Online Encyclopedia

Pompeii, and votive offerings of anatomical parts found in the temples show that various gynaecological malformations were known to the ancients. Writers who have treated of this branch are See also:

CELSUS (c. A.D. 178)

Celsus (50 B.C.–A.D. 7) and See also:

Soranus of See also:

Ephesus (A.D. 98–138), who refers in his works to the fact that the See also:

ROMAN

Roman midwives frequently called to their aid practitioners who made a See also:

SPECIAL

special study of diseases of women.

These midwives attended the simpler gynaecological ailments. This was no innovation, as in See also:

Athens, as mentioned by See also:

Hyginus, we find one Agnodice, a See also:

MIDWIFE (Mid. Eng. midwif, mydwyf or medewife, from preposition mid, with, and wife, i.e. woman, in the sense of one who is with ,the mother, or from adjective mid, one who is the means of delivering the mother, a woman who assists other women in 'childbi

midwife, disguising herself in See also:

man's attire so that she might attend lectures on medicine-and diseases of women. After instruction she practised as a gynaecologist. This being contrary to Athenian See also:

law she was prosecuted, but was saved by the wives of some of the See also:

CHIEF (from Fr. chef, head, Lat. caput)

chief men testifying on her behalf. Besides Agnodice we have Sotira, who wrote a See also:

WORK

work on menstruation which is preserved in the library at See also:

Florence, while See also:

ASPASIA

Aspasia is mentioned by See also:

Aetius as the author of several chapters of his work. It is evident that during the Roman See also:

period much of the gynaecological work was in the hands of women. See also:

MARTIAL (MARCUS VALERIUS MARTIALIS)

Martial alludes to the " feminae medicae" in his See also:

EPIGRAM

epigram on See also:

LEDA

Leda. These women must not be confounded with the midwives who on monuments are always described as " obstetrices." See also:

Galen devotes the See also:

SIXTH

sixth See also:

CHAPTER (a shortened form of chapiter, a word still used in architecture for a capital; derived from O. Fr. chapitre, Lat. capitellum, diminutive of caput, head)

chapter of his work De locis affectis to gynaecological ailments. During the See also:

BYZANTINE

Byzantine period may be mentioned the work of Oribasius (A.D. 325) and Moschion (2nd century A.D.) who wrote a See also:

BOOK

book in Latin for the use of matrons and midwives ignorant of Greek. In See also:

MODERN

modern times See also:

James See also:

Parsons (1705—1770) published his Elenchus gynaicopathologicus et obstetricarius, and in 1755 See also:

Charles See also:

Perry published his See also:

MECHANICAL

Mechanical See also:

account and explication of the hysterical See also:

PASSION (post-classical Lat. passio, formed from pati, passus, to suffer, endure)

passion and of all other See also:

NERVOUS

nervous disorders incident to the sex, with an appendix on cancers. In the See also:

early See also:

PART

part of the 19th century fresh See also:

INTEREST

interest in diseases of women awakened.

See also:

Joseph See also:

RECAMIER, JEANNE FRANCOISE JULIE ADELAIDE (1777-1849)

Recamier (1774–1852) by his writings and teachings advocated the use of the speculum and See also:

sound. This was followed in 1840 by the writings of See also:

Simpson in See also:

England and Huguier in See also:

France. In 1845 See also:

John See also:

Hughes See also:

Bennett published his See also:

GREAT

great work on inflammation of the uterus, and in 185o Tilt published his book on ovarian inflammation. The See also:

CREDIT (Lat. credere, to believe)

credit of being the first to perform the operation of See also:

OVARIOTOMY

ovariotomy is now credited to McDowell of See also:

KENTUCKY

Kentucky in 1809, and to See also:

Robert See also:

Lawson See also:

Tait (1845–1899) in 1883 the first operation for ruptured ectopic gestation. Menstruation.—Normal menstruation comprises the See also:

ESCAPE (in mid. Eng. eschape or escape, from the O. Fr. eschapper, modern echapper, and escaper, low Lat. escapium, from ex, out of, and cappa, cape, cloak; cf. for the sense development the Gr. iichueoOat, literally to put off one's clothes, hence to sli

escape of from 4 to 6 oz. of See also:

BLOOD

blood together with mucus from the uterus at intervals of twenty-eight days (more or less). The flow begins at the See also:

AGE (Fr. age, through late Lat. aetaticum, from aetas)

age of See also:

PUBERTY (Lat. pubertas, from pubes, puber, mature, adult)

puberty, the See also:

AVERAGE

average age of which in England is between fourteen and sixteen years. It ceases between See also:

FORTY

forty-five and fifty years of age, and this is called the menopause or See also:

CLIMACTERIC (from the Gr. KAupaKr'Jp, the rung or step of a aXiµaE or ladder)

climacteric period, commonly spoken of as " the See also:

CHANGE (derived through the Fr. from the Late Lat. cambium, cambiare, to barter; the ultimate derivation is probably from the root which appears in the Gr. «a urmu', to bend)

change of See also:

LIFE

life." Both the age ofPpuberty and that of the menopause may supervene earlier or later according to See also:

LOCAL

local conditions. At both times the menstrual flow may be replaced by See also:

HAEMORRHAGE (Gr. atµa, blood, and prryvvvac, to burst)

haemorrhage from distant See also:

ORGANS

organs (epistaxis, haematemesis, haemoptysis) ; this is called vicarious menstruation. Menstruation is usually but not necessarily coincident with ovulation. The usual disorders of menstruation are: (1) amenorrhoea (See also:

ABSENCE (Lat. absentia)

absence of flow), (2) dysmenorrhoea (painful flow), (3) menorrhagia (excessive flow), (4) metrorrhagia (excessive and irregular flow). Amenorrhoea may arise from physiological causes, such as pregnancy, lactation, the menopause; constitutional causes, such as See also:

PHTHISIS (Gr. 49Lnns " wasting ")

phthisis, See also:

ANAEMIA (from Gr. ay-, privative, and aiµa, blood)

anaemia and See also:

CHLOROSIS (Gr. xXwpbs, pale green)

chlorosis, febrile disorders, some chronic intoxications, such as morphinomania, and some forms of cerebral disease; local causes, which include malformations or absence of one or more of the genital parts, such as absence of ovaries, uterus or vagina, atresia of vagina, imperforate cervix, disease of the ovaries, or sometimes imperforate See also:

HYMEN, or HYMENAEUS

hymen. The treatment of amenorrhoea must be directed towards the cause.

In anaemia and phthisis menstruation often returns after improvement in the See also:

general See also:

CONDITION (Lat. condicio, from condicere, to agree upon, arrange; not connected with conditio, from condere, conditum, to put together)

condition, with See also:

GOOD, JOHN MASON (1764-1827)

good See also:

food and good sanitary conditions, an outdoor life and the See also:

ADMINISTRATION (Lat. administrare, to serve)

administration of See also:

IRON [symbol Fe, atomic weight 55.85 (0=16)]

iron or other tonics. In local conditions of imperforate hymen, imperforate cervix or ovarian disease, surgical interference is necessary. Amenorrhoea is permanent when due to absence of the genital parts. The causes of dysmenorrhoea are classified as follows: (I) ovarian, due to disease of the ovaries or Fallopian tubes; (2) obstructive, due to some obstacle to the flow, as stenosis, flexions and malpositions of the uterus, or malformations; (3) congestive, due to subinvolution, chronic inflammation of the uterus or its lining membrane, fibroid growths and polypi of the uterus, cardiac or hepatic disease; (4) neuralgic; (5) membranous. The foremost See also:

PLACE (through Fr. from Lat. platea, street; Gr. IrAar6s, wide)

place in the treatment of dysmenorrhoea must be given to aperients and purgatives administered a See also:

day or two before the period is expected. By this means congestion is reduced. Hot See also:

BATHS

baths are useful, and various drugs such as hyoscyanus, cannabis indica, phenalgin, ammonol or See also:

PHENACETIN

phenacetin have been prescribed. Medicinal treatment is, however, only palliative, and flexions and malpositions of the uterus must be corrected, stenosis treated by See also:

DILATATION (from Lat. dis-, distributive, and lotus, wide)

dilatation, fibroid growths if See also:

PRESENT

present removed, and endometritis when present treated by local applications or curetting according to its severity. Menorrhagia signifies excessive bleeding at the menstrual periods. Constitutional causes are See also:

PURPURA

purpura, See also:

HAEMOPHILIA

haemophilia, excessive food and alcoholic drinks and warm climates; while local causes are congestion and displacements of the uterus, endometritis, subinvolution, retention of the products of conception, new growths in the uterus such as mucous and fibroid polypi, See also:

MALIGNANT (Lat. malignus, evil-disposed, from maligenus)

malignant growths, tubo-ovarian inflammation and some ovarian tumours. Metrorrhagia is a See also:

DISCHARGE (adapted from the O. Fr. discharge, modern decharge, from a med. Lat. discargare, to unload, dis- and earn care, to load, cf. " charge ")

discharge of blood from the uterus, See also:

INDEPENDENT

independent of menstruation. It always arises from disease of the uterus or its appendages.

Local causes are polypi, retention of the, products of conception, extra uterine gestation, haemorrhages in connexion with pregnancy, and new growths in the uterus. In the treatment of both menorrhagia and metrorrhagia the local condition must be carefully ascertained. When pregnancy has been excluded, and constitutional causes treated, efforts should be made to relieve congestion. Uterine haemostatics, as See also:

ERGOT, or SPURRED RYE

ergot, ergotin, See also:

TINCTURE (Fr. teinture, Lat. tinctura, tingere, to dye, stain)

tincture of hydrastis or hamamelis, are of use, together with See also:

REST (O. Eng. rest, reste, bed, cognate with other Teutonic forms, e.g. Ger. Rast, Riiste, rest, and probably Gothic Rasta, league, i.e. resting or stopping place)

rest in See also:

bed. Fibroid polypi and other new growths must be removed. Irregular bleeding in women over forty years of age is frequently a sign of early malignant disease, and should on no account be neglected. Diseases of the See also:

EXTERNAL

External Genital Organs.—The vulva comprises several organs and structures grouped together for convenience of description (see REPRODUCTIVE See also:

SYSTEM

SYSTEM). The affections to which these structures are liable may be classified as follows: (I) Injuries to the vulva, either accidental or occurring during parturition; these are generally rupture of the perinaeum. (2) Vulvitis. See also:

SIMPLE

Simple vulvitis is due to want of cleanliness, or irritating discharges, and in See also:

CHILDREN, LAW RELATING TO

children may result from threadworms. The symptoms are See also:

HEAT (0. E. haktu, which like " hot," Old Eng. hat, is from the Teutonic type haita, hit, to be hot; cf. Ger. hitze, heiss; Dutch, hitte, heet, &c.)

heat, itching and throbbing, and the parts are red and swollen. The treatment consists of rest, thorough cleanliness and fomentations.

Infective vulvitis is nearly always due to gonorrhoea. The symptoms are the same as in simple vulvitis, with the addition of mucopurulent yellow discharge and scalding See also:

pain on micturition; if neglected, See also:

EXTENSION (Lat. ex, out ; tendere, to stretch)

extension of the disease may result. The treatment consists of rest in bed, warm medicated baths several times a day or fomentations of boracic See also:

ACID (from the Lat. root ac-, sharp; acere, to be sour)

acid. The parts must be kept thoroughly clean and discharges swabbed away. Diphtheritic vulvitis occasionally occurs, and See also:

ERYSIPELAS

erysipelas of the vulva may follow wounds, but since the use of See also:

ANTISEPTICS (Gr. avrl, against, and 6177rrnKor, putrefactive)

antiseptics is rarely seen. (3) Vascular disturbances may occur in the vulva, including varix, haematoma, oedema and See also:

GANGRENE (from Gr. y&yypawa, an eating sore, from ypaivewv, to gnaw)

gangrene; the treatment is the same as for the same disease in other parts. (4) The vulva is likely to be affected by a number of cutaneous affections, the most important being erythema, See also:

ECZEMA (Gr. EKE a, a cutaneous eruption)

eczema, See also:

HERPES (from the Gr. 'paety, to creep)

herpes, See also:

LICHEN (lichen ruber)

lichen, tubercle, See also:

ELEPHANTIASIS (Barbadoes leg; Boucnemia)

elephantiasis, vulvitis pruriginosa, syphilis and kraurosis. These affections present the same characters as in other parts of the See also:

BODY

body. Kaaurosis vulvae, first described by LawsonTait in 1875, is an atrophic change accompanied by pain and a yellowish discharge; the cause is unknown. Pruritis vulvae is due to parasites, or to irritating discharges, as leucorrhoea, and is frequent in diabetic subjects. The hymen may be occasionally imperforate and require incision. Cysts and painful carunculae may occur on the clitoris.

Any part of the vulva may be the seat of new growths, simple or malignant. Diseases of the Vagina.—(I) Malformations. The vagina may be absent in whole or in part or may present a septum. Stenosis of the vagina may be a barrier to menstruation. (2) Displacements of the vagina; (a) cystocele, which is a See also:

HERNIA (Lat. hernia, perhaps from Gr. Epvos, a sprout)

hernia of the See also:

BLADDER (from A.S. blaeddre, connected with bl¢wan, to blow, cf. Ger. blase)

bladder into the vagina; (b) rectocele, a hernia of the rectum into the vagina. Thecause of these conditions is relaxation of the tissues due to parturition. The palliative treatment consists in keeping up the parts by the insertion of a pessary; when this fails operative interference is called for. (3) Fistulae may See also:

FORM (Lat. forma)

form between. the vagina and bladder or vagina and rectum; they are generally caused by injuries during parturition or the See also:

LATE

late stages of carcinoma. Persistent fistulae require operative treatment. The vagina normally secretes a thin opalescent acid fluid derived from the See also:

LYMPH

lymph serum and the shedding of squamous epithelium. This fluid normally contains the vagina bacillus. In pathological conditions of the vagina this secretion undergoes changes.

For See also:

PRACTICAL

practical purposes three varieties of vaginitis may be described: (a) simple catarrhal vaginitis is due to the same causes as simple vulvitis, and occasionally in children is important from a medico-legal aspect when it is complicated by vulvitis. The symptoms are heat and discomfort with copious mucopurulent discharge. The only treatment required is rest, with vaginal douches of warm unirritating lotions such as boracic acid or subacetate of See also:

lead. (b) Gonorrhoeal vaginitis is most See also:

COMMON

common in adults. The patient complains of pain and burning, pain on passing See also:

WATER

water and discharge which is generally See also:

green or yellow. The results of untreated gonorrhoeal vaginitis are serious and far-reaching. The disease may spread up the genital passages, causing endometritis, salpingitis and septic See also:

PERITONITIS

peritonitis, or may extend into the bladder, causing cystitis. Strict rest should be enjoined, douches of carbolic acid (1 in 40) or of perchloride of See also:

mercury (I in 2000) should be ordered See also:

MORNING

morning and evening, the vagina being packed with See also:

TAM, JACOB BEN MEIR (1100-1171)

tam-pons of See also:

IODOFORM, CHI3

iodoform See also:

GAUZE

gauze. Saline purgatives and alkaline diuretics should be given. (c) Chronic vaginitis (leucorrhoea or " the whites ") may follow acute conditions and persist indefinitely. The vagina is rarely the seat of tumours, but cysts are common. Diseases of the Uterus.—The uterus undergoes important changes during life, chiefly at puberty and at the menopause.

At puberty it assumes the See also:

PEAR (Pyrus communis)

pear shape characteristic of the mature uterus. At the menopause it shares in the general See also:

ATROPHY (Gr. It- priv., rpo4, nourishment)

atrophy of the reproductive organs. It is subject to various disorders and misplacements. (a) Displacements of the Uterus.—The normal position of the uterus, when the bladder is empty, is that of anteversion. We have there-fore to consider the following conditions as pathological: ante-flexion, retroflexion, retroversion, See also:

INVERSION (Lat. invertere, to turn about)

inversion, prolapse and procidentia. Slight anteflexion or bending forwards is normal; when exaggerated it gives rise to dysmenorrhoea, sterility and reflex nervous phenomena. This condition is usually congenital and is often associated with under-development of the uterus, from which the sterility results. The treatment is by dilatation of the See also:

canal or by a plastic operation. Retroflexion is a bending over of the uterus backwards, and occurs as a complication of retroversion (or displacement backwards). The causes are (I) any cause tending to make the fundus or upper part of the uterus extra heavy, such as tumours or congestion, (2) loss of See also:

TONE, THEOBALD WOLFE (1763-1798)

tone of the uterine walls, (3) adhesions formed after cellulitis, (3) violent See also:

MUSCULAR

muscular efforts, (4) weakening of the uterine supports from parturition. The symptoms are dysmenorrhoea, pain on defaecation and See also:

CONSTIPATION (from Lat. constipare, to press closely together, whence also the adjective " costive ")

constipation from the pressure of the fundus on the rectum; the patient is often sterile. The treatment is the replacing of the uterus in position, where it can be kept by the insertion of a pessary; failing this, operative treatment may be required.

Retroversion when pathological is rarer than retroflexion. It may be the result of injury or is associated with pregnancy or a fibroid. The symptoms are those of retroflexion with feeling of pain and See also:

WEIGHT

weight in the See also:

PELVIS (Lat. for " basin," cf. Gr. 7rEX?a )

pelvis and See also:

DESIRE

desire to micturate followed by retention of urine due to the pressure of the cervix against the See also:

BASE

base of the bladder. The uterus must be skilfully re-placed in position; when pessaries fail to keep it there the operation of hysteropexy gives excellent results. Inversion occurs when the uterus is turned inside out. It is only possible when the cavity is dilated, either after pregnancy or by a See also:

POLYPUS

polypus. The greater number of cases follow delivery and are acute. Chronic inversions are generally due to the weight of a polypus. The symptoms are menorrhagia, metrorrhagia and bladder troubles; on examination a See also:

TUMOUR (Lat. tumor, a swelling)

tumour-like See also:

mass occupies the vagina. Reduction of the condition is often difficult, particularly when the condition has lasted for along See also:

time. The tumour which has caused the inversion must be excised. Prolapse and procidentia are different degrees of the same variety of displacement.

When the uterus lies in the vagina it is spoken of as prolapse, when it protrudes through the vulva. it is procidentia. The causes are directly due to increased See also:

INTRA

intra-abdominal pressure, increased weight of the uterus by fibroids, violent straining, chronic cough and weakening of the supporting structures of the pelvic See also:

FLOOR (from O. Eng. flor, a word common to many Teutonic languages, cf. Dutch vloer, and Ger. Flur, a field, in the feminine, and a floor, masculine)

floor, such as laceration of the vagina and perinaeum. See also:

TRACTION (Lat. trahere, to draw)

Traction on the uterus from below (as a cervical tumour) may be a cause; advanced age, laborious occupations and frequent pregnancies are indirect causes. The symptoms are a " bearing down " feeling, pain and fatigue in walking, trouble with micturition and defaecation. The condition is generally obvious on examination. As a See also:

RULE

rule the uterus is easy to replace in position. A See also:

RUBBER, INDIARUBBER

rubber See also:

RING (O.E. hring; a word common to Teutonic languages; and probably cognate with the Lat. circus, Gr. KtpKOS or KpLKOS, Skt'. chakra, wheel, circle, cf. also " harangue "); in art, a band of circular shape of varying sizes, made of any material and used f

ring pessary will often serve to keep it there. If the perinaeum is very much torn it may be necessary to repair it. Various operations for retaining the uterus in position are described. (b) Enlargements of the Uterus (See also:

HYPERTROPHY (Gr. inrEp, over, and rpo(A, nourishment)

hypertrophy or hyperplasia). This condition may some-times involve the uterus as a whole or may be most marked in the body or in the cervix. It follows chronic congestion or inflammatory prolapse, or any condition interfering with the circulation.

The symptoms comprise local discomfort and sometimes dysmenorrhoea, leucorrhoea or menorrhasia. When the See also:

ELONGATION

elongation occurs in the cervical portioh the only possible treatment is amputation of the cervix. Atrophy of the uterus is normal after the menopause. It may follow the removal of the tubes and ovaries. Some constitutional diseases produce the same result, as See also:

TUBERCULOSIS

tuberculosis, chlorosis, chronic morphinism and certain diseases of the central nervous system. (c) Injuries and Diseases resultant from Pregnancy.—The most frequent of these injuries is laceration of the cervix uteri, which is frequent in precipitate labour. Once the cervix is torn the raw surfaces become covered by granulations and later by cicatricial See also:

TISSUE (Fr. tissu, tissue, participle of tisser, Lat. texere, to weave)

tissue, but as a rule they do not unite. The torn lips may become unhealthy, and the congestion and oedema spread to the body of the uterus. A lacerated cervix does not usually give rise to symptoms; these depend on the accompanying endometritis, and include leucorrhoea, aching and a feeling of weight. Lacerations are to be See also:

FELT (cognate with Ger. Filz, Du. vilt, Swed. and Dan. fill; the root is unknown; the word has given Med. Lat. filtrum, " filter ")

felt digitally. As lacerations predispose to See also:

ABORTION (from Lat. aboriri, to fail to be born, or perish)

abortion the operation of trachelorraphy or repair of the cervix is indicated. Perforation of the uterus may occur from the use of the sound in diseased conditions of the uterine walls.

Superinvolution means premature atrophy following parturition. Subinvolution is a condition in which the uterus fails to return to its normal See also:

SIZE

size and remains enlarged. Retention of the products of conception may cause irregular haemorrhages and may lead to a diagnosis of tumour. The uterus should be carefully explored. (d) Inflammations Acute and Chronic.—The mucous membrane lining the cervical canal and body of the uterus is called the endometrium. Acute inflammation or endometritis may attack it. The chief causes are See also:

SEPSIS (Gr. Qi7,/iss, putrefaction), or SEPTIC INFECTION

sepsis following labour or abortion, extension of a gonorrhoeal vaginitis, or gangrene or infection of a uterine myoma. The puerperal endometritis following labour is an avoidable disease due to lack of scrupulous aseptic precautions. Gonorrhoeal endometritis is an acute form associated with copious purulent discharge and well-marked constitutional disturbance. The temperature.ranges from 99° to 105° F., associated with pelvic pain, and rigors are not uncommon. The tendency is to recovery with more or less protracted convalescence. The most serious complications are extension of the disease and later sterility.

Rest in bed and intrauterine See also:

IRRIGATION (Lat. in, and rigare, to water or wet)

irrigation, followed by the introduction of iodoform pencils into the uterine cavity, should be resorted to, while pain is relieved by hot fomentations and sitz baths. Chronic endometritis may be the See also:

SEQUOIA

sequoia of the acute form, or may be septic in origin, or the result of chronic congestion, acute retroflection or subinvolution following delivery or abortion. The varieties are glandular, interstitial, haemorrhagic and senile. The symptoms are disturbance of the menstrual See also:

FUNCTION

function, headache, pain and pelvic discomfort, and more or less profuse thick leucorrhoeal discharge. The treatment consists in See also:

ATTENTION (from Lat. ad-tendo, await, expect; the condition of being " stretched " or " tense ")

attention to the general See also:

HEALTH

health, with suit-able laxatives and local injections, and in obstinate cases curettage is the most effectual measure. The disease is frequently associated with adenomatous disease of the cervix, formerly called erosion. In this disease there is a new formation of glandular elements, which enlarge and multiply, forming a soft velvety areola dotted with See also:

PINK

pink spots. This was formerly erroneously termed ulceration. The cause is unknown. It occurs in virgins as well as in mothers, but it often accompanies lacerations of the cervix. The symptoms are indefinite pain and leucorrhoea. The condition is visible on inspection with a speculum.

The treatment is swabbing with iodized phenol or curettage. The body of the uterus may also be the seat of adenomatous disease. Tuberculosis may attack the uterus; this usually forms part of a general tuberculosis. (e) New Growths in the Uterus.—The uterus is the most common seat of new growths. From the researches of von Gurlt, compiled from the See also:

Vienna See also:

HOSPITAL (Lat. haspitalis, the adjective of hospes, host or guest)

Hospital Reports, embracing 15,88o cases of tumour, See also:

FEMALES

females exceed See also:

MALES

males in the proportion of seven to three, and of this large See also:

MAJORITY (Fr. majorite; Med. Lat. majoritas; Lat. major, greater)

majority uterine growths account for 25 % . When we consider its periodic monthly engorgements and the alternate hypertrophy and involution it undergoes in connexion with pregnancy, we can anticipate the special proneness of the uterus to new growths. Tumours of the uterus are divided into benign and malignant. The benign tumours known as fibroids or myomata are very common. They are stated by See also:

BAYLE, PIERRE (1647-1706)

Bayle to occur in 20 % of women over 35 years of age, but happily in a great number of cases they are small and give rise to no symptoms. They are definitely associated with the period of sexual activity and occur more frequently in married women than in single, in the proportion of two to one (Winckel). It is doubtful if they ever originate after the menopause. Indeed if uncomplicated by changes in them they See also:

SHARE (O. Eng. scearu, chiefly in compounds, e.g. land-scearu, a share of land, from sceran to cut; cf. " shear" )

share in the general atrophy of the sexual organs which then takes place.

They are divided according to their position in the tissues into intramural, subserous and submucous (the last when it has a pedicle forms a polypus), or as to the part of the uterus in which they develop into fibroids of the cervix and fibroids of the body. Intramural and submucous fibroids give rise to haemorrhage. The menses may be so increased that the patient is scarcely ever See also:

FREE

free from haemorrhage. The pressure of the growth may cause dysmenorrhoea, or pressure on the bladder and rectum may cause dysuria, retention or rectal tertesmus. The uterus may be displaced by the weight of the tumour. Secondarychanges take place in fibroids, such as mucous degeneration, fatty See also:

METAMORPHOSIS

metamorphosis, calcification, septic infection (sloughing fibroid) and malignant (sarcomatous) degeneration. The modes in which fibroids imperil life are haemorrhage (the commonest of all), septic infection, which is one of the most dangerous, impaction when it fits the true pelvis so tightly that the tumour cannot rise, twisting of the pedicle by rotation, leading to sloughing and intestinal and urinary obstruction. When fibroids are complicated by pregnancy, impaction and consequent abortion may take place, or a cervical myoma may offer a mechanical obstacle to delivery or lead to serious See also:

POST

post partem haemorrhage. In the treatment of fibroids various drugs (ergot, hamamelis, hydrastis canadensis) may be tried to See also:

CONTROL (Fr. contrdle, older form contre rolle, from Med. Lat. contra-rotulus, a counter roll or copy of a document used to check the original; there is no instance in English of the use of " control " in this, its literal, meaning)

control the haemorrhage, and repose and the injection of hot water (120° F.) are sometimes successful, together with See also:

electrical treatment. Surgical See also:

MEASURES

measures are needed, however, in severe recurrent haemorrhage, intestinal obstruction, sloughing and the co-existence of pregnancy. An endeavour must be made if possible to enucleate the fibroid, or hysterectomy (removal of the uterus) may be required. The operation of removal of the ovaries to precipitate the menopause has fallen into disuse.

(f) Malignant Disease of the Uterus.—The varieties of malignant disease met with in the uterus are sarcoma, carcinoma and chorionepithelioma malignum. Sarcomata may occur in the body and in the See also:

NECK (O. Eng. hnecca; the word appears in many Teutonic languages; cf. Dutch ride, Ger. Nacken; in O. E. the common word was heals; cf. Ger. Hals)

neck. They occur at an earlier age than carcinomata. Marked enlargement and haemorrhage are the symptoms. The See also:

DIFFERENTIAL

differential diagnosis is microscopic. Extirpation of the uterus is the only See also:

CHANCE (through the O. Fr. cheance, from the Late Lat. cadentia, things happening, from cadere, to fall out, happen; cf. " case ")

chance of prolonging life. The age at which women are most subject to carcinoma (See also:

cancer) of the uterus is towards the decline of sexual life. Of 3385 collected cases of cancer of the uterus 1169 occurred between 40 and 50, and 856 between 5o and 6o. In contradistinction to fibroid tumours it frequently arises after the menopause. It may be divided into cancer of the body and cancer of the neck (cervix). Cancer of the neck of the uterus is almost exclusively confined to women who have been pregnant (Bland-See also:

Sutton). Predisposing causes may be injuries during delivery.

The symptoms which induce women to seek medical aid are haemorrhage, foetid discharge, and later pain and cachexia. An unfortunate belief amongst the public that the menopause is associated with irregular bleeding and offensive discharges has prevented many women from seeking medical See also:

ADVICE (Fr. avis, from Lat. ad, to, and visum, viewed)

advice until too late. It cannot be too widely understood that cancer of the cervix is in its early stages a purely local disease, and if removed in this See also:

STAGE (Fr. 6/age; from Lat. stare, to stand)

stage usually results in cure. So important is the recognition of this fact in the saving of human life that at the See also:

MEETING (from " to meet," to come together, assemble, 0. Eng. metals ; cf. Du. moeten, Swed. mota, Goth. gamotjan, &c., derivatives of the Teut. word for a meeting, seen in O. Eng. Wit, moot, an assembly of the people; cf. witanagemot)

meeting of the See also:

BRITISH

British Medical Association in See also:

APRIL

April 1909 the See also:

COUNCIL (Lat. concilium, from cum, together, and the root cal, to call)

council issued for publication a special See also:

APPEAL

appeal to medical practitioners, midwives and nurses, and directed it to be published in British and colonial medical and See also:

NURSING

nursing See also:

JOURNALS

journals. It will be useful to quote here a part of the appeal directed to midwives and nurses: " Cancer may occur ,at any age and in a woman who looks quite well, and who may have no pain, no wasting, no foul discharge and no profuse bleeding. To wait for pain, wasting, foul discharge or profuse bleeding is to throw away the chance of successful treatment. The early symptoms of cancer of the womb are: (1) bleeding which occurs after the change of life, (2) bleeding after sexual intercourse or after a vaginal douche, (3) bleeding, slight or abundant, even in See also:

young women, if occurring between the usual monthly periods, and especially when accompanied by a See also:

BAD, BCD

bad-smelling or watery blood-tinged discharge, (4) thin watery discharge occurring at any age." On examination the cervix presents certain characteristic signs, though these may be modified according to the variety of cancer present. Hard nodules or definite loss of substance, extreme friability and bleeding after slight manipulation, are suspicious. See also:

EPITHELIAL, ENDOTHELIAL

Epithelial cancer of the cervix may assume a proliferating ulcerative type, forming the well-known " cauliflower" excrescence. The treatment of cancer of the cervix is free removal at the earliest possible moment. Cancer of the body of the uterus is rare before the 45th See also:

YEAR

year. It is most frequent at or subsequent to the menopause.

The majority of the patients are nulliparae (Bland-Sutton). The signs are fitful haemorrhages after the menopause, followed by profuse and offensive discharges. The uterus on examination often feels enlarged. The diagnosis being made, hysterectomy (removal of the uterus) is the only treatment. Cancer of the body of the uterus may complicate fibroids. Chorion-epithelioma malignum (deciduoma) was first described in 1889 by See also:

SANGER, JOHN (1816–1889)

Sanger and See also:

Pfeiffer. It is a malignant disease presenting microscopic characters resembling decidual tissue. It occurs in connexion with See also:

RECENT

recent pregnancy, and particularly with the variety of abortion termed hydatid See also:

mole. In many cases it destroys life with a rapidity unequalled by any other See also:

KIND (O. E. ge-cynde, from the same root as is seen in " kin," supra)

kind of growth. It quickly ulcerates and infiltrates the uterine tissues, forming metastatic growths in the See also:

LUNG

lung and vagina. Clinically it is recognized by the occurrence after pregnancy of violent haemorrhages, progressive cachexia and See also:

FEVER (Lat. febris, connected with fervere, to burn)

fever with rigors. Recent suggestions have been made as to chorionepithelioma being the result of pathological changes in the lutein tissue of the ovary.

The growth is usually See also:

PRIMARY

primary in the uterus, but may be so in the Fallopian tubes and in the vagina. A few cases have been recorded unconnected with pregnancy. The virulence of chorion-epithelioma varies, but in the present See also:

state of our knowledge immediate removal of the primary growth along with the affected See also:

ORGAN

organ is the only treatment. Diseases of the Fallopian Tubes.—The Fallopian tubes or oviducts are liable to inflammatory affections, tuberculosis, sarcomata, cancer, chorion-epithelioma and tubal pregnancy. Salpingitis (inflammation of the oviducts) is nearly always secondary to septic infection of the genital See also:

TRACT (from Lat. tractare, to treat of a matter, through Provencal tractat and Ital. trattato)

tract. The chief causes are septic endometritis following labour or abortion, gangrene of a myoma, gonorrhoea, tuberculosis and cancer of the uterus; it sometimes follows the specific fevers. When the pus escapes from the tubes into the coelom it sets up pelvic peritonitis. When the inflammation is adjacent to the ostium it leads to the See also:

MATTING

matting together of the tubal fimbriae and glues them to an adjacent organ. This See also:

SEALS

seals the ostium. The occluded See also:

TUBE (Lat. tuba)

tube may now have an See also:

ACCUMULATION (from Lat. accumulare, to heap up)

accumulation of pus in it (pyosalpinx). When in consequence of the sealing of the ostium the tube becomes distended with serous fluid it is termed hydrosalpinx. Haematosalpinx is a See also:

TERM

term applied to the non-gravid tube distended with blood; later the tubes may become sclerosed.

Acute septic salpingitis is ushered in by a rigor, the temperature rising to 103°, 104° F., with severe pain and constitutional disturbance. The symptoms may become merged in those of general peritonitis. In chronic disease there is a See also:

HISTORY

history of puerperal trouble followed by sterility, with excessive and painful menstruation. Acute salpingitis requires See also:

ABSOLUTE (Lat. absolvere, to loose, set free)

absolute rest, See also:

OPIUM (Gr. amov, dim. from Orbs, juice)

opium suppositories and hot fomentations. With urgent symptoms removal of the inflamed adnexa must be resorted to. Chronic salpingitis often renders a woman an invalid. Permanent See also:

RELIEF

relief can only be afforded by surgical intervention. Tuberculous salpingitis is usually secondary to other tuberculous infections. The Fallopian tubes may be the seat of malignant disease. This is rarely primary. By far the most important of the conditions of the Fallopian tubes is tubal pregnancy (or ectopic gestation). It is now known that fertilization of the human ovum by the spermatozoon may take place even when the ovum is in its follicle in the ovary, for oosperms have been found in the ovary and Fallopian tubes as well as in the uterus.

Belief in ovarian pregnancy is of old See also:

STANDING

standing, and had been regarded as possible but unproved, no See also:

case of an early embryo in its membranes in the See also:

sac of an ovary being forthcoming, until the remarkable case published by Dr See also:

Catherine See also:

van Tussenboek of See also:

Amsterdam in 1899 (Bland-Sutton). Tubal pregnancy is most frequent in the See also:

LEFT

left tube; it sometimes complicates uterine pregnancy; rarely both tubes are pregnant. When the oosperm lodges in the See also:

AMPULLA (either a diminutive of amphora, of from Lat. ambo, both, and olla, a pot)

ampulla or See also:

ISTHMUS (Gr.io0pbs, neck)

isthmus it is called tubal gestation; when it is retained in the portion traversing the uterine See also:

wall it is called tubo-uterine gestation. Wherever the fertilized ovum remains and implants its villi the tube becomes turgid and swollen, and the abdominal ostium gradually closes. The ovum in this situation is liable to See also:

APOPLEXY (Gr. arov n i.a, from aroaMvvew, to strike down, to stun)

apoplexy, forming tubal mole. When the abdominal ostium remains pervious the ovum may escape into the coelomic cavity (tubal abortion); See also:

DEATH

death from See also:

SHOCK, or COLLAPSE

shock and haemorrhage into the abdominal cavity may result. When neither of these occurrences has taken place the ovum continues to grow inside the tube, the rupture of the distended tube usually taking place between the sixth and the tenth See also:

WEEK (from A.S. wicu, Germanic *wikon, probably=change, turn)

week. The rupture of the tube may be intraperitoneal or extraperitoneal. The danger is death from haemorrhage occurring during the rupture, or adhesions may form, the retained blood forming a See also:

HAEMATOCELE (Gr. aiya, blood, and rd7X17, tumour)

haematocele. The ovum may be destroyed or may continue to develop. In rare cases rupture may not occur, the tube bulging into the peritoneal cavity; and the foetus may break through the membranes and See also:

lie free among the intestines, where it may See also:

die, becoming encysted or calcified. The tubal See also:

PLACENTA (Lat. for a cake)

placenta possesses foetal structures, the true decidua forming in the uterus.

The signs suggestive of tubal pregnancy before rupture are missed periods, pelvic pains and the presence of an enlarged tube. When rupture takes place it is attended in both varieties with sudden and severe pain and more or less marked collapse, and a tumour may or may not be felt according to the situation of the rupture. There is a general " feeling of something having given way." If diagnosed before rupture, the sac must be removed by abdominal See also:

section. In intraperitoneal rupture immediate operation affords the only chance of saving life. In extraperitoneal rupture the foetus may occasion-ally remain alive until full term and be rescued by abdominal section, if the condition is recognized, or a false labour may take place, accompanied by death of the foetus. Diseases of the Ovaries and Parovarium.—The ovaries undergo striking changes at puberty, and again at the menopause, after which there is a See also:

GRADUAL (Med. Lat. gradualis, of or belonging to steps or degrees; gradus, step)

gradual shrinkage. One or both may be absent or malformed, or they are subject to displacements, being either undescended, contained in a hernia or prolapsed. Either of these conditions, if a source of pain, may necessitate their removal. The ovary is also subject to haemorrhage or apoplexy. Acute inflammations (oliphorites) are constantly associated with salpingitis or other septic conditions of the genital tract or with an attack of See also:

MUMPS (syn. Cynanche parotidaea, parotitis; also, " The Branks ")

mumps. The relation of oophoritis to mumps is at present unknown. Acute oophoritis may culminate in See also:

ABSCESS (from Lat. abscedere, to separate)

abscess but more usually adhesions are formed.

The surgical treatment is that of pyosalpinx. Chronic inflammation may follow acute or be consequent on pelvic cellulitis. Its See also:

CONSTANT, BENJAMIN (1845-1902)

constant features are more or less pain followed by sterility. The ovary may be the seat of tuberculosis, which is generally secondary to other lesions. Suppuration and abscess of the ovary also occur. Perioophoritis, or chronic inflammation in the neighbourhood, may also involve the gland. The cause of cirrhosis of the ovaries is unknown, though it may be associated with cirrhotic See also:

LIVER (O. Eng. lifer; cf. cognate forms, Dutch lever, Ger. Leber, Swed. lefver, &c.; the O. H. Ger. forms are libara, lipora, &c.; the Teut. word has been connected with Gr. i'prap and Lat. jecur)

liver. The change is met with in women between 20 and40 years of age, the ovaries being In a shrunken, hard, wrinkled condition. Under ovarian See also:

NEURALGIA (Gr. veiipov, nerve, and iXyos, pain)

neuralgia are grouped indefinite painful symptoms occurring frequently in neurotic and alcoholic subjects, and often worse during menstruation. The treatment, whether local or operative, is usually unsatisfactory. The ovary is frequently the seat of tumours, dermoids and cysts. Cysts may be simple, unilocular or multilocular, and may attain an enormous size.

The largest on See also:

RECORD (Lat. recordari, to recall to mind, from cor, heart or mind)

record was removed by Dr See also:

Elizabeth Reifsnyder of See also:

SHANGHAI

Shanghai, and contained 100 litres of fluid, and the patient recovered. The operation is termed ovariotomy. Dermoid cysts containing skin, bones, See also:

TEETH (O.E. Eel); plural of tooth, O.E. top)

teeth and See also:

HAIR (a word common to Teutonic languages)

hair, are of frequent growth in the ovary, and have attained the weight of from 20 to 40 kilogrammes. In one case a girl weighed 27 kilogrammes and her tumour 14 kilogrammes (Keen). Papillomatous cysts also occur in the ovary. Parovarian and Gartnerian cysts are found, and adenomata form 20% of all ovarian cysts. Occasionally the See also:

TUNIC (0. Eng. tunice, tunical, taken, before the Norman con-quest, directly from Lat. tunica, of which the origin is unknown)

tunic of peritoneum surrounding the ovary becomes distended with serous fluid. This is termed ovarian hydrocele. Ovarian fibroids occur, and malignant disease (sarcoma and carcinoma) is fairly frequent, sarcoma being the most usual ovarian tumour occurring before puberty. Carcinoma of the ovary is rarely primary, but it is a common situation for secondary cancer to that of the See also:

BREAST (a word common to Teutonic languages, cf. the Ger. Brust, possibly connected with an O. Sax. brustian, to bud)

breast, See also:

gall-bladder or gastro-intestinal tract. The treatment of all rapidly-growing tumours of the ovary is removal. Diseases of the Pelvic Peritoneum and Connective Tissue.—Women are excessively liable to peritoneal infections.

(I) Septic infection often follows acute salpingitis and may give rise to pelvic peritonitis (perimetritis), which may be adhesive, serous or purulent. It may follow the rupture of ovarian or dermoid cysts, rupture of the uterus, extra uterine pregnancy or extension from pyosalpinx. The symptoms are severe pain, fever, 103° F. and higher, marked constitutional disturbances, vomiting, restlessness, even See also:

DELIRIUM (a Latin medical term for madness, from delirare, to be mad, literally to wander from the lira, or furrow)

delirium. The abdomen is fixed and tympanitic. Its results are the formation of adhesions causing abnormal positions of the organs, or chronic peritonitis may follow. The treatment is rest in bed, opium, hot stupes to the abdomen and See also:

QUININE

quinine. (2) Epithelial infections take place in the peritoneum in connexion with other malignant growths. (3) Hydroperitoneum, a collection of free fluid in the abdominal cavity, may be due to tumours of the abdominal viscera or to tuberculosis of the peritoneum. (4) Pelvic cellulitis (parametritis) signifies the inflammation of the connective tissue between the folds of the broad See also:

LIGAMENT (Lat. ligamentum, from ligare, to bind)

ligament (mesometrium). The general causes are septic changes following abortion, delivery at term (especially instrumental delivery), following operations on the uterus or salpingitis. The symptoms are chill followed by severe intrapelvic pain and tension, fever 1o0° to 102° F. There may be See also:

NAUSEA (from Gr. vain, a ship)

nausea and vomiting, See also:

DIARRHOEA (from Gr. &Q, through, pfw, flow)

diarrhoea, rectal tenseness and dysuria.

If consequent on parturition the lochia cease or become offensive. On examination there is tenderness and swelling in one flank and the uterus becomes fixed and immovable in the exudate as if embedded in See also:

PLASTER

plaster of See also:

Paris. The illness may go to See also:

RESOLUTION

resolution if treated by rest, opium, hot stupes or icebags and glycerine tampons, or may go on to suppuration forming pelvic abscess, which signifies a collection of pus between the layers of the broad ligament. The pus in a pelvic abscess may point and escape through the walls of the vagina, rectum or bladder. It occasionally points in the See also:

GROIN

groin. If the pus can be localized an incision should be made and the abscess drained. The tumours which arise in the broad ligament are haematocele, solid tumours (as myomata, lipomata and sarcomata), and echinnococcus colonies (hydatids).

End of Article: GYNAECOLOGY (from Gr. 'mil, yuvausos, a woman, andAoyos, discourse)

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GYNAECEUM (Gr. yvvaiseiov, from yuvii, woman)

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GYONGYOSI, ISTVAN [STEPHEN] (1620-1704)