) (not sol-\\nuble in water).\\n4. Albumin -peptone\\n(fibrin-peptone).\\nSolubility.\\nBoiling\\n1. -j Acetic acid pre-\\ncipitates.\\nf Boiling -f-\\n2. -J Acetic acid pre-\\ncipitates.\\n3. Alcohol precipi-\\ntates, mineral acids\\ndo not.\\n4. Precipitated by\\nneutral metallic\\nsalts, potassium\\nferrocyanid, and\\ntannin; soluble in\\nwater.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0370.jp2"}, "371": {"fulltext": "DIFFERENTIAL DIAGNOSIS. 219\\nThe albuminous series is differentiated from the mucous series by\\nthe fact that the former contains nitrogen and sulphur and is precipi-\\ntated by tannin and neutral metallic salts.\\nThe fluid is boiled, and upon the addition of nitric acid all the\\nalbumins, as far as and including paralbumin, are precipitated. These,\\ntogether with the corresponding mucins, are removed by filtration.\\nUpon the addition of alcohol to the filtrate, the metalbumin is coagu-\\nlated and sinks to the bottom in white clouds. If acetic acid alone is\\nadded to the filtrate, a cloudiness occurs, but no precipitation. Met-\\nalbumin is distinguished from the corresponding colloid substance by\\nits insolubility in water, or by its being precipitated by a new test\\nwith ferrocyanid of potash.\\nThe reduction test with 10% cupric sulphate solution (Trommer s\\nsugar test) is employed for more exact examinations.\\nThe chemic differential diagnosis between ascitic transudate and\\nperitoneal exudate is given in the explanation of plate 58, 1.\\nParovarian Cysts. Contents clear as water; specific gravity from\\n1002 to 1006; rarely richer than this in albumin; ciliated epithelium\\nwithout other formed elements, such as blood-corpuscles.\\nHydrosalpinx. Contents serous, mucoid, or gritty; rich in albu-\\nmin; cholesterin, red and white blood-corpuscles, cylindric epithe-\\nlium.\\nHydronephrosis, Much urea is present, demonstrable by partial\\nevaporation, extraction with alcohol, and evaporation the residue is\\ndissolved in a small amount of water and treated with concentrated\\nnitric acid. Rhomboid plates of urea nitrate are formed. Low\\nspecific gravity; little albumin.\\nEchinococcus Cysts. (Occur in the genitalia in 4% of all cases, espe-\\ncially in the uterine submucosa and in Douglas pouch.) Specific\\ngravity from 1007 to 1015; hooklets and scolices; no albumin; much\\nNaCl, and especially succinic acid. The latter is demonstrable by\\npartial evaporation, dilution with water, and extraction with ether;\\nupon evaporation the monoclinic prisms six-sided plates of succinic\\nacid are obtained, or the watery solution gives a rust-colored floccu-\\nlent precipitate with ferric chlorid.\\nI. Intrauterine Tumors.\\nDifferential Diagnosis. 1. Pregnancy. Absence of\\nthe menses, gradual typical increase in size, and, after the\\nfifth month, fetal movements, ballotement, and audible car-\\ndiac sounds. The cervix is livid and soft. Characteristic\\nsoftening of the lower uterine segment (bimanual through\\nthe rectum). The variable signs of pregnancy and secre-\\ntion from the breasts are worthless, as they also occur\\nwith cystomata. The sound and the trocar are not to be\\nused until pregnancy is absolutely excluded.", "height": "4583", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0371.jp2"}, "372": {"fulltext": "220 OVARIAN CYSTOMATA.\\nPLATE 72.\\nFig. 1.\u00e2\u0080\u0094 Primary Formation of Cysts from a Multilocular\\nGlandular Mucoid Cyst of the Ovary. (See also Plates 68-70\\nand Figs. 60, 62.) The individual cystic spaces (1) are formed be-\\ncause the walls tear, from mucoid degeneration (2, 3), and float about\\nin the fluid colloid contents as free papillae (2). (4) Smallest cyst.\\n(5) Connective tissue. (Original drawing from a specimen.\\nFig. 2. Papillary Proliferating Cyst of the Ovary. (Orig-\\ninal drawing from a specimen from the Munich Frauenklinik. (1)\\nBroad papilla containing a cyst (2) lined, as is the entire cyst, with\\ncolumnar epithelium (4), with pouchings similar to glands or folds\\n(5); (3) cross-section of papillse (8) fine dendritic papillae; (6) dense\\nconnective tissue of the cystic wall; (7) external wavy elastic layer of\\nconnective tissue.\\nFig. 3. Necrotic Cyst=wall. Myxomatous degeneration and\\nseparation of the connective-tissue fibers (2); vascular space (1).\\n(Original drawing from a specimen.)\\nFig. 4.\u00e2\u0080\u0094 Sediment from the Fluid of an Ovarian Cyst. (1)\\nCholesterin crystals; (2) red blood-corpuscles; (3) granular columnar\\nepithelium; (4) fatty granular cell; (5) leukocytes; (6) endothelium.\\n(Original drawing.\\nRetroflexion of a gravid uterus is to be especially con-\\nsidered. The chief symptom is ischuria.\\nIt is to be further remembered that the product may\\nhave died (chilliness).\\n2. Hematomdra, with or without Hematosalpinx. If\\ncongenital, the menses have never appeared if acquired,\\nthey have been absent since a definite time. The patulous\\ncondition of the vagina and uterus is to be demonstrated\\nby the sound.\\n3. Intramural and Submucous Myomata. Menorrhagia,\\nlabor-like pains, slower growth than in cystomata. They\\nare dense, and vascular murmurs are usually present the\\nuterine cavity is elongated. They frequently coexist with\\ncvstomata.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0372.jp2"}, "373": {"fulltext": "Tab. 72.\\nFiif.2.\\nv,viV,\\\\\\\\ \\\\-S\\n5 2 A\\nQ\\ni e\\nQ\\nfmfwm)^\\nFig,y.\\nFig A,\\nLith. Anst. E Reidrfwld, Miinchzn.", "height": "4597", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0373.jp2"}, "374": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0374.jp2"}, "375": {"fulltext": "DIFFERENTIAL DIAGNOSIS. 221\\nII. Pedunculated Tumors of the Uterus and Adnexa.\\n4- Subserous uterine myomcda present symptoms similar\\nto those just mentioned, and, in addition, the cervix moves\\nwith the tumor, sometimes being forced in the opposite\\ndirection by leverage. With the exception of cystic fibro-\\nmata and edematous tumors, their consistency is greater\\n(cystomata may also become hard from extravasation of\\nblood after torsion of the pedicle).\\n5. Intraligamentous Uterine Myomcda. Symptoms as in\\n3 and 4. They are intimately associated with the uterus,\\nand are to be differentiated from intraligamentous cysts\\nonly by their hardness.\\n6. Hydrosalpinx, Hematosalpinx, Pyosalpinx. Anam-\\nnesis, fever, tenderness and pain, lateral situation and\\nsausage-shaped or horn-shaped, with constrictions. (Plates\\n41, 44, 59, 74.) Tapping.\\n7. Parovarian Cysts, These are round they show\\nmarked fluctuation, and are not nodular, but unilocular.\\nThey are close to the uterus and have, at most, an insig-\\nnificant pedicle. Tapping.\\n8. Ovarian Fibromata. These possess a uniform\\ndensity, a surface covered with small protuberances, and\\nare of slower growth.\\nIII. Tumors of the Pouch of Douglas.\\n9. Abdominal Pregnancy. This is characterized by\\ntemporary amenorrhea and by pain, and occasionally the\\ndecidua is cast off. The sac has no pedicle, and portions\\nof the fetus may be recognized.\\n10. Intraperitoneal Retro-uterine Hematocele. -Sudden\\norigin, with collapse. The fluctuating tumor fills the\\nrecto-uterine pouch. The vaginal vault is tender. No\\ndiagnostic incision should be made. (Plate 58.)\\nThe extraperitoneal peri-uterine hematocele (hematoma)\\nleaves Douglas pouch free and lies to the side of the\\nuterus.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0375.jp2"}, "376": {"fulltext": "222 OVARIAN CYSTOMATA.\\nPLATE 73.\\nF IG# i Myxosarcoma of the Uterus. (Original drawing from\\na specimen from the Munich Frauenklinik. It arises primarily or\\nfrom an unusually rapidly growing fibroma (which has undergone\\ndegeneration from insufficient nutrition or from infection). (1) Ma-\\nlignant l giant cells. 2 Round-cell proliferation. 3 and 4 Myx-\\nomatous connective tissue the fibers are pressed apart. (See also\\nPlate 73, 2.)\\nFig. 2.\u00e2\u0080\u0094 Spindle=cell Sarcoma of the Uterus. With cyst\\nformation (2) (1) giant cells abundantly present among the spindle\\ncells. (Original drawing from a specimen from the Munich Frauen-\\nklinik. (See also Plate 87, 2.\\nBy sarcomata we understand tumors of the connective-tissue type\\nwith an abnormal predominance of the cellular elements (round,\\nspindle, giant, and stellate cells). They occur as soft, lobulated\\ntumors, which grow rapidly, soon give rise to metastases, and recur\\nupon removal. In contrast to epitheliomata, they arise more com-\\nmonly in early life. They are found in the uropoietic apparatus, in\\nthe vulva, in the vagina, in the uterus, in the ovaries, and in the\\nremaining adnexa.\\nThey occur in the vulva as round-cell sarcomata, spindle-cell sarco-\\nmata, myxosarcomata, and melanosarcomata in the vagina (Plate 73)\\nin the uterus (Plate 87, Fig. 2) in the ovary they present a spindle-\\ncell type, with or without cyst formation.\\nFig. 3.\u00e2\u0080\u0094 Malignant Adenoma Growing through a Cyst=wall.\\n(Half diagrammatic original drawing from a specimen from the Munich\\nFrauenklinik.) The superficial columnar epithelium (1) grows out\\ninto an atypically arranged adenomatous mass (6), consisting of cystic\\nglandular spaces (7), with columnar epithelium (6)J which is strati-\\nfied in various places (8). The interstitial connective tissue (9) is\\nscanty. The cyst- wall consists of columnar epithelium (1), dense\\nfibrous connective tissue (2), wavy elastic connective tissue (3), with\\nthin-walled vascular spaces (4), and the endothelium of the serosa (5).\\nFig. 4;\u00e2\u0080\u0094 Angioma of the Urethra. (Original drawing from a\\nspecimen.) The blood-capillaries (1) consist of endothelial cells\\nalone, and lie close together in the connective tissue (2). (See also\\nexplanation to Plate 51, Fig. 2.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0376.jp2"}, "377": {"fulltext": "Tab. 73.\\nJ\\n.\u00c2\u00a9s Bj\\nFig.l.\\ng^---/\\nV\\nFig.S.\\nFig.J.\\nFig A.\\nLith. Anst F Reichhold, Mdndien.", "height": "4599", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0377.jp2"}, "378": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0378.jp2"}, "379": {"fulltext": "DIFFERENTIAL DIAGNOSIS. 22$\\n11. Fluid Exudative Peritonitis. This pursues a febrile\\ncourse, with violent pains, tympanites, and vomiting.\\nDiarrhea is often present. The patient is unable to walk.\\nThe tumor is at first fluctuating or doughy later, it is\\nnodular and the uterus is immobile. (Plate 17, Fig. 1.)\\n12. Parametritic tumors present characteristics similar\\nto the foregoing. They are to one side or posterior, and\\nabove the vaginal vault. Contracted intraligamentous\\nabscesses are connected with the margin of the uterus.\\n(Plate 59, 1.)\\nIS. Pedal tumors are rarer, and are occasionally adher-\\nent to cystomata. They are to be palpated from the rec-\\ntum as they are located in its wall. Stenosis is sometimes\\npresent. It is often impossible to establish the true con-\\ndition of affairs a cyst may be adherent to the intestine.\\n11^.. Tumors of the pelvic bones are immovably connected\\nwith them, and grow more slowly. It is very important\\nthat the ovaries should be located, since cysts adherent to\\nthe pelvis may closely simulate them upon palpation.\\n15. Anterior sacral hydromeningocele (a hydromeningo-\\ncele of the dura mater between the body and ala of the\\nsacrum) is a great rarity.\\nIV. Other Abdominal Tumors.\\n16. Floating Kidney. The movable tumor is reniform,\\nfirm, and somewhat sensitive. The normal renal dullness\\nis absent, and in its place a tympanitic percussion-note\\nmay be obtained. A pelvic pedicle is wanting.\\n17. Hydronephrosis. This will have existed for a long\\ntime, and grows downward from the lumbar region with-\\nout a pelvic pedicle. The intestines are in front of the\\ntumor, whereas in ovarian growths they are either behind\\nor above. Tapping.\\n18. Penal tumors Hematomata (Plate 77). Echino-\\ncoccus cysts of the kidneys, of the liver, and of the pelvis\\ngive a hydatid thrill. Tapping.\\n19. Splenic Tumor. This extends to the pelvis from", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0379.jp2"}, "380": {"fulltext": "224\\nOT ABIAX CYSTOMATA.\\ni?\\nI\\n1~^\\nM S s\\np\\nI\\nJ:\\nr\\nu\\n\u00e2\u0080\u00a2s\\nm\\nz\\n||1|\\n3\\n6\\nfl\\n5\\nH\\nT3\\na\\ns.\\na;\\nPi. i .i.\\ne\\nc\u00c2\u00a7\\nn-e\\nc*\\n73\\nC\\nC\\nu\\n3\\nit\\nc\\nC r ij:\\nd\\n_\\nj=\\nH\\nM\\nP\\nH\\no\\nO\\np\\nP\\n53\\no\\nc\\nC3\\nMi g ft\\nw r\\nB. N\\n4\\ns\\n.5;\\n5 J? 2\\no\\ng\\nPQ\\n-2\\no o d\\nin I\\nC\u00e2\u0080\u0094 c3\\nB\\nDO O O P\\nB\\nC ffi w\u00c2\u00a3 d\\n03 3 13,\\nB E y. S 3?\\no g g g\\nX B.S\\n;z e5 5- oo\\n.a Z\\na K s\\n.5 5 \u00c2\u00a35\\nJh 5CS\u00c2\u00bb_\\nS\\ni J j\\nrs c ce\\nC a o\\n5\\nS\u00c2\u00a3 S", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0380.jp2"}, "381": {"fulltext": "DIFFERENTIAL DIAGNOSIS.\\n225\\na 5 2l\u00e2\u0080\u0094 o r\\nA 4*35\\nCO (D 9\\nPIfc\\nj D\\nZ\\n-1\\nO\\n^11\\nI r\\nb9 do 3 .2\\nt; o s S 29 h\\nz y S^\\nC a x _ \u00e2\u0080\u00a2_ y r,\\nd Q c3 H S\\nEh\\nfei\\nx\\nill\\n5\\n03 e3\\n^E o\\nII\\nI-\\nSfB*5\\nOosS Oco\\nfag 3\\nis-\\nO ,fjq\\nt w x a\\nCj-= r- p\\n1 cS\u00c2\u00abCl\\nX5 o 5\\n15", "height": "4585", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0381.jp2"}, "382": {"fulltext": "226 OVARIAN CYST03IATA.\\nPLATE 74.\\nFigs. 1 and 2.\u00e2\u0080\u0094 Bimanual Examination of a Pyosalpinx with\\na Full and with an Empty Rectum. Both bladder and rectum are\\nto be emptied before every bimanual examination, as these illustrations\\nshow how easily deceptive ideas of the form and of the size of tumors\\nmay be obtained. Py, Pyosalpinx; B, rectum; U, uterus.\\np IG 3.\u00e2\u0080\u0094 Bimanual Examination, with Assistance, of the\\nPedicle of an Ovarian Cyst (according to B. S. Schultze). (Orig-\\ninal diagrammatic drawing. The uterus is drawn downward with\\nthe bullet-forceps; the cyst is elevated through the abdominal wall;\\npalpation is made from below through the rectum. In this way the\\npedicle is made as tense as possible. In the illustration the latter is\\ntwisted.\\nthe left side of the abdomen, but has no pelvic pedicle.\\nLeukemia.\\n20. Tumors of the omentum, subperitoneal hematomata\\n(Plate 78), and tubercular and carcinomatous adhesions\\nhave no pedicle extending into the pelvis. Ascites or a\\ntympanitic note may be demonstrated beneath them. The\\novaries are normal.\\n21. Cysts of the pancreas have no pelvic pedicle.\\n22. Tumors of the bladder produce characteristic vesical\\ndisturbances. The urine should be examined for portions\\nof tumor tissue. Dilatation of the urethra. They may be\\nadherent to cystomata.\\n23. Tumors of the abdominal walls and parietal peri-\\ntoneum are intimately adherent to the skin, and their out-\\nlines are strikingly distinct to palpation. During respira-\\ntion they move backward and forward with the abdominal\\nwall intraperitoneal tumors move up and down with the\\ndiaphragm and disappear with increased tension of the\\nabdominal muscles. In all positions of the body the tumor\\nholds the same relation to the abdominal parietes. If the\\ntumor is flattened by the contraction of the abdominal\\nmuscles, and can be felt immediately underneath their", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0382.jp2"}, "383": {"fulltext": "OS\\n6\\n3\\n1\\n^__", "height": "4595", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0383.jp2"}, "384": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0384.jp2"}, "385": {"fulltext": "TORSION OF PEDICLE. 227\\ntense fibers, it springs from the serosa or from the trans-\\nverse fascia if the tumor becomes more prominent and\\nfixed by the abdominal tension, it springs from the\\nmuscles themselves if the tumor remains movable, it is\\nsituated in the subcutaneous connective tissue.\\nA fluctuating tumor in the lower abdomen may be a\\nperimetritic or a parametritic abscess, or, if tubercular\\nlumbar scoliosis is present, a psoas abscess if the tumor\\nis right-sided, appendicitis, typhlitis, perityphlitis, and\\nan adherent pus tube in the vesico-uterine pouch must be\\nconsidered.\\nV. Conditions Simulating Tumors.\\n21^. Distended Bladder.\\n25. Ascites. (See Plate 58, 1.)\\n26. Increased Amount of Fat in the Abdominal Wall.\\n27. Meteorism. General tympany is present the geni-\\ntalia are normal localized hardness is absent so-called\\nphantom tumors are to be observed.\\nPrognosis. Ninety per cent, of all cysts larger than a\\nman s head are fatal from rupture and peritonitis, from\\nsuppuration, or from exhaustion. Malignant degeneration\\nis always possible. Dermoid cysts suppurate easily or\\nundergo carcinomatous degeneration.\\nTorsion of the pedicle is dangerous. It produces dis-\\nturbances of the circulation with venous thrombosis,\\nextravasation of blood, or rupture of the tumor. If the\\nnutritional disturbance is gradual, retrograde metamor-\\nphoses occur if it is rapid, necrosis (Plates 69 and 72)\\nand gangrene follow.\\nDiagnosis of Sudden Torsion of the Pedicle. Acute\\nincrease of pain the tumor, often the abdomen also,\\nbecomes tender, causing the patient to bend forward in\\nwalking reflex nausea moderate evening rises of tem-\\nperature, with morning remissions.\\nTreatment. (See 32.) If a cyst is as large as a\\nchild s head, it must be removed pregnancy is no longer", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0385.jp2"}, "386": {"fulltext": "228 OVARIAN CYST031ATA.\\nPLATE 75.\\nFigs. 1 and 2. Two Different Cut Surfaces of a Sarcoma of\\nthe Ovary. (Original water-color from an operative specimen from\\nthe Heidelberg surgical clinic.\\nconsidered to be a contraindication to^the operation. It\\nis also best, however, to remove smaller cysts by ovari-\\notomy, especially if they produce violent pressure phe-\\nnomena, severe nervous symptoms, or render the indi-\\nvidual unable to work. Since the other ovary likewise\\nmay easily undergo carcinomatous degeneration, the age\\nof the patient, the family history, and the marriage rela-\\ntion must be carefully considered in every case, in order\\nto determine whether the immediate removal of this organ\\nis not also advisable.\\nTapping should be resorted to only when special indi-\\ncations are present. These are as follows When the\\noperation is refused during delivery when marked\\ndyspnea or other pressure symptoms are present and\\novariotomy is contraindicated by malignancy, weak heart\\nwith edema, etc., profound anemia, pulmonary tubercu-\\nlosis, nephritis, or other severe incurable constitutional\\ndiseases.\\nThe cyst is to be tapped through the abdominal walls or the vagina\\nby Bresgen s trocar or Potain s apparatus, the most rigid asepsis being\\nobserved and the entrance of air being carefully guarded against.\\nPLATE 76.\\nFig. 1.\u00e2\u0080\u0094 Sarcoma of the Ovary. (Original water-color from an\\noperative specimen from the Heidelberg surgical clinic.\\nFig. 2. A Case of Commencing Sarcomatous Degeneration\\nof the Ovary. The albuginea is thickened, and small follicular cysts\\nmaybe seen through the otherwise atrophic germinal layer. (Original\\nwater-color from an operative specimen from the Heidelberg surgical\\nclinic.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0386.jp2"}, "387": {"fulltext": "iO\\na\\nH\\n1", "height": "4594", "width": "3053", "jp2-path": "atlasepitomeofgy00scha_0387.jp2"}, "388": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0388.jp2"}, "389": {"fulltext": "Si\\n5\\ns", "height": "4597", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0389.jp2"}, "390": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0390.jp2"}, "391": {"fulltext": "TREATMENT. 229\\nThe trocar and elastic tube are to be previously filled with sterile\\nwater, and the free end of the tube is to be immersed in a receptacle\\ncontaining the same fluid. This prevents the air from being sucked\\nin by an accidental falling-back of the tumor; this accident is further\\nhindered by sewing the cyst to the abdominal wall, which also renders\\nimpossible the escape of the fluid into the abdominal cavity. The\\ncyst is to be evacuated by placing the patient in an appropriate posi-\\ntion and not by manual pressure. The fluid is to be slowly drawn off,\\nsince a rapid removal is frequently followed by collapse. The punc-\\nture is to be closed by adhesive plaster (in the shape of a Maltese\\ncross or by an occlusive dressing.\\nOvarian cysts rarely contract after tapping; they usually refill, and\\nthe patient becomes profoundly exhausted. Extirpation by modern\\naseptic methods has a mortality of only c c (Fritsch). At the\\nHeidelberg Frauenklinik, in 1896, there was only one fatal result in\\nsixty celiotomies severe anemia and multiple my omata there was\\nnot a fatal case from ovariotomy.\\nIt is not within the scope of this book to go into the\\ndetails of the technic of ovariotomy, but the preparation\\nof the patient and the after-treatment, with its complica-\\ntions, will now be considered. The clay before the oper-\\nation the patient receives a full bath the abdominal walls\\nare shaved, scrubbed, and disinfected (soap and brush,\\nalcohol and brush, sublimate solution and brush). Dur-\\ning the night a sublimate compress is applied to the lower\\nabdomen (Fritsch). Since infectious germs always exist\\nin the cutaneous glands and in the deeper layers of the\\nepidermis, the disinfection must be repeated immediately\\nbefore the operation, special attention being given to the\\nnavel, old scars, or other uneven places in the skin.\\nFor several days preceding the operation the diet should\\nbe liquid but nutritious (bouillon, eggs, milk, oatmeal-\\nwater). The bowels must be thoroughly and energetically\\nevacuated, care being taken, however, that this is not car-\\nried to excess. Immediately before the operation the\\nbladder is to be emptied the vulva and vagina are to be\\nthoroughly cleansed and tightly packed with iodoform\\ngauze in case it is necessary to open the vaginal vault or\\nto perform other operations through the vagina.\\nDressing and After=treatment. Dermatol is to be", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0391.jp2"}, "392": {"fulltext": "230 OVARIAN CYSTOMATA.\\nPLATES 77 AND 78.\\nMultiple Extraperitoneal Extravasations of Blood, Espe=\\ncially in the Great Omentum. The largest one was connected with\\nthe atrophic kidney by numerous peritoneal adhesions, and simulated\\na renal tumor. Plate 77. The different stages of development are\\nshown in plate 78 in their natural size. Figures 1 and 2, primary\\nextraperitoneal hemorrhages; as the hemorrhage increases a peritoneal\\npedicle is formed Fig. 3 the greater portion of the wall is now in-\\nsufficiently nourished, and undergoes necrosis; the capillary vessels\\nare seen radiating from the pedicle into the tumor; complete necrosis\\noccurs upon torsion of the pedicle. (Fig. 4.) A cross-section shows\\nthe bloody contents and the thickening of the wall. (Fig. 5. (Orig-\\ninal water-color from specimens in the* Heidelberg Path. Inst.\\ndusted upon the line of incision this is to be followed by\\niodoform gauze or iodoform collodion, cotton, and an\\nabdominal binder. This dressing is not to be changed\\nfor several days unless it is absolutely necessary. The\\nsutures are to be removed on the tenth day if vaginal\\nsutures suppurate, they are to be removed earlier, and a\\ncompress saturated with a solution of aluminum acetate x\\nis to be applied.\\nImmediately after the operation free diaphoresis is to be\\nencouraged (the bed is to be previously warmed), partly to\\nhasten reaction, partly to prevent abdominal transudation,\\nwhich furnishes a culture-medium for any micro-organisms\\nwhich may have accidentally gained access to the peritoneal\\ncavity (Fritsch).\\nFirst day Allow the patient very little fluid in the form\\nof restorative drinks cold tea especially small quantities\\nof wine, cognac, or rum and water are exceptionally\\nallowable bouillon, coffee perhaps, and cracked ice and\\nrectal injections of normal saline solution for the thirst.\\nThe patient must be kept warm. If reaction is tardy,\\nrectal injections of alcohol, wine, or ether may be given in\\n1 See Therapeutic Table.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0392.jp2"}, "393": {"fulltext": "Xi\\na\\nH", "height": "4602", "width": "2997", "jp2-path": "atlasepitomeofgy00scha_0393.jp2"}, "394": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0394.jp2"}, "395": {"fulltext": "Tab. 78.\\niq. J.\\nLith. Arist. ReuithoUl. Mi inch en", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0395.jp2"}, "396": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0396.jp2"}, "397": {"fulltext": "AFTER-TREATMENT. 231\\naddition to the foregoing remedies. If signs of internal\\nhemorrhage present themselves, the wound is to be\\nreopened.\\nFirst week: Liquid nutritious diet. An enema of infu-\\nsion of senna 1 is given on the second day to guard against\\nthe formation of intestinal adhesions (Kehrer).\\nFrom then on two enemata are to be given daily,\\nespecially if abdominal pain is present. Mild cathartics\\nmay also be employed. If the urine is not passed spon-\\ntaneously, the patient is to be carefully catheterized twice\\ndaily. Dorsal position the lateral position (caution is\\nto be allowed only with threatened hypostasis of the lungs.\\nVomiting may occur from swallowed chloroform (cracked\\nice and iced champagne), meteorism, constipation, or peri-\\ntonitis. The bed is not to be changed until the beginning\\nof the\\nSecond week Easily digested solids if the condition of\\nthe patient is absolutely good, veal, chicken, Zwieback,\\ntoast, wheat-bread, etc., may be allowed after the fourth\\nor fifth day.\\nThe patient may get up in the third week.\\nFor meteorism warm fomentations, oil of peppermint,\\nfennel tea, high introduction of the rectal tube if com-\\nbined with marked vomiting, increased temperature, ten-\\nderness, and peritoneal exudate (peritonitis), inunctions\\nof blue ointment, and administration of calomel. (See p.\\n123 15.)\\nIf very severe sudden collapse with anemia occurs (in-\\nternal hemorrhage), the wound should be immediately\\nreopened. Severe sudden collapse with dyspnea and\\ncyanosis (especially in fibromyomata) indicates pulmonary\\nembolism.\\n1 The author is in a position to compare the routine treatments of\\ntwo clinics for many years. In the one, the opium treatment, placing\\nthe intestines at rest, was employed; in the other, the enemata of\\nsenna infusion were adopted. The latter treatment is, in his opinion,\\nundoubtedly the better, especially as the subjective condition of the\\npatient more nearly approaches the normal.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0397.jp2"}, "398": {"fulltext": "232 OVARIAN CYSTOMATA.\\nPLATE 79.\\nFig. 1.\u00e2\u0080\u0094 Epithelioma of the Vulva. (Original drawing from a\\nspecimen from the Munich Frauenklinik.) (Compare with Plate 80,\\nFig. 2.) The epithelioma originates in the squamous epithelium (4).\\nNumerous plugs of cells (5) are seen dipping down from the surface\\n(4) into the stroma (3) and forming cell nests, which are sur-\\nrounded by connective tissue richly infiltrated with round cells. The\\ncapillaries are dilated. At the edge of the stroma epitheliomatous\\npearls are formed from the cuboid cells of the matrix (1) and\\nfrom the polygonal epithelium which proliferates centrally from them.\\nA giant cell is seen among these cells at (2).\\nFig. 2.\u00e2\u0080\u0094 Part of an Epitheliomatous Papilloma of the Vag=\\ninal Cervix. (Original drawing from a specimen from the Munich\\nFrauenklinik.) 1, Epitheliomatous papilla: the central connective\\ntissue is infiltrated with round cells and contains thick-walled vessels;\\nthe squamous epithelial cells are seen at the periphery. 2, Connec-\\ntive tissue infiltrated with nests of cancer cells. 3, Extra vasated\\nblood.\\nFig. 3\u00e2\u0080\u0094 Epitheliomatous Pearls from an Ulcer of the\\nCervix. The structure is the same as in figure 1. 1, Cuboid cells\\nof the matrix; 2, polygonal cancer epithelium; 3, connective tissue\\ninfiltrated with round cells and traversed by dilated vessels; 4,\\nlymph capillaries. (Original drawing from a specimen from the\\nMunich Frauenklinik.)\\nFig. 4. Dermoid Cyst. (See Plate 45, Fig. 2.) (Original\\ndrawing from a specimen from the Munich Frauenklinik. 1, Super-\\nficial squamous epithelium with connective-tissue papillae; 2, low\\nepithelium resting upon an even stroma 3, hair, with sebaceous gland\\nconsisting of cuboid epithelium; 4, cross-section of a hair; 5, muscle-\\nfiber; 6, connective tissue.\\nDermoid cysts generally originate in the ovary (very rarely also in\\nthe vulva). They develop from the same tissue elements as do the\\ncystomata, only with this difference they assume a cutaneous char-\\nacter and are made up of all portions of the skin, from the epidermis\\nto the subcutaneous connective tissue. There is scarcely a tissue or\\nan organ in the body, be it ever so complicated, which may not also\\noccasionally appear in these tumors (maxillary bones with teeth,", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0398.jp2"}, "399": {"fulltext": "C^m\\nmm(Ph\\n\u00c2\u00b03\\nIKSlli\\n$tf\\nlilflS$l\u00c2\u00ae|", "height": "4585", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0399.jp2"}, "400": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0400.jp2"}, "401": {"fulltext": "AFTER-TREATJIEXT. 233\\nbrain -substance, eye, etc.). The cysts are filled with sebaceous mat-\\nter and blond hair.\\nThese dermoid growths may coexist with ovarian cysts; they may\\nalso undergo carcinomatous degeneration. With these exceptions\\nthey are always unilocular; they have thick walls and vary in size\\nfrom that of a man s fist to tumors the size of a man s head.\\nTheir etiology is uncertain; they may be due to intraf elation,\\nfrom fission and displacement of the fetal rudiments.\\nAs the peritonitis subsides the exudate undergoes ab-\\njrption, organization, and encapsulation. (For the treat-\\nlent see 18.)", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0401.jp2"}, "402": {"fulltext": "CHAPTER III.\\nMALIGNANT TUMORS.\\nThe malignant tumors consist of epitheliomata (squa-\\nmous epithelial tumors), malignant adenomata (glandular\\ncancers), malignant papillary cysts of the ovary (papillary\\nglandular proliferations), sarcomata (round-cell and\\nspindle-cell proliferations, with or without mucoid degen-\\neration or deposits of pigment in the intercellular tissue),\\nand endotheliomata (proliferations of the endothelium of\\nthe vessels, or angiosarcomata, since they are a connecting\\nlink between epitheliomata and the connective-tissue\\ntumors).\\n36. MALIGNANT TUMORS OF THE VULVA, BLADDER,\\nAND VAGINA.\\nThese occur:\\nOn the Vulva.\u00e2\u0080\u0094 (1) Epithelioma (Plates 80, Fig. 1; 79, Fig. 1);\\n(2) fibrous carcinoma (rare); (3) malignant adenoma of the glands of\\nBartholin 4 sarcoma see explanation of Plate 73, Fig. 3\\nIn the Urethra. (5) Epithelioma (very rarely primary).\\nIn the Bladder.\u00e2\u0080\u0094 (6) Villous cancer (Plate 88, Fig. 5); (7) diffuse\\nscirrhus of the entire wall; (8) multiple nodular carcinoma; (9) sar-\\ncoma (very rarely primary).\\nIn the Vagina. (10) Papillary epithelioma (Plates 79, Fig. 2; 80,\\nFig. 2; 88); (11) flat diffuse carcinomatous infiltration (Plates 80, Fig.\\n2; 88); (12) sarcoma (Plate 73, Figs. 2 and 3; rare).\\nSymptoms and Diagnosis. Epithelioma of the vulva:\\npruritus often exists long before the small, flat, reddened\\nnodules make the skin uneven. Later the edges are livid\\nand dense small nodules are observed in the surrounding\\nskin. Disintegration soon occurs and there is early met-\\nastasis to the inguinal glands. The ulcer has irregular\\n234", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0402.jp2"}, "403": {"fulltext": "VULVA.\u00e2\u0080\u0094 BLADDER.\u00e2\u0080\u0094 VAGINA. 235\\nedges with hard surroundings. The patient is usually\\nover forty years of age.\\nSarcoma of the vulva occurs in younger patients, and\\nmay be congenital the tumor has a fibrous structure.\\nFor the anatomy of sarcoma see explanation of Plate 73,\\nfigure 2.\\nCancer of the bladder: symptoms as in \u00c2\u00a731 under\\nBladder. Urethral dilatation is necessary. The tumor\\nconsists of soft, crumbling, polypoid masses, which are\\nreadily torn away from the tumor these do not consist\\nof intact villi, as in a fibrous tumor, but of disintegrated\\nshreds of tissue (microscope). These tumors are usually\\nsecondary metastasis occurs early embolism is frequent\\nperitoneal symptoms are observed.\\nEpithelioma of the vagina pruritus is also observed\\nhere irregular hemorrhages. Pain, both during coitus\\nand spontaneous. If ulcerated, purulent and offensive\\ndischarges and casting-off of fetid, crumbling pieces of\\ntissue. Vesical disturbances gradually appear, and finally\\nfistulous tracts are formed. (See Plate 79.) When a\\nvaginal epithelioma is diagnosed, it must be determined\\nwhether it is not a secondary growth from the cervix.\\n(Plate 88.) Papillary epithelioma usually begins anteriorly\\nwith a broad base (chronic vaginitis). The nodular form\\nis usually peri-urethral the nodules quickly coalesce and\\nsoon ulcerate.\\nSarcoma causes analogous disturbances. (See Plate 73.)\\nDeath follows from venous metastases, septicemia, or hem-\\norrhage. Recurrent fibromata or polyps are to be looked\\nupon with suspicion.\\nTreatment. All these tumors must be removed as\\nsoon as they are diagnosed. This is accomplished with\\nthe knife and the Paquelin cautery the limits of the ex-\\ntirpation must lie outside of the infiltrated zone. Glandular\\nmetastases are not to be neglected. As a prophylactic\\nmeasure at the time of the menopause, every suspicious\\nlarge or weeping warty prominence on the vulva should be", "height": "4601", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0403.jp2"}, "404": {"fulltext": "236 MALIGNANT TUMORS.\\nPLATE 80.\\nFig. 1. Ulcerated Epithelioma of the Left x Labium Majus.\\n(Original water-color.) This tumor at first consists of slightly red-\\ndened individual flat prominences and nodules. The edge of the\\ntumor is very dense and is of a bluish color; the central portion soon\\nbecomes disintegrated. The tumor creeps along slowly, giving early\\nmetastases to the inguinal glands. The vagina is usually spared.\\nHistologically, the tumor consists of squamous epithelium (Plate 79,\\nFig. 1 it is very rarely a fibrous carcinoma.\\nFig. 2. Flat Ulcerating Epithelioma of the Posterior Lip\\nof the Os Uteri and of the Posterior Vaginal Vault. (Original\\nwater-color. This tumor has grown from epitheliomatous nodules.\\n(See Plate 88, Fig. 1.)\\nremoved. It is not right first to subject them to prolonged\\ncauterizations.\\nUrethral carcinoma does not lead to incontinence as long\\nas the sphincter remains intact. If the case is inoperable,\\nthe decomposing urine is to be drawn off as quickly as\\npossible and the interior of the bladder disinfected.\\nIn cancer of the bladder (Plate 88, Fig. 5), if it is a cir-\\ncumscribed villous tumor, the affected portion of the vesical\\nwall is to be removed if it is diffuse, flat, and consists of\\nnodular formations, excochleation with the sharp curet.\\nIrrigation with solutions of salicylic acid or silver nitrate\\nif hemorrhage occurs, ice-water irrigations, ice-bag, and\\nvaginal tamponade. On the following day the coagula are\\nto be removed through a large catheter.\\nPLATE 81\\nFig. 1.\u00e2\u0080\u0094 Nodular Epithelioma of the Vaginal Cervix. (Orig-\\ninal water-color.)\\nFig. 2.\u00e2\u0080\u0094 Epitheliomatous Papilloma of the Anterior Lip of\\nthe Os Uteri. (View of the cervical canal. (Original water-color.\\n1 Translator s Note. The original reads right.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0404.jp2"}, "405": {"fulltext": "", "height": "4593", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0405.jp2"}, "406": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0406.jp2"}, "407": {"fulltext": "I", "height": "4609", "width": "3015", "jp2-path": "atlasepitomeofgy00scha_0407.jp2"}, "408": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0408.jp2"}, "409": {"fulltext": "UTERINE CARCINOMA. 237\\n37. MALIGNANT TUMORS OF THE UTERUS.\\nI. Carcinoma of the Uterus.\\nThe individual varieties of uterine cancer are\\n1. Epitheliomatous papilloma of the vaginal cervix. (Plates 79,\\nFig. 2; 81; 84, Figs. 1 and 2 (beginning); 85, 1; 88, 1-4; 90, 2.)\\n2. Flat epithelioma of the cervix and of the vaginal vault. (Plate\\n80, Fig. 2.\\n3. Epitheliomatous ulcer of the cervix. (Plates 79, Fig. 3; 82; 83;\\n85, Fig. 2; 86; 89.)\\n4. Xodular epithelioma of the cervix. (Plates 80, Fig. 2; 83.)\\n5. Superficial epithelioma of the body of the uterus. (Plate 89,\\nFigs. 3 and 4.\\n6. Glandular cancer, malignant adenoma of the body of the uterus.\\n(Plates 30, Fig. 3; 87, Fig. 1.)\\nSymptoms. It is of the utmost importance to diag-\\nnose these malignant tumors as early as possible, because\\nit is only in the beginning, before metastases have occurred,\\nthat the opportunity exists for a thorough removal without\\nrecurrence.\\nThe initial symptoms in nearly every case are hemor-\\nrhages, discharge (first mucoid, then purulent, and finally\\nsanious with or without crumbling particles of tissue), and\\npain (sometimes pruritus). Finally, the discharge assumes\\na most offensive character.\\nIf the hemorrhages and pain are not so pronounced, the\\ncase is probably one of cancer of the uterine body.\\nThe irregularity of the hemorrhages at the climacteric\\nperiod easily deceive both the patient and the physician.\\nThese cases must consequently be watched all the more\\nclosely.\\nThe pain is inconstant, of a tearing, boring, or lancinat-\\ning character, and radiates to the sacrum and thighs. In\\ncorporeal carcinoma the pain is colicky or paroxysmal and\\nis associated with the discharge of solid tissue particles\\nfrom the uterine cavity. Other causes for the pain are\\npressure upon nerves, destruction of the uninvolved soft\\nparts by the foul cancer discharge, the formation of fistu-\\nlas, and the subsequent vesical catarrh.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0409.jp2"}, "410": {"fulltext": "238 UTERINE CARCINOMA.\\nPLATE 82.\\nA View of an Epitheliomatous Ulceration of the Mucous\\nMembrane of the Cervical Canal. The external os is intact. In\\nspite of its apparent insignificance, this case was an inoperable\\none, as the atypical proliferation, as a matter of fact, extended deep\\ninto the parametritic tissues, involving the bladder wall and fixing the\\nuterus. (Original water-color from an actual case.\\nAll varieties of vesical disturbance make their appear-\\nance. Vomiting and headache occur very early, from\\npressure upon the ureters (v. YTinckel), and are to be\\nlooked upon as uremic in character. The urine is always\\ndecreased in amount.\\nLater, as the wall of the bladder becomes affected, usu-\\nally at the trigonum, with closure of the ureters by a dense\\ninfiltration, the symptoms assume an unmistakable uremic\\ncharacter. Almost complete anuria exists, the patient\\nbecomes unconscious, edematous, and has convulsions.\\nThe edema is increased by the firm infiltration of the para-\\nmetritic tissues, which compresses the pelvic veins and\\nproduces thromboses. These infiltrations gradually nar-\\nrow the rectum and cause fecal stasis, hemorrhoids, and\\ntenesmus.\\nGeneral symptoms occur cachexia, reflex dyspepsia,\\nand disgust for food. Death follows from exhaustion,\\nuremia, or peritonitis.\\nDiagnosis. Inspection of the cervix through the\\nspeculum. (See colored plates.) The tumors bleed easily,\\nand are so friable that they tear when seized by tenacula.\\nIn cervical ulceration it is to be noted that the os uteri\\nremains closed and intact, while the cervical canal is\\ntransformed into a dilated, disintegrated cavity. This is\\ndemonstrated by the sound, as is also the disintegration of\\nthe walls of the dilated uterine cavity. These ulcers are\\npunched out, with reddened, swollen edges they have a\\nlardaceous coating and bleed easily. They are found espe-", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0410.jp2"}, "411": {"fulltext": "Tab. 82.\\nLith.Arist E Retchhold, Mtinchm.", "height": "4601", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0411.jp2"}, "412": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0412.jp2"}, "413": {"fulltext": "DIAGNOSIS.\u00e2\u0080\u0094 TREATMENT. 239\\ncially in the vaginal vault as extensions from the cervix,\\nas well as in the cervical canal. (Plate 82.)\\nAn absolute diagnosis is made by the microscopic ex-\\namination of pieces of tissue, which are either cast off or\\nintentionally scraped from the uterine wall. (Regarding\\nglandular cancer, see Plate 30, Figs. 2 and 3.)\\nAn exact anamnesis must always be obtained to avoid\\nerrors in diagnosis. In this way a decomposing abortion\\nor retained placenta may be excluded at the beginning\\nthe microscope would, in addition, reveal chorionic villi\\nand decidual tissue. A disintegrating fibromyoma (see\\n34, Differential Diagnosis) is recognized by the firm\\nconsistency of the pieces of tissue removed for diagnosis\\nand by their histologic fibrous structure. The rare mul-\\ntiple condylomata of the cervix must be considered they\\nare not yellow, like the epitheliomata, but bluish-red they\\nhave the same etiology as the condylomata of the vulva.\\nIt is also to be mentioned that certain obstinate inflam-\\nmations of the endometrium occurring at the menopause,\\nand having the microscopic structure of fungous endome-\\ntritis, are often nothing more than the beginnings of gland-\\nular cancers in the same manner papillary erosions and\\nlaceration scars act as predisposing causes of papillary\\nepitheliomata.\\nTreatment. The suspected masses, with at least one\\nor two centimeters of the surrounding healthy tissues, are\\nto be immediately removed by operation.\\nAs a prophylactic measure endometritis, erosions, lacer-\\nation scars, and ectropion are to receive appropriate and\\nearly treatment.\\nIf an epitheliomatous papilloma is certainly limited to\\nthe cervix (Plates 84, Fig. 2 88, Figs. 2 to 4 90, Fig.\\n2), one or both lips of the os and the affected portion\\nof the vaginal vault mav be removed. (Plates .80, Fig.\\n2 81 84, Fig. 1 85, Fig. 1 88, Fig. 1.)\\nIf, on the contrary, we have to do with an ulcer of the\\ncervix, it seems to me that its removal can be surely", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0413.jp2"}, "414": {"fulltext": "240 UTERINE CARCINOMA.\\nPLATE 83.\\nFigs. 1 and 2. Epitheliomatous Ulcer of the Cervix.\\n(Through the speculum and in cross-section; original water-color.)\\n(See also Plate 89, Fig. 2. The tumor consists of the solitary pri-\\nmary nodules and of their ulcerations. Figure 2 shows the nodular\\ninfiltration of the cervical wall.\\nsecured only by the total extirpation of the uterus.\\nSchroder s supravaginal amputation of the cervix through\\nthe vagina, even if the ulcer does not reach to the internal\\nos, is frequently followed by recurrences in the body of\\nthe uterus, from which metastases may occur. It may\\nnot be a question of metastasis at all, as we have speci-\\nmens which show that beginning carcinomatous degener-\\nation may simultaneously exist in the body or fundus of\\nthe uterus and in the cervix. (Plates 82 83 85, Fig. 2\\n89, Figs. 1 and 2.)\\nTotal extirpation may be performed\\n1. Through the vagina (Langenbeck-Czerny) colpo-\\nhysterotomy.\\n2. After opening the abdominal cavity (Freund) celio-\\nhysterotomy.\\n3. By the sacral method (Hochenegg-Herzfeld-Hegar).\\n4. By the parasacral method (Wolfler).\\nPLATE 84.\\nFig. 1.\u00e2\u0080\u0094 Epitheliomatous Papilloma of the Anterior Lip of\\nthe Os Uteri and of the Anterior Vaginal Vault. (Original\\nwater-color.) (See Plates 79, 85, and 88.) The tumor consists of\\nuneven bluish masses, which render the os difficult of recognition by\\npalpation. This form spreads along the surface.\\nFig. 2.\u00e2\u0080\u0094 Beginning Epithelioma of the Cervix. (Original\\nwater-color from a case of v. Winckel s. Small round nodules develop\\nat the external os. They are in the cervix, beneath the mucous mem-\\nbrane, and soon ulcerate.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0414.jp2"}, "415": {"fulltext": "\u00e2\u0096\u00a0H|", "height": "4608", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0415.jp2"}, "416": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0416.jp2"}, "417": {"fulltext": "", "height": "4543", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0417.jp2"}, "418": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0418.jp2"}, "419": {"fulltext": "TREATMENT. 241\\nThe patients are prepared as usual (full bath, evacuation of the\\nbowels by laxatives and enemata, bladder emptied immediately before\\nthe operation); the vaginal and uterine cavities are to be irrigated\\nseveral times with antiseptic solutions and then wiped out.\\n1. Vaginal Extirpation. The cervix is made accessible by means\\nof Simon s duckbill specula (one posterior, one anterior, and two\\nlateral retractors), and is drawn down by a stout ligature passed\\nthrough its substance. If the parametritic tissues are infiltrated, the\\nuterus is more or less fixed, and a removal of all the diseased tissue is\\nout of the question.\\nThe stout ligature not only aids in drawing down the uterus, but\\nat the same time it also closes the external os and prevents the escape\\nof the infectious masses of an intra-uterine carcinoma. If the case is one\\nof papilloma of the cervix, as much as possible of the carcinomatous\\ntissue is to be removed by the knife, scissors, and sharp curet, and\\nthe remainder is to be destroyed with carbolic acid or Paquelin s\\ncautery before the vaginal vault is oxDened. The vagina is to be again\\nwiped clean with antiseptics.\\nAfter the removal of the uterus from the ligated adnexa, the wound\\nin the vaginal vault is made smaller by several sutures and is drained\\nwith iodoform gauze. The ligatures left in the adnexa and about the\\nparametritic vessels usually come away spontaneously. The patient\\nis to be kept in bed for two or three weeks.\\n2. Total Extirpation by Celiotomy. This operation, devised by\\nFreund, is still indicated to-day for large dense tumors or those com-\\nplicated with fibromyomata) that can not be removed through the\\nvagina. Bardenheuer s modification is the best: the cervix is cir-\\ncumscribed by a vaginal incision; the abdominal cavity is opened,\\nthe ligaments are tied off on each side in three sections, the uterus is\\nremoved, and the wound is united by suture.\\n3. The sacral and the parasacral methods maybe carried out if ad-\\nhesions, parametritic cancer nodules, or a large uterus (it may be\\npuerperal) render the median incision ineffectual.\\nThe inoperable cases demand symptomatic treatment.\\n1. For the putrid suppuration removal of the carcinoma-\\ntons masses by means of knife, scissors, curet, and ther-\\nmocautery. As an eschar, and later a malignant granu-\\nlating surface, is left behind, the wound should be closed\\nas far as possible by sutures, which exert a certain restrain-\\ning pressure upon the all-too-rapid proliferation. During\\nthis excochleation, avoid creating rectal or vesical fistulas.\\nAtmocausis is to be employed in such cases.\\nAs far as caustics are concerned, especially in cases that\\ncan not be cureted, I wish to mention only carbolic acid\\nand formalin. Schroder applied 20 bromin alcohol for\\n16", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0419.jp2"}, "420": {"fulltext": "242 UTERINE CARCINOMA,\\nPLATE 85.\\nFig. 1. Epitheliomatous Papilloma of Both Lips of the Os.\\nThe tumor has ulcerated, invaded the deeper tissues, and spread to the\\nanterior vaginal vault. (Original water-color.)\\nFig. 2. Epitheliomatous Ulcer of the Cervix. (Original\\nwater-color. The external os and the cervix are intact the lips of\\nthe os and the cervical wall are, however, markedly thickened by the\\ncarcinomatous infiltration. The cervical canal is ulcerated and forms\\na crater between the external and the internal os, which is easily\\ndemonstrable by the sound. The walls contain disintegration cysts\\nfilled with putrid masses. Solitary cancer nodules are seen in the body\\nof the uterus. The neck of the uterus is much enlarged, in contrast\\nto the body.\\nfive minutes by means of cotton tampons. These were\\nheld in position by tampons saturated in normal saline\\nsolution. Nitrate of lead (powdered, 30 parts, with 70\\nparts lycopodium) is slower in its action from twelve to\\nsixty hours.\\nFor the fetid odor potassium permanganate in strong\\nsolution (dark reddish-brown), or irrigation several times\\ndaily with 1 or 2 creolin, cresol soap, or lysol.\\nQuinin iodid and aristol are to be used as dusting-powders.\\n2. For the hemorrhages the following treatment is pallia-\\nPLATE 86.\\nFig. 1. Epithelioma of the Cervix That Has Perforated\\ninto the Bladder. (Original water-color. In spite of the great de-\\nstruction above it, inspection shows the os uteri to be almost com-\\npletely unchanged. Greenish-gray putrid masses and necrotic shreds\\ncover the floor of the carcinomatous ulcer. The uterine wall is infil-\\ntrated with nests of cancer cells. (See Plate 89, 5.\\nFig. 2. Perforation of an Epithelioma of the Cervix into\\nthe Bladder and Rectum. (Original water-color from a specimen\\nof v. TVinckel s. The os uteri has become ulcerated and the process\\nextends to the vagina. (See Plate 89, 6.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0420.jp2"}, "421": {"fulltext": "f", "height": "4581", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0421.jp2"}, "422": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0422.jp2"}, "423": {"fulltext": "", "height": "4589", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0423.jp2"}, "424": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0424.jp2"}, "425": {"fulltext": "TREATMENT. 243\\ntive astringent irrigations or vaginal suppositories, vin-\\negar, alum, ferripyrin powder, chloricl of iron iodoform\\ngauze tamponade, or packing with gauze soaked in solution\\nof aluminum acetate or in formalin solution.\\nThe general nutrition is to be carefully regulated.\\nPreference is to be given to a light, easily digestible and\\nstimulating diet, with stomachics (compound tincture of\\ncinchona), hematogen, hemalbumin, ferratin, wine of iron\\npeptonate, and the like. Laxatives and high injections,\\nif necessary, with infusion of senna.\\n3. For the Lancinating Pains. The following may be\\nused successively as the pains grow more severe sul-\\nphonal, trional, urethan, and chloralamid by the mouth\\nantipyrin, extracts of hyoscyamin and belladonna, chloral,\\nand laudanum by the rectum, later also by the mouth\\nfinally, morphin subcutaneously in gradually increasing\\ndoses.\\nIf.. For the vomiting stomachics, decoctions of condu-\\nrango, cracked ice, cold milk (buttermilk), iced champagne,\\ncold tea.\\n5. For the headache cold applications, lactophenin,\\nphena c et i n, a ntipy rin\\nSince the two latter symptoms are of a uremic nature,\\nthey are also to be treated by warm baths, hot packs, and\\nthe induction of profuse sweating.\\nII. Sarcoma of the Uterus.\\nFor anatomy see Plate 73.\\nThese tumors are as malignant as the carcinomata, if not\\nmore so. They occur in the uterine body as primary\\ngrowths or as secondary deposits from ovarian sarcomata\\n(see Plate 87, 2) the patients affected are often in their\\nyouth. They usually consist of a round-cell proliferation,\\nsometimes associated with spindle cells. (Plate 73.) They\\nbecome villous or polypoid, and dilate the os uteri. Met-\\nastases take place through the venous system finally as", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0425.jp2"}, "426": {"fulltext": "244 UTERINE SARCOMA.\\nPLATE 87.\\nFig. 1.\u00e2\u0080\u0094 Carcinoma of the Uterine Body. (Original water-\\ncolor from a specimen of v. WinckePs. Nodular, soft, easily crum-\\nbling, bluish-red masses are seen upon the mucous membrane. They\\nalso extend into its depths, either as solid plugs of cells from the\\nsuperficial epithelium, or as a malignant adenoma from the glandular\\nepithelium.\\nFig. 2. Sarcoma of the Uterus. (Original water-color from a\\nspecimen from the Munich Frauenklinik. The soft, fibrous masses\\nare like tinder. They are mucous, muscular, or subperitoneal, and\\nmay arise from the myxomatous degeneration of a fibroma. (See also\\nPlate 73.\\npulmonary emboli. Endotheliomata occur very rarely on\\nthe cervix.\\nSymptoms. The discharge is profuse, mucoid, not\\nPLATE 88.\\nFig. 1. Flat Cervical Epithelioma of Both Lips of the Os\\nUteri Involving Both Vaginal Vaults. There are two varieties of\\nepithelioma of the cervix: (1) the superficial form; (2) the epithelio-\\nmatous papilloma. Both consist of pings of the proliferating squa-\\nmous epithelium. (See Plate 79.\\nFig. 2. Epitheliomatous Papilloma of Both Lips of the Os\\nUteri. (See Plate 85, Fig. 1.\\nFig. 3. Polypoid Epitheliomatous Papilloma of the Ante=\\nrior Lip of the Os Uteri.\\nFig. 4. Epitheliomatous Papilloma of the Posterior Lip of\\nthe Os Uteri Filling the Entire Posterior Vaginal Vault.\\nFig. 5. Villous Cancer of the Bladder in Its Most Frequent\\nPosition. (In the region of the ureteral orifices. It has infiltrated\\nthe vesicovaginal septum. It causes cystitis; cancer cells and shreds\\nof tissue are found in the urine.\\nFig. 6. Rectal Carcinoma (Glandular Cancer) Infiltrating\\nthe Rectovaginal Septum, The tumor undergoes a crater-like dis-\\nintegration, so that examination reveals two stenoses, between which\\na considerable dilatation is situated.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0426.jp2"}, "427": {"fulltext": "_.o_", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0427.jp2"}, "428": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0428.jp2"}, "429": {"fulltext": "Tab. 88.\\nFig I\\nFig.\u00c2\u00a3.\\nFig.3:\\nFir/. 4\\nFig. 5.\\nFig. 6.\\nLith. AnstF Rsichhold. Munch en", "height": "4589", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0429.jp2"}, "430": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0430.jp2"}, "431": {"fulltext": "SYMPTOMS\u00e2\u0080\u0094 DIAGNOSIS.\u00e2\u0080\u0094 TREATMENT. 245\\nvery bloody, and, in contrast to carcinoma, not offensive\\nuntil late in the disease. Pain first appears with the dila-\\ntation of the os uteri. Metastases to the lung cause dyspnea\\nand cyanosis. Anemia is present if the hemorrhages are\\nsevere.\\nDiagnosis. Enlargement of the uterus (see Plate 87)\\nwith or without dilatation of the os uteri. If the os is\\nintact, dilate and palpate the uterine cavity villous poly-\\npoid excrescenses are present. Microscopic examination\\nof cureted pieces. If the fibrous character of the tissue\\nrenders its nature doubtful, look especially for giant\\ncells. (See Plate 73, Fig. 2.) It is to be remembered\\nthat afibromyoma may undergo sarcomatous degeneration.\\n(See Differential Diagnosis, 34.)\\nTreatment. If mucous, excochleation if the uterus\\nis enlarged, total extirpation. If too far advanced, symp-\\ntomatic as in carcinoma.\\nI 38. MALIGNANT TUMORS OF THE ADNEXA, ESPE=\\nCIALLY OF THE OVARIES.\\nI. Carcinoma.\\nCarcinoma of the ovary occurs in various forms: (1) Solid papil-\\nlary; (2) a form resembling the papillary eystadenomata, but more\\nsolid: (3) a form resembling the multilocular eystadenomata, but with\\nareas of softening; (4) metastases from a uterine carcinoma, diffuse\\nnodules in the enlarged ovary (very rare).\\nAnatomy. The ovaries are disposed to carcinomatous\\ndegeneration, not infrequently at the age of puberty\\n(Olshausen).\\nSymptoms. Nonappearance of the menses, ascites\\nand peritoneal phenomena, early cachexia, and metastases\\nwith disturbances of the circulation in the lower extremi-\\nties. Stenosis of the rectum. (See Plate 59, Fig. 4.)\\nDiagnosis. An enlarged, rapidly growing ovary, or\\nascites with a previous pure glandular cystoma. Explor-\\natory incision and demonstration of nodules, and multiple,", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0431.jp2"}, "432": {"fulltext": "246 MALIGNANT TUMORS OF THE ADNEXA.\\nPLATE 89.\\nFig. 1. Cancer Nodules in the Cervix, Which Has Not Yet\\nUlcerated. The os uteri is closed; the anterior lip is thickened from\\nthe carcinoma tons infiltration. (See also Plates 80, 82, 83.)\\nFig. 2. Epitheliomatous Ulcer of the Cervix. The os nteri is\\nclosed. (See Plate 85.)\\nFig. 3. Epitheliomatous Ulcer of the Cervix Which Has\\nInvaded the Uterine Body. The os nteri is destroyed.\\nFig. 4. Carcinoma of the Body of the Uterus Which Has\\nPerforated into the Bladder. (Plate 86, Fig. 1. The os nteri is\\nintact.\\nFig. 5. Epitheliomatous Ulcer of the Cervix Which Has\\nPerforated into the Bladder. The fundus of the nterus is intact;\\nthe os is destroyed.\\nFig. 6. Epitheliomatous Ulcer of the Cervix Perforating\\ninto Both Bladder and Rectum. (Plate 86, Fig. 2.\\ndiffuse, papillary, excrescences in and upon the peri-\\ntoneum.\\nTreatment. Extirpation, if limited to the ovary if\\nthe growth is not so localized, violent pressure symptoms\\ndemand tapping or the formation of an artificial anus.\\nGlandular carcinomata of the tubes are very rarely primary, and,\\nas such, are impossible to diagnose.\\nPLATE 90.\\nFour Tumor=Iike Changes at the External Os.\\nFig. 1. Fungous Endometritis and Ectropion. (See Plates\\n30, 31, 56. Cystic dilated glands in the cervical mucosa.\\nFig. 2 \u00e2\u0080\u0094Epitheliomatous Papilloma of Both Lips of the Os.\\n(See Plates 81, 84, 85.)\\nFig. 3. Ovules of Naboth in a Mucous Polyp, Visible at the\\nOs Uteri. (See Plates 29, 56.\\nFig. 4. Fibroid Polyp Separating the Lips of the Os Uteri,\\n(See Plate 60, Fig. 2.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0432.jp2"}, "433": {"fulltext": "Tab. 89.\\nIig.l.\\nFi f.3.\\nFig. 4%\\nFig. 5.\\nFig. 6.\\nLitJi. AnstE Reidihoid, Mindvm", "height": "4594", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0433.jp2"}, "434": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0434.jp2"}, "435": {"fulltext": "Tab. 90.\\nTit/ J.\\nFig.J.\\nFia.2.\\nFig. 4-.\\nLilh Aast F. Reichhald. Miinche-n.", "height": "4589", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0435.jp2"}, "436": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0436.jp2"}, "437": {"fulltext": "SARCOMA. 247\\nII. Sarcoma.\\nThese are visually spinclle-cell tumors in early life, combined with\\ndeposits of round cells and degenerations of a myxomatous or carcino-\\nmatous character. They grow slowly, and their diagnosis and treat-\\nment are the same as those of ovarian fibromata. (See ^33 and 35.\\nSarcomata also occur in the ligaments.\\nEndothelioma^ angiosarcoma^ may grow to a considerable size\\nand show a decidedly malignant character. They have a cavernous\\nstructure; the tissue is usually myxomatous.\\nThe treatment is generally hopeless, as total removal is usually\\nfruitless, even when carried out at the first appearance of symptoms.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0437.jp2"}, "438": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0438.jp2"}, "439": {"fulltext": "THERAPEUTIC TABLE.\\n1. Absorbents. Sapo medicatus, potassium iodid, tinct. iodi, iodin\\nglycerin, ichthyol, hot vaginal douches, mud-baths, brine-\\nbaths, hot sand-baths.\\nAcids\\n2. Acetic Acid (Pyroligneous Acid). 1 3 or concentrated. To be\\napplied through the speculum (with 3 to 4% carbolic acid) every\\ntwo or three days for weeks and months; erosions; cervical\\ncatarrhs.\\n3. Boric Acid.--2 to 3%. In cystitis, urethritis 2 to 4 injections\\ndaily.\\n4. Boric Acid Vaselin.\u00e2\u0080\u0094 5 20, for pruritus.\\n5. Carbolic Acid. J to 2%, in vaginitis, endometritis. 2 to 5%,\\nin vulvitis. 3 to 5% or concentrated, to wipe out the uterine\\ncavity, multiple recurrent polyps, fistulas.\\n6. Carbolic Acid.\u00e2\u0080\u0094 2%. Subcutaneously, J to 2 syringefuls in lu-\\npus, erysipelas.\\n7. Carbolic Acid Glycerin. 2 to 4%, endometritis, metritis.\\n8. Carbolic Acid Intoxication.\u00e2\u0080\u0094 Small doses of opium, morphin,\\nice, milk, soluble sulphates.\\n9. Chromic Acid.\u00e2\u0080\u0094 25 to 33%, as a caustic for condylomata,\\n10. Chromic Acid. 33%, in fistulas, endometritis (every week).\\n11. Fuming Nitric Acid. As a caustic in lupus, fistulas, endome-\\ntritis, one drop upon cotton every four to five days. It acts\\nmost promptly when immediately followed by the application\\nof liquefied carbolic acid.\\n12. Salicylic Acid.\u00e2\u0080\u0094 1 to 5 1000, in pruritis, vaginitis, cystitis.\\n1.0 to 5.0 (gr. xv to gr. lxxv) salicylic acid powder are dissolved\\nin alcohol, and added to one liter of lukewarm water (irrigator)\\nit is not caustic.\\nSalicylic Acid Vaselin (Lanolin, Mollin). 1 300, for pruritus.\\n13. Tannic Acid. 0.3 (gr. v), intra-uterine pencil for endometritis.\\n(See Intra-uterine Pencils.\\n14. Tannic Acid Vaginal Suppositories.\u00e2\u0080\u0094 0.4 (gr. vj) with 3.0\\n(gr. xlv) cacao-butter in blenorrhea,\\n249", "height": "4593", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0439.jp2"}, "440": {"fulltext": "250 THERAPEUTIC TABLE.\\n15. Aloes Extract. Ext. rhei comp., aa 3.0 (gr. xlv). Ft. in pil.\\nNo. xxx, two pills daily. Laxative, emmenagog.\\n16. Althea Decoction. Injection for vaginitis, acute endometritis,\\nacnte myometritis.\\n17. Alum in Intrauterine Pencils. 0.3 (gr. v), 4 cm. long, 0.2 to\\n0.4 cm. thick, with gnm arabic and glycerin, in endometritis.\\n18. Alum Solution. 1 to 3 to 6%, as injection or npon tampons in\\nvaginitis, vaginal inversion. Iodoform gauze is saturated with\\nthe solution, and renewed every three hours in acute vaginal\\ngonorrhea.\\n19. Alum Vaselin (Lanolin, Mollin). 2 to 4 :50, in pelvitis, vagin-\\nitis, vaginal inversion.\\n20. Aluminum Acetate Solution. 10 to 20%, astringent vaginal\\ninjection. 2 to 5%, intra-uterine application.\\n21. Antipyrin. 0.5 to 1.0 (gr. viij-xv), in pill, every two hours (6.0\\n3iss pro die), for menstrual molimina, dysmenorrhea, pain,\\nfever.\\n22. Antipyrin. 2.0 (gr. xxx), in solution, as an enema. Also used\\nsubcutaneously, 1:2; the syringe must be carefully cleaned after\\neach injection to prevent the precipitation of antipyrin crystals.\\n23. Antispasmodics. (See Antipyrin, Chloral, Chloroform, Mor-\\nphin, Opium, Ext. Yiburn. Prunifol. Fid.)\\n24. Applications and Fomentations. Priessnitz, for paralysis\\nof the vesical sphincter, peritoneal irritation, acute corporeal\\nendometritis, oophoritis.\\nBrine. In myoma ta, chronic parametritis, perimetritis, me-\\ntritis, and oophoritis.\\nHot Water. In menorrhagia, dysmenorrhea, combined with\\nhot alcohol.\\nLead-water. (See Same.)\\n25. Argent. Nitrat. 2% solution, in endometritis, ulcerations of\\nthe vaginal cervix, urethritis; to be applied or injected (every\\nweek); or 0.2 to 0.5 1000 to be injected from 4 to 6 times\\ndaily.\\n26. Argent. Nitrat.\u00e2\u0080\u0094 1 to 2 to 6 1000, in cystitis.\\n27. Argent. Nitrat. 5 to 10 to 20% or solid stick, in pruritus,\\nvaginitis, fistulas; applied every week.\\n28. Argentamin. Specific for older cases of gonorrhea: 1 to 2%,\\nintra-uterine; 5%, in the vagina.\\n29. Argonin. Specific for gonorrhea: 3 to 5%, intra-uterine; 2%,\\nvesical irrigation; 5 to 10%, vaginal irrigation.\\n30. Astringents. Alum, aluminum acetate solutions, cupric sul-\\nphate, decoctions of oak-bark, formalin, glycerin, lead-water,\\ntannin.\\n31. Bathing Resorts. Mud-baths (absorbent), Teplitz, Franzens-\\nbad, Kissingen, Elster and Mattoni s mixture (5 liters to the", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0440.jp2"}, "441": {"fulltext": "THERAPEUTIC TABLE. 251\\nbath) in metritis, parametritis, and perimetritis, chronic oophor-\\nitis, hematocele.\\nBrine-baths. Kreuznach, Tolz, Xauheirn, Ki sen, Ocynhausen.\\nHall (upper Austria), Heilbronn, or artificially produced\\nby adding from 10 to 20 pounds of lye or sea-salt to the\\nwarm bath. Applicable in myomata. scrofula, vulvitis,\\nmetritis, chronic parametritis, and perimetritis (one-half to\\none and one-half hours in duration, followed by one hour s\\nrest).\\nFor Anemia: Briickenau, Triburg, Elster, Franzenshad, Pyr-\\nmont, Schlangenbad, Schwalbach, St. Moritz, Wildbad.\\nHot Sand-baths. Blasewitz near Dresden, Ki stritz near Gera.\\nApplicable for same affections as mud-baths. May be\\nreplaced by thermaphore.\\nIodin Baths. Kreuznach, Tblz, Hall, in scrofula.\\nSea-baths. In nocturnal enuresis, scrofulous vulvitis, menor-\\nrhagia.\\nFor Vesical and Renal Disease: Carlsbad, Wildungen (0.5\\n(gr. viij) sodium salicylate with 0.015 (gr. i morphin to J\\nof a liter, in cystitis Xeuenahr, Assmannshausen, Ober-\\nsalzbrunn, Vichy, for menorrhagia from nephritis.\\n32. Baths.\u00e2\u0080\u0094 Warm baths, 95\u00c2\u00b0 to 100\u00c2\u00b0 F. (one-quarter to one-half\\nhour), in paralysis of the vesical sphincter, uremia (carcinoma-\\ntous), oophoritis, acute endometritis, chronic metritis, and\\nsubinvolution.\\nFoot-baths (100\u00c2\u00b0 F.), with 1 to 3 tablespoonfuls of salt or\\nmustard once or twice daily in oligorrhea, amenorrhea,\\nanemic dysmenorrhea.\\nSitz-baths (90\u00c2\u00b0 to 100\u00c2\u00b0 F.). with wheat bran I to 1 pound),\\ndecoctions of oak-bark (7 to 10 fo), one and a half to two\\nhours, in pruritus, urethritis.\\nSitz-baths, with tannin or alum [2% sea-salt or lye (1 pound\\nto 2 bucketfuls of water), as before, in dysmenorrhea,\\namenorrhea, urethritis, pruritis. parametritis, and perime-\\ntritis (ten to twenty minutes in the beginning).\\n33. Belladonna Extract. As rectal or vaginal suppository 0.02\\n(gr. J) with 3.0 (gr. xlv) cacao-butter, in rectal and vesical\\ntenesmus, dysmenorrhea, endometritis, and myometritis, neu-\\nroses of the uterus and vagina.\\n34. Belladonna Tinct. 20 drops t. i. d. (with potassium brornid,\\n0.3 (gr. v), in nocturnal enuresis.\\n35. Belladonna vaseiin (Lanolin, Mollin). 1 to 2:50, in pru-\\nritus.\\n36. Bismuth Subnitrate. Intra-uterine pencils (0.2, gr. iij), in en-\\ndometritis.\\n37. Bismuth Subnitrate Solution. 2 to 3j\u00c2\u00a3, astringent intra-\\nuterine application.\\n38. Bismuth Subnitrate Ointment. 10 in eczema, herpes.\\n39. Bismuth Talcum. Dusting-powder for profuse secretion.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0441.jp2"}, "442": {"fulltext": "252 THERAPEUTIC TABLE.\\n40. Bromin Alcohol. 20%, hemostatic injection in carcinoma.\\n41. Byrolin=boric Acid LanoIin=glycerin. Good salve for the\\nhands.\\n42. Caffein Citrate. 0.1 (gr. iss) (with lactophenin, sacchar. alb.,\\naa 0.5, gr. vij), for hemicrania.\\n43. Caffein Sodium Benzoate.\u00e2\u0080\u0094 0.2 (gr. iij), t. i. d., in migraine.\\n44. Calomel. 0.25 (gr. iv) (with sacchar. alb., 0.5, gr. viij) several\\ntimes daily, or 0.5 (gr. viij) at one dose, as a laxative, in acute\\nperitonitis, parametritis, and metritis. To be followed by from\\n15 to 20 drops tinct. opii; later, 0.05 to 0.1 (gr. f to iss).\\n45. Camphor. 1.0 (gr. xv), ol. amygd. dnlc, 9.0 ^ij), subcutane-\\nously in collapse.\\n46. Camphor, Monobromate.\u00e2\u0080\u0094 0.1 to 0.3 (gr. iss to v) with sacchar.\\nalb., 0.5 (gr. viij), three times daily in hysteric conditions of ir-\\nritability.\\n47. Carlsbad Salts. 1 to 3 teaspoonfuls on rising, in a glass of luke-\\nwarm water, as a laxative.\\n48. Cascara Sagrada. Ext. fid., syr. zingiberis, aquae, aa 10.0\\ngiiss), a teaspoonful twice daily, as a laxative.\\n49. Catheter, Permanent. 15 to 30 cm. long, 0.6 to 0.7 cm. thick;\\nleft in position for three days it is to be well sterilized\\n50. Catheterization. Before every operation, after perineoplasty,\\nin paralysis of the vesical sphincter, incontinence of reten-\\ntion.\\n51. Caustics. (See Fuming Nitric Acid; Argent. Nitratis, 2 to 20%\\nCarbolic Acid, 3%, cone; Chromic Acid, 33%; Zinc Chlorid, 5\\nto 10 to 50 Vienna Paste Solution of Mercurous Nitrate\\nCaustic Potash; Sublimate, 1 1000; Formalin, cone.) The\\nvagina is to be thoroughly irrigated after cauterizing the\\nuterus.\\n52. Caustic Potash \u00e2\u0080\u0094Fistulas, lupus.\\n53. Caustic Potash. 1 300, aq., in severe cases of intertrigo.\\n54. Chloral. By the rectum, 1 to 2 15 (with potassium bromid,\\naa), in rectal and vesical tenesmus, dysmenorrhea, carcinoma.\\n55. Chloral in Rectal or Vaginal Suppositories. 0.5 (gr. viij)\\nwith 3.0 (gr. xlv) cacao-butter, for vesical and intestinal tenes-\\nmus, dysmenorrhea, uterine and vaginal neuroses, carcinoma.\\n56. Chloral Solution. 5 100 (with syr. aurant. cort., 25), to be\\ntaken for the same affections as above.\\nChloral Solution, (With syr. aurant. cort., aa), 15 175 aq.\\none teaspoonful 3 or 4 times daily, in nocturnal enuresis.\\nIt may be combined with potassium bromid.\\n57. Chlorin Water. (and aq. dest., aa 50.0 (giss) with 1.0 (gr.\\nxv acid, hydrochlor. one tablespoonful every two hours in\\nmeteorism, peritonitis, diarrhea.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0442.jp2"}, "443": {"fulltext": "THERAPEUTIC TABLE. 253\\n5?. Chloroform Narcosis. Chloroform, 3: sulphuric ether, 1; ab-\\nsolute alcohol, 1 (Billroth). Chloroform -J- ether (1:2)\\nYieuua mixture.\\n59. Chloroform and 01. Hyoscyami, aa 10.0 (giiss). Inunction in\\npruritus; upon tampons for the pain from carcinoma, peri-\\nmetritis and parametritis, oophoritis.\\n60. Cocain Hydrochlor.\u00e2\u0080\u0094 5 to 10 solution or ointment as a local\\nanesthetic, in pruritis (alternating with 10 to 20 r r argent, ni-\\ntrat. vaginismus, uterine and vaginal neuroses, dysmenorrhea.\\nCocain Hydrochlor. to 1 1000, as injection, in cystitis.\\nCocain Hydrochlor. 0.01 to 0.2 in 0.2 V Nad solution for\\nSchleich s infiltration anesthesia.\\nCocain Hydrochlor. In rectal or vaginal suppositories 0.1\\n(gr. issj to 3.0 (gr. xlv) cacao-butter, in vesical and rectal\\ntenesmus, carcinoma.\\n61. Colocynth. Ext.\u00e2\u0080\u0094 0.005 to 0.02 (gr. T to J), as a drastic\\ncathartic.\\n62. Condurango Decoction. 12 175, in carcinomatous dyspepsia.\\n63. Cornutin Citrate.\u00e2\u0080\u0094 0.003 to 0.005 (gr. oV to T K), in pill, twice\\ndaily, in metrorrhagia.\\n64. Cupric Aluminat. 1.0 to 5.0 1 liter of water, in endometritis.\\n65. Cupric Sulphate. J to 2% injection or upon tampons, in metror-\\nrhagia: 1 1000, in endometritis.\\n66. Cupric Sulphate Vaselin or Zinc Sulphate Vaselin. 2 to\\n3 to 5 50 to 75, on tampons, in metrorrhagia.\\n67. Dermatol, as a dusting-powder after plastic operations.\\n68. Diaphoretics. Ammonium chlorid solution (5 200), liq.\\namnion, acetat. (1 to 2 teaspoonfuls in elderflower or chamo-\\nmile tea\\n69. Diet in Anemia. (See 3, under 7, Treatment.)\\n70. Digitalis Inf. 2 180, syrupi 20, one teaspoonful every two\\nhours (with potassium nitrate 10.0 giiss), in menorrhagia\\nfrom cardiac disease.\\n71. Disinfection of the Hands. (See 34. under Treatment.) In\\noffice practice the hands must be scrubbed with alcohol and\\n1 2000 sublimate, especially if they have come into contact\\nwith discharges. Instruments (specula, sounds) are to be well\\nboiled each time they are used.\\n72. Diuretics. Potassium nitrate, urotropin. (See under Digitalis\\nin Pelvic Peritonitis.\\n73. Douches, Hot. See Vaginal Injections.\\n74. Dry Cups. In oligomenorrhea, dysmenorrhea.\\n75. Emollients. Linseed decoctions, oatmeal water, althea decoction,\\nstarch.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0443.jp2"}, "444": {"fulltext": "254 THERAPEUTIC TABLE.\\n76. Enemata for Hemorrhage. 0.6 ft warm NaCl solution (2 liters\\nor more) alcohol, wine.\\n77. Enemata of Oil. In intestinal and vesical tenesmus. (See\\nTinct. Opii, Emollients, and Injections, Kectal.)\\n78. Enemata (Purgative). J to 1| liters of lukewarm mucilaginous\\nor oily fluid, or of water with or without salt, soap, glycerin, or\\nsenna (5.0 gr. lxxv to the cup).\\n79. Ergotin. (See Secale Cornutum.)\\n2.0 (gss) with aq. dest. 8.0. 3 i j and acid, carbolic, fid.\\ngtt. j, one syringeful daily (three to six times a week); 0.2\\n(gr. iij), in menorrhagia, metrorrhagia, myomatosis.\\n80. Ergotin.\u00e2\u0080\u0094 2.5 (gr. xxxviij) with aq. dest, 15.0 (3 iij) and acid.\\nsalicyl. 0.05 (gr. f); 1 to 2 syringefuls 0.15 to 0.3 (gr. ij-\\nivss as in above affections.\\n81. Ferric Chlorid Solution. 20 to 50% or concentrated, applied\\nupon cotton to the interior of the uterus by means of the\\naluminum sound; or, upon tampons or injected, in multiple\\nrecurrent sessile polypi, menorrhagia, carcinoma, Werlhof s dis-\\nease, myomata.\\n82. Ferric Chlorid Solution.\u00e2\u0080\u0094 1 800, injected into the bladder in\\nhematuria ferripyrin is better.\\n83. Ferripyrin. In powder or solution, 1 5, as a hemostatic.\\n84. Formalin (35% formaldehyd solution). 1 2 to 3 parts of\\nwater, 1 tablespoonf ul to a liter of water, as a vaginal and intra-\\nuterine irrigation. Undiluted as a caustic agent.\\n85. Frangula Cortex. Add 1 tablespoonful to 3 cups of water, and\\nevaporate to 2 cups; or\\n86. Frangula Decoctions. 25.0 55 viss) 180.0 (f 3 vj with sodium\\nsalicylate 5.0 (gr. lxxv) and sodium sulphate 20.0 (,^v). A\\nwineglass of this mixture is given morning and evening as a\\nlaxative. The fluid extract is given in doses of from 20 to 40\\ndrops.\\n87. Gelatin Injections. Intra-uterine, as a hemostatic.\\n88. Hemostatics. Ferripyrin, ferric chlorid solution, aluminum\\nacetate solution, gelatin emulsion.\\nIodoform gauze tampon galvanocautery, Pacquelin s cautery,\\nactual cautery, atmocausis (in operations for carcinoma and\\nmyoma); bromin alcohol (carcinoma).\\n89. Hydrarg., Ung. 1.0 to 8.0 (gr. xv to gij) pro die, with equal\\npart of vaselin, inunctions, every two hours for a week, in peri-\\ntonitis.\\n90. Hydrastis Canad. Ext. Fid. 15 to 25 drops, four times daily,\\nfor months, in menorrhagia (especially if ovarian).", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0444.jp2"}, "445": {"fulltext": "THERAPEUTIC TABLE. 255\\n91. Hydrastinin Hydrochlor. 0.05 (gr. f) in pill, three times\\ndaily; or 10% solution, J to 2 syringefuls( subcutaneous )pro die.\\n92. Hyoscyami, Oleum. As inunction. (See Chloroform.\\n93. Hyoscyami Ext. 1.5 (gr. xxiij) with aq. amygd. am. 150.0\\n(f gv), 15 drops, four times daily, in uterine and vaginal neu-\\nroses, vesical and intestinal tenesmus, dysmenorrhea.\\nHyoscyamus Injections. 15 1000, in vaginitis, dysmenorrhea.\\n94. Hysteria. Asafetida; ext. cannabis indica; lactophenin, 0.5 to\\n1.0 (gr. vij to xv salophen, 1.0 (gr. xv); salipyrin, 1.0 (gr.\\nxv phenacetin, 0.5 to 1.0 (gr. vij to xv); antipyrin, 0.5 to\\n1.0 (gr. vij to xv), also by the rectum; monobromated camphor;\\ncastoreum chloral chloroform belladonna cocain hyos-\\ncyamus potassium bromid morphin opium nor. chamo-\\nmillse fol. menth. pip. valerian.\\n95. Ice=bag. In acute oophoritis, peritonitis, parametritis, metritis,\\nhematocele, erysipelas, uremia (carcinomatous).\\n96. Ice, Cracked. In vomiting.\\n97. Ichthyol. For the exanthemata seen with amenorrhea.\\n98. Ichthyol. 10% solution in water or glycerin, in vulvitis, pru-\\nritus, parametritis, hematocele.\\n99. Ichthyol or Ammonium Sulpho=ichthyoIate Vaselin (Lan-\\nolin, Mollin, Glycerin). 10%, in chronic perimetritis, para-\\nmetritis, oophoritis, vulvitis, hematocele; 10% with green soap,\\nupon the abdomen for peritoneal exudate.\\n100. Ichthyol in Intrauterine Pencils. 0.2 (gr. iij), in endo-\\nmetritis.\\n101. Intrauterine Pencils. With gum arabic and glycerin (4 cm.\\nlong, 0.2 to 0.4 cm. thick). (See Alum, Bismuth Subnitrate,\\nIodoform (90%) Itrol Protargol, Ferric Chlorid Solution,\\nTannin, Zinc Oxid, Zinc Chlorid.) Iodoform may be added\\nto them all.\\n102. Injections.\u00e2\u0080\u0094 Into the Bladder (82\u00c2\u00b0 to 88\u00c2\u00b0 F.), one cup of oat-\\nmeal water with 15 to 25 drops of laudanum, in vesical spasm.\\nInto the bladder in cystitis to 1 liter, 1 to 3 times daily,\\n90\u00c2\u00b0 to 95\u00c2\u00b0 F. (See Argent. Nitrat., Boric Acid, Cocain, Lime-\\nwater, Saline Solution, Tannin.\\nInto the Vagina.\u00e2\u0080\u0094 Hot (115\u00c2\u00b0 to 130\u00c2\u00b0 F.), several liters 2 to\\n3 times daily, or every two hours in menorrhagia, metror-\\nrhagia, myomatosis (for the hemorrhage and as an absorb-\\nent) to soften the cervix (in dilatation), in chronic in-\\ndurated parametritis and perimetritis, chronic oophoritis,\\nchronic metritis (during the menses also). They are also\\nused when the uterus is infantile, or when it is under-\\ngoing involution. Into the vagina 82\u00c2\u00b0 to 88\u00c2\u00b0 F., several\\ntimes daily astringents, antiseptics (carbolic acid, lysol,\\npotassium permanganate, salicylic acid, sublimate), or\\nemollients in beginning metritis.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0445.jp2"}, "446": {"fulltext": "256 THERAPEUTIC TABLE.\\nVaginal injections of brine in chronic metritis are best given\\nin the full or sitz-bath (5 to 8 liters, 111\u00c2\u00b0 to 118\u00c2\u00b0 F.\\nInto the Uterus. By means of Braun s syringe (drop by\\ndrop), the two-way catheter; or permanent irrigation by\\nmeans of an elastic catheter, which is held in the uterine\\ncavity by a rubber cross-piece.\\nRectal Injections. (See Chloral, Glycerin, Narcotics, Saline\\nSolution, and also Enemata.\\n103. lodin Glycerin.\u00e2\u0080\u0094 10 200, upon tampons, for above affections.\\n104. Iodin, Tincture. Applied to the abdomen, cervix, and vaginal\\nvault in corporeal carcinoma, chronic metritis, parametritis,\\nperimetritis, and oophoritis.\\n105. Iodoform Emulsion, or Iodoform Glycerin.\u00e2\u0080\u0094 10%, in cor-\\nporeal carcinoma, endometritis.\\nIodoform Vaselin (Lanolin, Mollin). 10 to 20%, in vulvi-\\ntis, pruritus, oophoritis, parametritis, and perimetritis\\n(upon tampons).\\n106. Iodoform Gauze, 10 to 20%, intra-uterine tamponade (for\\ntwenty-four hours), vaginal tamponade (at first, for six hours\\nlater, from twelve to twenty-four hours), in menorrhagia,\\nmetrorrhagia, hemorrhages from myomata and carcinomata.\\nIt is also used to dilate the cervix and in endometritis.\\n107. Iodoform Intrauterine Pencils. 90%, 4 cm. long, 0.2 to\\n0.4 cm. thick in acute (puerperal) and chronic endometritis.\\nIn puerperal endometritis they are to be made 6 cm. long and\\n0.4 to 0.6 cm. wide; in inflammations of the vulva and vagina\\nin children, they are to be made 5 to 8 cm. long.\\n108. Ipecac. 1.0 (gr. xv) every ten minutes, until vomiting is pro-\\nduced. Dover s powder, 0.3 (gr. v), several times daily, in\\ndysmenorrhea, dyspepsia.\\n109. Itrol. Excellent dusting-powder for wounds and ulcers 1 4000\\nto 5000 for intra-uterine and vaginal irrigation. It is also\\nused as a bougie (3% to 10%) and as a salve (3% to 10%) in\\nsepsis (instead of blue ointment).\\n110. Krameriae Ext. 4 50, upon tampons, in vaginitis it is not\\npainfully astringent. It is also used in intestinal catarrh.\\n111. Lactophenin. 0.5 to 1.0 (gr. viij to gr. xv), several times\\ndaily (with 0.1 gr. iss\u00e2\u0080\u0094 caffein), in neuralgia.\\n112. Laminaria. As intra-uterine tamponade, in metrorrhagia, men-\\norrhagia, to dilate the cervix. They are to be previously care-\\nfully disinfected for fourteen days in 5% carbolic acid solution,\\n10% iodoform-ether, or 1% corrosive sublimate alcohol. They\\nare left in situ twenty-four hours.\\n113. Largin. Specific for gonorrhea used like protargol, (See p.\\n99.)", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0446.jp2"}, "447": {"fulltext": "THERAPEUTIC TABLE. 257\\n114. Lassar s Paste Sulph. prec. 50.0 (|iss) with /3-naphthol\\n10.0 3 iiss) and lanolin, saponis viridis, aa 25.0 3 viss) This\\nis to be rubbed into a smooth paste. It is applied for acne.\\n115. Laxatives (in the Order of Their Efficiency). Enemata\\n(see the same), senna infusion by the rectum calcined mag-\\nnesia, with or without sulphur citrate of magnesia compound\\nlicorice powder castor oil decoctions of frangula wine of\\ncascara sagrada calomel .tamarind (Grillon) Carlsbad salts\\ntincture of cascara sagrada various waters, such as Kissingen,\\nFriedrichshall, Carlsbad, etc. powdered rhubarb with aloes\\ninfusion of senna compound extract of colocynth by the mouth.\\nDietetic Fruit boiled kefir, whey, buttermilk, in chronic\\nperimetritis, dysmenorrhea, oophoritis, metritis, and para-\\nmetritis.\\n116. Lead Acetate. One teaspoonful to one cup of water lead-\\nwater (2 to 5 teaspoonfuls to a liter of lukewarm water), in\\npruritus, vulvitis, vaginitis, erysipelas.\\n117. Lime= water. Used in full strength, for irrigation in cystitis;\\nor 25.0 in 500.0 milk internally.\\n118. Linseed Decoctions. In vaginitis, cystitis, acute endometri-\\ntis, and metritis.\\n119. Magnesia, Calcined.\u00e2\u0080\u0094 TO to 2.0 (gr. xv to gr. xxx), 1 to 3\\ntimes daily, as a laxative.\\n120. Massage. In oligomenorrhea, infantile uterus, chronic para-\\nmetritis and perimetritis, ovarian adhesions.\\n121. Menthol Spirit. b% in pruritus of the vulva, urticaria, and\\npruriginous exanthemata the result of amenorrhea.\\n122. Mercuric Chlorid. 1 2000, intra-uterine injection, in mul-\\ntiple recurring uterine polypi, endometritis; 1 5000, in ure-\\nthritis.\\n123. Mercuric Chlorid.\u00e2\u0080\u0094 1 to 2 1000, in vulvitis, pruritus.\\n124. Mercuric Chlorid.\u00e2\u0080\u0094 to 1 1000, in vaginitis.\\n125. Mercurous Nitrate.\u00e2\u0080\u0094 Caustic for catarrh of the cervix.\\n126. Morphin Hydrochlorate.\u00e2\u0080\u0094 0.2 to 10.0 (gr. iij, to f 3 iiss) aq.\\ndest, to J to 1 syringeful hypodermically 0.005 to 0.01\\nto 0.02 (gr. ^3 to i to i) morphin hydrochlorate, in vesical\\nspasm, carcinoma.\\n127. Morphin Hydrochlorate (Powder).\u00e2\u0080\u0094 0.01 (gr. with sacch.\\nalb. 0.5 (gr. viij), in menstrual molimina, dysmenorrhea,\\nuterine neuralgia, vesical spasm, and as a hypnotic in car-\\ncinoma.\\n128. Morphin Suppositories (Rectal or Vaginal).\u00e2\u0080\u0094 0.02 (gr.i)\\nwith 2.5 (gr. xxxviij), cacao-butter, for same affections as the\\npreceding.\\n129. Morphin Vaseljn (Lanolin, Mollin).\u00e2\u0080\u0094 1.0 to 2.0 (gr. xv to gr.\\nxxx) 50.0 5iss) in pruritus.\\n17", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0447.jp2"}, "448": {"fulltext": "258 THERAPEUTIC TABLE,\\n130. Narcotics (in the Order of Their Efficiency). Hyoscyainus\\n(with chloroform) as an injection; ext. belladonna, in rectal or\\nvaginal suppositories; cocain, to be administered in the same\\nmanner; laudanum, by the rectum; chloral potassium\\nbromid), by the rectum; antipyrin. by the mouth or rectum;\\nmorphin, by the mouth, by the rectum, or hypodermically.\\nHypnotics: Sulphonal, trional, potassium bromid, codein,\\nchloral, morphin.\\n131. Nosophen. Antiseptic and desiccating dusting-powder for\\nwounds.\\n132. Oak=bark Decoctions.\u00e2\u0080\u0094 10 to 20 250, in vaginal inversion,\\nvaginitis.\\n133. Oatmeal Water. (See under Injections into the Bladder in\\nCystitis; and under Injections into the Vagina in Vaginitis,\\nAcute Endometritis, and Myometritis.\\n134. Obesity Cures. Banting, Oertel, Epstein. Mendelsohn; used\\nwhen the panniculus adiposus is excessively developed a\\ncause of menorrhagia.\\n135. Oleum Ricini. 2 to 3 capsules, one tablespoonful several times\\ndaily.\\n136. Oophorin. For menstrual molimina; after removal of the\\novaries.\\n137. Opium. Laudanum, 15 to 25 drops, by the rectum or upon vag-\\ninal tampons in menstrual molimina. dysmenorrhea, oophor-\\nitis, metritis, parametritis, perimetritis, carcinoma, hemato-\\ncele, peritonitis.\\nOpium: Extract of opium 0.2 (gr. iij) with emuls. amygd.\\ndulc. 150.0 (f\u00c2\u00a7v), one tablespoonful every two hours\\n(mixture only keeps a day!), in carcinoma, intestinal\\ncatarrh, acute metritis, pelvic peritonitis.\\n138. Phenacetin. 0.5 to 1.0 (gr. viij to gr. xv) t. i. d., for neuralgia.\\n139. Potassium Bromid. In powder (1.0 gr. xv once or twice\\ndaily) or solution (15 175, 2 to 4 tablespoonfuls daily), in\\nnocturnal enuresis, uterine neuralgia, dysmenorrhea, oophori-\\ntis, hysteria, pruritus.\\n140. Potassium Carbonate Solution. In folliculitis of the vulva\\n1 c /c solution for boiling instruments.\\n141. Potassium Iodid. In vaginal suppositories, 0.2 to 0.5 (gr. iij\\nto gr. viij)., with 3.0 (gr. xlv) cacao-butter, in parametritis,\\nperimetritis, metritis, uterine and vaginal inversion, oophoritis,\\nhematocele.\\n142. Potassium Iodid=glycerin. 10 to 15 200, upon tampons\\n(may add 15 to 20 drops of laudanum), for the affections just\\nmentioned above.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0448.jp2"}, "449": {"fulltext": "THERAPEUTIC TABLE. 259\\n143. Potassium Iodid=vaselin (Lanolin, Mollin). 3 to 10% in\\npruritis, vaginismus, acute (puerperal metritis, and para-\\nmetritis.\\n144. Potassium Permanganate. Dark cherry-red solution, as an\\nirrigation fluid in foul carcinomata. Given as an emmenagog,\\nin pill form (0.5 gr. viij in a pill, 2 or 3 pills thrice daily).\\n145. Protargol. 0.5 to 2.5 (or even o}%, intra-uterine irrigation;\\n5%, vaginal irrigation; 1 to 2.5%, vesical irrigation. Protar-\\ngol with glycerin or salve, 5 to 10% intra-uterine (or as a\\nbougie), in urethritis. Used in vaginal tamponade 7/ is a\\nspecific for gonorrhea (Xeisser).\\n146. Quinin, Compound Tincture.\u00e2\u0080\u0094 20 drops to a half-teaspoonful,\\nthrice daily, in anemia, uremia, dyspepsia.\\n147. Quinin=iodin. Dusting-powder, in foul carcinomata.\\n148. Rhubarb, Infusion of Root.\u00e2\u0080\u0094 5.0 to 15.0 180.0 (gr. lxxv to\\nf^ivif^vj) with sulphate of sodium 10.0 (gr. iiss) and\\nelgeosacch. menth. piperit.. 5.0 (gr. lxxv), 2 tablespoonfuls\\nevery two hours as a laxative.\\n149. Rhubarb, Powdered Root. Used as a laxative.\\n150. Sagrada, Wine. J teaspoonful. as a laxative.\\n151. Saline Infusion.\u00e2\u0080\u0094 0.6$ XaCl solution, h to 1 liter (sometimes\\nmore), intravenous or subcutaneous injections.\\n152. Saline Solution. 5 fir, in cystitis, especially after injections of\\nsilver nitrate.\\n153. Salol. 1.0 to 2.0 (gr. xv to xxx), 3 or 4 times daily, in cystitis.\\n154. Santonin.\u00e2\u0080\u0094 Troches or pills, 0.025 to 0.05 to 0.1 (gr. f to f to\\niss 3 times daily, with laxatives to prevent xanthuria as an\\nemmenagog and anthelmintic.\\n155. Secale Cornut., Aqueous Extract. 15.0 175.0 Jjiv g vss)\\nwith dilute sulphuric acid 2.5 (gr. xxx viij) and tract, cinna-\\nmomi 15.0 (giv); 1 tablespoonful every fifteen minutes, for\\nacute hemorrhage.\\n156. Secale Cornut., Extract. With pulv. secale cornut., aa 2.0\\n(gr. xxx). Ft. inpil. Xo. xxx 1 pill every two or three hours,\\nin conditions mentioned above.\\n157. Secale Cornut., Ext. Aqueous. 2 to 4 :180( ^ssto 7. j :f \u00c2\u00a3vj)\\naquae with syr. cinnamomi 30.0 (f^j); 1 tablespoonful every\\ntwo hours, in conditions mentioned above and in paralysis of\\nthe vesical sphincter.\\n158. Secale Cornut. Pulv. In vesical or uterine hemorrhage, in\\nmetritis (chronic hyperemia), and after reduction of an in-\\nverted uterus.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0449.jp2"}, "450": {"fulltext": "260 THERAPEUTIC TABLE.\\n159. Sennas Fol., Infusum.\u00e2\u0080\u0094 2 to 4 teaspoonfuls (with 1 teaspoonful\\nof fennel) to 1 cup of water, as a laxative.\\n160. Sinapisms. Mustard plasters and analogous applications; can-\\ntharidal plasters; or two parts of cantharides, dissolved in sul-\\nphuric ether, to one part of a solution of gutta percha in\\nchloroform, to be applied to the cervix Tincture of iodin is\\nalso applied to the cervix. It is painted upon the abdomen in\\ndysmenorrhea, and upon the thigh in amenorrhea.\\n161. Sodium Salicylate. With sacch., aa 0.5 (gr. viij); 1 powder\\nevery two hours, or in solution 0.5 150.0 (gr. viij f v), in\\nneuroses, cystitis, erythemata.\\n162. Strychnin.\u00e2\u0080\u0094 0.005 to 0.0075 to 0.01 (gr. T to i to subcuta-\\nneously, in vesical paralysis.\\n163. Stypticin.\u00e2\u0080\u0094 0.05 (gr. f (6 to 8 tablets daily), or 1 20 aq. cin-\\nnamomi (30 drops 5 times daily), or 1 or 2 syringef uls of a 10\\nsolution subcutaneously.\\n164. Sulphonal.\u00e2\u0080\u0094 1.0, as a somnifacient.\\n165. Sulphur. 2 teaspoonfuls daily precipitated sulphur, powdered\\nrhubarb root, compound licorice powder, aa 7.5 (3ij), as a\\nlaxative.\\n166. Suppositories (Rectal). 2.5 to 3.0 (gr. xxxviij to xlv) cacao-\\nbutter. (See Morphin, 0.01 to 0.02 (gr. J to J); Ext, Bella-\\ndonna, 0.01 to 0.02 (gr. i to J); Chloral, 0.5 (gr. viij); Cocain\\nHydrochlorate, 0.1 (gr. iss).)\\n167. Suppositories (Vaginal). 2.5 to 3.0 (gr. xxxviij to xlv) cacao-\\nbutter. (See Morphin, 0.02 (gr. J); Ext. Bellad., 0.02 to\\n0.03 (gr. J to J); Chloral, 0.5 (gr. viij); Cocain Hydrochlor-\\nate, 0.1 (gr. iss); Potassium Iodid, 0.2 (gr. iij); Tannic Acid,\\n0.4 (gr. vj).)\\n168. Tamarind Decoction.\u00e2\u0080\u0094 8.0 to 50.0:100.0 to 300.0 3 ij to\\niss f ^iiiss to f \u00c2\u00a7x) aquae at one dose, as a laxative. It is\\nalso administered in the form of tamarind paste (Grillon).\\n169. Tampons. Glycerin (in vaginal inversion), vaselin, lanolin, or\\nmollin with tannin, alum, ichthyol. potassium iodid. chloroform\\nwith oil of hyoscyamus, cupric sulphate, zinc chlorid or sul-\\nphate.\\n170. Tannin Solution.\u00e2\u0080\u0094 0.5 to 1.0 100.0 (gr. viij togr. xv f giiiss),\\nin cystitis.\\n171. Tannin Solution. 2 to 4%, in vaginitis, vaginal inversion,\\nvulvitis.\\n172. Tannin Vaselin (Glycerin, Lanolin, Mollin).\u00e2\u0080\u0094 2 to 4 50.0 (^ss\\nt\u00c2\u00b0 Z] \u00c2\u00a7i ss for the above-mentioned affections.\\n173. Trional. 0.5 (gr. viij), in powder, as a somnifacient.\\n174. Ung. Hydrarg. Ammoniati. For pruritus.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0450.jp2"}, "451": {"fulltext": "THERAPEUTIC TABLE. 261\\n175. Ung. Zinci Oxidi. For eczema, herpes.\\n176. Ung. Zinci Oxidi. With amyli aa 50.0 giss) and acid, salicyl.\\n3.0 (gr. xlv) and vaselin (lanolin, mollin), 100.0 Jiiiss), for\\npruritus, wounds.\\n177. Urotropin. 0.5 (gr. viij), 3 times daily, as a diuretic.\\n178. Viburnum Prunifol., Ext. Fid.\u00e2\u0080\u0094 1.0 to 4.0 (gr. xv to ^j)\\nseveral times daily, as an antispasmodic in dysmenorrhea,\\nthreatened abortion 1 teaspoonful may be given several times\\ndaily for one or two weeks.\\n179. Washing with Cool Water. For nocturnal enuresis.\\n180. Weir Mitchell Rest=cure. For nervous anemic patients.\\n181. Zinc Chlorid. h% intra-uterine pencil held in position by a\\ntampon, for endometritis (three days rest in bed).\\n182. Zinc Chlorid. 10 to 50^ solution, for intra-uterine application\\n(once a week) after dilatation of* the cervix in endometritis;\\n5 to 10$ injection, for multiple recurrent sessile polypi.\\n183. Zinc Chlorid. to 1% injection or upon tampons in vaginitis,\\nvaginal inversion.\\n184. Zinc Oxid Intrauterine Pencils. 0.3 (gr. v), in endometritis.\\n185. Zinc Oxid. 2 40 pulv. amyli, for intertrigo.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0451.jp2"}, "452": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0452.jp2"}, "453": {"fulltext": "NDEX\\nA.\\nAbdominal pregnancy, 221\\nAbsence of entire genital tract, 19\\nof nterus and adnexa, 18\\nof vagina, 29\\nAcne in amenorrhea, 39, 41\\nAdenomyomata, 193\\nAdnexa, benign tumors of, 199\\ndiagnosis, 200\\nsymptoms, 200\\ntreatment, 201\\nmalignant tumors of, 245\\ndiagnosis, 245\\nsymptoms, 245\\ntreatment, 246\\nAlexander s operation, 88\\nAmenorrhea, 39\\nphysiologic, 40\\nsymptomatic, 39\\ntreatment, 41\\nAngiosarcoma ta, 234\\nAnomalies of formation, fetal, 17\\nhyperplastic, 29\\ninfantile, 35\\nof menstruation, 38\\nAnteflexion, infantile, 36\\npuerile, 36\\nAnterior sacral hvdromeningo-\\ncele, 223\\nAnteversion and anteflexion, 76\\ndiagnosis, 76\\netiology, 76\\ntreatment, 78\\nAnus perinealis, 27\\nAplasia, 17\\nArrested development, 35\\nAscites, 178, 227\\nAscitic fluid, characteristics of, 178\\nAtmocausis, 115\\nAtresia ani, 22\\nvaginalis, 22, 27, 29\\nvestibularis, 27\\nhymenalis, 25, 27\\nunilateral, of duplicate geni-\\ntalia, 26, 27\\nurethra?, 22\\nvulva\\\\ 22\\nAtresias, congenital, 22\\ntraumatic, 155, 163\\nAzoospermism, 47\\nB.\\nBartholinitis, 93, 96, 99\\nBiers constriction, 100\\nBladder, atrophy of, 142\\nbenign tumors of, 188\\ncarcinoma of, 235, 236\\ncatarrh of, 140\\ncysts of, 187\\ndistended, 227\\ndrainage of, 147\\nfibromata, fibromyomata, 187\\nhypertrophy of, 142\\nmalignant tumors of, 235\\npapillomata of, 186, 188\\ndiagnosis, 189\\nprognosis, 189\\ntreatment, 189\\npolyps, 187\\nsenile, 142\\ntuberculosis of, 137, 139\\n263", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0453.jp2"}, "454": {"fulltext": "264\\nINDEX.\\nBraun s syringe, 197\\nBroad ligament, cysts of, 199\\nfibromyomata, 199\\nfibromyxomata, 199\\nlipomata, 199\\nBnboes, 139\\nBullet-forceps, 83\\nC.\\nCastration, 209\\nCeliosalpingectomy, 126\\nCervical canal, diameter of, 37\\nlength of, 59\\nCervicitis, acute, 101\\nchronic, 101\\ndiagnosis, 105\\nsymptoms, 104\\ntreatment, 106\\npurulent, 101\\nCervix, atresia of, 27\\ncatarrh of, 101\\ndilatation of, 37, 109, 163\\ntears of, 161\\ntreatment, 161\\nChancre, hard, 139\\nsoft, 139\\nChancroidal bubo, 139\\nCharcot s arch, 153\\nChrobak s extraperitoneal\\nmethod, 210\\nClitoris, duplication of, 49\\nfissa, 23\\nhvpertrophy of, 49\\nCloaca, 26\\nCoccygodynia, 154\\ntreatment, 154\\nColpeurynter, 56\\nColpitis crouposa, 117\\ndiphtheritica, 117\\nexfoliativa, 44\\ngonorrhoeica, 94, 97\\nulcerosa adhsesiva, 151\\nvetularum, 151\\nColpocleisis, 172\\nColpocystotomy, 183\\nColpohyperplasia cystica, 187\\nColpomyotomy, 208\\nColpoperineauxesis, 68\\nColpoperineoplasty, 68\\nColpoperineorrhaphy, 68\\nColporrhaphy, anterior, 68\\nposterior, 68\\nCondylomata^ acuminate, 99, 100\\nflat, 139\\nCuretment, 110, 111\\nCystitis, anatomy, 140\\ndiagnosis, 141\\ndiphtheritica, 141, 142\\netiology, 141, 142\\nsequels, 143\\nsymptoms, 141\\ntreatment, 146\\nCystocele, 53\\nCystoscope, operative, 144\\nCystoscopy, 144\\nD.\\nDecidua menstrualis, 43, 44\\nvera graviditatis, 44\\nDeciduoma, 190\\nDefects of uterus, 18\\nof vagina, 22\\nDermatitis simplex, 149\\nDescensus uteri, 57, 60\\nDiagnosis, differential, of ante-\\nuterine and retro-uterine tu-\\nmors, 224, 225\\nDilatation of cervix, 37, 109, 163\\nDisplacements of tubes and ova-\\nries, 75\\nof uterus, 74\\nDistended bladder, 227\\nDouglas pouch, turners of, 221,\\n224, 225\\nDuplication by a septum, 31\\nof cervix, 32\\nof clitoris, 49\\nof entire genital tract, 29\\nof nymphse, 49\\nof organs, 29\\nof uterine appendages, 30\\nof uterus, 30\\nDysmenorrhea, congestive, 42\\netiology, 42\\nin infantile anteflexion, 36\\nin intramural myomata, 42\\ninflammatory, 42\\nmembranacea, 43", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0454.jp2"}, "455": {"fulltext": "INDEX.\\n265\\nDysmennorrhea, obstructive, 42\\nreflex, 42\\ntreatment, 43\\nEchinococcus cysts, 219\\nEctopia vesicae, 167\\nEctropion, 104, 107\\ndifferential diagnosis, 105\\nElephantiasis vulvae, 152, 187\\nElevatio uteri, 72\\ndiagnosis, 72\\ntreatment, 72\\nElongatio colli, 61\\nEmboli after operations for myo-\\nmata, 202, 205\\nEndometritis acuta, 118\\nchronica, 100\\ndiagnosis, 105\\nsymptoms, 104\\ntreatment, 106\\ncorporis uteri, 107\\nsymptoms, 108\\ntreatment, 109\\ndissecans, 108\\nexfoliativa, 44, 108\\nfrom stenosis, 38\\nfungosa, 108\\nglandularis, 107\\nhaemorrhagica, 108\\ninterstitialis, 108\\npolyposa, 108, 185\\npost abortum, 108\\nyeast cultures, introduction of,\\n110\\nEndothelioma, 234, 244, 247\\nEnemata, Hegar s, 133, 135\\nEnterocolpocele, 50\\nEnuresis nocturna, 146\\nEpisioplasty, 159\\nEpispadias, feminine, 23, 29\\nEpithelioma, 185, 234\\nErosion, differential diagnosis,\\n105\\nfollicular, 105\\npapillary, 105\\ndifferential diagnosis from\\ncancer, 234\\nsimple, 105\\nEversio vesicae, 167\\nEvolutio praecox, 39\\nExanthemata, periodic, 149\\nvulvar, 149\\nExcisions, wedge-shaped, 107, 116\\nExf oliatio mucosae menstrualis, 43\\ndiagnosis, 44\\nExstrophia vesicae, 167\\nExtra-uterine pregnancy, 176\\nExudates, parametritic, 135\\nperimetritic, 132\\nFacies ovarica, 200\\nFallopian tube, cysts of, 199\\nfibromata, fibromvomata, 199\\nhydatids of, 199\\nlipomata of, 199\\npapillary proliferations of,\\n199\\nFaradization for cervical stenosis,\\n37\\nFerripyrin, 46\\nFibroma of ovary, 208, 211, 221\\nFibromvomata, cervical, 199\\ndelivery of, 196\\ndiagnosis^ 196, 206\\nenuncleation of, 209\\netiology, 191\\nhistoid, 192\\nindications for operation, 209\\nintercorporeal, 194\\nintraligamentous, 194\\nintramural, 194\\norganoid, 193\\npolypoid submucous, 194\\nsubserous, 194\\nsarcomatous changes in, 207\\nsequels of, 202\\nsubmucous, 194\\nsubserous, 194\\nsymptoms, 195, 205\\ntorsion of pedicle, 202\\ntreatment, 197, 208\\nFibrosarcoma, 207\\nFissura vesicae inferior, 167\\nsuperior, 167\\nFistula, cauterizations for, 173\\ncongenital, 22", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0455.jp2"}, "456": {"fulltext": "266\\nIXDEX.\\nFistula, ileo-uretero vesical, 168\\nileo vaginal, 168, 173\\nileovesical, 168\\nintestinal, 168\\noperations for, 172\\nrectohymenalis, 23\\nrecto-ureterovesical, 168\\nrectovaginal, 168, 171\\nrectovesical, 168\\nrectovestibularis, 23\\nureterocervical, 167\\nurethrovaginal, 165, 170\\nurinary, 165\\nafter-treatment, 173\\ndiagnosis, 171\\nsymptoms, 170\\ntreatment, 172\\nvesico-abdominal, 167\\nvesicocervical, 166\\nvesicocervico vaginal. 165, 166\\nvesieo-umbilicalis, 167\\nvesico-ureterovaginal, 166, 171\\nvesicovaginal, 165, 170\\nFloating kidney, 223\\nFolliculitis vulvae, 150\\nForeign bodies in bladder, 180\\ntreatment, 180\\nin genital tract, 180\\ntreatment, 180\\nFritsch s operation, 159\\nFurunculosis vulvae, 149\\nG.\\nGarrulitas vulvae, 158\\nGartner s ducts, 200\\nGenital canal, duplications of, 29\\ntuberculosis, diagnosis, 137\\nhistology, 136\\nprognosis, 138\\nsymptoms, 137\\ntreatment, 138\\nGonococci, 94, 97\\nGonorrhea, 93\\ndiagnosis, 97\\nlatent, 95\\nsymptoms, 96\\ntreatment, 97\\nGonorrheal endometritis, 95\\nmixed infection, 96\\nGonorrheal peritonitis, 96\\npyosalpinx, 95\\nurethritis, 99\\nGummata, 140\\nH.\\nHegar s castration. 211\\nenemata, 133, 135\\nfunnel, 99, 147\\noperations, 116, 159, 211\\nHematocele, intraperitoneal retro-\\nuterine. 176, 221, 224\\ndiagnosis, 177\\netiology, 176\\nprognosis, 179\\nsymptoms, 177\\ntreatment. 179\\nHematocolpos, 25\\nHematoma, extraperitoneal, 175\\nvaginae, 26\\nvulvae, 26, 175\\nHematometra. 25, 163, 164, 220\\nHematosalpinx, 25, 220\\nHermaphroditism, 20\\nHernia, diagnosis, 48\\ninguinalis labialis, 48\\ntreatment, 49\\nvaginalis labialis, 48\\nHot sand-baths, 135\\nHydatids, formation of, 199\\nHydrocolpocele, 50\\ntreatment, 52\\nHvdromeningocele sacralis ante-\\nrior. 223\\nHvdrometra. 163\\nHydronephrosis, 219, 223\\nHydrops folliculorum, 211\\nHydrosalpinx, 124\\nHymen bifenestratus, 33\\nseptus, 33\\nHvperin volution, puerperal, 40,\\n134\\nHyperplasias, 29\\nHypertrophy of bladder, 142\\nHypoplasia. 17\\nHypospadias, feminine, 22, 27. 29\\nHysteric symptom-complex, 153\\nI Hysterocleisis, 172\\nJ Hysterotrachelorraphy, 162", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0456.jp2"}, "457": {"fulltext": "INDEX.\\n267\\nIleovaginal preternatural anus,\\n169\\nImpotentia coeundi, 46\\nImpressio fundi uteri, 54, 55\\nIncontinence, fecal, 157\\nof retention, 145\\nurinary, 145\\nvulvar, 155, 158\\nInflammation, etiology, 93\\nglandular, 92\\ninterstitial, 92\\nterminations, 93\\nIntermenstrual pain, 109\\nIntertrigo, 158\\nIntestinal fistula, 168\\nInversion of anterior vaginal wall,\\n53\\ntreatment, 53\\nof posterior vaginal wall, 52\\ntreatment, 53\\nof uterus, complete, 55\\ndiagnosis, 55\\netiology, 54\\npartial, 54\\nsymptoms, 55\\ntreatment, 55\\nof vagina, 50\\ndiagnosis, 52\\ntreatment, 52\\nIschuria paradoxa, 145\\nK.\\nKehrer s operations, 37, 57, 116\\nKustner s operation, 57\\nurethral funnel, 99, 147\\nL.\\nLacerations, 154, 157, 158\\nLaminaria, 109\\nLochiometra, 163\\nLupus vulvae, 137\\nM.\\nMackenrodt s operation, 172\\nMartin s operation, 68, 89\\nMassage, 90\\nMasturbation, 42, 93, 101, 151\\nMenorrhagia, etiology, 45\\ntreatment, 45\\nMenstrualis, decidua, 43, 44\\nexfoliatio mucosae, 43, 44\\nMenstruation, disturbances of, 39\\nphysiologic, 38\\nvicarious, 41\\nMetalbumin, 218\\nMeteorism, 227\\nMethod of Schultze, 216, 226\\nMetritis, acute, 118\\ndiagnosis, 120\\nsymptoms, 119\\ntreatment, 123\\nchronic, 111\\ndiagnosis, 113\\netiology, 113\\nprognosis, 113\\nsymptoms, 113\\ntreatment. 114\\nMetrorrhagia, 195, 205\\nMolimina menstrualia, 20\\nMollusca, 195\\nMorphinism as a cause of amenor-\\nrhea, 39, 40\\nMiillerian ducts, 17, 25, 26, 32\\nMyomata, cervical, 207\\nintraligamentous, 207, 221\\nvascular bruit in, 208\\nMyometritis, 109, 120\\nMyomotomy, 209\\nMyxedema, peritoneal, 213\\nMyxofibroma ovarii, 198\\nMyxosarcoma, 204, 222\\nN.\\nNervous symptoms in retroflexion,\\n81\\nNeuralgia in laceration scars, 158\\nin uterine and ovarian tumors,\\n195, 198, 201\\nlumbo-abdominal, 154\\nuteri, 42\\nNeuritis in carcinoma, 237\\nNeuroses in amenorrhea, 39\\nof the vagina, 143, 150\\nperiodic, 41", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0457.jp2"}, "458": {"fulltext": "268\\nINDEX.\\nXew growths, etiology of. 184\\nXymphse, duplication of, 49\\nO.\\nOligocvstic degeneration, 128\\nOligomenorrhea, etiology, 39\\ntreatment. 40\\nOophoritis, acute, 119, 222\\nchronic, 126\\ndiagnosis, 128\\netiology, 126\\nsymptoms, 123\\ntreatment, 129\\nOophorosalpingitis. 127\\nOperation. Alexander s, 88\\nFritsclrs. 159\\nHegar s, 116, 159\\nKehrer s, 37, 57, 116\\nKustner s, 57\\nMackenrodt s. 172\\nMartin s. 6-. 89\\nMartin s (A.), 116\\nSchroder s, 116\\nSimon s, 116, 159\\nSims 37. 116, 164\\nSkutsch s, 89\\nv. AVinckel s. 163\\nOvarian cystomata. anatomy, 211\\ncharacter of contents, 218\\ndefinition, 211\\ndiagnosis. 216, 219\\nhistology, 211\\nmultilocular, 211\\nprognosis, 227\\nsequels, 213\\nsymptoms, 213\\ntapping, 228\\ntorsion of pedicle, 227\\ntreatment, 227\\nunilocular, 211\\nOvarica, facies, 200\\nOvarie, 154\\nOvariocolpocele. 50. 75\\nOvary, abscess of, 127\\natrophy of. 127\\ndermoid cyst of. 213\\nfibroma of, 199. 221\\nfibromyomata of, 199, 221\\nOvary, multilocular glandular\\nmucoid cysts of, 211\\noligocvstic degeneration of. 128\\npapillarv proliferative cysts of,\\n213, 216\\npresence of third. 34\\nracemose cysts of. 213\\nunilocular cysts of. 211\\nOvulation. 38\\nOvules of Xaboth, 108\\nP.\\nPancreas, cysts of. 226\\nPapillary vulvitis. 149\\nParacolpitis, acute. 117\\nchronic. 134\\nParalbumin, 218\\nParametritis, acute, 120, 123\\nchronic. 134\\natrophic, 134\\nsymptoms, 135\\ntreatment. 135\\ndiagnosis. 134\\netiology. 134\\nsymptoms. 134\\ntreatment, 135\\nexudates of, 121, 223\\nParaproctitis, 117\\nParoophoritic adenomvomata,\\n195, 199\\ncvsts. 200\\nParovarian cvsts. 200, 201, 219,\\n221\\nPean-Hegar s extraperitoneal\\nmethod, 210\\nPelvic peritonitis, diagnosis, 132\\netiology, 131\\nprognosis, 131\\nsymptoms, 131\\ntreatment, 132\\nPelvis fissa, 23\\nPericystitis, 131\\nPerimetritis, chronic. 131\\nexudates of. 132\\nPerimetro-oophoritis, 96\\nPerimetrosalpingitis. 96\\nserosa, 131\\nPerineal defects, congenital. 29\\nlacerations, etiology of, 156", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0458.jp2"}, "459": {"fulltext": "INDEX.\\n269\\nPerineal lacerations, operations\\nfor, 159\\nsequels, 157\\nsymptoms, 157\\ntreatment, 159\\nperforation, 156\\nPerineoplasty, 159\\nPerineorrhaphy, 159, 160\\nPeriproctitis, 131\\nPeritoneal myxedema, 213\\nPeritonitis, acute, 119, 231\\nexudativa saccata, 119\\ngonorrheal, 133\\npelvic, 131, 132\\nsacculated, 233\\ntubercular, 133, 138\\nPessaries, application of, 84, 89\\ncare of, 87\\ndisadvantages of, 87\\nintra-uterine, 37, 38\\nlever-, 71, 84\\nPessary, Breisky s, 71\\nHewitt s, 71\\nHodge s, 71, 84, 85\\nMayer s ring, 70, 84\\nSchultze s 8-shaped, 71, 84, So\\nsledge-, of B. S. Schultze, 71\\nreversed application of, 90\\nZ angerle-Martin stem-, 71\\nPhlebectasia, vulvar, 151\\nPhlegmone vaginae, 117\\nvulvae, 117, 149\\nPlacenta, retention of, 239\\nPlayfair s aluminum sound, 195,\\n199\\nPregnancy, abdominal, 221\\ndiagnosis of, 219\\nProlapse, vaginal and uterine, 57\\ncomplete, 57\\ndevelopment, 60\\ndiagnosis, 63\\netiology, 62\\npartial, 57\\nreposition, 71\\nsymptoms, 61\\ntreatment, 64-74\\nPropeptone, 218\\nPruritis vulvas, 149, 150\\nPseudohermaphroditism, 20\\nPseudomucin, 218\\nPulmonary emboli, 202, 205\\nPyocolpocele, 50, 75\\ntreatment, 52\\nPyocolpometra, 29\\nPyometra, 163\\nPyo-oophorosalpinx, 127\\nPyosalpinx, 125, 126\\nR.\\nRectal injections, Hegar s, 133,\\n135\\nRectocele, 52\\nReposition of prolapsed uterus,\\n71\\nRetained catheter, 147, 174\\nRetention of urine, 145\\nRetrorixatio colli, 89\\nRetroflexion, puerile, 79\\nRetroversion and retroflexion,\\ncongenital, 79\\ndiagnosis, 82\\netiology, 79\\nreposition, 90\\nsymptoms, 81\\ntreatment, 83\\nRhagades, 157\\nRose s procedure, 181\\nRound ligament, adenomvomata\\nof, 199\\nfibromyomata of, 199\\nRudimentary cornua of the uter-\\nus, 26\\nS.\\nSalpingitis, acute catarrhal paren-\\nchymatous, 125\\npurulent catarrhal and inter-\\nstitial, 125\\nchronic catarrhal parenchyma-\\ntous, 124\\ninterstitial, 126\\ndiagnosis, 125\\nnodosa, 199\\nsymptoms, 125\\ntreatment, 125\\nSarcoma of uterus, 222, 243\\nof vagina, 235\\nof vulva, 235", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0459.jp2"}, "460": {"fulltext": "270\\nIXDEX.\\nSchroder s intraperitoneal meth-\\nod, 210\\nSectio alta, 183\\nSenna infusion, 231\\nSepsis, 117\\nSimon s operation, 116, 159\\nspecula, 32, 147\\nSims operation, 37, 116, 164\\nposition, 32\\nSingultus hystericus, 153\\nSinus urogenitalis, 27\\nSkene s glands, 31\\nStem-pessary in anteflexion, 37\\nStenosis, congenital, of cervix, 36\\nhymenalis, 38\\ntraumatic, 162\\nanatomy, 163\\ndiagnosis, 163\\netiology, 163\\nsymptoms, 163\\ntreatment, 163\\nvulvovaginalis, 38\\nSterility, etiology. 46\\nexamination of patient, 47\\nfollowing gonorrhea, 96\\nin anteflexion, 77\\nin infantile anteflexion, 36\\nin uterine prolapse, 62\\ntreatment, 47\\nwith bilateral ovarian cyst,\\n200\\nSubinvolution as a cause of metri-\\ntis, 93\\nas a cause of prolapse, 62\\nSuprapubic cystotomy, 183\\nSupravaginal amputation, 209\\nSuspensio uteri, 89\\nT.\\nTamponade of pouch of Douglas,\\n138\\nTapping, 228\\nTenesmus, rectal, 53, 78\\nvesical, 146\\nTertiary syphilides, 140\\nTorsion of uterus, pathologic, 91\\nphysiologic, 91\\nTransmigratio seminis, 22\\nTraumatic effusions, 175\\nTube. See Fallopian tube.\\nTubercular peritonitis, 133, 138\\ntumors of omentum, 226\\nTuberculosis, genital, 136, 137\\nperitoneal, 139\\nvesical, 137, 139\\nTumors, benign, 186\\nconditions simulating, 227\\netiology of, 184\\nintraligamentous, 199\\nmalignant, 234\\nof abdominal walls, 226\\nof bladder, 186, 187, 188, 235\\nof Fallopian tube, 199\\nof kidney, 223\\nof ligaments, 199\\nof omentum, 226\\nof ovary, 199\\nof parietal peritoneum, 226\\nof pelvic bones, 223\\nof pouch of Douglas, 221, 224\\nof rectum, 223\\nof tube, 199\\nU.\\nUlcer, cervical, 120\\nvaginal, 120\\nvulvar, 120\\nUlcus durum, 139\\ngangrenosum, 139\\nmolle, 139\\nUremia, 142\\nin carcinoma, 238\\nUreters, angulation of. 60, 86\\nUrethra, carcinoma of, 236\\ncaruncle of, 186\\ncondylomata of. 186\\ncystic myxo- adenomata, 187\\nfibromata of, 187\\nfibromyomata of, 187\\npolyps of, 187\\ntumors of, 187\\ntreatment, 188\\nUrethritis gonorrhceica, 99\\nUrinary fistula. 165\\nUrina spastica, 143\\nUrine, retention of, 145\\nUrogenital septum, 27\\nsinus, 27", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0460.jp2"}, "461": {"fulltext": "IXDEX.\\n271\\nUterine asthma, 41\\ncavity, size of, 59\\nUterus, auiputatio supravaginalis,\\n209\\nantepositio, 73\\nante versions and anteflexions,\\n76-79\\nbenign tumors of, 189\\nbicornis, 30\\nseptus, 32, 33\\ncarcinoma of, 237\\ncavity of, 59\\ndiadelphus (didelphys), 29\\nduplex, 29\\nfibromyomata of, 192\\ntotalis, 35\\ninfantilis, 32, 35, 38\\nlateropositio, 73\\nligaments of, 59\\nmalignant tumors of, 237, 243\\ndiagnosis, 238, 245\\nsymptoms, 237\\ntreatment, 239, 241, 245\\nmembranaceus, 35, 36\\nmucous polyps of, 190\\ndiagnosis, 190\\nsymptoms, 190\\ntreatment, 191\\nmyxosarcoma of, 222\\nnormal length of, 36, 59\\nrelations of, 59\\nsituation of, 57\\nwidth of, 59\\npathologic positions, 73\\nretropositio, 73\\nretroversions and retroflexions,\\n79-91\\nsarcoma of, 222, 243\\nsupports of, 59\\ntotal extirpation of, 209\\ntuberculosis of, 137\\nunicornis, 20\\nV.\\nVagina, atresia of, 22, 27, 29\\ncysts of, 187\\ntreatment of, 187\\nduplex, 29\\nepitheliomata of, 235\\nVagina, fibromata of, 187\\nfibromyomata of, 187\\ninversion of, 50, 52, 53\\nlacerations of, 160\\nsymptoms, 161\\ntreatment, 161\\nmyxofibroma, 187\\nneuroses of, 143, 150\\nphlegmon of, 117\\nsarcoma of, 235\\nsepta, 33\\nsubsepta, 33\\ntuberculosis of, 137, 138\\nulcers of, 120\\nVaginismus, 38, 150\\netiology, 151\\ntreatment, 151\\nVaginitis, acute. 110\\ngonorrheal, 94. 9?\\nVaginofixation. 67. 89\\nVaricocele parovarialis, 151\\nVenereal diseases, 139\\nVentrofixation. 67. 89\\nVesical calculi, diagnosis, 181\\netiology, 181\\nsymptoms, 181\\ntreatment. 183\\nirrigations. 147\\nparalysis, 145\\ndiagnosis, 146\\nsymptoms, 146\\ntreatment, 148\\nspasm. 143\\ndiagnosis, 144\\nsymptoms, 143\\ntreatment. 148\\ntuberculosis, 137, 139\\nVesicofixation, 67\\nVulva, condylomata of, 186\\ncysts of, 187\\nduplex, 29\\nelephantiasis of, 100\\nepithelioma of. 234\\nfibromata of, 186\\nfibromyomata of, 186\\nfissures of. 155\\nfolliculitis of, 149, 150\\nfurunculosis of, 149\\nhematoma of, 175\\nhistology of, 98", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0461.jp2"}, "462": {"fulltext": "272\\nINDEX.\\nVulva, incontinence, 155, 158\\ninjuries of, 155\\nlipomata of, 187\\nlupus of, 137\\nmyxofibromata of, 186\\npapillomata of, 186\\nsarcoma of, 235\\ntuberculosis of, 137, 138\\nVulvitis diabetica, 149, 150\\ngonorrheal, 98\\nVulvitis, papillary, 149\\npruriginosa, 149, 150\\nYeast cultures in endometritis,\\n110\\nZ.\\nZestocausis, 115", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0462.jp2"}, "463": {"fulltext": "Medical and Surgical Works\\nPUBLISHED BY\\nW. B. SAUNDERS, 925 Walnut Street, Philadelphia, Pa.\\nAbbott on Transmissible Diseases 18\\nAmerican Pocket Medical Dictionary 35\\n*American Text-Book of Applied Thera-\\npeutics 8\\n\u00e2\u0099\u00a6American Text-Book of Dis. of Children 13\\n*An American Text-Book of Diseases of the\\nEye, Ear, Nose, and Throat 15\\n*An American Text-Book of Genito-Uri-\\nnary and Skin Diseases 14\\n\u00e2\u0099\u00a6American Text-Book of Gynecology 12\\n\u00e2\u0099\u00a6American Text-Book of Legal Medicine 44\\n\u00e2\u0099\u00a6American Text-Book of Obstetrics 9\\n\u00e2\u0099\u00a6American Text-Book of Pathology 44\\n\u00e2\u0099\u00a6American Text-Book of Physiology 7\\n\u00e2\u0099\u00a6American Text-Book of Practice 10\\n\u00e2\u0099\u00a6American Text-Book of Surgery n\\nAnders Theory and Practice of Medicine 21\\nAshton s Obstetrics 43\\nAtlas of Skin Diseases 28\\nBall s Bacteriology 43\\nBastin s Laboratory Exercises in Botany 36\\nBeck s Surgical Asepsis 41\\nBoisliniere s Obstetric Accidents 39\\nBrockway s Physics 43\\nBurr s Nervous Diseases 41\\nButler s Materia Medica and Therapeutics 24\\nCerna s Notes on the Newer Remedies 32\\nChapin s Compendium of Insanity 35\\nChapman s Medical Jurisprudence 41\\nChurch and Peterson s Nervous and Men-\\ntal Diseases 17\\nClarkson s Histology 33\\nCohen and Eshner s Diagnosis 43\\nConvin s Diagnosis of the Thorax 37\\nCragin s Gynaecology -43\\nCrookshank s Text-Book of Bacteriology 27\\nDaCosta s Manual of Surgery 23\\nDe Schweinitz s Diseases of the Eye 29\\nDorland s Pocket Medical Dictionary 35\\nDorland s Obstetrics 41\\nFrothingham s Bacteriological Guide 30\\nGarrigues Diseases of Women 34\\nGleason s Diseases of the Ear 43\\n\u00e2\u0099\u00a6Gould and Pyle s Curiosities of Medicine 17\\nGrafstrom s Massage 28\\nGriffith s Care of the Baby 38\\nGriffith s Infant s Weight Chart 39\\nGross s Autobiography 26\\nHampton s Nursing 39\\nHare s Physiology 43\\nHart s Diet in Sickness and in Health 36\\nHaynes Manual of Anatomy 41\\nHeisler s Embryology 19\\nHirst s Obstetrics .20\\nHyde s Syphilis and Venereal Diseases 41\\nInternational Text-Book of Surgery 6\\nJackson s Diseases of the Eye 19\\nJackson and Gleason s Diseases of the Eye,\\nNose, and Throat 43\\nKeating s Pronouncing Dictionary 26\\nKeating s Life Insurance 39\\nKeen s Operation Blanks a 36\\nKeen s Surgery of Typhoid Fever 22\\nKyle s Diseases of Nose and Throat 18\\nLaine s Temperature Charts 32\\nLevy Klemperer s Clinical Bacteriology44\\nLockwood s Practice of Medicine 41\\nLong s Syllabus of Gynecology 34\\nMacdonald s Surgical Diagnosis and Treat-\\nment 22\\nMcFarland s Pathogenic Bacteria 30\\nMallory and Wright s Pathological Tech-\\nnique 22\\nMartin s Surgery 43\\nMartin s Minor Surgery, Bandaging, and\\nVenereal Diseases 43\\nMeigs Feeding in Early Infancy 30\\nMoore s Orthopedic Surgery 23\\nMorris Materia Medica and Therapeutics 43\\nMorris Practice of Medicine 43\\nMorten s Nurses Dictionary 38\\nNancrede s Anatomy and Dissection 31\\nNancrede s Anatomy 43\\nNancrede s Principles of Surgery 19\\nNorris Syllabus of Obstetrical Lectures 37\\nPenrose s Diseases of Women 24\\nPowell s Diseases of Children 43\\nPryor s Pelvic Inflammations 33\\nPye s Bandaging and Surgical Dressing 23\\nRaymond s Physiology 41\\nSaundby s Renal and Urinary Diseases 25\\n\u00e2\u0099\u00a6Saunders American Year-Book of Medi-\\ncine and Surgery 16\\nSaunders Medical Hand-Atlases 3, 4, 5\\nSaunders Pocket Medical Formulary 35\\nSaunders New Series of Manuals 40, 41\\nSaunders Series of Question Compends 42, 43\\nSayre s Practice of Pharmacy 43\\nSemple s Pathology and Morbid Anatomy 43\\nSemple s Legal Medicine and Toxicology. 43\\nSenn s Genito-Urinary Tuberculosis 24\\nSenn s Tumors 25\\nSenn s Syllabus of Lectures on Surgery 37\\nShaw s Nervous Diseases and Insanity 43\\nStarr s Diet-Lists for Children 38\\nStelwagon s Diseases of the Skin 43\\nStengel s Pathology 20\\nStevens Materia Medica and Therapeutics 32\\nStevens Practice of Medicine 31\\nStewart s Manual of Physiology 37\\nStewart and Lawrance s Medical Elec-\\ntricity 43\\nStoney s Materia Medica for Nurses 31\\nStoney s Practical Points in Nursing 27\\nSutton and Giles Diseases of Women 29, 41\\nThomas s Diet-List and Sick-Room 38\\nThornton s Dose-Book and Manual of Pre-\\nscription-Writing 41\\nVan Valzah and Nisbet s Diseases of the\\nStomach 21\\nVecki s Sexual Impotence 33\\nVierordt and Stuart s Medical Diagnosis 28\\nWarren s Surgical Pathology 25\\nWatson s Handbook for Nurses 26\\nWolff s Chemistry 43\\nWolff s Examination of Urine 43", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0463.jp2"}, "464": {"fulltext": "GENERAL INFORMATION.\\nOne Price.\\nOrders.\\nGash or Credit.\\nHow to Send\\nMoney by-\\nMail.\\nShipments.\\nOne price absolutely without deviation. No discounts allowed,\\nregardless of the number of books purchased at one time. Prices\\non all works have been fixed extremely low, with the view to\\nselling them strictly net and for cash.\\nAn order accompanied by remittance will receive prompt\\nattention, books being sent to any address in the United States, by\\nmail or express, all charges prepaid. We prefer to send books by-\\nexpress when possible.\\nTo physicians of approved credit who furnish satisfactory\\nreferences our books will be sent free of C. O. D. One volume\\nor two on thirty days time if credit is desired larger purchases\\non monthly payment plan. See offer below.\\nThere are four ways by which money can be sent at our risk,\\nnamely: a post-office money order, an express money order, a\\nbank-check (draft), and in a registered letter. Money sent in any\\nother way is at the sender s risk. Silver should not be sent through\\nthe mail.\\nAll books, being packed in patent metal-edged boxes, neces-\\nsarily reach our patrons by mail or express in excellent condi-\\ntion.\\nSubscription\\nBooks.\\nMiscellaneous\\nBooks.\\nLatest\\nEditions.\\nBindings.\\nBooks in this catalogue marked with a star are for sale by\\nsubscription only, and may be secured by ordering them through\\nany of our authorized travelling salesmen, or direct from the\\nPhiladelphia office they are not for sale by booksellers. All\\nother books in our catalogue can be procured of any bookseller\\nat the advertised price, or directly from us.\\nWe carry in stock only our own publications, but can supply\\nthe publications of other houses (except subscription books} on\\nreceipt of publisher s price.\\nIn every instance the latest revised edition is sent.\\nIn ordering, be careful to state the style of binding desired-\\nCloth, Sheep, or Half Morocco.\\nSpecial Offer. To physicians of approved credit who furnish satisfactory\\nMonthly references books will be sent express prepaid terms, $5.00 cash\\nPayment upon delivery of books, and monthly payments of $5 00 thereafter\\nPlan, until full amount is paid. Any of the publications of W. B. Saunders\\n(100 titles to select from) may be had in this way at catalogue price,\\nincluding the American Text-Book Series, the Medical Hand-\\nAtlases, etc. All payments to be made by mail or otherwise, free\\nof all expense to us.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0464.jp2"}, "465": {"fulltext": "SAU NDERS\\nMEDICAL HAND-ATLASES.\\nThe series of books included under this title consists of authorized translations\\ninto English of the world-famous Lehmann Medicinische Handatlanten,\\nwhich for scientific accuracy, pictorial beauty, compactness, and cheap-\\nness surpass any similar volumes ever published. Each volume contains from\\n50 to 100 colored plates, executed by the most skilful German lithographers,\\nbesides numerous illustrations in the text. There is a full and appropriate de-\\nscription, and each book contains a condensed but adequate outline of the\\nsubject to which it is devoted.\\nIn planning this series arrangements were made with representative pub-\\nlishers in the chief medical centers of the world for the publication of transla-\\ntions of the atlases into nine different languages, the lithographic plates for all\\nbeing made in Germany, where work of this kind has been brought to the greatest\\nperfection. The enormous expense of making the plates being shared by the\\nvarious publishers, the cost to each one was reduced to practically one-tenth.\\nThus by reason of their universal translation and reproduction, affording in-\\nternational distribution, the publishers have been enabled to secure for these\\natlases the best artistic and professional talent, to produce them in the most\\nelegant style, and yet to offer them at a price heretofore unapproached\\nin cheapness. The great success of the undertaking is demonstrated by the\\nfact that the volumes have already appeared in thirteen different languages\\nGerman, English, French, Italian, Russian, Spanish, Japanese, Dutch, Danish,\\nSwedish, Roumanian, Bohemian, and Hungarian.\\nIn view of the unprecedented success of these works, Mr. Saunders has con-\\ntracted with the publisher of the original German edition for one hundred\\nthousand copies of the atlases. In consideration of this enormous under-\\ntaking, the publisher has been enabled to prepare and furnish special additional\\ncolored plates, making the series even handsomer and more complete than\\nwas originally intended.\\nAs an indication of the great practical value of the atlases and of the im-\\nmense favor with which they have been received, it should be noted that the\\nMedical Department of the U. S. Army has adopted the Atlas of Opera-\\ntive Surgery, as its standard, and has ordered the book in large quantities for\\ndistribution to the various regiments and army posts.\\nThe same careful and competent editorial supervision has been secured in\\nthe English edition as in the originals. The translations have been edited by\\nthe leading American specialists in the different subjects.\\n[For List of Volumes in this Series see next two pages.\\n3", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0465.jp2"}, "466": {"fulltext": "SAUNDERS MEDICAL HAND-ATLASES.\\nVOLUMES NOW READY.\\nAtlas and Epitome of Internal Medicine and Clinical Diagnosis.\\nBy Dr. Chr. Jakob, of Erlangen. Edited by Augustus A. Eshner, M. D.,\\nProfessor of Clinical Medicine, Philadelphia Polyclinic. With 68 colored\\nplates, 64 text-illustrations, and 259 pages of text. Cloth, $3.00 net.\\nThe charm of the book is its clearness, conciseness, and the accuracy and beauty of its\\nillustrations. It deals with facts. It vividly illustrates those facts. It is a scientific work\\nput together for ready reference. Brooklyn Medical Journal.\\nAtlas of Legal Medicine. By Dr. E. R. von Hofmann, of Vienna. Edited\\nby Frederick Peterson, M. D., Chief of Clinic, Nervous Dept., College\\nof Physicians and Surgeons, New York. With 120 colored figures on 56\\nplates, and 193 beautiful half-tone illustrations. Cloth, $3.50 net.\\nHofmann s Atlas of Legal Medicine is a unique work. This immense field finds in this\\nbook a pictorial presentation that far excels anything with which we are familiar in any other\\nwork Philadelphia Medical Journal.\\nAtlas and Epitome of Diseases of the Larynx. By Dr. L. Grunwald,\\nof Munich. Edited by Charles P. Grayson, M. D., Physician-in-Charge,\\nThroat and Nose Department, Hospital of the University of Pennsylvania.\\nWith 107 colored figures on 44 plates, 25 text-illustrations, and 103 pages\\nof text. Cloth, $2.50 net.\\nAided as it is by magnificently executed illustrations in color, it cannot fail of being of\\nthe greatest advantage to students, general practitioners, and expert laryngologists. St.\\nLouis Medical and Surgical Journal.\\nAtlas and Epitome of Operative Surgery. By Dr. O. Zuckerkandl.\\nof Vienna. Edited by J. Chalmers DaCosta, M. D., Clinical Professor\\nof Surgery, Jefferson Medical College, Philadelphia. With 24 colored plates,\\n217 text-illustrations, and 395 pages of text. Cloth, S3. 00 net.\\nWe know of no other work that combines such a wealth of beautiful illustrations with\\nclearness and conciseness of language, that is so entirely abreast of the latest achievements,\\nand so useful both for the beginner and for one who wishes to increase his knowledge of oper-\\native surgery. Munchener medicinische Wochenschrift.\\nAtlas and Epitome of Syphilis and the Venereal Diseases. By\\nProf. Dr. Franz Mracek, of Vienna. Edited by L. Bolton Bangs,\\nM. D., Professor of Genito-Urinary Surgery, University and Bellevue Hos\\npital Medical College, New York. With 71 colored plates, 16 black-and-\\nwhite illustrations, and 122 pages of text. Cloth, $3.50 net.\\nA glance through the book is almost like actual attendance upon a famous clinic.\\nJournal of the American Medical Association.\\nAtlas and Epitome of External Diseases of the Eye. By Dr. O-\\nHaab, of Zurich. Edited by G. E. de Schweinitz, M. D., Professor of\\nOphthalmology, Jefferson Medical College, Philadelphia. With 76 colored\\nillustrations on 40 plates, and 228 pages of text. Cloth, $3.00 net.\\nIt is always difficult to represent pathological appearances in colored plates, but this\\nwork seems to have overcome these difficulties, and the plates, with one or two exceptions,\\nare absolutely satisfactory. Boston Medical and Surgical Journal.\\nAtlas and Epitome of Skin Diseases. By Prof. Dr. Franz Mracek,\\nof Vienna. Edited by Henry W. Stelwagon, M. D., Clinical Professor\\nof Dermatology, Jefferson Medical College, Philadelphia. With 63 colored\\nplates, 39 half-tone illustrations, and 200 pages of text. Cloth, $3.50 net.\\nThe importance of personal inspection of cases in the study of cutaneous diseases is\\nreadily appreciated, and next to the living subjects are pictures which will show the appear-\\nance of the disease under consideration. Altogether the work will be found of very great\\nvalue to the general practitioner. Journal of the American Medical Association.\\n4", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0466.jp2"}, "467": {"fulltext": "SAUNDERS MEDICAL HAND-ATLASES-\\nVOLUMES IN PRESS FOR EARLY PUBLICATION.\\nAtlas and Epitome of Diseases Caused by Accidents. By Dr. Ed.\\nGolebiewski, of Berlin. Translated and edited with additions by Pearce\\nBailey, M.D., Attending Physician to the Department of Corrections\\nand to the Almshouse and Incurable Hospitals, New York. With 40\\ncolored plates, 143 text-illustrations, and 600 pages of text.\\nAtlas and Epitome of Special Pathological Histology. By Dr. H.\\nDurck, of Munich. Edited by Ludvig Hektoen, M.D., Professor of\\nPathology, Rush Medical College, Chicago. Two volumes, with about\\n120 colored plates, numerous text-illustrations, and copious text.\\nAtlas and Epitome of General Pathological Histology. With an\\nAppendix on Patho-histological Technic. By Dr. H. DtJRCK, of Munich.\\nEdited by Ludvig Hektoen, M.D., Professor of Pathology, Rush Medi-\\ncal College, Chicago. With 80 colored plates, numerous text-illustrations,\\nand copious text.\\nAtlas and Epitome of Gynecology. By Dr. O. Schaffer, of the\\nUniversity of Heidelberg. With 90 colored plates, 65 text-illustrations,\\nand 308 pages of text. Edited by Richard C. Norris, A. M., M. D.,\\nGynecologist to the Philadelphia and the Methodist Episcopal Hospitals.\\nIN PREPARATION.\\nAtlas and Epitome of Orthopedic Surgery. By Dr. Schultess and\\nDr. Luning, of Zurich. About 100 colored illustrations.\\nAtlas and Epitome of Operative Gynecology. By Dr. O. Schaffer,\\nof Heidelberg. With 40 colored plates and numerous illustrations in\\nblack and white from original paintings.\\nAtlas and Epitome of Diseases of the Ear. Edited by Prof. Dr.\\nPolitzer, of Vienna, and Dr. G. Bruhl, of Berlin. With 120 colored\\nillustrations and about 200 pages of text.\\nAtlas and Epitome of General Surgery. Edited by Dr. Marwedel,\\nwith the cooperation of Prof. Dr. Czerny. With about 200 colored\\nillustrations.\\nAtlas and Epitome of Psychiatry. By Dr. Wilh. Weygandt, of Wtirz-\\nburg. With about 120 colored illustrations.\\nAtlas and Epitome of Normal Histology. By Dr. Johannes Sobotta,\\nof Wurzburg. With 80 colored plates and numerous illustrations.\\nAtlas and Epitome of Topographical Anatomy. By Prof. Dr.\\nSchultze, of Wiirzburg. About 100 colored illustrations and a very\\ncopious text.\\n5", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0467.jp2"}, "468": {"fulltext": "W. B. SAUNDERS\\n*THE INTERNATIONAL TEXT-BOOK OF SURGERY. In\\ntwo volumes. By American and British authors. Edited by J. Col-\\nlins Warren, M.D., LL.D., Professor of Surgery, Harvard Medical School,\\nBoston Surgeon to the Massachusetts General Hospital and A. Pearce\\nGould, M. S., F. R. C. S., Eng., Lecturer on Practical Surgery and Teacher\\nof Operative Surgery, Middlesex Hospital Medical School; Surgeon to the\\nMiddlesex Hospital, London, England. Vol. I. General and Operative\\nSurgery. Handsome octavo volume of 947 pages, with 458 beautiful\\nillustrations, and 9 lithographic plates. Vol. II. Special or Regional\\nSurgery. Handsome octavo volume of 1050 pages, with over 500 wood-\\ncuts and half-tones, and 8 lithographic plates. Prices per volume Cloth,\\n$5.00 net; Half-Morocco, $6.00 net.\\nJust Issued.\\nIn presenting a new work on surgery to the medical profession the publisher\\nfeels that he need offer no apology for making an addition to the list of excellent\\nworks already in existence. Modern surgery is still in the transition stage of its\\ndevelopment. The art and science of surgery are advancing rapidly, and the\\nnumber of workers is now so great and so widely spread through the whole of\\nthe civilized world that there is certainly room for another work of reference\\nwhich shall be untrammelled by many of the traditions of the past, and shall at\\nthe same time present with due discrimination the results of modern progress.\\nThere is a real need among practitioners and advanced students for a work on\\nsurgery encyclopedic in scope, yet so condensed in style and arrangement that\\nthe matter usually diffused through four or five volumes shall be given in one-\\nhalf the space and at a correspondingly moderate cost.\\nThe ever-widening-field of surgery has been developed largely by special\\nwork, and this method of progress has made it practically impossible for one\\nman to write authoritatively on the vast range of subjects embraced in a modern\\ntext-book of surgery. In order, therefore, to accomplish their object, the editors\\nhave sought the aid of men of wide experience and established reputation in the\\nvarious departments of surgery.\\nCONTRIBUTORS\\nDr. Christian Fenger. Dr\\nRobert W. Abbe.\\nC. H. Golding Bird.\\nE. H. Bradford.\\nW. T. Bull.\\nT. G. A. Burns.\\nHerbert L. Burrell.\\nR. C. Cabot.\\nI. H. Cameron.\\nJames Cantlie.\\nW. Watson Cheyne.\\nWilliam B. Clarke.\\nWilliam B. Coley.\\nEdw. Treacher Collins.\\nH. Holbrook Curtis.\\nJ. Chalmers Da Costa.\\nN. P. Dandridge.\\nJohn B. Deaver.\\nJ. W. Elliot.\\nHarold Ernst.\\nChristian Fenger.\\nW. H. Forwood.\\nGeorge R. Fowler.\\nGeorge W. Gay.\\nA. Pearce Gould.\\nJ. Orne Green.\\nJohn B. Hamilton.\\nM. L. Harris.\\nFernand Henrotin.\\nG. H. Makins.\\nRudolph Matas.\\nCharles McBurney.\\nA. J. McCosh.\\nL. S. McMurtry.\\nJ. Ewing Mears.\\nGeorge H. Monks.\\nJohn Murray.\\nRobert W. Parker.\\nRushton Parker.\\nGeorge A. Peters.\\nFranz Pfaff.\\nLewis S. Pilcher.\\nJames J. Putnam.\\nM. H. Richardson.\\nA. W. Mayo Robson.\\nW. L. Rodman.\\nC. A. Siegfried.\\nG. B. Smith.\\nW. G. Spencer.\\nJ. Bland Sutton.\\nL. McLane Tiffany.\\nH. Tuholske.\\nWeller Van Hook.\\nJames P. Warbasse.\\nJ. Collins Warren.\\nDe Forest Willard.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0468.jp2"}, "469": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 7\\n\u00e2\u0099\u00a6AN AMERICAN TEXT-BOOK OF PHYSIOLOGY. Edited by\\nWilliam H. Howell, Ph. D., M. D., Professor of Physiology in the\\nJohns Hopkins University, Baltimore, Md. One handsome octavo volume\\nof 1052 pages, fully illustrated. Prices Cloth, $6.00 net; Sheep or Half-\\nMorocco, $7.00 net.\\nI This work is the most notable attempt yet made in America to combine in\\nnne volume the entire subject of Human Physiology by well-known teachers\\nwho have given especial study to that part of the subject upon which they write.\\nThe completed work represents the present status of the science of Physiology,\\nparticularly from the standpoint of the student of medicine and of the medical\\npractitioner.\\nThe collaboration of several teachers in the preparation of an elementary text-\\nbook of physiology is unusual, the almost invariable rule heretofore having been\\nfor a single author to write the entire book. One of the advantages to be derived\\nfrom this collaboration method is that the more limited literature necessary for\\nconsultation by each author has enabled him to base his elementary account\\nupon a comprehensive knowledge of the subject assigned to him; another, and\\nperhaps the most important, advantage is that the student gains the point of view\\nof a number of teachers. In a measure he reaps the same benefit as would be\\nobtained by following courses of instruction under different teachers. The\\ndifferent standpoints assumed, and the differences in emphasis laid upon the\\nvarious lines of procedure, chemical, physical, and anatomical, should give the\\nstudent a better insight into the methods of the science as it exists to-day. The\\nwork will also be found useful to many medical practitioners who may wish to\\nkeep in touch with the development of modern physiology.\\nCONTRIBUTORS\\nHENRY P. BOWDITCH, M. D.,\\nProfessor of Physiology, Harvard Medi-\\ncal School.\\nJOHN G. CURTIS, M. D.,\\nProfessor of Physiology, Columbia Uni-\\nversity, N. Y. (College of Physicians\\nand Surgeons).\\nHENRY H. DONALDSON, Ph.D.,\\nHead-Professor of Neurology, Univer-\\nsity of Chicago.\\nW. H. HOWELL, Ph. D., M. D.,\\nProfessor of Physiology, Johns Hopkins\\nUniversity.\\nFREDERIC S. LEE, Ph.D.,\\nAdjunct Professor of Physiology, Colum-\\nbia University, N. Y. (College of\\nPhysicians and Surgeons).\\nWARREN P. LOMBARD, M.D.,\\nProfessor of Physiology, University of\\nMichigan.\\nGRAHAM LUSK, Ph.D.,\\nProfessor of Physiology, Yale MedicaJ\\nSchool.\\nW. T. PORTER, M.D.,\\nAssistant Professor of Physiology, Har-\\nvard Medical School.\\nEDWARD T. REICHERT, M.D.,\\nProfessor of Physiology, University of\\nPennsylvania.\\nHENRY SEWALL, Ph.D., M.D..\\nProfessorof Physiology, Medical Depart-\\nment, University of Denver.\\nWe can commend it most heartily, not only to all students of physiology, but to every\\nphysician and pathologist, as a valuable and comprehensive work of reference, written by\\nmen who are of eminent authority in their own special subjects. London Lancet.\\nTo the practitioner of medicine and to the advanced student this volume constitutes,\\nwe believe, the best exposition of the present status of the science of physiology in the Eng-\\nlish language. American Journal of the Medical Sciences.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0469.jp2"}, "470": {"fulltext": "8\\nW. B. SAUNDERS\\n*AN AMERICAN TEXT-BOOK OF APPLIED THERAPEU-\\nTICS. For the Use of Practitioners and Students. Edited by\\nJames C. Wilson, M. D., Professor of the Practice of Medicine and of\\nClinical Medicine in the Jefferson Medical College. One handsome octavo\\nvolume of 1326 pages. Illustrated. Prices: Cloth, $7.00 net; Sheep or\\nHalf-Morocco, $8.00 net.\\nThe arrangement of this volume has been based, so far as possible, upon\\nmodern pathologic doctrines, beginning with the intoxications, and following\\nwith infections, diseases due to internal parasites, diseases of undetermined\\norigin, and finally the disorders of the several bodily systems digestive, re-\\nspiratory, circulatory, renal, nervous, and cutaneous. It was thought proper to\\ninclude also a consideration of the disorders of pregnancy.\\nThe articles, with two exceptions, are the contributions of American writers.\\nWritten from the standpoint of the practitioner, the aim of the work is to facili-\\ntate the application of knowledge to the prevention, the cure, and the allevia-\\ntion of disease. The endeavor throughout has been to conform to the title of\\nthe book Applied Therapeutics to indicate the course of treatment to be\\npursued at the bedside, rather than to name a list of drugs that have been used\\nat one time or another.\\nThe list of contributors comprises the names of many who have acquired dis-\\ntinction as practitioners and teachers of practice, of clinical medicine, and of\\nthe specialties.\\nCONTRIBUTORS\\nDr. I. E. Atkinson, Baltimore, Md.\\nSanger Brown, Chicago, lil.\\nJohn B. Chapin, Philadelphia, Pa.\\nWilliam C. Dabney, Charlottesville, Va.\\nJohn Chalmers DaCosta, Philada., Pa.\\nI. N. Danforth, Chicago, 111.\\nJohn L. Dawson, Jr., Charleston, S. C.\\nF. X. Dercum, Philadelphia, Pa.\\nGeorge Dock, Ann Arbor, Mich.\\nRobert T. Edes, Jamaica Plain, Mass.\\nAugustus A. Eshner, Philadelphia, Pa.\\nJ. T. Eskridge, Denver, Col.\\nF. Forchheimer, Cincinnati, O.\\nCarl Frese, Philadelphia, Pa.\\nEdwin E. Graham, Philadelphia, Pa.\\nJohn Guiteras, Philadelphia, Pa.\\nFrederick P. Henry, Philadelphia, Pa.\\nGuy Hinsdale, Philadelphia, Pa.\\nOrville Horwitz, Philadelphia, Pa.\\nW. W. Johnston, Washington, D. C.\\nErnest Laplace, Philadelphia, Pa.\\nA. Laveran, Paris, France.\\nAs a work either for study or reference it will be of great value to the practitioner, as\\nit is virtually an exposition of such clinical therapeutics as experience has taught to be of\\nthe most value. Taking it all in all, no recent publication on therapeutics can be compared\\nwith this one in practical value to the working physician. Chicago Clinical Review.\\nThe whole field of medicine has been well covered. The work is thoroughly practical,\\nand while it is intended for practitioners and students, it is abetter book for the general\\npractitioner than for the student. The young practitioner especially will find it extremely\\nsuggestive and helpful. The Indian Lancet.\\nDr. James Hendrie Lloyd, Philadelphia, Pa.\\nJohn Noland Mackenzie, Baltimore, Md.\\nJ. W. McLaughlin, Austin, Texas.\\nA. Lawrence Mason, Boston, Mass.\\nCharles K. Mills, Philadelphia, Pa.\\nJohn K. Mitchell, Philadelphia, Pa.\\nW. P. Northrup, New York City.\\nWilliam Osier, Baltimore, Md.\\nFrederick A. Packard, Philadelphia, Pa.\\nTheophilus Parvin, Philadelphia, Pa.\\nBeaven Rake, London, England.\\nE. O. Shakespeare, Philadelphia, Pa.\\nWharton Sinkler, Philadelphia,. Pa.\\nLouis Starr, Philadelphia, Pa.\\nHenry W. Stelwagon, Philadelphia, Pa.\\nJames Stewart, Montreal, Canada.\\nCharles G. Stockton, Buffalo, N. Y.\\nJames Tyson, Philadelphia, Pa.\\nVictor C. Vaughan, Ann Arbor, Mich.\\nJames T. Whittaker, Cincinnati, O.\\nJ. C. Wilson, Philadelphia, Pa.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0470.jp2"}, "471": {"fulltext": "CATALOGUE OF MEDICAL WORKS.\\n*AN AMERICAN TEXT-BOOK OF OBSTETRICS. Edited by\\nRichard C. Norris, M. D. Art Editor, Robert L. Dickinson, M. D.\\nOne handsome octavo volume of over iooo pages, with nearly 900 colored\\nand half-tone illustrations. Prices Cloth, $7.00 net Sheep or Half\\nMorocco, $8.00 net.\\nThe advent of each successive volume of the series of the American Text-\\nBooks has been signalized by the most flattering comment from both the Press\\nand the Profession. The high consideration received by these text-books, and\\ntheir attainment to an authoritative position in current medical literature, have\\nbeen matters of deep international interest, which finds its fullest expression in\\nthe demand for these publications from all parts of the civilized world.\\nIn the preparation of the American Text-Book of Obstetrics the\\neditor has called to his aid proficient collaborators whose professional prominence\\nentitles them to recognition, and whose disquisitions exemplify Practical\\nObstetrics. While these writers were each assigned special themes for dis-\\ncussion, the correlation of the subject-matter is, nevertheless, such as ensures\\nlogical connection in treatment, the deductions of which thoroughly represent\\nthe latest advances in the science, and which elucidate the best ??wdem methods\\nof procedure.\\nThe more conspicuous feature of the treatise is its wealth of illustrative\\nmatter. The production of the illustrations had been in progress for several\\nyears, under the personal supervision of Robert L. Dickinson, M. D., to whose\\nartistic judgment and professional experience is due the most sumptuously\\nillustrated work of the period. By means of the photographic art, combined\\nwith the skill of the artist and draughtsman, conventional illustration is super-\\nseded by rational methods of delineation.\\nFurthermore, the volume is a revelation as to the possibilities that may be\\nreached in mechanical execution, through the unsparing hand of its publisher.\\nCONTRIBUTORS\\nDr. James C. Cameron.\\nEdward P. Davis.\\nRobert L. Dickinson.\\nCharles Warrington Earle.\\nJames H. Etheridge.\\nHenry J. Garngues.\\nBarton Cooke Hirst.\\nCharles Jewett.\\nDr. Howard A. Kelly.\\nRichard C. Norris.\\nChauncey D. Palmer.\\nTheophilus Parvin.\\nGeorge A. Piersol.\\nEdward Reynolds.\\nHenry Schwarz.\\nAt first glance we are overwhelmed by the magnitude of this work in several respects,\\nviz. First, by the size of the volume, then by the array of eminent teachers in this depart-\\nment who have taken part in its production, then by the profuseness and character of the\\nillustrations, and last, but not least, the conciseness and clearness with which the text is ren-\\ndered. This is an entirely new composition, embodying the highest knowledge of the art as\\nit stands to-day by authors who occupy the front rank in their specialty, and there are many\\nof them. We cannot turn over these pages without being struck by the superb illustrations\\nwhich adorn so many of them. We are confident that this most practical work will find\\ninstant appreciation by practitioners as well as students. New York Medical Times.\\nPermit me to say that your American Text-Book of Obstetrics is the most magnificent\\nmedical work that 1 have ever seen. I congratulate you and thank you for this superb work\\nwhich alone is sufficient to place you first in the ranks of medical publishers.\\nWith profound respect I am sincerely yours, Alex. J. C. Skene.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0471.jp2"}, "472": {"fulltext": "IO IV. B. SAUNDERS\\n*AN AMERICAN TEXT-BOOK OF THE THEORY AND\\nPRACTICE OF MEDICINE. By American Teachers. Edited\\nby William Pepper, M. D., LL.D., Provost and Professor of the Theory\\nand Practice of Medicine and of Clinical Medicine in the University of\\nPennsylvania. Complete in two handsome royal- octavo volumes of about\\niooo pages each, with illustrations to elucidate the text wherever necessary.\\nPrice per Volume Cloth, $5.00 net; Sheep or Half-Morocco, $6.00 net.\\nVOLUME I. COXTAIXS:\\nHygiene. Fevers (Ephemeral, Simple Con-\\ntinued, Typhus, Typhoid, Epidemic Cerebro-\\nspinal Meningitis, and Relapsing). Scarla-\\ntina, Measles, Rotheln, Variola, Varioloid,\\nVaccinia, Varicella, Mumps. Whooping-cough,\\nAnthrax, Hydrophobia, Trichinosis, Actino-\\nmycosis, Glanders, and Tetanus. Tubercu-\\nlosis, Scrofula, Syphilis, Diphtheria, Erysipe-\\nlas, Malaria, Cholera, and Yellow Fever.\u00e2\u0080\u0094\\nNervous, Muscular, and Mental Diseases etc.\\nVOLUME II. CONTAINS:\\nUrine (Chemistry and Microscopy). Kid-\\nney and Lungs. Air-passages (Larynx and\\nBronchi) and Pleura. Pharynx, (Esophagus,\\nStomach and Intestines (including Intestinal\\nParasites), Heart, Aorta, Arteries and Veins.\\nPeritoneum, Liver, and Pancreas. Diathet-\\nic Diseases (Rheumatism, Rheumatoid Ar-\\nthritis, Gout, Lithaemia, and Diabetes.)\\nBlood and Spleen. Inflammation, Embolism,\\nThrombosis, Fever, and Bacteriology.\\nThe articles are not written as though addressed to students in lectures, but\\nare exhaustive descriptions of diseases, with the newest facts as regards Causa-\\ntion, Symptomatology, Diagnosis, Prognosis, and Treatment, including a large\\nnumber of approved formulae. The recent advances made in the study\\nof the bacterial origin of various diseases are fully described, as well as the\\nbearing of the knowledge so gained upon prevention and cure. The subjects\\nof Bacteriology as a whole and of Immunity are fully considered in a separate\\nsection.\\nMethods of diagnosis are given the most minute and careful attention, thus\\nenabling the reader to learn the very latest methods of investigation without\\nconsulting works specially devoted to the subject.\\nCONTRIBUTORS\\nDr. J. S. Billings, Philadelphia.\\nFrancis Delafield, New York.\\nReginald H. Fitz, Boston.\\nJames W. Holland, Philadelphia.\\nHenry M. Lyman, Chicago.\\nWilliam Osier, Baltimore.\\nDr. William Pepper, Philadelphia.\\nW. Gilman Thompson, New York.\\nW. H. Welch, Baltimore.\\nJames T. Whittaker, Cincinnati.\\nJames C. Wilson, Philadelphia.\\nHoratio C. Wood, Philadelphia.\\nWe reviewed the first volume of this work, and said It is undoubtedly one of the best\\ntext-books on the practice of medicine which we possess. A consideration of the second\\nand last volume leads us to modify that verdict and to say that the completed work i-s, in our\\nopinion, the best of its kind it has ever been our fortune to see. It is complete, thorough,\\naccurate, and clear. It is well written, well arranged, well printed, well illustrated, and well\\nbound. It is a model of what the modern text-book should be. New York Medical Journal.\\nA library upon modern medical art. The work must promote the wider diffusion of\\nsound knowledge. American Lancet.\\nA trusty counsellor for the practitioner or senior student, on which he may implicitly\\nely. Edinburgh Medical Journal.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0472.jp2"}, "473": {"fulltext": "CATALOGUE OF MEDICAL WORKS. II\\n*AN AMERICAN TEXT-BOOK OF SURGERY. Edited by Wil-\\nliam W. Keen, M. D., LL.D., and J. William W t hite, M. D., Ph. D.\\nForming one handsome royal octavo volume of 1230 pages (10x7 inches),\\nwith 496 wood-cuts in text, and 37 colored and half-tone plates, many of\\nthem engraved from original photographs and drawings furnished by the\\nauthors. Price Cloth, $7.00 net; Sheep or Half Morocco, $8.00 net.\\nTHIRD EDITION. THOROUGHLY REVISED.\\nIn the present edition, among the new topics introduced are a full considera-\\ntion of serum-therapy leucocytosis post-operative insanity; the use of dry heat\\nat high temperatures Kronlein s method of locating the cerebral fissures\\nHoffa s and Lorenz s operations of congenital dislocations of the hip; Allis s re-\\nsearches on dislocations of the hip-joint lumbar puncture the forcible reposi-\\ntion of the spine in Pott s disease the treatment of exophthalmic goiter the\\nsurgery of typhoid fever gastrectomy and other operations on the stomach\\nnew methods of operating upon the intestines the use of Kelly s rectal specula\\nthe surgery of the ureter Schleich s infiliration-method and the use of eucain\\nfor local anesthesia Krause s method of skin-grafting the newer methods of\\ndisinfecting the hands; the use of gloves, etc. The sections on Appendicitis,\\non Fractures, and on Gynecological Operations have been revised and enlarged.\\nA considerable number of new illustrations have been added, and enhance the\\nvalue of the work.\\nThe text of the entire book has been submitted to all the authors for their\\nmutual criticism and revision an idea in book-making that is entirely new and\\noriginal. The book as a whole, therefore, expresses on all the important sur-\\ngical topics of the day the consensus of opinion of the eminent surgeons who\\nhave joined in its preparation.\\nOne of the most attractive features of the book is its illustrations. Very\\nmany of them are original and faithful reproductions of photographs taken\\ndirectly from patients or from specimens*\\nCONTRIBUTORS\\nDr. Phineas S. Conner, Cincinnati.\\nFrederic S. Dennis, New York.\\nWilliam W. Keen, Philadelphia.\\nCharles B. Nancrede, Ann Arbor, Mich.\\nRoswell Park, Buffalo, New York.\\nLewis S. Pileher. New York.\\nDr. Nicholas Senn, Chicago.\\nFrancis J. Shepherd, Montreal, Canada.\\nLewis A. Stimson, New York.\\nJ. Collins Warren, Boston.\\nJ. William White, Philadelphia.\\nIf this text-book is a fair reflex of the present position of American surgery, we must\\nadmit it is of a very high order of merit, and that English surgeons will have to look very\\ncarefuilv to their laurels if they are to preserve a position in the van of surgical practice.\\nLondon Lancet.\\nPersonally, 1 should not mind it being called THE Text-Book (instead of A Text-Book),\\nfor I know ot no single volume which contains so readable and complete an account of the\\nscience and art of Surgery as this does. Edmund Owen, F. R. C. S., Member of the Board\\nof Examiners of the Royal College of Surgeons, England.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0473.jp2"}, "474": {"fulltext": "12 W. B. SAUNDERS 1\\n^AN AMERICAN TEXT-BOOK OF GYNECOLOGY, MEDICAL\\nAND SURGICAL, for the use of Students and Practitioners.\\nEdited by J. M. Baldy, M. D. Forming a handsome royal-octavo volume\\nof 718 pages, with 341 illustrations in the text and 38 colored and half-\\ntone plates. Prices Cloth, $6.00 net; Sheep or Half-Morocco, $7.00 net.\\nSECOND EDITION, THOROUGHLY REVISED.\\nIn this volume all anatomical descriptions, excepting those essential to a clear\\nunderstanding of the text, have been omitted, the illustrations being largely de-\\npended upon to elucidate the anatomy of the parts. This work, which is\\nthoroughly practical in its teachings, is intended, as its title implies, to be a\\nworking text-book. for physicians and students. A clear line of treatment has\\nbeen laid down in every case, and although no attempt has been made to dis-\\ncuss mooted points, still the most important of these have been noted and ex-\\nplained. The operations recommended are fully illustrated, so that the reader,\\nhaving a picture of the procedure described in the text under his eye, cannot fail\\nto grasp the idea. All extraneous matter and discussions have been carefully\\nexcluded, the attempt being made to allow no unnecessary details to cumber\\nthe text. The subject-matter is brought up to date at every point, and the\\nwork is as nearly as possible the combined opinions of the ten specialists who\\nfigure as the authors.\\nIn the revised edition much new material has been added, and some of the\\nold eliminated or modified. More than forty of the old illustrations have been\\nreplaced by new ones, which add very materially to the elucidation of the\\ntext, as they picture methods, not specimens. The chapters on technique and\\nafter-treatment have been considerably enlarged, and the portions devoted to\\nplastic work have been so greatly improved as to be practically new. Hyste-\\nrectomy has been rewritten, and all the descriptions of operative procedures\\nhave been carefully revised and fully illustrated.\\nCONTRIBUTORS\\nDr. Henry T. Byford.\\nJohn M. Baldy.\\nEdwin Cragin.\\nJ. H. Etheridge.\\nWilliam Goodell.\\nDr. Howard A. Kelly.\\nFlorian Krug.\\nE. E. Montgomery.\\nWilliam R. Pryor.\\nGeorge M. Tuttle.\\nThe most notable contribution to gynecological literature since 1887, and the most\\ncomplete exponent of gynecology which we have. No subject seems to have been neglected,\\nand the gynecologist and surgeon, and the general practitioner who has any desire\\nto practise diseases of women, will find it of practical value. In the matter of illustrations\\nand plates the book surpasses anything we have seen. Boston Medical and Surgical\\nJournal.\\nA thoroughly modern text-book, and gives reliable and well-tempered advice and in-\\nstruction. Edinburgh Medical Journal.\\nThe harmony of its conclusions and the homogeneity of its style give it an individuality\\nwhich suggests a single rather than a multiple authorship. Annals 0/ Surgery.\\nIt must command attention and respect as a worthy representation of our advanced\\nclinical teaching. American Journal of Medical Sciences.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0474.jp2"}, "475": {"fulltext": "CATALOGUE OF MEDICAL WORKS.\\n13\\n*AN AMERICAN TEXT-BOOK OF THE DISEASES OF CHIL-\\nDREN. By American Teachers. Edited by Louis Starr, M. D.,\\nassisted by Thompson S. Westcott, M. D. In one handsome royal-8vo\\nvolume of 1244 pages, profusely illustrated with wood-cuts, half-tone and\\ncolored plates. Net Prices: Cloth, $7.00; Sheep or Half-Morocco, $8.00.\\nSECOND EDITION, REVISED AND ENLARGED.\\nThe plan of this work embraces a series of original articles written by some\\nsixty well-known podiatrists, representing collectively the teachings of the most\\nprominent medical schools and colleges of America. The work is intended to\\nbe a practical book, suitable for constant and handy reference by the practi-\\ntioner and the advanced student.\\nEspecial attention has been given to the latest accepted teachings upon the\\netiology, symptoms, pathology, diagnosis, and treatment of the disorders of chil-\\ndren, with the introduction of many special formulae and therapeutic procedures.\\nIn this new edition the whole subject matter has been carefully revised, new\\narticles added, some original papers emended, and a number entirely rewritten.\\nThe new articles include Modified Milk and Percentage Milk-Mixtures,\\nLithemia, and a section on Orthopedics. Those rewritten are Typhoid\\nFever, Rubella, Chicken-pox, Tuberculous Meningitis, Hydroceph-\\nalus, and Scurvy; while extensive revision has been made in Infant\\nFeeding, Measles, Diphtheria, and Cretinism. The volume has thus\\nbeen much increased in size by the introduction of fresh material.\\nCONTRIBUTORS 1\\nDr. S. S. Adams, Washington.\\nJohn Ashhurst, Jr., Philadelphia.\\nA. D. Blackader, Montreal, Canada.\\nDavid Bovaird, New York.\\nDillon Brown, New York.\\nEdward M. Buckingham, Boston.\\nCharles W. Burr, Philadelphia.\\nW. E. Casselberry, Chicago.\\nHenry Dwight Chapin, New York.\\nW. S. Christopher, Chicago.\\nArchibald Church, Chicago.\\nFloyd M. Crandall, New York.\\nAndrew F. Currier, New York.\\nRoland G. Curtin, Philadelphia\\nJ. M. DaCos a, Philadelphia.\\nI. N. Danforth, Chicago.\\nEdward P. Davis, Philadelphia.\\nJohn B. Deaver, Philadelphia.\\nG. E. de Schweinitz, Philadelphia.\\nJohn Doming, New York.\\nCharles Warrington Earle, Chicago.\\nWm. A. Edwards, San Diego, Cal.\\nF. Forchheimer, Cincinnati.\\nJ. Henry Fruitnight, New York.\\nJ. P. Crozer Griffith, Philadelphia.\\nW. A. Hardaway. St. Louis.\\nM. P Hatfield, Chicago.\\nBarton Cooke Hirst, Philadelphia.\\nH. Illoway, Cincinnati.\\nHenry Jackson, Boston.\\nCharles G. Jennings, Detroit.\\nHenry Koplik, New York.\\nDr. Thomas S. Latimer, Baltimore.\\nAlbert R. Leeds, Hoboken, N. J.\\nJ. Hendrie Lloyd, Philadelphia.\\nGeorge Roe Lockwood, New York.\\nHenry M. Lyman, Chicago.\\nFrancis T. Miles, Baltimore.\\nCharles K Mills, Philadelphia.\\nJames E. Moore, Minneapolis.\\nF. Gordon Morrill, Boston.\\nJohn H. Musser, Philadelphia.\\nThomas R. Neilson, Philadelphia.\\nW. P. Northrup, New York.\\nWilliam Osier, Baltimore.\\nFrederick A. Packard, Philadelphia.\\nWilliam Pepper, Philadelphia.\\nFrederick Peterson, New York.\\nW. T. Plant, Syracuse, New York.\\nWilliam M. Powell, Atlantic City.\\nB. K. Rachford, Cincinnati.\\nB. Alexander Randall, Philadelphia.\\nEdward O. Shakespeare, Philadelphia\\nF. C. Shattuck, Boston.\\nJ. Lewis Smith, New York.\\nLouis Starr, Philadelphia.\\nM. Allen Starr, New York.\\nCharles W. Townsend, Boston.\\nJames Tyson, Philadelphia.\\nW. S. Thayer, Baltimore.\\nVictor C. Vaughan, Ann Arbor, Mich\\nThompson S. Westcott, Philadelphia.\\nHenry R. Wharton, Philadelphia.\\nJ. William White, Philadelphia.\\nJ. C. Wilson, Philadelphia.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0475.jp2"}, "476": {"fulltext": "14\\nW. B. SAUNDERS\\n*AN AMERICAN TEXT-BOOK OF GENITO-URINARY AND\\nSKIN DISEASES. By 47 Eminent Specialists and Teachers. Edited\\nby L. Bolton Bangs, M. D., Professor of Genito-Urinary Surgery, Uni-\\nversity and Bellevue Hospital Medical College, New York; and W. A.\\nHardaway, M. D., Professor of Diseases of the Skin, Missouri Medical\\nCollege. Imperial octavo volume of 1229 pages, with 300 engravings ana\\n20 full-page colored plates. Cloth, $7.00 net; Sheep or Half Morocco,\\n$8.00 net.\\nThis addition to the series of American Text-Books, it is confidently be-\\nlieved, will meet the requirements of both students and practitioners, giving, as\\nit does, a comprehensive and detailed presentation of the Diseases of the\\nGenito-Urinary Organs, of the Venereal Diseases, and of the Affections of the\\nSkin.\\nHaving secured the collaboration of well-known authorities in the branches\\nrepresented in the undertaking, the editors have not restricted the contributors\\nii. regard to the particular views set forth, but have offered every facility for the\\nfree expression of their individual opinions. The work will therefore be found\\nto be original, yet homogeneous and fully representative of the several depart-\\nments of medical science with which it is concerned.\\nCONTRIBUTORS\\nChas. W. Allen, New York.\\nI. E. Atkinson, Baltimore.\\nL Bolton Bangs, New York.\\nP. R. Bolton, New York.\\nLewis C. Bosher, Richmond, Va.\\nJohn T. Bowen, Boston.\\nJ. Abbott Cantrell. Philadelphia.\\nWilliam T. Corlett, Cleveland, Ohio.\\nB. Farquhar Curtis, New York.\\nCondict W. Cutler, New York.\\nIsadore Dyer, New Orleans.\\nChristian Fenger, Chicago.\\nJohn A. Fordyce, New York.\\nEugene Fuller, New York.\\nR. H. Greene, New York.\\nJoseph Grindon, St. Louis.\\nGraeme M. Hammond, New York.\\nW. A. Hardaway, St. Louis.\\nM. B. Hartzell, Philadelphia.\\nLouis Heitzmann. New York.\\nJames S- Howe, Boston.\\nGeorge T. Jackson, New York.\\nAbraham Jacobi, New York.\\nJames C. Johnston. Mew Yo.iv.\\nDr. Hermann G. Klotz, New YqrK.\\nJ. H. Linsley, Burlington, V t.\\nG. F. Lydston, Chicago,\\nHartwell N. Lyon, St. Louis.\\nEdward Martin, Philadelphia.\\nD. G. Montgomery, San Franciscc.\\nJames Pedersen, New York.\\nS. Pollitzer, New York.\\nThomas R. Pooley. New York.\\nA. R. Robinson, New York.\\nA. E. Regensburger, San Franciscc.\\nFrancis J. Shepherd, Montreal, Can.\\nS. C. Stanton, Chicago, 111.\\nEmmanuel J. Stout. Philadelphia.\\nAlonzo E. Taylor Philadelphia.\\nRobert W. Taylor, New York.\\nPaul Thorndike, Boston.\\nH. Tuholske, St. Louis.\\nArthur Van Harlingen, Philadelphia.\\nFrancis S. Watson. Boston.\\nJ. William White, Philadelphia.\\nJ. McF. Winfield. Brooklyn.\\nAlfred C. Wood, Philadeipnia.\\nThis voluminous work is thoroughly up to date, and the chapters on genito-urmary dis-\\neases are especially valuable. The illustrations are fine and are mostly original. _ The section\\non dermatology is concise and in every way admirable. Journal of the American Medical\\nAssociation.\\nThis volume is one of the best yet issued of the publisher s series of American Text-\\nBooks. The list of contributors represents an extraordinary array of talent and extended\\nexperience. The book will easily take the place in comprehensiveness and value of the\\nhalf dozen or more costly works on these subjects which have hitherto been necessary to a\\nwell-equipped library. New York Polyclinic.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0476.jp2"}, "477": {"fulltext": "CATALOGUE OF MEDICAL WORKS.\\n15\\nAN AMERICAN TEXT-BOOK OF DISEASES OF THE EYE,\\nEAR, NOSE, AND THROAT. Edited by George E. de Schweinitz,\\nA. M., M. D., Professor of Ophthalmology, Jefferson Medical College and\\nB. Alexander Randall, A. M., M. D., Clinical Professor of Diseases of\\nthe Ear, University of Pennsylvania. One handsome imperial octavo\\nvolume of 1251 pages; 766 illustrations, 59 of them colored. Prices:\\nCloth, $7.00 net; Sheep or Half- Morocco, $8.00 net.\\nJust Issued.\\nThe present work is the only book ever published embracing diseases of the\\nintimately related organs of the eye, ear, nose, and throat. Its special claim\\nto favor is based on encyclopedic, authoritative, and practical treatment of the\\nsubjects.\\nEach section of the book has been entrusted to an author who is specially\\nidentified with the subject on which he writes, and who therefore presents his\\ncase in the manner of an expert. Uniformity is secured and overlapping pre-\\nvented by careful editing and by a system of cross-references which forms a\\nspecial feature of the volume, enabling the reader to come into touch with all\\nthat is said on any subject in different portions of the book.\\nParticular emphasis is laid on the most approved methods of treatment, so\\nthat the book shall be one to which the student and practitioner can refer for\\ninformation in practical work. Anatomical and physiological problems, also,\\nare fully discussed for the benefit of those who desire to investigate the more\\nabstruse problems of the subject.\\nCONTRIBUTORS\\nHenry A. Alderton, Brooklyn.\\nHarrison Allen, Philadelphia.\\nFrank Allport, Chicago.\\nMorris J. Asch. New York.\\nS. C. Ayres, Cincinnati.\\nR. O. Beard, Minneapolis.\\nClarence J. Blake, Boston.\\nArthur A. Bliss, Philadelphia.\\nAlbert P. Brubaker, Philadelphia.\\nJ. H. Bryan, Washington, D. C.\\nAlbert H. Buck, New York.\\nF. Buller, Montreal, Can.\\nSwan M. Burnett, Washington, D. C.\\nFlemming Carrow, Ann Arbor, Mich.\\nW. E. Casselberry, Chicago.\\nColman W. Cutler, New York.\\nEdward B. Dench, New York.\\nWilliam S. Dennett, New York.\\nGeorge E. de Schweinitz, Philadelphia.\\nAlexander Duane, New York.\\nJohn W. Farlow, Boston, Mass.\\nWalter J. Freeman, Philadelphia.\\nH. Giflford, Omaha, Neb.\\nW. C. Glasgow, St. Louis.\\nJ Orne Green, Boston.\\nWard A. Holden, New York.\\nChristian R. Holmes, Cincinnati.\\nWilliam E. Hopkins, San Francisco.\\nF. C. Hotz, Chicago.\\nLucien Howe, Buffalo, N. Y.\\nDr. Alvin A. Hubbell, Buffalo, N. Y.\\nEdward Jackson, Philadelphia.\\nJ. Ellis Jennings, St. Louis.\\nHerman Knapp, New York.\\nChas. W. Kollock, Charleston, S. C.\\nG. A. Leland, Boston.\\nJ. A. Lippincott, Pittsburg, Pa.\\nG. Hudson Makuen, Philadelphia.\\nJohn H. McCollom, Boston.\\nH. G. Miller, Providence, R. I.\\nB. L. Miliiken, Cleveland, Ohio.\\nRobert C. Myles, New York.\\nJames E. Newcomb, New York.\\nR. J. Phiilips, Philadelphia.\\nGeorge A. Piersol, Philadelphia.\\nW. P. Porcher, Charleston, S. C.\\nB. Alex. Randall, Philadelphia.\\nRobert L. Randolph, Baltimore.\\nJohn O. Roe, Rochester, N. Y.\\nCharles E. de M. Sajous, Philadelphia.\\nJ. E. Sheppard, Brooklyn, N. Y.\\nE. L. Shurly, Detroit, Mich.\\nWilliam M. Sweet, Philadelphia.\\nSamuel Theobald. Baltimore, Md.\\nA. G. Thomson, Philadelphia.\\nClarence A. Veasey, Philadelphia.\\nJohn E. Weeks, New York.\\nCasey A. Wood, Chicago, 111.\\nJonathan Wright, Brooklyn.\\nH. V. Wiirdemann, Milwaukee, Wis.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0477.jp2"}, "478": {"fulltext": "i6\\nW. B. SAUNDERS\\n*AN AMERICAN YEAR-BOOK OF MEDICINE AND SUR-\\nGERY. A Yearly Digest of Scientific Progress and Authoritative\\nOpinion in all branches of Medicine and Surgery, drawn from journals*\\nmonographs, and text-books of the leading American and Foreign authors\\nand investigators. Collected and arranged, with critical editorial com-\\nments, by eminent American specialists and teachers, under the general\\neditorial charge of George M. Gould, M. D. Volumes for 1896, 97,\\n98, and 99 each a handsome imperial octavo volume of about 1200 pages.\\nPrices Cloth, $6.50 net Half- Morocco, $7.50 net. Year-Book for 1900 in\\ntwo octavo volumes of about 600 pages each. Prices per volume Cloth,\\n$3.00 net; Half-Morocco, $3.75 net.\\nIn Two Volumes. No Increase in Price*\\nIn response to a widespread demand from the medical profession, the pub-\\nlisher of the American Year-Book of Medicine and Surgery has decided to\\nissue that well-known work in two volumes, Vol. I. treating of General Medi-\\ncine, Vol. II. of General Surgery. Each volume is complete in itself, and\\nthe work is sold either separately or in sets.\\nThis division is made in such a way as to appeal to physicians from a class\\nstandpoint, one volume being distinctly medical, and the other distinctly surgi-\\ncal. This arrangement has a two-fold advantage. To the physician who uses\\nthe entire book, it offers an increased amount of matter in the most convenient\\nform for easy consultation, and without any increase in price; while the man\\nwho wants either the medical or the surgical section alone secures the complete\\nconsideration of his branch without the necessity of purchasing matter for which\\nhe has no use.\\nCONTRIBUTORS\\nVol. I.\\nDr. Samuel W. Abbott, Boston.\\nArchibald Church, Chicago.\\nLouis A. Duhring, Philadelphia.\\nD. L. Edsall, Philadelphia.\\nAlfred Hand, Jr., Philadelphia.\\nM. B. Hartzell, Philadelphia.\\nReid Hunt, Baltimore.\\nWyatt Johnston, Montreal.\\nWalter Jones, Baltimore.\\nDavid Riesman, Philadelphia.\\nLouis Starr, Philadelphia.\\nAlfred Stengel, Philadelphia.\\nA. A. Stevens, Philadelphia.\\nG. N. Stewart. Cleveland.\\nReynold W. Wilcox, New York City.\\nVol. II.\\nDr. J. Montgomery Baldy, Philadelphia.\\nCharles H. Burnett, Philadelphia.\\nJ. Chalmers DaCosta, Philadelphia.\\nW. A. N. Dorland, Philadelphia.\\nVirgil P. Gibney, New York City.\\nC. H. Hamann, Cleveland.\\nHoward F. Hansell, Philadelphia.\\nBarton Cooke Hirst, Philadelphia.\\nE. Fletcher lngals, Chicago.\\nW. W. Keen, Philadelphia.\\nHenry G. Ohls, Chicago.\\nWendell Reber, Philadelphia.\\nJ. Hilton Waterman, New York City.\\nIt is difficult to know which to admire most the research and industry of the distin-\\nguished band of experts whom Dr. Gould has enlisted in the service of the Year-Book, or fche\\nwealth and abundance of the contributions to every department of science that have been\\ndeemed worthy of analysis. It is much more than a mere compilation of abstracts, for,\\nas each section is entrusted to experienced and able contributors, the reader has the advan-\\ntage of certain critical commentaries and expositions proceeding from writers fully\\nqualified to perform these tasks. It is emphatically a book which should find a place in\\nevery medical library, and is in several respects more useful than the famous Jahrbucher\\nof Germany. London Lancet.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0478.jp2"}, "479": {"fulltext": "CATALOGUE OF MEDICAL WORKS. \\\\J\\nANOMALIES AND CURIOSITIES OF MEDICINE. By George\\nM. Gould, M.D., and Walter L. Pyle, M.D. An encyclopedic collec-\\ntion of are and extraordinary cases and of the most striking instances of\\nabnormality in all branches of Medicine and Surgery, derived from an ex-\\nhaustive research of medical literature from its origin to the present day,\\nabstracted, classified, annotated, and indexed. Handsome imperial octavo\\nvolume of 968 pages, with 295 engravings in the text, and 12 full-page\\nplates. Cloth, $3.00 net Half-Morocco, $4.00 net.\\nPOPULAR EDITION REDUCED FROM $6*00 to $3.00.\\nIn view of the greatsuccess of this magnificent work, the publisher has decided\\nto issue a Popular Edition at a price so low that it may be procured by every\\nstudent and practitioner of medicine. Notwithstanding the great reduction in\\nprice, there will be no depreciation in the excellence of typography, paper, and\\nbinding that characterized the earlier editions.\\nSeveral years of exhaustive research have been spent by the authors in the\\ngreat medical libraries of the United States and Europe in collecting the mate-\\nrial for this work. Medical literature of all ages and all languages has\\nbeen carefully searched, as a glance at the Bibliographic Index will show. The\\nfacts, which will be of extreme value to the author and lecturer, have been\\narranged and annotated, and full reference footnotes given.\\nOne of the most valuable contributions ever made to medical literature. It is, so far as\\nwe know, absolutely unique, and every page is as fascinating as a novel. Not alone for the\\nmedical profession has this volume value it will serve as a book of reference for all who are\\ninterested in general scientific, sociologic, or medico-legal topics. Brooklyn Medical Jour-\\nnal.\\nNERVOUS AND MENTAL DISEASES. By Archibald Church,\\nM. D., Professor of Clinical Neurology, Mental Diseases, and Medical\\nJurisprudence, Northwestern University Medical School; and Frederick\\nPeterson, M. D., Clinical Professor of Mental Diseases, Woman s Medi-\\ncal College, New York. Handsome octavo volume of 843 pages, with\\nover 300 illustrations. Prices: Cloth, $5.00 net; Half-Morocco, $6.00\\nnet.\\nSecond Edition.\\nThis book is intended to furnish students and practitioners with a practical,\\nworking knowledge of nervous and mental diseases. Written by men of wide\\nexperience and authority, it presents the many recent additions to the subject.\\nThe book is not filled with an extended dissertation on anatomy and pathology,\\nbut, treating these points in connection with special conditions, it lays particular\\nstress on methods of examination, diagnosis, and treatment. In this respect the\\nwork is unusually complete and valuable, laying down the definite courses of\\nprocedure which the authors have found to be most generally satisfactory.\\nThe work is an epitome of what is to-day known of nervous diseases prepared for the\\nstudent and practitioner in the light of the author s experience We believe that no work\\npresents the difficult subject of insanity in such a reasonable and readable way. Chicago\\nMedical Recorder.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0479.jp2"}, "480": {"fulltext": "1 8 W. B. SAUNDERS\\nDISEASES OF THE NOSE AND THROAT. By D. Braden Kyle,\\nM. D., Clinical Professor of Laryngology and Rhinology, Jefferson Medi-\\ncal College, Philadelphia; Consulting Laryngologist, Rhinologist, and\\nOtologist, St. Agnes Hospital. Octavo volume of 646 pages, with over\\n150 illustrations and 6 lithographic plates. Cloth, $4.00 net; Half-Mo-\\nrocco, $5.00 net.\\nJust Issued.\\nThis book presents the subject of Diseases of the Nose and Throat in as con-\\ncise a manner as is consistent with clearness, keeping in mind the needs of the\\nstudent and general practitioner as well as those of the specialist. The arrange-\\nment and classification are based on modern pathology, and the pathological\\nviews advanced are supported by drawings of microscopical sections made in the\\nauthor s own laboratory. These and the other illustrations are particularly fine,\\nbeing chiefly original. With the practical purpose of the book in mind, ex-\\ntended consideration has been given to details of treatment, each disease being\\nconsidered in full, and definite courses being laid down to meet special condi-\\ntions and symptoms.\\nIt is a thorough, full, and systematic treatise, so classified and arranged as greatly to facili-\\ntate the teaching of laryngology and rhinology to classes, and must prove most convenient\\nand satisfactory as a reference book, both for students and practitioners. International\\nMedical Magazine.\\nTHE HYGIENE OF TRANSMISSIBLE DISEASES theirCausa-\\ntion, Modes of Dissemination, and Methods of Prevention. By\\nA. C. Abbott, M. D., Professor of Hygiene in the University of Pennsyl-\\nvania Director of the Laboratory of Hygiene. Octavo volume of 311\\npages, with charts and maps, and numerous illustrations. Cloth, $2.00 net.\\nJust Issued.\\nIt is not the purpose of this work to present the subject of Hygiene in the\\ncomprehensive sense ordinarily implied by the word, but rather to deal directly\\nwith but a section, certainly not the least important, of the subject viz., that\\nembracing a knowledge of the preventable specific diseases. The book aims to\\nfurnish information concerning the detailed management of transmissible dis-\\neases. Incidentally there are discussed those numerous and varied factors that\\nhave not only a direct bearing upon the* incidence and suppression of such dis-\\neases, but are of general sanitary importance as well.\\nThe work is admirable in conception and no less so in execution. It is a practical work,\\nsimply and lucidly written, and it should prove a most helpful aid in that department of\\nmedicine which is becoming daily of increasing importance and application namely, prophy-\\nlaxis. Philadelphia Medical Journal.\\nIt is scientific, but not too technical it is as complete as our present-day knowledge of\\nhygiene and sanitation allows, and it is in harmony with the efforts of the profession, which\\nare tending more and more to methods of prophylaxis. For the student and for the practi-\\ntioner it is well nigh indispensable. Medical News, New York.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0480.jp2"}, "481": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 1 9\\nA TEXT-BOOK OF EMBRYOLOGY. By John C. Heisler, M. D..\\nProfessor of Anatomy in the Medico- Chirurgical College, Philadelphia.\\nOctavo volume of 405 pages, with 190 illustrations, 26 in colors. Cloth\\n$2.50 net.\\nJust Issued.\\nThe facts of embryology having acquired in recent years such great interesl\\nin connection with the teaching and with the proper comprehension of human\\nanatomy, it is of first importance to the student of medicine that a concise and\\nyet sufficiently full text-book upon the subject be available. It was with the\\naim of presenting such a book that this volume was written, the author, in his\\nexperience as a teacher of anatomy, having been impressed with the fact that\\nstudents were seriously handicapped in their study of the subject of embryology\\nby the lack of a text-book full enough to be intelligible, and yet without that\\nminuteness of detail which characterizes the larger treatises, and which so often\\nserves only to confuse and discourage the beginner.\\nIn short, the book is written to fill a want which has distinctly existed and which it\\ndefinitely meets commendation greater than this it is not possible to give to anything.\\nMedical News, New York.\\nA MANUAL OF DISEASES OF THE EYE. By Edward Jack-\\nson, A. M., M. D., sometime Professor of Diseases of the Eye in the Phila-\\ndelphia Polyclinic and College for Graduates in Medicine. I2mo, 604\\npages, with 178 illustrations from drawings by the author. Cloth, $2.50 net.\\nJust Issued.\\nThis book is intended to meet the needs of the general practitioner of medi-\\ncine and the beginner in ophthalmology. More attention is given to the condi-\\ntions that must be met and dealt with early in ophthalmic practice than to the\\nrarer diseases and more difficult operations that may come later.\\nIt is designed to furnish efficient aid in the actual work of dealing with dis-\\nease, and therefore gives the place of first importance to the recognition and\\nmanagement of the conditions that present themselves in actual clinical work.\\nLECTURES ON THE PRINCIPLES OF SURGERY. By Charles\\nB. Nancrede, M. D., LL.D., Professor of Surgery and of Clinical Surgery,\\nUniversity of Michigan, Ann Arbor. Handsome octavo, 398 pages, illus-\\ntrated. Cloth, $2.50 net.\\nJust Issued.\\nThe present book is based on the lectures delivered by Dr. Nancrede to his\\nundergraduate classes, and is intended as a text-book for students and a practi-\\ncal help for teachers. By the careful elimination of unnecessary details of\\npathology, bacteriology, etc., which are amply provided for in other courses of\\nstudy, space is gained for a more extended consideration of the Principles of\\nSurgery in themselves, and of the application of these principles to methods\\nof practice.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0481.jp2"}, "482": {"fulltext": "20 W. B. SAUNDERS\\nA TEXT-BOOK OF PATHOLOGY. By Alfred Stengel, M. D.,\\nProfessor of Clinical Medicine in the University of Pennsylvania Physi-\\ncian to the Philadelphia Hospital Physician to the Children s Hospital,\\nPhiladelphia. Handsome octavo volume of 848 pages, with 362 illustra-\\ntions, many of which are in colors. Prices: Cloth, $4.00 net; Half-\\nMorocco, $5.00 net.\\nSecond Edition.\\nIn this work the practical application of pathological facts to clinical medicine\\nis considered more fully than is customary in works on pathology. While the\\nsubject of pathology is treated in the broadest way consistent with the size of\\nthe book, an effort has been made to present the subject from the point of view\\nof the clinician. The general relations of bacteriology to pathology are dis-\\ncussed at considerable length, as the importance of these branches deserves. It\\nwill be found that the recent knowledge is fully considered, as well as older and\\nmore widely-known facts.\\nI consider the work abreast of modern pathology, and useful to both students and prac-\\ntitioners. It presents in a concise and well-considered form the essential facts of general and\\nspecial pathological anatomy, with more than usual emphasis upon pathological physiology.\\nWilli aim H. Welch, Professor of Pathology Johns Hopkins University, Baltimore, Md.\\nI regard it as the most serviceable text-book for students on this subject yet written by\\nan American author. L. Hektoen, Professor of Pathology, Rush Medical College,\\nChicago, III.\\nA TEXT-BOOK OF OBSTETRICS. By Barton Cooke Hirst, M.D.,\\nProfessor of Obstetrics in the University of Pennsylvania. Handsome oc-\\ntavo volume of 846 pages, with 618 illustrations and seven colored plates.\\nPrices: Cloth, $5.00 net; Half-Morocco, $6.00 net.\\nSecond Edition.\\nThis work, which has been in course of preparation for several years, is in-\\ntended as an ideal text-book for the student no less than an advanced treatise\\nfor the obstetrician and for general practitioners. It represents the very latest\\nteaching in the practice of obstetrics by a man of extended experience and\\nrecognized authority. The book emphasizes especially, as a work on obstetrics\\nshould, the practical side of the subject, and to this end presents an unusually\\nlarge collection of illustrations. A great number of these are new and original,\\nand the whole collection will form a complete atlas of obstetrical practice.\\nAn extremely valuable feature of the book is the large number of refer-\\nences to cases, authorities, sources, etc., forming, as it does, a valuable bib-\\nliography of the most recent and authoritative literature on the subject\\nof obstetrics. As already stated, this work records the wide practical ex-\\nperience of the author, which fact, combined with the brilliant presentation\\nof the subject, will doubtless render this one of the most notable books on\\nobstetrics that has yet appeared.\\nThe illustrations are numerous and are works of art, many of them appearing for the\\nfirst time. The arrangement of the subject-matter, the foot-notes, and index are beyond\\ncriticism. The author s style, though condensed, is singularly clear, so that it is never\\nnecessary to re-read a sentence in order to grasp its meaning. As a true model of what a\\nmodern text-book in obstetrics should be, we feel justified in affirming that Dr. Hirst s\\nbook is without a rival. New York Medical Record.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0482.jp2"}, "483": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 21\\nA TEXT-BOOK OF THE PRACTICE OF MEDICINE. By\\nJames M. Anders, M.D., Ph.D., LL.D., Professor of the Practice of\\nMedicine and of Clinical Medicine, Medico-Chirurgical College, Philadel-\\nphia. In one handsome octavo volume of 1292 pages, fully illustrated.\\nCloth, $5.50 net Sheep or Half-Morocco, $6.50 net.\\nTHIRD EDITION, THOROUGHLY REVISED.\\nThe present edition is the result of a careful and thorough revision. A few\\nnew subjects have been introduced Glandular Fever, Ether-pneumonia, Splenic\\nAnemia, Meralgia Paresthetica, and Periodic Paralysis. The affections that\\nhave been substantially rewritten are: Plague, Malta Fever, Diseases of the\\nThymus Gland, Liver Cirrhoses, and Progressive Spinal Muscular Atrophy.\\nThe following articles have been extensively revised Typhoid Fever, Yellow\\nFever, Lobar Pneumonia, Dengue, Tuberculosis, Diabetes Mellitus, Gout, Ar-\\nthritis Deformans, Autumnal Catarrh, Diseases of the Circulatory System, more\\nparticularly Hypertrophy and Dilatation of the Heart, Arteriosclerosis and\\nThoracic Aneurysm, Pancreatic Hemorrhage, Jaundice, Acute Peritonitis, Acute\\nYellow Atrophy, Hematoma of Dura Mater, and Scleroses of the Brain. The\\npreliminary chapter on Nervous Diseases is new, and deals with the subject of\\nlocalization and the various methods of investigating nervous .affections.\\nIt is an excellent book concise, comprehensive, thorough, and up to date. It is a\\ncredit to you but, more than that, it is a credit to the profession of Philadelphia to us.\\nJames C. Wilson, Professor of the Practice of Medicine and Clinical Medicine, Jeffer-\\nson Medical College, Philadelphia.\\nThe book can be unreservedly recommended to students and practitioners as a safe, full\\ncompendium of the knowledge of internal medicine of the present day It is a work\\nthoroughly modern in every sense. Medical News, New York.\\nDISEASES OF THE STOMACH. By William W. Van Valzah,\\nM. D., Professor of General Medicine and Diseases of the Digestive System\\nand the Blood, New York Polyclinic and J. Douglas Nisbet, M. D.,\\nAdjunct Professor cf General Medicine and Diseases of the Digestive Sys-\\ntem and the Blood, New York Polyclinic. Octavo volume of 674 pages,\\nillustrated. Cloth, $3.50 net.\\nAn eminently practical book, intended as a guide to the student, an aid to the\\nphysician, and a contribution to scientific medicine. It aims to give a complete\\ndescription of the modern methods of diagnosis and treatment of diseases of the\\nstomach, and to reconstruct the pathology of the stomach in keeping with the\\nrevelations of scientific research. The book is clear, practical, and complete,\\nand contains the results of the authors investigations and of their extensive ex-\\nperience as specialists. Particular attention is given to the important subject of\\ndietetic treatment. The diet-lists are very complete, and are so arranged that\\nselections can readily be made to suit individual cases.\\nThis is the most satisfactory work on the subject in the English language. Chicago\\nMedical Recorder.\\nThe article on diet and general medication is one of the most valuable in the book, and\\nshould be read by every practising physician. New York Medical Journal.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0483.jp2"}, "484": {"fulltext": "22 m B. SAUNDERS\\nSURGICAL DIAGNOSIS AND TREATMENT. By J. W. Mao\\ndonald, M. D., Edin., F. R. C. S., Edin., Professor of the Practice of Sur-\\ngery and of Clinical Surgery in Hamline University Visiting Surgeon to St.\\nBarnabas Hospital, Minneapolis, etc. Handsome octavo volume of 800\\npages, profusely illustrated. Cloth, $5.00 net; Half-Morocco, $6.00 net.\\nThis work aims in a comprehensive manner to furnish a guide in matters of\\nsurgical diagnosis. It sets forth in a systematic way the necessities of examina-\\ntions and the proper methods of making them. The various portions of the\\nbody are then taken up in order and the diseases and injuries thereof succinctly\\nconsidered and the treatment briefly indicated. Practically all the modern and\\napproved operations are described with thoroughness and clearness. The work\\nconcludes with a chapter on the use of the Rontgen rays in surgery.\\nThe work is brimful of just the kind of practical information that is useful alike to\\nstudents and practitioners. It is a pleasure to commend the book because of its intrinsic\\nvalue to the medical practitioner. Cincinnati Lancet-Clinic.\\nPATHOLOGICAL TECHNIQUE. A Practical Manual for Laboratory\\nWork in Pathology, Bacteriology, and Morbid Anatomy, with chapters on\\nPost-Mortem Technique and the Performance of Autopsies. By Frank\\nB. Mallory, A. M., M. D., Assistant Professor of Pathology, Harvard\\nUniversity Medical School, Boston and James H. Wright, A. M., M. D.,\\nInstructor in Pathology, Harvard University Medical School, Boston. Oc-\\ntavo volume of 396 pages, handsomely illustrated. Cloth, $2.50 net.\\nThis book is designed especially for practical use in pathological laboratories,\\nboth as a guide to beginners and as a source of reference for the advanced. The\\nbook will also meet the wants of practitioners who have opportunity to do general\\npathological work. Besides the methods of post-mortem examinations and of\\nbacteriological and histological investigations connected with autopsies, the\\nspecial methods employed in clinical bacteriology and pathology have been\\nfully discussed.\\nOne of the most complete works on the subject, and one which should be in the library\\nof every physician who hopes to keep pace with the great advances made in pathology.\\nyournal of American Medical Association.\\nTHE SURGICAL COMPLICATIONS AND SEQUELS OF TY-\\nPHOID FEVER. By Wm. W. Keen, M. D., LL.D., Professor of the\\nPrinciples of Surgery and of Clinical Surgery, Jefferson Medical College,\\nPhiladelphia. Octavo volume of 386 pages, illustrated. Cloth, $3.00 net.\\nThis monograph is the only one in any language covering the entire subject\\nof the Surgical Complications and Sequels of Typhoid Fever. The work will\\nprove to be of importance and interest not only to the general surgeon and phy-\\nsician, but also to many specialists laryngologists, ophthalmologists, gynecolo-\\ngists, pathologists, and bacteriologists as the subject has an important bearing\\nupon each one of their spheres. The author s conclusions are based on reports\\nof over 1700 cases, including practically all those recorded in the last fifty years.\\nReports of cases have been brought down to date, many having been added\\nwhile the work was in press.\\nThis is. probably the first and only work in the English language that gives the reader a\\nclear view of what typhoid fever really is, and what it does and can do to the human organ-\\nism. This book should be in the possession of every medical man in America. American\\nMedico-Surgical Bulletin.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0484.jp2"}, "485": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 2$\\nMODERN SURGERY, GENERAL AND OPERATIVE. By John\\nChalmers DaCosta, M.D., Clinical Professor of Surgery, Jefferson Medi-\\ncal College, Philadelphia; Surgeon to the Philadelphia Hospital, etc.\\nHandsome octavo volume of 911 pages, profusely illustrated. Cloth, $4.00\\nnet Half- Morocco, $5.00 net.\\nSecond Edition, Rewritten and Greatly Enlarged.\\nThe remarkable success attending DaCosta s Manual of Surgery, and the\\ngeneral favor with which it has been received, have led the author in this\\nrevision to produce a complete treatise on modern surgery along the same lines\\nthat made the former edition so successful. The book has been entirely re-\\nwritten and very much enlarged. The old edition has long been a favorite not\\nonly with students and teachers, but also with practising physicians and sur-\\ngeons, and it is believed that the present work will find an even wider field of\\nusefulness.\\nWe know of no small work on surgery in the English language which so well fulfils the\\nrequirements of the modern student. Medico-Chirurgical Journal, Bristol, England.\\nThe author has presented concisely and accurately the principles of modern surgery.\\nThe book is a valuable one which can be recommended to students and is of great value to\\nthe general practitioner. American Journal of the Medical Sciences.\\nA MANUAL OF ORTHOPEDIC SURGERY. By James E. Moore,\\nM.D., Professor of Orthopedics and Adjunct Professor of Clinical Surgery,\\nUniversity of Minnesota, College of Medicine and Surgery. Octavo volume\\nof 356 pages, with 177 beautiful illustrations from photographs made spec-\\nially for this work. Cloth, $2.50 net.\\nA practical book based upon the author s experience, in which special stress\\nis laid upon early diagnosis and treatment such as can be carried out by the\\ngeneral practitioner. The teachings of the author are in accordance with his\\nbelief that true conservatism is to be found in the middle course between the\\nsurgeon who operates too frequently and the orthopedist who seldom operates.\\nA very demonstrative work, every illustration of which conveys a lesson. The work is\\na most excellent and commendable one, which we can certainly endorse with pleasure.\\nSt. Louis Medical and Surgical Journal.\\nELEMENTARY BANDAGING AND SURGICAL DRESSING.\\nWith Directions concerning the Immediate Treatment of Cases of Emer-\\ngency. For the use of Dressers and Nurses. By Walter Pye, F.R.C.S.,\\nlate Surgeon to St. Mary s Hospital, London. Small i2mo, with over 80\\nillustrations. Cloth, flexible covers, 75 cents net.\\nThis little book is chiefly a condensation of those portions of Pye s Surgical\\nHandicraft which deal with bandaging, splinting, etc., and of those which\\ntreat of the management in the first instance of cases of emergency. The\\ndirections given are thoroughly practical, and the book will prove extremely use-\\nful to students, surgical nurses, and dressers.\\nThe author writes well, the diagrams are clear, and the book itself is small and portable,\\nalthough the paper and type are good. British Medical Journal.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0485.jp2"}, "486": {"fulltext": "24 W. B. SAUNDERS\\nA TEXT-BOOK OF MATERIA MEDICA, THERAPEUTICS\\nAND PHARMACOLOGY. By George F. Butler, Ph.G., M.D.,\\nProfessor of Materia Medica and of Clinical Medicine in the College of\\nPhysicians and Surgeons, Chicago; Professor of Materia Medica and\\nTherapeutics, Northwestern University, Woman s Medical School, etc.\\nOctavo, 874 pages, illustrated. Cloth, $4.00 net; Sheep, $5.00 net.\\nThird Edition, Thoroughly Revised,\\nA clear, concise, and practical text-book, adapted for permanent reference no\\nless than for the requirements of the class-room.\\nThe recent important additions made to our knowledge of the physiological\\naction of drugs are fully discussed in the present edition. The book has been\\nthoroughly revised and many additions have been made.-\\nTaken as a whole, the book may fairly be considered as one of the most satisfactory of any\\nsingle-volume works on materia medica in the market/ Journal of the American Medical\\nAssociation.\\nTUBERCULOSIS OF THE GENITO-URINARY ORGANS,\\nMALE AND FEMALE. By Nicholas Senn, M.D., Ph.D., LL.D.,\\nProfessor of the Practice of Surgery and of Clinical Surgery, Rush Medical\\nCollege, Chicago. Handsome octavo volume of 320 pages, illustrated^\\nCloth, $3.00 net.\\nTuberculosis of the male and female genito-urinary organs is such a frequent,\\ndistressing, and fatal affection that a special treatise on the subject appears to\\nfill a gap in medical literature. In the present work the bacteriology of the sub-\\nject has received due attention, the modern resources employed in the differen-\\ntial diagnosis between tubercular and other inflammatory affections are fully\\ndescribed, and the medical and surgical therapeutics are discussed in detail.\\nAn important book upon an important subject, and written by a man of mature judg-\\nment and wide experience. The author has given us an instructive book upon one of the\\nmost importanr subjects of the day. Clinical Reporter.\\nA work which adds another to the many obligations the profession owes the talented\\nauthor. Chicago Medical Recorder.\\nA TEXT-BOOK OF DISEASES OF WOMEN. By Charles B.\\nPenrose, M.D., Ph.D., Professor of Gynecology in the University of\\nPennsylvania; Surgeon to the Gynecean Hospital, Philadelphia. Octavo\\nvolume of 531 pages, with 217 illustrations, nearly all from drawings made\\nfor this work. Cloth, $3.75 net.\\nThird Edition, Revised.\\nIn this work, which has been written for both the student of gynecology and\\nthe general practitioner, the author presents the best teaching of modern gyne-\\ncology untrammelled by antiquated theories or methods of treatment. In most\\ninstances but one plan of treatment is recommended, to avoid confusing the\\nstudent or the physician who consults the book for practical guidance.\\nI shall value very highly the copy of Penrose s Diseases of Women received. I have\\nalready recommended it to my class as THE BEST book. Howard A. Kelly, Professor\\nof Gynecology and Obstetrics Johns Hopkins University, Baltimore, Md.\\nThe book is to be commended without reserve, not only to the student but to the general\\npractitioner who wishes to have the latest and best modes of treatment explained with absolute\\nclearness. Therapeutic Gazette.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0486.jp2"}, "487": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 2$\\nSURGICAL PATHOLOGY AND THERAPEUTICS. By John\\nCollins Warren, M. D., LL.D., Professor of Surgery, Medical Depart-\\nment Harvard University. Handsome octavo, 832 pages, with 136 relief\\nand lithographic illustrations, 33 of which are printed in colors.\\nSecond Edition,\\nwith an Appendix devoted to the Scientific Aids to Surgical Diagnosis, and\\na series of articles on Regional Bacteriology. Cloth, $5.00 net; Half-\\nMorocco, $6.00 net.\\nWithout Exception, the Illustrations are the Best ever Seen in a\\nWork of this Kind.\\nA most striking and very excellent feature of this book is its illustrations. Without ex-\\nception, from the point of accuracy and artistic merit, they are the best ever seen in a work\\nof this kind. Many of those representing microscopic pictures are so perfect in their\\ncoloring and detail as almost to give the beholder the impression that he is looking down the\\nbarrel of a microscope at a well-mounted section. Annals of Surgery, Philadelphia.\\nIt is the handsomest specimen of book-making that has ever been issued from the\\nAmerican medical press. American Journal of the Medical Sciences, Philadelphia.\\nPATHOLOGY AND SURGICAL TREATMENT OF TUMORS.\\nBy N. Senn, M. D., Ph. D., LL. D., Professor of Practice of Surgery and\\nof Clinical Surgery, Rush Medical College; Professor of Surgery, Chicago\\nPolyclinic Attending Surgeon to Presbyterian Hospital Surgeon-in-Chief,\\nSt. Joseph s Hospital, Chicago. One volume of 710 pages, with 515\\nengravings, including full-page colored plates. New and enlarged Edition\\nin Preparation.\\nBooks specially devoted to this subject are few, and in our text-books and\\n.systems of surgery this part of surgical pathology is usually condensed to a de-\\ngree incompatible with its scientific and clinical importance. The author spent\\nmany years in collecting the material for this work, and has taken great pains\\nto present it in a manner that should prove useful as a text-book for the student,\\na work of reference for the practitioner, and a reliable guide for the surgeon.\\nThe most exhaustive of any recent book in English on this subject. It is well illus-\\ntrated, and will doubtless remain as the principal monograph on the subject in our language\\nfor some years. The book is handsomely illustrated and printed, and the author has\\ngiven a notable and lasting contribution to surgery. Journal of the American Medical\\nAssociation, Chicago.\\nLECTURES ON RENAL AND URINARY DISEASES. By\\nRobert Saundby, M. D., Edin., Fellow of the Royal College of Physicians,\\nLondon, and of the Royal Medico-Chirurgical Society; Physician to the\\nGeneral Hospital. Octavo volume of 434 pages, with numerous illustra-\\ntions and 4 colored plates. Cloth, $2.50 net.\\nThe volume makes a favorable impression at once. The style is clear and succinct.\\nWe cannot find any part of the subject in which the views expressed are not carefully thought\\nout and fortified by evidence drawn from the most recent sources. The book may be cordially\\nrecommended. British Medical Journal.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0487.jp2"}, "488": {"fulltext": "26 W. B. SAUNDERS\\nA HANDBOOK FOR NURSES. By J. K. Watson, M.D., Edin.,\\nAssistant House-Surgeon, Sheffield Royal Hospital. American Edition,\\nunder the supervision of A. A. Stevens, A. M., M. D., Professor of\\nPathology, Woman s Medical College, Philadelphia. i2mo, 413 pages,\\n73 illustrations. Cloth, $1.50 net.\\nThis work aims to supply in one volume that information which so many\\nnurses at the present time are trying to extract from various medical works, and\\nto present that information in a suitable form. Nurses must necessarily acquire\\na certain amount of medical knowledge, and the author of this book has aimed\\njudiciously to cater to this need with the object of directing the nurses pursuit\\nof medical information in proper and legitimate channels. The book represents\\nan entirely new departure in nursing literature, insomuch as it contains useful\\ninformation on medical and surgical matters hitherto only to be obtained from\\nexpensive works written expressly for medical men.\\nA NEW PRONOUNCING DICTIONARY OF MEDICINE, with\\nPhonetic Pronunciation, Accentuation, Etymology, etc. By John\\nM. Keating, M. D., LL.D., Fellow of the College of Physicians of Phila-\\ndelphia; Editor Cyclopaedia of the Diseases of Children, etc.; and\\nHenry Hamilton, with the Collaboration of J. Chalmers DaCosta,\\nM. D., and Frederick A. Packard, M. D. One very attractive volume\\nof over 800 pages. Second Revised Edition. Prices: Cloth, $5.00 net;\\nSheep or Half-Morocco, $6.00 net; with Denison s Patent Ready- Refer-\\nence Index without patent index, Cloth, $4.00 net Sheep or Half-\\nMorocco, $5.00 net.\\nPROFESSIONAL OPINIONS.\\nI am much pleased with Keating s Dictionary, and shall take pleasure in recommending\\nit to my classes.\\nHenry M. Lyman, M. D.,\\nProfessor of Principles and Practice of Medicine, Rtish Medical College, Chicago, III.\\nI am convinced that it will be a very valuable adjunct to my study-table, convenient in\\nsize and sufficiently full for ordinary use.\\nC. A. LlNDSLEY, M. D.,\\nProfessor of Theory and Practice of Medicine, Medical Dept. Yale University;\\nSecretary Connecticut State Board of Health, New Haven, Co?m x\\nAUTOBIOGRAPHY OF SAMUEL D. GROSS, M. D., Emeritus Pro-\\nfessor of Surgery in the Jefferson Medical College of Philadelphia, with\\nReminiscences of His Times and Contemporaries. Edited by his sons,\\nSamuel W. Gross, M. D., LL.D., and A. Haller Gross, A.M., of the\\nPhiladelphia Bar. Preceded by a Memoir of Dr. Gross, by the late\\nAustin Flint, M. D., LL.D. In two handsome volumes, each containing\\nover 400 pages, demy 8vo, extra cloth, gilt tops, with fine Frontispiece\\nengraved on steel. Price per Volume, $2.50 net.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0488.jp2"}, "489": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 2/\\nPRACTICAL POINTS IN NURSING. For Nurses in Private\\nPractice. By Emily A. M. Stoney, Graduate of the Training-School\\nfor Nurses, Lawrence, Mass. Superintendent of the Training-School for\\nNurses, Carney Hospital, South Boston, Mass. 456 pages, handsomely\\nillustrated with 73 engravings in the text, ana 9 colored and half-tone\\nDiates. Cloth. Price, $1.75 neK e\\nSECOND EDITION, THOROUGHLY REVISED.\\nIn this volume the author explains, in popular language and in the shortest\\npossible form, the entire range of private nursing as distinguished from hospital\\nnursing, and the nurse is instructed how best to meet the various emergencies of\\nmedical and surgical cases when distant from medical or surgical aid or when\\nthrown on her own resources.\\nAn especially valuable feature of the work will be found in the directions to\\nthe nurse how to improvise everything ordinarily needed in the sick-room, where\\nthe embarrassment of the nurse, owing to the want of proper appliances, is fre-\\nquently extreme.\\nThe work has been logically divided into the following sections\\nI. The Nurse her responsibilities, qualifications, equipment, etc.\\nII. The Sick-Room its selection, preparation, and management.\\nTIL The Patient duties of the nurse in medical, surgical, obstetric, and gyne-\\ncologic cases.\\nIV. Nursing in Accidents and Emergencies.\\nV. Nursing in Special Medical Cases.\\nVI. Nursing of the New-born and Sick Children.\\nVII. Physiology and Descriptive Anatomy,\\nThe Appendix contains much information in compact form that will be found\\nof great value to the nurse, including Rules for Feeding the Sick; Recipes for\\nInvalid Foods and Beverages Tables of Weights and Measures Table for\\nComputing the Date of Labor; List of Abbreviations Dose-List; and a full\\nand complete Glossary of Medical Terms and Nursing Treatment.\\nThis is a well-written, eminently practical volume, which covers the entire range of\\nprivate nursing as distinguished from hospital nursing, and instructs the nurse how best to\\nmeet the various emergencies which may arise and how to prepare everything ordinarily\\nneeded in the illness of her patient. American Journal of Obstetrics and Diseases of\\nWomen and Children, Aug., i8g6.\\nA TEXT-BOOK OF BACTERIOLOGY, including the Etiology and\\nPrevention of Infective Diseases and an account of Yeasts and Moulds,\\nHsematozoa, and Psorosperms. By Edgar M. Crookshank, M. B., Pro-\\nfessor of Comparative Pathology and Bacteriology, King s College, London.\\nA handsome octavo volume of 700 pages, with 273 engravings in the text,\\nana 22 original and colored plates. Price, $6.50 net.\\nThis book, though nominally a Fourth Edition of Professor Crookshank s\\nManual of Bacteriology, is practically a new work, the old one having\\nbeen reconstructed, greatly enlarged, revised throughout, and largely rewritten,\\nforming a text-book for the Bacteriological Laboratory, for Medical Ofhcers of\\nHealth, and for Veterinary InsDectot-s.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0489.jp2"}, "490": {"fulltext": "28 W. B. SAUNDERS 1\\nMEDICAL DIAGNOSIS. By Dr. Oswald Vierordt, Professor of\\nMedicine at the University of Heidelberg. Translated, with additions,\\nfrom the Fifth Enlarged German Edition, with the author s permission, by\\nFrancis H. Stuart, A. M., M. D. In one handsome royal-octavo volume\\nof 600 pages. 194 fine wood-cuts in the text, many of them in colors.\\nPrices: Cloth, $4.00 net; Sheep or Half-Morocco, $5.00 net.\\nFOURTH AMERICAN EDITION, FROM THE FIFTH REVISED AND\\nENLARGED GERMAN EDITION.\\nIn this work, as in no other hitherto published, are given full and accurate\\nexplanations of the phenomena observed at the bedside. It is distinctly a clin-\\nical work by a master teacher, characterized by thoroughness, fulness, and accu-\\nracy. It is a mine of information upon the points that are so often passed over\\nwithout explanation. Especial attention has been given to the germ-theory as a\\nfactor in the origin of disease.\\nThe present edition of this highly successful work has been translated from\\nthe fifth German edition. Many alterations have been made throughout the\\nbook, but especially in the sections on Gastric Digestion and the Nervous System.\\nIt will be found that all the qualities which served to make the earlier editions\\nso acceptable have been developed with the evolution of the work to its present\\nform.\\nTHE PICTORIAL ATLAS OF SKIN DISEASES AND SYPHI-\\nLITIC AFFECTIONS. (American Edition.) Translation from\\nthe French. Edited by J. J. Pringle, M. B., F. R. C. P., Assistant Phy-\\nsician to, and Physician to the department for Diseases of the Skin at, the\\nMiddlesex Hospital, London. Photo-lithochromes from the famous models\\nof dermatological and syphilitic cases in the Museum of the Saint-Louis\\nHospital, Paris, with explanatory wood-cuts and letter-press. In 12 Parts,\\nat $3.00 per Part.\\nOf all the atlases of skin diseases which have been published in recent years, the present\\none promises to be of greatest interest and value, especially from the standpoint of the\\ngeneral practitioner. American Medico-Surgical Bulletin, Feb. 22, 1896.\\nThe introduction of explanatory wood-cuts in the text is a novel and most important\\nfeature which greatly furthers the easier understanding of the excellent plates, than which\\nnothing, we venture to say, has been seen better in point of correctness, beauty, and general\\nmerit. New York Medical Journal Feb. 15, 1896.\\nAn interesting feature of the Atlas is the descriptive text, which is written for each picture\\nby the physician who treated the case or at whose instigation the models have been made.\\nWe predict for this truly beautiful work a large circulation in all parts of the medical world\\nwhere the names St. Louis and Baretta have preceded it. Medical Record, N. Y., Feb. I,\\n1896.\\nA TEXT-BOOK OF MECHANO-THERAPY (MASSAGE AND\\nMEDICAL GYMNASTICS). By Axel V. Grafstrom, B. Sc,\\nM. D., late Lieutenant in the Royal Swedish Army; late House Physi-\\ncian, City Hospital, Blackwell s Island, New York. i2mo, 139 pages,\\nillustrated. Cloth, $1.00 net.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0490.jp2"}, "491": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 2g\\nDISEASES OF THE EYE. A Hand-Book of Ophthalmic Prac-\\ntice. By G. E. DE Schweinitz, M. D., Professor of Ophthalmology in\\nthe Jefferson Medical College, Philadelphia, etc. A handsome royal-\\noctavo volume of 696 pages, with 255 fine illustrations, many of which are\\noriginal, and 2 chromo-lithographic plates. Prices Cloth, $4.00 net\\nSheep or Half-Morocco, $5.00 net.\\nTHIRD EDITION, THOROUGHLY REVISED.\\nIn the third edition of this text-book, destined, it is hoped, to meet the favor-\\nable reception which has been accorded to its predecessors, the work has been\\n\u00e2\u0080\u00a2revised thoroughly, and much new matter has been introduced. Particular\\nattention has been given to the important relations which micro-organisms bear\\nto many ocular diseases. A number of special paragraphs on new subjects have\\nbeen introduced, and certain articles, including a portion of the chapter on\\nOperations, have been largely rewritten, or at least materially changed. A\\nnumber of new illustrations have been added. The Appendix contains a full\\ndescription of the method of determining the corneal astigmatism with the\\nophthalmometer of Javal and Schiotz, and the rotation of the eyes with the\\ntropometer of Stevens.\\nA work that will meet the requirements not only of the specialist, but of the general\\npractitioner in a rare degree. I am satisfied that unusual success awaits it.\\nWilliam Pepper, M. D.\\nProvost and Professor of Theory and Practice of Medicine and Clinical Medicine\\nin the University of Pennsylvania.\\nA clearly written, comprehensive manual. One which we can commend to students\\nas a reliable text-book, written with an evident knowledge of the wants of those entering upon\\nthe study of this special branch of medical science. British Medical Journal.\\nIt is hardly too much to say that for the student and practitioner beginning the study of\\nOphthalmology, it is the best single volume at present published. Medical News.\\nIt is a very useful, satisfactory, and safe guide for the student and the practitioner, and\\none of the best works of this scope in the English language. Annals of Ophthalmology.\\nDISEASES OF WOMEN. By J. Bland Sutton, F. R. C. S., Assistant\\nSurgeon to Middlesex Hospital, and Surgeon to Chelsea Hospital, London\\nand Arthur E. Giles, M. D., B. Sc, Lond., F. R.C. S., Edin., Assistant\\nSurgeon to Chelsea Hospital, London. 436 pages, handsomely illustrated.\\nCloth, $2.50 net.\\nThe authors have placed in the hands of the physician and student a concise\\nyet comprehensive guide to the study of gynecology in its most modern develop-\\nment. It has been their aim to relate facts and describe methods belonging to\\nthe science and art of gynecology in a way that will prove useful to students for\\nexamination purposes, and which will also enable the general physician to prac-\\ntice this important department of surgery with advantage to his patients and with\\nsatisfaction to himself.\\nThe book is very well prepared, and is certain to be well received by the medical public.\\nBritish Medical Journal.\\nThe text has been carefully prepared. Nothing essential has been omitted, and its\\nteachings are those recommended by the leading authorities of the day. Journal of the\\nAmerican Medical Association.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0491.jp2"}, "492": {"fulltext": "30 m SAUNDEA-\\nTEXT-BOOK UPON THE PATHOGENIC BACTERIA, Spe-\\ncially written for Students of Medicine. By Joseph McFarland,\\nM. D., Professor of Pathology and Bacteriology in the Medico-Chirurgical\\nCollege of Philadelphia, etc. 497 pages, finely illustrated. Price, Cloth,\\n$2.50 net,\\nSECOND EDITION, REVISED AND GREATLY ENLARGED,\\nThe work is intended to be a text-book for the medical student and for the\\npractitioner who has had no recent laboratory training in this department of medi-\\ncal science. The instructions given as to needed apparatus, cultures, stainings,\\nmicroscopic examinations, etc. are ample for the student s needs, and will afford\\nto the physician much information that will interest and profit him relative to a\\nsubject which modern science shows to go far in explaining the etiology of many\\ndiseased conditions.\\nIn this second edition the work has been brought up to date in all depart-\\nments of the subject, and numerous additions have been made to the technique\\nin the endeavor to make the book fulfil the double purpose of a systematic work\\nupon bacteria and a laboratory guide.\\nIt is excellently adapted for the medicai students and practitioners for whom it is avowedly\\nwritten. The descriptions given are accurate and readable, and the book should prove\\nuseful to those for whom it is written. London Lancet, Aug. 29, 1896.\\nThe author has succeded admirably in presenting the essential details of bacteriological\\ntechnics, together with a judiciously chosen summary of our present knowledge of pathogenic\\nbacteria. The work, we think, should have a wide circulation among English-speaking\\nstudents of medicine. N. Y. Medical Journal, April 4, 1896.\\nThe book will be found of considerable use by medical men who have not had a special\\nbacteriological training, and who desire to understand this important branch of medicai\\nscience. Edinburgh Medical Journal, July, 1896.\\nLABORATORY GUIDE FOR THE BACTERIOLOGIST. By\\nLangdon Frothingham, M. D. V., Assistant in Bacteriology and Veteri-\\nnary Science, Sheffield Scientific School. Yale University. Illustrated.\\nPrice, Clotn. 75 cents.\\nThe technical methods involved in bacteria-culture, methods of staining, ana\\nmicroscopical study are fully described and arranged as simply and concisely as\\npossible. The book is especially intended for use in laboratory work\\nIt is a convenient and useful little work, and will more than repay the outlay necessary\\nfor its purchase in the saving of time which would otherwise be consumed in looking up the\\nvarious points of technique so ciearlv and concisely laid down in its pages. American Mea.-\\nSurg. Bulletin,\\nFEEDING IN EARLY INFANCY. By Arthur V. Meigs. M. D.\\nBound in limp cloth, flush edges. Price, 25 cents net.\\nSynopsis Analyses of Milk Importance of the Subject of Feeding in Early\\nInfancy Proportion of Casein and Sugar in Human Milk Time to Begin Arti-\\nficial Feeding of Infants Amount of Food to be Administered at Each Feed-\\ning Intervals between Feedings Increase in Amount of Food at Different\\nPeriods of Infant Development Unsuitableness of Condensed Milk as a Sub-\\nstitute for Mother s Milk Objections to Sterilization or Pasteurization ot\\nMilk Advances made in the Method of Artificial Feeding of Infants,", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0492.jp2"}, "493": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 3 1\\nMATERIA MEDICA FOR NURSES. By Emily A. M. Stoney,\\nGraduate of the Training-school for Nurses, Lawrence, Mass. late\\nSuperintendent of the Training-school for Nurses, Carney Hospital, South\\nBoston, Mass. Handsome octavo, 300 pages. Cloth, $1.50 net.\\nThe present book differs from other similar works in several features, all of\\nwhich are introduced to render it more practical and generally useful. The\\ngeneral plan of contents follows the lines laid down in training-schools for\\nnurses, but the book contains much useful matter not usually included in works\\nof this character, such as Poison-emergencies, Ready Dose-list, Weights and\\nMeasures, etc., as well as a Glossary, defining all the terms in Materia Medica,\\nand describing all the latest drugs and remedies, which have been generally\\nneglected by other books of the kind.\\nESSENTIALS OF ANATOMY AND MANUAL OF PRACTI-\\nCAL DISSECTION, containing Hints on Dissection. By Charles\\nB. Nancrede, M. D., Professor of Surgery and Clinical Surgery in the\\nUniversity of Michigan, Ann Arbor; Corresponding Member of the Royal\\nAcademy of Medicine, Rome, Italy late Surgeon Jefferson Medical Col-\\nlege, etc. Fourth and revised edition. Post 8vo, over 500 pages, with\\nhandsome full-page lithographic plates in colors, and over 200 illustrations.\\nPrice Extra Cloth or Oilcloth for the dissection-room, $2.00 net.\\nNeither pains nor expense has been spared to make this work the most ex-\\nhaustive yet concise Student s Manual of Anatomy and Dissection ever pub-\\nlished, either in America or in Europe.\\nThe colored plates are designed to aid the student in dissecting the muscles,\\narteries, veins, and nerves. The wood-cuts have all been specially drawn anc(\\nengraved, and an Appendix added containing 60 illustrations representing the\\nstructure of the entire human skeleton, the whole being based on the eleventh\\nedition of Gray s Anatomy*\\nA MANUAL OF PRACTICE OF MEDICINE. By A. A. Stevens,\\nA. M., M. D., Instructor in Physical Diagnosis in the University of Penn-\\nsylvania, and Professor of Pathology in the Woman s Medical College of\\nPennsylvania. Specially intended for students preparing for graduation\\nand hospital examinations. Post 8vo, 519 pages. Numerous illustrations\\nand selected formulae. Price, bound in flexible leather, $2.00 net.\\nFIFTH EDITION, REVISED AND ENLARGED.\\nContributions to the science of medicine have poured in so rapidly during the\\nlast quarter of a century that it is well-nigh impossible for the student, with the\\nlimited time at his disposal, to master elaborate treatises or to cull from them\\nthat knowledge which is absolutely essential. From an extended experience in\\nteaching, the author has been enabled, by classification, to group allied symp-\\ntoms, and by the judicious elimination of theories and redundant explanations\\nto bring within a comparatively small compass a complete outline of the prac-\\ntice of medicine.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0493.jp2"}, "494": {"fulltext": "32 W. B. SAUNDERS 9\\nMANUAL OF MATERIA MEDICA AND THERAPEUTICS.\\nBy A. A. Stevens, A. M., M. D., Instructor of Physical Diagnosis in the\\nUniversity of Pennsylvania, and Professor of Pathology in the Woman s\\nMedical College of Pennsylvania. 445 pages. Price, bound in flexible\\nleather, $2.25.\\nSECOND EDITION, REVISED.\\nThis wholly new volume, which is based on the last edition of the Pharma-\\ncopoeia, comprehends the following sections Physiological Action of Drugs\\nDrugs; Remedial Measures other than Drugs; Applied Therapeutics; Incom-\\npatibility in Prescriptions; Table of Doses; Index of Drugs; and Index of\\nDiseases; the treatment being elucidated by more than two hundred formulae.\\nThe author is to be congratulated upon having presented the medical student with as\\naccurate a manual of therapeutics as it is possible to prepare. Therapeutic Gazette.\\nFar superior to most of its class in fact, it is very good. Moreover, the book is reliable\\nand accurate. New York Medical Journal.\\nThe author has faithfully presented modern therapeutics in a comprehensive work,\\nand it will be found a reliable guide. University Medical Magazine.\\nNOTES ON THE NEWER REMEDIES: their Therapeutic Ap-\\nplications and Modes of Administration. By David Cerna, M. D.,\\nPh. D., Demonstrator of and Lecturer on Experimental Therapeutics in\\nthe University of Pennsylvania. Post-octavo, 253 pages. Price, #1.25.\\nSECOND EDITION, RE-WRITTEN AND GREATLY ENLARGED.\\nThe work takes up in alphabetical order all the newer remedies, giving their\\nphysical properties, solubility, therapeutic applications, administration, and\\nchemical formula.\\nIt thus forms a very valuable addition to the various works on therapeutics\\nnow in existence.\\nChemists are so multiplying compounds, that., if each compound is to be thor-\\noughly studied, investigations must be carried far enough to determine the prac-\\ntical importance of the new agents.\\nEspecially valuable because of its completeness, its accuracy, its systematic consider-\\nation of the properties and therapy of many remedies of which doctors generally know but\\nlittle, expressed in a brief yet terse manner. Chicago Clinical Review.\\nTEMPERATURE CHART. Prepared by D. T. Laine, M. D. Size\\n8x 13)4 inches. Price, per pad of 25 charts, 50 cents.\\nA conveniently arranged chart for recording Temperature, with columns for\\ndaily amounts of Urinary and Fecal Excretions, Food, Remarks, etc. On they\\nback of each chart is given in full the method of Brand in the treatment of\\nTyphoid Fever.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0494.jp2"}, "495": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 33\\nA TEXT-BOOK OF HISTOLOGY, DESCRIPTIVE AND PRAC-\\nTICAL. For the Use of Students. By Arthur Clarkson, M. B.,\\nC. M., Edin., formerly Demonstrator of Physiology in the Owen s College,\\nManchester; late Demonstrator of Physiology in the Yorkshire College,\\nLeeds. Large 8vo, 554 pages, with 22 engravings in the text, and 174\\nbeautifully colored original illustrations. Price, strongly bound in Cloth,\\n$4.00 net.\\nThe purpose of the writer in this work has been to furnish the student of His-\\ntology, in one volume, with both the descriptive and the practical part of the\\nscience. The first two chapters are devoted to the consideration of the general\\nmethods of Histology subsequently, in each chapter, the structure of the tissue\\nor organ is first systematically described, the student is then taken tutorially over\\nthe specimens illustrating it, and, finally, an appendix affords a short note of the\\nmethods of preparation.\\nThe work must be considered a valuable addition to the list of available text-books, and\\nis to be highly recommended. New York Medical Journal.\\nOne of the best works for students we have ever noticed. We predict that the book will\\nattain a well-deserved popularity among our students. Chicago Medical Recorder.\\nTHE PATHOLOGY AND TREATMENT OF SEXUAL IM-\\nPOTENCE. By Victor G. Vecki, M. D. From the second Ger-\\nman edition, revised and rewritten. Demi-octavo, about 300 pages.\\nCloth, $2.00 net.\\nThe subject of impotence has but seldom been treated in this country in the\\ntruly scientific spirit that it deserves, and this volume will come to many as a\\nrevelation of the possibilities of therapeusis in this important field. Dr. Vecki s\\nwork has long been favorably known, and the German book has received the\\nhighest consideration. This edition is more than a mere translation, for, although\\nbased on the German edition, it has been entirely rewritten by the author in\\nEnglish.\\nThe work can be recommended as a scholarly treatise on its subject, and it can be read\\nwith advantage by many practitioners. Journal of the American Medical -Association.\\nTHE TREATMENT OF PELVIC INFLAMMATIONS\\nTHROUGH THE VAGINA. By W. R. Pryor, M. D., Pro-\\nfessor of Gynecology in the New York Polyclinic. i2mo, 248 pages,\\nhandsomely illustrated. Cloth, $2.00 net.\\nIn this book the author directs the attention of the general practitioner to a\\nsurgical treatment of the pelvic diseases of women. There exists the utmost\\nconfusion in the profession regarding the most successful methods of treating\\npelvic inflammations and inasmuch as inflammatory lesions constitute the ma-\\njority of all pelvic diseases, the subject is an important one. It has been the\\nendeavor of the author to put down every little detail, no matter how insig-\\nnificant, which might be of service.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0495.jp2"}, "496": {"fulltext": "34 W. B. SAUNDERS\\nDISEASES OF WOMEN. By Henry J. Garrigues, A.M., M. D.,\\nProfessor of Gynecology in the New York School of Clinical Medicine;\\nGynecologist to St. Mark s Hospital and to the German Dispensary, New\\nYork City. In one handsome octavo volume of 728 pages, illustrated by\\n335 engravings and colored plates. Prices: Cloth, $4.00 net; Sheep or\\nHalf-Morocco, $5.00 net.\\nA practical work on gynecology for the use of students and practitioners,\\nwritten in a terse and concise manner. The importance of a thorough know-\\nledge of the anatomy of the female pelvic organs has been fully recognized by\\nthe author, and considerable space has been devoted to the subject. The chap-\\nters on Operations and on Treatment are thoroughly modern, and are based\\nupon the large hospital and private practice of the author. The text is eluci-\\ndated by a large number of illustrations and colored plates, many of them being\\noriginal, and forming a complete atlas for studying embryology and the anatomy\\nof the female genitalia, besides exemplifying, whenever needed, morbid condi-\\ntions, instruments, apparatus, and operations.\\nSecond Edition, Thoroughly Revised.\\nThe first edition of this work met with a most appreciative reception by the\\nmedical press and profession both in this country and abroad, and was adopted\\nas a text-book or recommended as a book of reference by nearly one hundred\\ncolleges in the United States and Canada. The author has availed himself of\\nthe opportunity afforded by this revision to embody the latest approved advances\\nin the treatment employed in this important branch of Medicine. He has also\\nmore extensively expressed his own opinion on the comparative value of the\\ndifferent methods of treatment employed.\\nOne of the best text-books for students and practitioners which has been published in\\nthe English language; it is condensed, clear, and comprehensive. The profound learning\\nand great clinical experience of the distinguished author find expression in this book in a\\nmost attractive and instructive form. Young practitioners, to whom experienced consultants\\nmay not be available, will find in this book invaluable counsel and help.\\nThad. A. Reamy, M. D., LL.D.,\\nProfessor of Clinical Gynecology, Medical College of Ohio Gynecologist to the Good\\nSamaritan and Cincinnati Hospitals.\\nk SYLLABUS OF GYNECOLOGY, arranged in conformity witn\\nAn American Text-Book of Gynecology. By J. W. Long, M. D.,\\nProfessor of Diseases of Women and Children, Medical College of Vir-\\nginia, etc. Price, Cloth (interleaved), $1.00 net.\\nBased upon the teaching and methods laid down in the larger work, this will\\nnot only be useful as a supplementary volume, but to those who do not already\\npossess the text-book it will also have an independent value as an aid to the\\npractitioner in gynecological work, and to the student as a guide in the lecture-\\nroom, as the subject is presented in a manner at once systematic, clear, succinct,\\n?nd practical.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0496.jp2"}, "497": {"fulltext": "CATALOGUE OF MEDIC A L WORKS. 3 5\\nTHE AMERICAN POCKET MEDICAL DICTIONARY. Edited\\nby W. A. Newman Dor land, M. D., Assistant Obstetrician to the Hospital\\nof the University of Pennsylvania; Fellow of the American Academy of\\nMedicine. Containing the pronunciation and definition of all the principal\\nwords used in medicine and the kindred sciences, with 64 extensive tables.\\nHandsomely bound in flexible leather, limp, with gold edges and patent\\nthumb index. Price, $1.00 net with thumb index, #1.25 net.\\nSECOND EDITION, REVISED.\\nThis is the ideal pocket lexicon. It is an absolutely new book, and not a re-\\nvision of any old work. It is complete, defining all the terms of modern medi-\\ncine and forming an unusually complete vocabulary. It gives the pronunciation\\nof all the terms. It makes a special feature of the newer words neglected by\\nother dictionaries. It contains a wealth of anatomical tables of special value to\\nstudents. It forms a handy volume, indispensable to every medical man.\\nSAUNDERS POCKET MEDICAL FORMULARY. By William\\nM. Powell, M. D., Attending Physician to the Mercer House for Invalid\\nWomen at Atlantic City. Containing 1800 Formulae, selected from several\\nhundred of the best-known authorities. Forming a handsome and con-\\nvenient pocket companion of nearly 300 printed pages, with blank leaves\\nfor Additions; with an Appendix containing Posological Table, Formulae\\nand Doses for Hypodermatic Medication, Poisons and their Antidotes,\\nDiameters of the Pemale Pelvis and Foetal Head, Obstetrical Table, Diet\\nList for Various Diseases, Materials and Drugs used in Antiseptic Surgery,\\nTreatment of Asphyxia from Drowning, Surgical Remembrancer, Tables\\nof Incompatibles, Eruptive Fevers, Weights and Measures, etc. Hand-\\nsomely bound in morocco, with side index, wallet, and flap. Price, $1-75\\nnet.\\nFIFTH EDITION, THOROUGHLY REVISED.\\nThis little book, that can be conveniently carried in the pocket, contains an immense\\namount of material. It is very useful, and as the name of the author of each prescription is\\ngiven, is unusually reliable. Neiv York Medical Record.\\nA COMPENDIUM OF INSANITY. By John B. Chapin, M.D., LL.D.,\\nPhysician-in-Chief, Pennsylvania Hospital for the Insane; late Physician-\\nSuperintendent of*the Willard State Hospital, New York Honorary Mem-\\nber of the Medico-Psychological Society of Great Britain, of the Society of\\nMental Medicine of Belgium. 121110, 234 pages, illust. Cloth, $1.25 net.\\nThe author has given, in a condensed and concise form, a compendium of\\nDiseases of the Mind, for the convenient use and aid of physicians and students.\\nIt contains a clear, concise statement of the clinical aspects of the various ab-\\nnormal mental conditions, with directions as to the most approved methods of\\nmanaging and treating the insane.\\nThe practical parts of Dr. Chapin s book are what constitute its distinctive merit. We\\ndesire especially, however, to call attention to the fact that in the subject of the therapeutics\\nof insanity the work is exceedingly valuable. The author has made a distinct addition to the\\nliterature of his specialty. Philadelphia Medical Journal.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0497.jp2"}, "498": {"fulltext": "36 W, B. SAUNDERS\\nAN OPERATION BLANK, with Lists of Instruments, etc. re-\\nquired in Various Operations. Prepared by W. W. Keen, M. D.,\\nLL.D., Professor of Principles of Surgery in the Jefferson Medical Col-\\nlege, Philadelphia. Price per Pad, containing Blanks for fifty operations,\\n50 cents net.\\nSECOND EDITION, REVISED FORM.\\nA convenient blank, suitable for all operations, giving complete instructions\\nregarding necessary preparation of patient, etc., with a full list of dressings and\\nmedicines to be employed.\\nOn the back of each blank is a list of instruments used viz. general instru\\nments, etc., required for all operations and special instruments for surgery of\\nthe brain and spine, mouth and throat, abdomen, rectum, male and female\\ngenito-urinary organs, the bones, etc.\\nThe whole forming a neat pad, arranged for hanging on the wall of a sur-\\ngeon s office or in the hospital operating-room.\\nM Will serve a useful purpose for the surgeon in reminding him of the details of prepa-\\nration for the patient and the room as well as for the instruments, dressings, and antiseptics\\nneeded New York Medical Record\\nCovers about all that can be needed in any operation. American Lancet.\\nThe plan is a capital one. Boston Medical and Surgical Journal.\\nLABORATORY EXERCISES IN BOTANY. By Edson S. Bastin,\\nM. A., Professor of Materia Medica and Botany in the Philadelphia Col-\\nlege of Pharmacy. Octavo volume of 536 pages, 87 full-page plates. Price,\\nCloth, $2.50.\\nThis work is intended for the beginner and the advanced student, and it fully\\ncovers the structure of flowering plants, roots, ordinary stems, rhizomes, tubers,\\nbulbs, leaves, flowers, fruits, and seeds. Particular attention is given to the gross\\nand microscopical structure of plants, and to those used in medicine. Illustra-\\ntions have freely been used to elucidate the text, and a complete index to facil-\\nitate reference has been added.\\nThere is no work like it in the pharmaceutical or botanical literature of this country, and\\nwe predict for it a wide circulation. American Journal of Pharmacy.\\nDIET IN SICKNESS AND IN HEALTH. By Mrs. Ernest Hart,\\nformerly Student of the Faculty of Medicine of Paris and of the London\\nSchool of Medicine for Women; with an Introduction by Sir Henry\\nThompson, F. R. C. S., M. D., London. 220 pages illustrated. Price,\\nCloth, $1.50.\\nUseful to those who have to nurse, feed, and prescribe for the sick. In\\neach case the accepted causation of the disease and the reasons for the special\\ndiet prescribed are briefly described. Medical men will find the dietaries and\\nrecipes practically useful, and likely to save them trouble in directing the dietetic\\ntreatment of patients.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0498.jp2"}, "499": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 37\\nA MANUAL OF PHYSIOLOGY, with Practical Exercises. For\\nStudents and Practitioners. By G. N. Stewart, M. A., M. D., D. Sc.,\\nlately Examiner in Physiology, University of Aberdeen, and of the New\\nMuseums, Cambridge University Professor of Physiology in the Western\\nReserve University, Cleveland, Ohio. Handsome octavo volume of 848\\npages, with 300 illustrations in the text, and 5 colored plates. Price, Cloth,\\n#3.75 net\\nTHIRD EDITION, REVISED.\\nIt will make its way by sheer force of merit, and amply deserves to do so. It is one oj\\nthe very best English text-books on the subject. London Lancet.\\nOf the many text-books of physiology published, we do not know of one that so nearly\\ncomes up to the ideal as does Professor Stewart s volume. British Medical Journal.\\nESSENTIALS OF PHYSICAL DIAGNOSIS OF THE THORAX.\\nBy Arthur M. Cor win, A. M., M. D., Demonstrator of Physical Diagno-\\nsis in the Rush Medical College, Chicago; Attending Physician to the\\nCentral Free Dispensary, Department of Rhinology, Laryngology, and\\nDiseases of the Chest. 219 pages. Illustrated. Cloth, flexible covers.\\nPrice, $1.25 net.\\nTHIRD EDITION, THOROUGHLY REVISED AND ENLARGED.\\nSYLLABUS OF OBSTETRICAL LECTURES in the Medical\\nDepartment, University of Pennsylvania. By Richard C. Norris,\\nA. M., M. D., Lecturer on Clinical and Operative Obstetrics, University\\nof Pennsylvania. Third edition, thoroughly revised and enlarged. Crown\\n8vo. Price, Cloth, interleaved for notes, $2.00 net.\\nThis work is so far superior to others on the same subject that we take pleasure in call-\\ning attention briefly to its excellent features. It covers the subject thoroughly, and will\\nprove invaluable both to the student and the practitioner. The author has introduced a\\nnumber of valuable hints which would only occur to one who was himself an experienced\\nteacher of obstetrics. The subject-matter is clear, forcible, and modern. We are especially\\npleased with the portion devoted to the practical duties of the accoucheur, care of the child,\\netc. The paragraphs on antiseptics are admirable; there is no doubtful tone in the direc-\\ntions given. No details are regarded as unimportant; no minor matters omitted. We ven-\\nture to say that even the old practitioner will find useful hints in this direction which he can-\\nnot afford to despise. New York Medical Record.\\nA SYLLABUS OF LECTURES ON THE PRACTICE OF SUR-\\nGERY, arranged in conformity with An American Text-Book\\nof Surgery. By N. Senn, M. D., Ph. D., Professor of Surgery in Rusl\\nMedical College, Chicago, and in the Chicago Polyclinic. Price, $2.00.\\nThis work by so eminent an author, himself one of the contributors to\\nAn American Text-Book of Surgery, will prove of exceptional value to\\nthe advanced student who has adopted that work as his text-book. It is not\\nonly the syllabus of an unrivalled course of surgical practice, but it is also an\\nepitome of or supplement to the larger work.\\nThe author has evidently spared no pains in making his Syllabus thoroughly comprehen*\\nsive, and bar. added new matter and alluded to the most recent authors and operations. Full\\nreferences are also given to all requisite details of surgical anatomy and pathology. British\\nMedical Journal, London.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0499.jp2"}, "500": {"fulltext": "3 8 W. B. SAUNDERS\\nTHE CARE OF THE BABY. By J. P. Crozer Griffith, M. D.,\\nClinical Professor of Diseases of Children, University of Pennsylvania;\\nPhysician to the Children s Hospital Philadelphia, etc. 404 pages, with\\n67 illustrations in the text, and 5 plates. i2mo. Price, $1.50.\\nSECOND EDITION, REVISED.\\nA reliable guide not only for mothers, but also for medical students and\\npractitioners whose opportunities for observing children have been limited.\\nThe whole book is characterized by rare good sense, and is evidently written by a mas.\\nter hand. _ It can be read with benefit not only by mothers, but by medical students and by\\nany practitioners who have not had large opportunities for observing children. A7nerican\\nJournal of Obstetrics.\\nTHE NURSE S DICTIONARY of Medical Terms and Nursing\\nTreatment, containing Definitions of the Principal Medical and Nursing\\nTerms, Abbreviations, and Physiological Names, and Descriptions of the\\nInstruments, Drugs, Diseases, Accidents, Treatments, Operations, Foods,\\nAppliances, etc. encountered in the ward or the sick-room. By Honnor\\nMorten, author of How to Become a Nurse, Sketches of Hospital\\nLife, etc. i6mo, 140 pages. Price, Cloth, $1.00.\\nThis little volume is intended for use merely as a small reference-book which\\ncan be consulted at the bedside or in the ward. It gives sufficient explanation\\nto the nurse to enable her to comprehend a case until she has leisure to look up\\nlarger and fuller works on the subject.\\nDIET LISTS AND SICK-ROOM DIETARY. By Jerome B. Thomas,\\nM. D., Visiting Physicia-n to the Home for Friendless Women and Children\\nand to the Newsboys Home Assistant Visiting Physician to the Kings\\nCounty Hospital; Assistant Bacteriologist, Brooklyn Health Department.\\nPrice, Cloth, $1.50 (Send for specimen List.)\\nOne hundred and sixty detachable (perforated) diet lists for Albuminuria,\\nAnaemia and Debility, Constipation, Diabetes, Diarrhoea, Dyspepsia, Fevers,\\nGout or Uric- Acid Diathesis, Obesity, and Tuberculosis. Also forty detachable\\nsheets of Sick-Room Dietary, containing full instructions for preparation of\\neasily-digested foods necessary for invalids. Each list is nu?nbered onfy, the\\ndisease for which it is to be used in no case being mentioned, an index key\\nbeing reserved for the physician s private use.\\nDIETS FOR INFANTS AND CHILDREN IN HEALTH AND\\nIN DISEASE. By Louis Starr, M. D., Editor of An American\\nText-Book of the Diseases of Children. 230 blanks (pocket-book size),\\nperforated and neatly bound in flexible morocco. Price, $1.25 net.\\nThe first series of blanks are prepared for the first seven months of infanl\\nlife; each blank indicates the ingredients, but not the qziantities, of the food,\\nthe latter directions being left for the physician. After the seventh month,\\nmodifications being less necessary, the diet lists are printed in full. Formula\\nto: tne preparation of diluents and foods are appended.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0500.jp2"}, "501": {"fulltext": "CATALOGUE OF MEDICAL WORKS. 39\\nHOW TO EXAMINE FOR LIFE INSURANCE. By Jofn M.\\nKeating, M. D., Fellow of the College of Physicians and Surgeons of\\nPhiladelphia; Vice-President of the American Psediatric Society; Ex-\\nPresident of the Association of Life Insurance Medical Directors. Royal\\n8vo, 211 pages, with two large half-tone illustrations, and a plate prepared\\nby Dr. McClellan from special dissections also, numerous cuts to elucidate\\nthe text. Third edition. Price, Cloth, $2.00 net.\\nThis is by far the most useful book which has yet appeared on insurance examination, a\\nsubject of growing interest and importance. Not the least valuable portion of the volume is\\nPart II., which consists of instructions issued to their examining physicians by twenty-four\\nrepresentative companies of this country. As the proofs of these instructions were corrected\\nby the directors of the companies, they form the latest instructions obtainable. If for these\\nalone, the book should be at the right hand of every physician interested in this special branch\\nof medical science. The Medical News, Philadelphia.\\nNURSING: ITS PRINCIPLES AND PRACTICE. By Isabel\\nAdams Hampton, Graduate of the New York Training School for\\nNurses attached to Bellevue Hospital; Superintendent of Nurses and\\nPrincipal of the Training School for Nurses, Johns Hopkins Hospital,\\nBaltimore, Md. late Superintendent of Nurses, Illinois Training School\\nfor Nurses, Chicago, 111. In one very handsome i2mo volume of 512\\npages, illustrated. Price, Cloth, $2.00 net.\\nSECOND EDITION, REVISED AND ENLARGED.\\nThis original work on the important subject of nursing is at once comprehensive\\nand systematic. It is written in a clear, accurate, and readable style, suitable\\nalike to the student and the lay reader. Such a work has long been a desidera-\\ntum with those entrusted with the management of hospitals and the instruction of\\nnurses in training-schools. It is also of especial value to the graduated nurse\\nwho desires to acquire a practical working knowledge of the care of the sick\\nand the hygiene of the sick-room.\\nOBSTETRIC ACCIDENTS, EMERGENCIES, AND OPERA-\\nTIONS. By L. Ch. Boisliniere, M. D., late Emeritus Professor of\\nObstetrics in the St. Louis Medical College. 381 pages, handsomely illus-\\ntrated. Price, $2.00 net.\\nFor the use of the practitioner who, when away from home, has not the\\nopportunity of consulting a library or of calling a friend in consultation. He\\nthen, being thrown upon his own resources, will find this book of benefit in\\nguiding and assisting him in emergencies.\\nINFANT S WEIGHT CHART. Designed by J. P. Crozer Grjffzth,\\nM. D., Clinical Professor of Diseases of Children in the University of Peni*\\nsylvania. 25 charts in each pad. Price per pad, 50 cents net.\\nA convenient blank for keeping a record of the child s weight during the first\\ntwo years of life. Printed on each chart is a curve representing the average weight\\nof a healthy infant, so that any deviation from the normal can readily be detected.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0501.jp2"}, "502": {"fulltext": "saunders\\nNew Series\\nof Manuals\\nfor Students\\nand\\nPractitioners*\\nTHAT there exists a need for thoroughly reliable hand-books on the leading\\nbranches of Medicine and Surgery is a fact amply demonstrated by the\\nfavor with which the SAUNDERS NEW SERIES OF MANUALS have been\\nreceived by medical students and practitioners and by the Medical Press.\\nThese manuals are not merely condensations from present literature, but\\nare ably written by well-known authors and practitioners, most of them being\\nteachers in representative American colleges. Each volume is concisely and\\nauthoritatively written and exhaustive in detail, without being encumbered\\nwith the introduction of cases, which so largely expand the ordinary text-\\nbook. These manuals will therefore form an admirable collection of advanced\\nlectures, useful alike to the medical student and the practitioner: to the latter,\\ntoo busy to search through page after page of elaborate treatises for what he\\nwants to know, they will prove of inestimable value to the former they will\\nafford safe guides to the essential points of study.\\nThe SAUNDERS NEW SERIES OF MANUALS are conceded to be\\nsuperior to any similar books now on the market. No other manuals afford so\\nmuch information in such a concise and available form. A liberal expenditure\\nhas enabled the publisher to render the mechanical portion of the work worthy\\nof the high literary standard attained by these books.\\nAny of these Manuals will be mailed on receipt of price (see next page\\nfor List).", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0502.jp2"}, "503": {"fulltext": "SAUNDERS NEW SERIES OF MANUALS.\\nVOLUMES PUBLISHED.\\nPHYSIOLOGY. By Joseph Howard Raymond, A. M., M. D., Professor\\nof Physiology and Hygiene and Lecturer on Gynecology in the Long\\nIsland College Hospital, etc. Price, J 1. 25 net.\\nSURGERY, General and Operative. By John Chalmers DaCosta,\\nM. D., Professor of Clinical Surgery, Jefferson Medical College, Philadel-\\nphia. Second edition, revised and greatly enlarged. Octavo, 91 1 pages,\\n386 illustrations. Cloth, $4.00 net; Half-Morocco, $5.00 net.\\nDOSE-BOOK AND MANUAL OF PRESCRIPTION- WRITING.\\nBy E. Q. Thornton, M. D., Demonstrator of Therapeutics, Jefferson\\nMedical College, Philadelphia. Price, $1.25 net.\\nMEDICAL JURISPRUDENCE. By Henry C. Chapman, M. D., Pro-\\nfessor of Institutes of Medicine and Medical Jurisprudence in the Jeffer-\\nson Medical College of Philadelphia, etc. Price, $1.50 net.\\nSURGICAL ASEPSIS. By Carl Beck, M.D., Surgeon to St. Mark s\\nHospital and to the German Poliklinik Instructor in Surgery, New York\\nPost-Graduate Medical School, etc. Price, J 1.25 net.\\nMANUAL OF ANATOMY. By Irving S. Haynes, M.D., Adjunct\\nProfessor of Anatomy and Demonstrator of Anatomy, Medical Department\\nof the New York University, etc. Price, $2.50 net.\\nSYPHILIS AND THE VENEREAL DISEASES. By James\\nNevins Hyde, M. D., Professor of Skin and Venereal Diseases, and\\nFrank H. Montgomery, M. D., Lecturer on Dermatology and Genito-\\nurinary Diseases in Rush Medical College, Chicago. Price, $2.50 net.\\nPRACTICE OF MEDICINE. By George Roe Lockwood, M. D.,\\nProfessor of Practice in the Woman s Medical College of the New York\\nInfirmary, etc. Price, $2.50 net.\\nOBSTETRICS. By W. A. Newman Dorland, M. D., Assistant Demon-\\nstrator of Obstetrics, University of Pennsylvania; Chief of Gynecological\\nDispensary, Pennsylvania Hospital. Price, $2.50 net.\\nDISEASES OF WOMEN. By J. Bland Sutton, F. R. C. S., Assistant\\nSurgeon to the Middlesex Hospital, and Surgeon to the Chelsea Hospital\\nfor Women, London and Arthur E. Giles, M. D., B. Sc. Lond., F. R. C. S.\\nEdin., Assistant Surgeon to the Chelsea Hospital for Women, London. 436\\npages, handsomely illustrated. Price, $2.50 net.\\nIN PREPARATION.\\nNERVOUS DISEASES. By Charles W. Burr, M. D\u00e2\u0080\u009e Clinical Profes-\\nsor of Nervous Diseases, Medico-Chirurgical College, Philadelphia, etc.\\nThere will be published in the same series, at short intervals, carefully prepared works\\non various subjects, by prominent specialists.", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0503.jp2"}, "504": {"fulltext": "SAUNDERS QUESTION COMPENDS.\\nArranged in Question and Answer Form,\\nTHE LATEST, MOST COMPLETE, and BEST ILLUSTRATED\\nSERIES OF COMPENDS EVER ISSUED.\\nNow the Standard Authorities in Medical Literature\\nStudents and Practitioners in every City of the United\\nStates and Canada.\\nTHE REASON WHY.\\nThey are the advance guard of Student s Helps that DO help; they are\\nthe leaders in their special line, well and atithoritatively written by able men,\\nwho, as teachers in the large colleges, know exactly what is wanted by a student\\npreparing for his examinations. The judgment exercised in the selection of\\nauthors is fully demonstrated by their professional elevation. Chosen from the\\nranks of Demonstrators, Quiz-masters, and Assistants, most of them have be-\\ncome Professors and Lecturers in their respective colleges.\\nEach book is of convenient size (5x7 inches), containing on an average 250\\npages, profusely illustrated, and elegantly printed in clear, readable type, on\\nfine paper.\\nThe entire series, numbering twenty-four subjects, has been kept thoroughly\\nrevised and enlarged when necessary, many of them being in their fourth and\\nfifth editions.\\nTO SUM UP.\\nAlthough there are numerous other Quizzes, Manuals, Aids, etc. in the mar-\\nket, none of them approach the Blue Series of Question Compends; and\\nthe claim is made for the following points of excellence\\n1. Professional distinction and reputation of authors.\\n2. Conciseness, clearness, and soundness of treatment.\\n3. Size of type and quality of paper and binding.\\n:f: Any of these Compends will be mailed on receipt of price (see next\\npage for List).", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0504.jp2"}, "505": {"fulltext": "1\\nSAUNDERS QUESTION-COMPEND SERIES.\\nPrice, Cloth, $L00 per copy, except wfien otherwise noted*\\n1. ESSENTIALS OF PHYSIOLOGY. 4th edition. Illustrated. Revised and enlarged.\\nBy H. A. Hare, M. D. (Price, #1.00 net.)\\n2. ESSENTIALS OF SURGERY. 7th edition, with a chapter on Appendicitis. 90 illus-\\ntrations. By Edward Martin, M. D. (Price, $1.00 net.)\\n3. ESSENTIALS OF ANATOMY. 6th edition, thoroughly revised. 151 illustrations.\\nBy Charles B. Nancrede, M. D. (Price, $1.00 net.)\\n4. ESSENTIALS OF MEDICAL CHEMISTRY, ORGANIC AND INORGANIC.\\n5th edition, revised, with an Appendix. By Lawrence Wolff, M. D. ($1.00 net.)\\n5. ESSENTIALS OF OBSTETRICS. 4th edition, revised and enlarged. 75 illustra-\\ntions. By W. Easterly Ashton, M. D.\\n6. ESSENTIALS OF PATHOLOGY AND MORBID ANATOMY. 7 th thousand.\\n46 illustrations. By C. E. Armand Semple, M. D.\\n7. ESSENTIALS OF MATERIA MEDICA, THERAPEUTICS, AND PRE-\\nSCRIPTION-WRITING. 5th edition. By Henry Morris, M. D.\\n8. g. ESSENTIALS OF PRACTICE OF MEDICINE. By Henry Morris, M.D.\\nAn Appendix on Urine Examin ation. Illustrated. By Lawrence Wolff, M. D.\\n3d edition, enlarged by some 300 Essential Formulae, selected from eminent authori-\\nties, by Wm. M. Powell, M. D. (Double number, price #2.00.)\\n10. ESSENTIALS OF GYNECOLOGY. 4th edition, revised. With 62 illustrations.\\nBy Edwin B. Cragin, M. D.\\n11. ESSENTIALS OF DISEASES OF THE SKIN. 4th edition, revised and enlarged.\\n71 letter-press cuts and 15 half-tone illustrations. By Henry W. Stelwagon, M.D.\\n(Price, $1.00 net.)\\n12. ESSENTIALS OF MINOR SURGERY, BANDAGING, AND VENEREAL\\nDISEASES. 2d edition, revised and enlarged. 78 illustrations. By Edward\\nMartin, M. D.\\n13. ESSENTIALS OF LEGAL MEDICINE, TOXICOLOGY, AND HYGIENE.\\n130 illustrations. By C. E. Armand Semple, M. D.\\n14. ESSENTIALS OF DISEASES OF THE EYE, NOSE, AND THROAT. 124\\nillustrations. 2d edition, revised. By Edward Jackson, M. D., and E. Baldwin\\nGleason, M. D.\\n15. ESSENTIALS OF DISEASES OF CHILDREN. 2d edition. By William M.\\nPowell, M. D.\\n16. ESSENTIALS OF EXAMINATION OF URINE. Colored Vogel Scale/\\nand numerous illustrations. By Lawrence Wolff, M. D. (Price, 75 cents.)\\n17. ESSENTIALS OF DIAGNOSIS. 2d edition, thoroughly revised. 60 illustrations.\\nBy S. Solis-Cohen, M. D., and A. A. Eshner, M. D. (Price, $1.00 net.)\\n18. ESSENTIALS OF PRACTICE OF PHARMACY. 2d edition, revised. By L.\\nE. Sayre.\\n20. ESSENTIALS OF BACTERIOLOGY. 3d edition. 82 illustrations. By M. V.\\nBall, M. D.\\n21. ESSENTIALS OF NERVOUS DISEASES AND INSANITY. 48 illustrations.\\n3d edition, revised. By John C. Shaw, M. D.\\n22. ESSENTIALS OF MEDICAL PHYSICS. 155 illustrations. 2d edition, revised.\\nBy Fred J. Brockway, M. D. (Price, $1.00 net.)\\n23. ESSENTIALS OF MEDICAL ELECTRICITY. 65 illustrations. By David D.\\nStewart, M. D., and Edward S. Lawrance, M. D.\\n24. ESSENTIALS OF DISEASES OF THE EAR. 114 illustrations. 2d edition, re-\\nvised and enlarged. By E. Baldwin Gleason, M. D.\\n43", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0505.jp2"}, "506": {"fulltext": "Some of the Books in Preparation for\\nPublication during 1900-\\nAMERICAN Text=Book of Pa=\\nthology.\\nEdited by Ludvig Hektoen, M.D., Pro-\\nfessor of Pathology, Rush Medical College,.\\nChicago; and David Riesman, M.D., De-\\nmonstrator of Pathological Histology, Uni-\\nversity of Pennsylvania.\\nAMERICAN Text=Book of Legal\\nMedicine and Toxicology.\\nEdited by Frederick Peterson, M.D.,\\nChief of Clinic, Nervous Department, College\\nof Physicians and Surgeons, New York City\\nand Walter S. Haines, M.D., Professor of\\nChemistry, Pharmacy, and Toxicology, Rush\\nMedical College, Chicago.\\nBECK\u00e2\u0080\u0094 Fractures.\\nBy Carl Beck, M.D., Professor of Surgery\\nin the N. Y. School of Clinical Medicine.\\nBOHM, DAVIDOFF, and HU=\\nBER\u00e2\u0080\u0094 A Text=Book of Human\\nHistology.\\nIncluding Microscopic Technic. By\\nDr. A. A. Bohm and Dr. M. von Davidoff,\\nof the Anatomical Institute of Munich, and\\nG. C. Huber,M.D., Junior Professor of Anat-\\nomy and Histology, University of Michigan,\\nAnn Arbor.\\nEICHHORST\u00e2\u0080\u0094 A Text=Book of\\nthe Practice of Medicine.\\nBy Dr. Herman Eichhorst, Professor of\\nSpecial Pathology and Therapeutics and Di-\\nrector of the Medical Clinic, University of\\nZurich. Translated and edited by Augustus\\nA. Eshner, M.D Professor of Clinical\\nMedicine in the Philadelphia Polyclinic.\\nFRIEDRICH Rhinology, La=\\nryngology, and Otology in\\ntheir Relations to General\\nMedicine.\\nBy Dr. E. P. Friedrich, of the Univer-\\nsity of Leipsig.\\nLEVY AND KLEMPERER\\nThe Elements of Clinical Bac=\\nteriology.\\nBy Dr. Ernst Levy, Professor in the\\nUniversity of Strassburg, and Dr. Felix\\nKlemperer, Privat-Docent in the Univer-\\nsity of Strassburg. Translated and edited\\nby Augustus A. Eshner, M.D., Professor j\\nof Clinical Medicine in the Philadelphia Poly- j\\nclinic. Just Ready. Cloth, $2 5c net. J\\nMcFARLAND\u00e2\u0080\u0094 X^ext=Book of\\nPathology.\\nBy Joseph McFarland, M.D., Professoi\\nof Pathology and Bacteriology, Medico-Chi-\\nrurgical College, Philadelphia.\\nOGDEN Clinical Examinatio\\nof the Urine.\\nBy J. Bergen Ogden, M.D., Assistant ii\\nChemistry, Harvard Medical School.\\nPYLE\u00e2\u0080\u0094 A Manual of Persona\\nHygiene.\\nEdited by Walter L. Pyle, M.D., Assi\\ntant Surgeon to Wills Eye Hospital, Philad;\\nSCUDDER\u00e2\u0080\u0094 The Treatment o\\nFractures.\\nBy Charles L. Scudder, M.D., Assistar\\nin Clinical and Operative Surgery, Harvai\\nUniversity.\\nSENN\u00e2\u0080\u0094 Practical Surgery.\\nBy Nicholas Senn, M.D., Ph.D., LL.D\\nProfessor of the Practice of Surgery and\\nClinical Surgery, Rush Medical College, Cr\\ncago. Octavo volume of about 800 page\\nprofusely illustrated.\\nThe Pathology andTreatmen\\nof Tumors.\\nBy Nicholas Senn, M.D., Ph.D., LL.D..\\nProfessor of the Practice of Surgery and of\\nClinical Surgery, Rush Medical College, Chi-\\ncago. A New and Thoroughly Revised Edi-\\ntion in preparation.\\nSTENGEL AND WHITE The\\nBlood in its Clinical and Patho\\nlogical Relations.\\nBy Alfred Stengel, M.D., Professor\\nClinical Medicine, University of Penns\\nvania; and C. Y. White, M.D., Instn\\ntor in Clinical Medicine, University of Pei\\nsylvania.\\nSTEVENS\u00e2\u0080\u0094 The Physical Dia\\nnosis of Diseases of the Che*\\nBy A. A. Stevens, A.M., M.D., Lecti\\non Terminology, and Instructor in Phys\\nDiagnosis, University of Pennsylvania.\\nSTONEY Surgical Techniqu\\nfor Nurses.\\nBy Emily A. M. Stoney, late Superi\\ntendent of the Training Schools for Nur?\\nCarney Hospital, South Boston, Mass.", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0506.jp2"}, "507": {"fulltext": "", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0507.jp2"}, "508": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0508.jp2"}, "509": {"fulltext": "", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0509.jp2"}, "510": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0510.jp2"}, "511": {"fulltext": "", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0511.jp2"}, "512": {"fulltext": "", "height": "4600", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0512.jp2"}, "513": {"fulltext": "", "height": "4602", "width": "2884", "jp2-path": "atlasepitomeofgy00scha_0513.jp2"}, "514": {"fulltext": "", "height": "4648", "width": "3066", "jp2-path": "atlasepitomeofgy00scha_0514.jp2"}}