Hans von Gersdorff — 1551 — Contemporary Color 
 
 Sfostaf) Cfcarles ®rent, MJB. 
 

 
 
 
 
 
 
 
 
 
 
 
 
Digitized by the Internet Archive 
 in 2016 with funding from 
 Duke University Libraries 
 
 https://archive.org/details/historicalsketch01jenk 
 

 
 
HISTORICAL SKETCH OF AMERICAN 
 GYNECOLOGY. 
 
 By EDWAED W. JENKS, M. D., LL.D., 
 Detroit, Michigan. 
 
 As in the case of most nations, so in that of medicine, of whose his- 
 tory it forms a part, the earliest dawnings are traceable to tradition, 
 and in many instances the historian is obliged to go back of authen- 
 ticated records for the material with which to construct the foundation 
 of his story. In writing a history of American medicine in any of its 
 divisions this difficulty does not, however, present itself, for, like the 
 American people itself, it arises from a foundation laid in centuries of 
 Transatlantic life. While, therefore, in essaying a history of the achieve- 
 ments of American surgeons in the treatment of diseases peculiar to 
 women I am not obliged to analyze aught which is of doubtful authen- 
 ticity as a basis for a starting-point, it has seemed to me that a brief 
 resume of the historical facts which form the foundation of gynecol- 
 ogy as it exists in America to-day will greatly assist to the clearest con- 
 ception of the superstructure. The explorations of antiquarians of later 
 years into that which has been hidden by the debris of centuries has, 
 moreover, unearthed so many of the prototypes of modern discoveries 
 that a consideration of the latter could scarcely be held to be complete 
 without a reference to their predecessors in the remote ages. 
 
 Gynecology is singularly rich in illustrations of the belief that prog- 
 ress is in the direction of a circle rather than in that of a straight 
 line — “ that which hath been is, and that which is shall be and many 
 of the brilliant discoveries with which it has been enriched in modern 
 times, and even in America, were really but rediscoveries of discoveries 
 which the mutations of time have effaced from the memories and the 
 records of men. 
 
 While the current of gynecology as it has flowed down to us in an 
 ever-widening stream from the past is traceable with definite clearness 
 only to the Greeks, there is evidence that it did not have its origin 
 among that remarkable people, but that it trickled in rivulets, too small 
 for the attention of the great majority of explorers, from the people living 
 on the Xile. That the stream was clearly recognized in the days of 
 Homer and Herodotus is attested in the writings of those immortal 
 
 Vol. I . — 2 17 
 
18 
 
 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 Greeks, who wrote in terms of the highest admiration of the skill and 
 the learning of the physicians of Egypt. 
 
 The physicians under the Ptolemies were required to regulate their 
 practice according to certain books, one of which was devoted to diseases 
 peculiar to women. These books were held as sacred, and their authority 
 was thus unquestionable. Doubtless, there existed among a people, evi- 
 dences of whose greatness have of more recent years been so abundantly 
 revealed, other works on this subject, but Saracen fanaticism in the 
 destruction of the Alexandrian Library with its 600,000 volumes blotted 
 out the story of what Egypt once was, and has left us only to conjecture. 
 When the difference in the language and political complexion of Greece 
 and Egypt is considered in connection with the necessarily limited in- 
 tercommunication of the two peoples, it is but reasonable to suppose 
 that comparatively little of the learning of the older civilization found 
 its way to Greece, and that such inkling as we have received through 
 the Greeks of the status of Egyptian medicine is very meagre when 
 compared with the actual advancement which obtained. 
 
 The destruction of the Alexandrian Library has left the writings 
 of Hippocrates, written about 450 B. c., the oldest extant containing 
 anything like a systematic consideration of the diseases of women. 
 Moses, who was versed in “ all the learning of the Egyptians,” shows 
 a remarkable familiarity with the sexual peculiarities of women, but 
 lie treats of them in their physiology, and interests himself in the 
 hygiene of the genitalia rather than in their diseases. 
 
 In the language of Adams, the learned commentator on the works 
 of Hippocrates, “ these works furnish the most indubitable proofs that 
 the obstetric art had been cultivated with most extraordinary ability at 
 an early period.” In regard to gynecology proper, these works are, 
 however, disappointing to him who has been led to admire and revere 
 the philosopher of Cos through a study of his works on general med- 
 icine. Hippocrates advised the use of aromatic fumigations in amenor- 
 rhoea, which fumigations lie also recommended as a test of fertility in 
 the female. The woman who did not conceive was wrapped in blanket- 
 and fumigated from beneath ; if the scent passed through her body to 
 the nostrils and mouth, then it was known that she was not unfruitful ! 
 While he recognized a causative relation between the uterus and hys- 
 teria, he maintained that the movement of the womb toward the head 
 caused pain under the eyes and nose, with abundant and frothy saliva ; 
 if it moved toward the hypochondrium, it caused vomiting of an acrid, 
 burning matter ; if it moved toward the liver, it caused loss of speech, 
 clenching of the teeth, and a livid skin. The remedies for these various 
 hysterical symptoms were as ludicrous as their etiology. Nulliparae were 
 held to be more subject to menstrual disorders than women who had 
 borne children, for the veins of the woman who has given birth to a 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 19 
 
 child carry oft’ the menstrual discharge more readily, because the lochial 
 discharge improves the circulation. The views of the “Father of 
 Medicine” on the treatment of uterine hemorrhage were, however, 
 more sensible. We discover, indeed, in them some of the fundamental 
 principles of the advanced methods of our own day. His knowledge 
 of the relation of sympathy between the uterus and the mammae is 
 apparent in his instruction to apply a large cupping instrument to the 
 breast as a means of staying uterine hemorrhage. His description of 
 leucorrhoea and the frequent attendant systemic condition is graphic, 
 although his therapy of the affection is crude. The prolapsed uterus, 
 he says, “ hangs down like a scrotum.” It should be well washed 
 with astringent lotions and restored to its place, when the woman must 
 be placed on her back with her legs crossed and tied together. That 
 Hippocrates recognized the fact that a molar pregnancy occurring in an 
 unmarried woman impeached her virtue is evident from his statement 
 that moles are caused by a superabundance of menstrual blood, together 
 with a bad condition of the semen. He gives a clear differential diag- 
 nosis between molar and true pregnancy. His description of cancer 
 of the uterus is clear, and his gloomy prognosis in such cases has not 
 been much brightened by the advances made since his day. We recog- 
 nize in the “ pliimus ” of his day the modern stenosis of the os. He 
 recommends an application containing verdigris for its relief. His 
 remarks on atresia of the vagina and uterus command attention : 
 “ Sometimes the vagina becomes obstructed after parturition. I have 
 seen a case where the parts were torn during delivery, causing excoria- 
 tions, after which the parts became seriously inflamed, so that the lips 
 touched and became united as in wounds. After the subsidence of the 
 inflammation the lips, which had reunited, offered an obstacle to the men- 
 strual discharge, preventing its free exit. It is necessary in such a case 
 to dress the lacerated parts and cause cicatrization, but it is also neces- 
 sary that the cicatrix be firm and complete, while it is very difficult 
 to secure this result. In the instance of which I speak all the results 
 took place which occur when the menses are suppressed by malforma- 
 tion of the uterus, but the principal pain was felt in the vagina, which 
 the woman found to be occluded. After suitable treatment the men- 
 strual flow was re-established, the woman recovered her health, and 
 afterward bore children. If the case had been neglected, the wound 
 would have increased in size, and a cancer would have been the final 
 result.” It is evident that the subject of sterility received much of 
 his attention, and his views concerning the causation of the same are 
 interesting. He held the cause to be one or several of the following : 
 “ 1. Because the os uteri is turned obliquely from the passage to it. 
 2. Because the inside of the uterus, being smooth, either naturallv or 
 in consequence of cicatrices and ulcers, does not retain the semen. 
 
20 
 
 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 3. When, owing to the suppression of the menses, any obstruction 
 takes place in the os uteri, it is apt to prevent impregnation. 4. W hen 
 impregnation does not take place, the veins of the uterus become so 
 engorged with blood that they do not retain the semen ; or, on the 
 contrary, the same effect may arise from profuse menstruation, whereby 
 the retentive faculty of the vessels is weakened and a return of the 
 menstrual fluid in too great quantity may wash away the semen. 5. 
 Prolapsus uteri, by rendering the mouth of the uterus hard and cal- 
 lous, prevents impregnation. ” 
 
 Among the Romans there is evidence that the diseases of woman 
 received especial attention. Their knowledge was, however, mainly 
 derived from Greece and Alexandria, their writings revealing none 
 of the originality of thought and boldness of procedure which have 
 always marked progress in this division of medicine. Celsus was a 
 voluminous writer, but it is to be regretted that so much of such parts 
 of his works as treated especially of the diseases of women have been 
 lost as to leave us at best a very disjointed reference to the subject. 
 Enough has, however, been preserved of his writings and of those of 
 Galen to convince us that as early as the first century of the Chris- 
 tian era the speculum, rediscovered by Recamier in 1816, was not 
 unknown ; that the vaginal touch was used as a means of diagnosis ; 
 and that ulceration of the womb and leueorrhcea in its several vari- 
 eties had been recognized. In the excavations of Pompeii and Her- 
 culaneum, overwhelmed with lava from Mount Vesuvius a. d. 79, 
 and remaining buried for nearly eighteen hundred years, there were 
 found among, other surgical instruments, two specula, such as were 
 probably in common use at the time of the catastrophe. 
 
 Following the faint glimmer of light emitted from Rome, we have 
 a period of almost absolute darkness extending over five hundred 
 years, all of such history of the medicine of those years as may 
 have been written having; at last become extinct. At the end of 
 
 <3> 
 
 this period we find at work in the library at Alexandria one fEtius, 
 a Greek, whom the fame of that wonderful collection had probably 
 attracted from his native land, although the fact that he refers occa- 
 sionally in his writings to cases occurring under his own eye gives 
 color to the belief that, besides delving in the accumulated lore, he 
 also engaged in the practice of his profession. The writings of Alt ins. 
 compilations chiefly from the Alexandrian collection, having fortu- 
 nately been preserved, we are permitted to know through them some- 
 thing of the status of medicine in Egypt a millennium and a half ago. 
 A study of these writings will open up a wonderful revelation to those 
 who regard gynecology as peculiarly a development of these later 
 times. They consist of four books ( tetrabiblus ), each of which i- in 
 turn subdivided into many chapters. The fourth discourse of the 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 21 
 
 fourth book, containing one hundred and twelve chapters varying iu 
 length from a few lines to several pages, is principally devoted to 
 obstetrics and diseases of women. In it the uterus and the ovaries, 
 their structure and function, are described with a degree of exactness 
 which both disposes of the assumption that the ancients were ignorant 
 of physiology, and proves that they possessed instruments for ocular 
 examination of the uterus (their dioptra) and sounds for determining 
 its size in the living subject. The description, too, which is given of 
 the methods in vogue for preventing the legitimate consequences of 
 sexual congress and for inducing abortion proves that the nefarious 
 practices by means of which the female of our day would accomplish 
 the same result are not of modern origin. Latero-version, antever- 
 sion, and retroversion of the uterus, and various methods for the relief 
 of these displacements, are discussed, and mention is even made of 
 the sound for correcting malpositions of that organ. Abscess of the 
 uterus was recognized, and the description of the examination for its 
 diagnosis and the methods for its treatment would, barring certain 
 crudities of expression, pass muster even in the light of our more 
 advanced knowledge of uterine ailments and the means of their 
 relief. The treatment, medical and surgical, laid down for pelvic 
 abscess would do no discredit to the modern gynecologist. The 
 relief of stenosis of the os by means of sponge tents is so graphically 
 described as either to compel the belief that the modern discoverer of 
 this use of these devices derived his knowledge from the writings of 
 kEtius, or to cause the reader to marvel at the remarkable coincidence. 
 Atresia of the vagina is discussed, and the operation, with instruments 
 therefor, for its relief clearly described. 
 
 The next writer in chronological order whose writings are preserved 
 to us is Paul of kEgina, between whom and kEtius there intervenes a 
 century. This writer has been accorded a prominence which he does 
 not merit. Dr. Adams, the translator of the Sydenham series, has 
 shown him much consideration. A studv of his writings in connection 
 with those of kEtius reveal him to have been a plagiarist. He was at 
 most a compiler, and his efforts even in this direction fell far short of 
 those of the industrious and able kEtius. 
 
 Following Paulus kEgineta we have a millennium of darkness, the 
 gloom being relieved only by the uncertain glints with which the Sar- 
 acens sought to make amends for their damnable vandalism in the 
 matter of the Alexandrian Library. But an insuperable obstacle to 
 their progress in the knowledge of the diseases of women presented 
 itself in the Moslem religion, which forbade visual and digital exami- 
 nation of the female genitalia, even under conditions of the most intol- 
 erable suffering, by male physicians. The ability of the Saracen physi- 
 cians, so abundantly illustrated in other departments of medicine, was 
 
22 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 therefore forbidden an opportunity of manifesting itself in this, and 
 such knowledge as formed the basis of their unsatisfactory practice in 
 gynecology was derived solely from the writings of the Greeks ; and 
 the fact that any treatment of a local nature which might have been 
 deemed necessary must be applied by ignorant midwives caused this 
 branch of medicine to soon fall into desuetude and consequent decay. 
 Of the Arabian writers, Albucasis, in the fourteenth century, alone 
 seems to have given it any considerable attention, and there is internal 
 evidence in his writings that he was a Jew, and was thus not hindered 
 by any religious scruples of his own from pursuing his studies after 
 the manner proscribed by the Moslem religion. He makes an occa- 
 sional allusion to the speculum, but doubtless the circumstances under 
 which he lived made even his employment of it rare. Although it is 
 apparent from the writings of subsequent authors, and notably Ambrose 
 Pare (1509-90) and Scultetus (1683), that the instrument was not abso- 
 lutely forgotten, it is nevertheless a fact that for a thousand years prior 
 to its rediscovery (if such it really was) by Recamier (1816) it was 
 practically a lost instrument, and gynecology certainly was during this 
 millennium a lost art. 
 
 While, as intimated at the outset, American gynecology, dating from 
 the earliest attention to this branch of medicine by the profession of 
 this country, is continuous with gynecology as we have traced it in 
 outline from its earliest dawn in the Old World, its achievements prior 
 to the renaissance ushered in by Recamier cannot be said to have been 
 of sufficient importance to entitle it to a distinctive national name. It 
 must not be inferred from this that this division of medicine was more 
 neglected on this side the Atlantic than on the other, or that the Ainer- 
 ican woman whose means forbade a visit to the European centres was 
 obliged to suffer from her ailments without having held out to her 
 by native talent as much hope as could be promised abroad. A hile it 
 may have been true, as charged by Dr. Douglass, that there was in his 
 day (1717) “ more danger from the physicians of Boston than from the 
 distemper,” this condition of affairs had much improved when the A ar 
 of Independence Avas declared. The Avritings of Joseph Osgood of 
 Andover and Joseph Orne and Augustus Holyoke of Salem eA-ince a 
 knowledge of the diseases of Avomen Avhich was probably quite abreast 
 of that possessed by their European contemporaries. In the year 1790, 
 nine years after its organization, the Medical Society of Massachusetts 
 first published such of the contributions as Avere presented before that 
 body. Among these publications is found an occasional article on 
 some gynecological subject, but the first which was devoted to a subject 
 unconnected with the puerperal condition Avas one entitled “ The His- 
 tory of a Hemorrhage from a Rupture on the Inside of the Left Labium 
 Pudendi.” This Avas contributed by Dr. Nathaniel A . Appleton of 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 23 
 
 Boston, and appears in the second part of the first volume of the 
 Transactions of the society, issued in the year 1806. 
 
 The influence of the teachings of Smellie and Hunter very naturally 
 extended to the profession in the colonies, and abundant evidence of it 
 is found in the reports of cases in such literature of the colonial days 
 as is extant. The causes, however, which operated to the repression of 
 progress in gynecology were operative here as in Europe ; and while 
 we believe that the latent energies of the profession of the New World, 
 necessarily thrown quite entirely on its own resources, must in course 
 of time have transcended in their results the achievements of the pro- 
 fession abroad, the struggle inaugurated by the Declaration of Inde- 
 pendence diverted those energies into channels which were incompat- 
 ible with scientific research. For seven long years the struggle for 
 personal and national existence not only forbade the development 
 of the native resources, but it also shut the profession out from the 
 influence of the mysterious awakening from the lethargy of centuries 
 which was going on in Europe. Nor did the cessation of hostilities 
 leave the road to professional progress free and unobstructed. The vic- 
 tory had been achieved, but at a cost of life and energy and treasure 
 which caused a depression from which it required many years to rally. 
 Although the profession of medicine, which has for its object the health 
 of the people — the supreme law — is a very essential factor in national 
 growth, there are other matters which are more immediately pressing 
 in seasons of great national depression — agriculture, manufactures, com- 
 merce. For a couple of decades following the close of the war these 
 were held to be of paramount concern, and it was not until the opening 
 of the present century that the profession of this country found itself 
 in a position to devote even a portion of its energies to the special 
 development of any particular division of the whole field of medicine 
 which commanded its attention. 
 
 It was a happy coincidence that the profession in America found 
 itself sufficiently recovered from the distractions of war to permit of 
 its placing itself in the line of the movement in gynecology inaugurated 
 bv Hunter in England, and stimulated to unprecedented activity by the 
 revival of the speculum by Recam ier in France. The comparative 
 leisure and wealth which followed in the wake of the prosperity ensured 
 by the elasticity of our people made it possible for the profession to 
 embrace the opportunity, which, had it presented a decade sooner, would 
 of necessity have been allowed to pass by unimproved. The dawn of 
 the present century found our young men and many of our older prac- 
 titioners repairing to the mother-country and to the various seats of 
 learning in Europe, and drinking in the spirit of the revival, and 
 bringing it back with them to these shores. Among these young men 
 was one Ephraim McDowell, who was born in Virginia in 1771, and 
 
24 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 who moved thence with his father and the rest of the family to settle 
 in Kentucky in the year 1783. Young McDowell was accorded the 
 educational advantages of that early day in that new country. His 
 subsequent writings show that his literary acquirements were not of a 
 much higher order than we could have expected under the impropitious 
 circumstances. After leaving school he studied medicine for two or 
 three years with a Dr. Humphreys of Staunton, Virginia, a graduate 
 of the University of Edinburgh. When we recall the contempt which 
 the physician educated abroad entertained in those days for American 
 educational institutions, we are not surprised at finding no evidence of 
 McDowell’s having attended any lectures in Philadelphia, then the onlv 
 seat of medical education in this country. At his preceptor’s dictation, 
 doubtless, he went to Edinburgh, where during the sessions of 1793 
 and 1794 he attended lectures in the famous university, then in the 
 zenith of its renown. Not fully satisfied, however, with the regular 
 course of the university on the subject of surgery, he took a private 
 course under Mr. John Bell, a surgeon noted alike for his enthusiasm, 
 his eloquence, his skill, and his hold on the affections of his students. 
 W e have no evidence that McDowell ever graduated. Mr. Bell is said 
 to have been an enthusiast on the subject of organic diseases of the 
 ovaries, and to have even discussed the possibility of their successful 
 removal, although never himself venturing to practically demonstrate 
 this possibility. Doubtless, the young Kentuckian resolved while under 
 the spell of his teacher’s enthusiasm to undertake what that teacher’s 
 timidity, perhaps, kept him from attempting, and he returned to his 
 Western home inspired with the high resolve. He settled in Danville 
 in 1795. Although but twenty-four years of age, the fame of his 
 sojourn at foreign seats of learning, and of the fact that he had studied 
 under John Bell, whose reputation had long before crossed the seas, 
 soon secured for him a large clientele. Patients soon flocked from all 
 parts of the South-west, and for hundreds of miles around he had the 
 monopoly of the important operations. He had been in practice four- 
 teen years when he was consulted by a Mrs. Crawford, who suffered 
 from a large abdominal tumor which a careful examination convinced 
 McDowell was ovarian. Here was the opportunity, and the man was 
 equal to it. The teachings of Bell had fallen in fruitful soil, and the 
 time of their fruition had arrived. Mrs. Crawford was no ordinary 
 woman, and when McDowell declared to her that her only hope lay in 
 the removal of her tumor, explaining to her the fact that such an 
 operation had never before been undertaken, and admonishing her of 
 the dangers which attended it, the brave woman placed herself unre- 
 servedly in the brave man’s hands. The consultation was held at Mrs. 
 Crawford’s residence, sixty miles from Danville, and Dr. McDowell 
 made it a condition of his operating that his patient come to his home 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 25 
 
 for the operation. The heroine travelled this distance on horseback, 
 was operated on in December, 1809, she being then forty-seven years 
 of age, and at the end of twenty-five days returned to her home, where 
 she lived for thirty-two more years, during which she enjoyed for the 
 most part excellent health, and died at length in the seventy -ninth year 
 of her age. When we remember the facts that this first operation for 
 the removal of an ovarian tumor was performed before the days of 
 anaesthesia, and that Dr. McDowell had none of the advantages of the 
 trained assistants and perfected instruments which are now deemed 
 so essentia] to the success of this operation, the courage of the woman 
 and the skill and intelligent daring of the surgeon combine to form a 
 picture which is unique for its grandeur in the annals of surgery. 
 
 Dr. McDowell’s delay in reporting this case of ovariotomy was 
 in singular contrast with the more commendable practice of these later 
 days. Instead of immediately giving a description of his wonderful 
 case for the benefit of his contemporaries, he waited for seven years, 
 during which time he successfully performed two other ovariotomies. 
 His report of these three cases appeared in the October (1816) issue 
 of the Eclectic Repertory and Analytical Review. It was a document 
 remarkable for its brevity, that portion of it covering the case which 
 has made his name immortal, and which demonstrated the practicability 
 of a procedure which more than any other has lengthened the average 
 of woman’s life and diminished the sum of her sorrow, not occupying 
 more space than a page the size of that on which this sketch appears. 
 The incision was made about three inches from the musculus rectus 
 abdominis on the left side, parallel to the fibres of this muscle, and 
 nine inches in length and extending into the abdomen. The abdominal 
 parietes were found to be very much contused, owing, it was supposed, 
 to the tumor’s resting on the horn of the saddle during the journey. 
 A ligature was thrown around the Fallopian tube near the uterus, when 
 the tumor was cut open, and “ fifteen pounds of a dirty, gelatinous- 
 looking substance ” removed. The sac was afterward amputated at the 
 ligature, and was found to weigh seven pounds and a half. As soon as 
 the external opening was made the intestines rushed out on the table, 
 and so completely Avas the abdomen filled by the tumor that they could 
 not be replaced during the operation, Avhich Avas terminated in about 
 twenty-five minutes. The Avoman was then placed on her left side, so 
 as to permit the blood to escape, after Avhich the external opening Avas 
 closed Avith the interrupted suture, leaving out at the lower end of the 
 incision the ligature Avhich surrounded the Fallopian tube. Between 
 every two stitches Avas put a piece of adhesive plaster, Avhich, by keep- 
 ing the parts in contact, hastened the healing of the incision. The 
 usual dressing AA'as then applied, the patient put to bed, and placed on 
 a strict antiphlogistic regimen. On visiting her (i ve days after, Dr. 
 
26 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 McDowell was astonished to find his patient engaged in making up 
 her bed. 
 
 The other two cases occurred in negro women, and the space devoted 
 to the consideration of both of them is less than that taken up bv a 
 description of the first operation. The whole report was loosely and 
 carelessly constructed, and poorly calculated to inspire confidence in the 
 author’s literary and scientific attainments. Had McDowell been gritted 
 with facility of expression the recognition of his operation would 
 doubtless have been more prompt. At his death, in 1830, it had not 
 yet been looked upon with favor, although he had himself performed 
 it thirteen times in all, with at least eight successes. The report of the 
 first three cases having been sent to Dr. Phvsick of Philadelphia, “the 
 Father of American Surgery,” and at that time the leader of the Amer- 
 ican profession, it failed to interest him, his opinion of the backwoods 
 surgeon being, probably, largely influenced by the display of his literary 
 ability. The report was also sent to the operator’s old preceptor, .John 
 Bell, but, owing to that gentlemen’s ill-health, he was at the time absent 
 on the Continent, and as he died not long afterward at Rome, he never 
 received it. The paper fell into the hands of Mr. Lizars of Edinburgh, 
 by whom it was published in the Edinburgh Medical and Surgical Jour- 
 nal in 1824. Mr. Lizars, with the instinct of a true surgeon, detected 
 its merit, and was the first to perform McDowell’s operation in Great 
 Britain. This recognition of the Kentucky surgeon by his eminent 
 Edinburgh contemporary won for the prophet and his operation an 
 honor in his own country which he had previously been denied. 
 
 Dr. McDowell when he operated on Mrs. Crawford had a reputation 
 which was only local, or he was at least known within but compara- 
 tively circumscribed limits from his own home. His name did not 
 appear on the list of the great surgeons of his day, and — such is one 
 of the peculiarities of human nature — when it was discovered that his 
 claims did not deserve the ridicule with which they were greeted even 
 in quarters in which one would suppose they would at least have 
 received respectful attention, if not indorsement, envv began to take 
 the place of ridicule. Accordingly, efforts were soon made to i'ob him 
 of the honor of his great accomplishment, and claims were set up for 
 a number who Avere alleged to liave pre\fiously performed the operation. 
 
 It is scarcely necessary in this place to review the nature ot these 
 claims or to discuss their validity. Suffice it to say that they were all 
 carefully investigated by the late Dr. Samuel D. Gross, and by him 
 pronounced untenable. 
 
 While the operation by McDowell marked an era in gynecology, 
 two years before he performed it an American, Dr. John Stearns ot 
 Saratoga county, New York, had given to medicine the drug ergot, 
 Avhich Avas destined to become one of the most important agents in both 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 27 
 
 gynecology and midwifery. It is true the drug had long before been 
 empirically employed by European midwives, but Dr. Stearns was the 
 first to reclaim it from such unscientific use by discovering its modus 
 operandi. The publication of his paper in the New York Medical 
 Repository in 1807 at once gave the drug a place in the physician’s 
 armamentarium, and its judicious employment since then has been the 
 means of relieving perhaps as large a percentage of woman’s suffering 
 as any one surgical procedure. 
 
 The next in chronological order to McDowell who undertook to 
 remove an ovarian tumor in this country was Dr. Nathan Smith of 
 Yale, who, it is claimed, was not at the time aware of McDowell’s 
 achievement. His first operation was performed on July 5, 1821, and 
 was successful, the patient being able to walk about in three weeks. 
 
 On May 23, 1823, Dr. Alban G. Smith of Danville, Ivy., success- 
 fully removed an ovarian tumor from a negress thirty years of age. 
 Dr. Smith had made a previous but unsuccessful ovariotomy in 1818. 
 Following this last successful case a number of unsuccessful attempts 
 were made by other surgeons, who in cutting down to the tumor found 
 the adhesions so extensive as to deter them from further attempt at 
 removal of the growth. 
 
 The fourth successful ovariotomist of this country was Dr. David L. 
 Rogers of New York, who performed the operation on September 24, 
 1829. The operation lasted two hours, and at the end of two weeks 
 the patient was able to be up and about her room. 
 
 In November, 1830, Dr. J. G. Warren of Boston made an unsuccess- 
 ful attempt at the removal of an ovarian tumor. In December, 1835, 
 Dr. J. Billinger performed a successful operation, following which there 
 are no records of any cases until 1843, when Dr. A. Dunlap had his 
 first case, an unsuccessful one. In the same year Dr. J. L. Atlee suc- 
 cessfully performed a double ovariotomy. In 1844, Dr. Washington 
 L. Atlee, who did more than any other American surgeon to establish 
 ovariotomy as a legitimate surgical procedure, had his first case, which 
 terminated unsuccessfully. Dr. Atlee took a decided stand in favor of 
 the legitimacy of the operation, and, although he encountered a number 
 of unsuccessful cases, he faithfully reported them in detail as a guide to 
 those who might be induced to study the operation with a view to 
 removing from it the discoverable reasons for its mortality. He 
 encountered violent opposition and much vituperation, but had the 
 satisfaction of living to witness such a general recognition of ovariot- 
 omy as a legitimate surgical procedure that scarcely any surgeon felt 
 deterred from performing it. In 1855 he published a synopsis of 
 his first thirty cases, of which seventeen recovered and thirteen died. 
 Such a percentage of recoveries from a disease in itself necessarily fatal 
 silenced opposition to the operation, and from that time the number 
 
28 
 
 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 of ovariotomists in this country has rapidly increased, even up to the 
 present time, while the percentage of mortality attending the operation 
 by competent operators has, under improved methods, antiseptic and 
 mechanical, grown to be quite as small as that attending most other 
 capital operations. 
 
 In 1853, Dr. Washington L. Atlee read before the American Medi- 
 cal Association a paper on fibrous tumors of the uterus which at once 
 became a portion of the classic gynecological literature of this country. 
 It dealt with such of these tumors as had heretofore been supposed to be 
 inaccessible to the knife or not amenable to curative measures. The paper 
 was based wholly on the author’s own experience, and gave important 
 information touching the classification and means of diagnosing these 
 tumors, besides indicating a method of their treatment bv enucleation. 
 It divided them into — 1 , extra-uterine or surface tumors ; 2, intra-ute- 
 rine or cavity tumors ; and 3, intramural tumors of the uterus. The 
 value of ergot given internally as a remedy was strongly insisted on, 
 and the use of that drug in the removal of these growths through 
 absorption due to pressure from contraction of the non-striated muscu- 
 lar tissue has since been regarded as the most efficacious means of treat- 
 ing such growths as are inaccessible to the knife. 
 
 In 1856 there appeared the prize essay by Dr. George H. Lyman of 
 Boston upon the History and Statistics of Ovariotomy , and the Circum- 
 stances under ivh ich this Operation may be regarded Safe and Expedient. 
 Up to that date Dr. Lyman’s monograph was, probably, the most com- 
 plete of any that had appeared, being a complete and careful research 
 of the ovariotomy statistics of all countries. 
 
 In the same year Dr. I. E. Taylor advocated a new operation for the 
 cure of recto-vaginal fistula, reporting two cases in which he had suc- 
 cessfully employed it. This operation consisted in the severing of the 
 sphincter ani in such cases. 
 
 Some remarkable operations for the removal of the extra-uterine 
 foetus were performed in the early history of this country. In 1791, 
 Dr. William Boynham of Virginia successfully removed the tumor by 
 incision of the abdominal parietes. In 1799 he performed a similar 
 operation, and with equally satisfactory results. In 1816, Dr. John 
 King of South Carolina cut through the walls of the vagina and 
 removed through the incision, by means of the forceps and abdom- 
 inal pressure, a living child which had been carried through the full 
 term of gestation in the abdominal cavity outside the uterus. The life 
 of the mother was also saved. This case stands on record as one of the 
 most remarkable ever encountered, and, being without precedent, doe- 
 all the greater credit to the operator’s judgment and resolution. In 
 1874, Dr. T. Gaillard Thomas incised the vaginal wall with the gal- 
 vano-caustic knife and removed a three months’ foetus; and in 1875, 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 29 
 
 Dr. D. Hayes Agnew of Philadelphia reported a case of vaginal section 
 performed by himself for the removal of an extra-uterine foetus. 
 
 Simon’s method of introducing the hand into the rectum for diag- 
 nostic and therapeutic purposes is not as new as many are disposed to 
 believe. In 1806, Dr. Clark, an American, recorded the fact that he 
 introduced his hand into the bowel, and, putting his finger into the 
 mouth of an extra-uterine foetus, made traction and delivered the head 
 per rectum. The body and secundines were removed spontaneously 
 some time after. On the next day the anus had contracted to its nat- 
 ural size, but on the third day it, as well as the perineum, began to 
 slough. On the ninth day the parts had commenced to heal, but the 
 fourchette was destroyed. 
 
 Although such records as are available show that American surgeons 
 and general practitioners were quite as successful in their treatment of 
 special diseases of the womb as were their contemporaries abroad, nearly 
 half a century had gone by since McDowell’s discovery before anything 
 occurred on this side of the Atlantic of a nature calculated to direct 
 special attention to American gynecology. But the native shrewdness 
 of the American practitioner qualified him for such utilization of exist- 
 ing knowledge as made him the peer of his Transatlantic brother in 
 this special direction. Not until the year 1852, however — if we except 
 Meigs’s discovery of cardiac thrombosis as a cause of sudden death in 
 childbed, and Hodge’s improvements in the construction of uterine 
 pessaries — did any of the great Kentuckian’s countrymen do aught 
 worthy of giving them marked distinction in the direction of gvnecol- 
 ogy. Hodge’s pessary was a very decided improvement on instruments 
 heretofore constructed for a similar purpose, being based on more cor- 
 rect physiological principles than any of its predecessors. The descrip- 
 tion of the steps which more immediately preceded the discoverv of 
 this pessary is best given in Dr. Hodge’s own words, as quoted in a 
 commemorative address by Dr. Penrose of Philadelphia : “ He had 
 been contemplating for a long time the subject of new shapes for pes- 
 saries, and after many experiments had found nothing satisfactorv. One 
 evening while sitting alone in the room where the meetings of the med- 
 ical faculty of the university were held his eyes rested on an upright 
 steel support bv the fireplace designed to hold the shovel and tongs. 
 The shovel and tongs were kept in position by a steel hook, and as he 
 surveyed the supporting curve of this hook the longed-for lumination 
 came : the shape, apparently so paradoxical, revealed itself in the clear 
 light and flickering volume of the burning grate, and the Hodge lever 
 pessary was the result.” This was in the year 1830. To him the pro- 
 fession is indebted for the origin and development of two ideas which 
 are at this day considered among the most important facts in uterine 
 pathology — namely, that the condition of the uterus characterized by 
 
30 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 enlargement, displacement, congestion, hypersecretion, and tenderness is 
 not inflammation, nor should it be treated as such — that sustaining the 
 uterus, and thus affording an easy and natural means of overcoming 
 congestion and its results, is a prime factor in their relief and cure. 
 
 In 1833, Dr. Walter Channing, professor of obstetrics at Harvard 
 University, wrote an article on “ Irritable Uterus.” This was the first 
 comprehensive monograph upon a purely gynecological subject in New 
 England, besides being one of the most valuable contributions extant 
 to this division of medicine. 
 
 In 1841, Dr. Gunning S. Bedford, one of the most graceful writers 
 of any age, established the first clinic for diseases of women ever held 
 on this side the Atlantic, in connection with his chair of obstetrics in 
 the University Medical College of New York. In this year also Dr. 
 Alonzo Clark of New York introduced his plan of treating peritonitis 
 with large doses of opium. This plan involves the exhibition of the 
 drug to the limit of profound narcotism. The amount of it which is 
 tolerated by the patient is greatly in excess of that which he will bear 
 in the physiological condition. It requires the close attention of the 
 physician in order that the limit be not inadvertently exceeded. 
 
 In 1844, Dr. J. C. Nott of Mobile, Alabama, published a report of 
 a case of the removal of a carious coccyx, which was followed by relief 
 of a very aggravated coccygodynia. 
 
 During the year 1852 there appeared in the American Journal of 
 Medical Sciences an article by an Alabama doctor which once more 
 directed the eyes of the medical world to this country. If Reeamier’s 
 resurrection of the speculum marked the rise of modern gynecology, 
 this article caused it to take a stride unprecedented. Recamier’s spec- 
 ulum had exposed the uterus, but it did so quite imperfectly, and was 
 of little or no service in placing the vagina under surgical control. The 
 writer of the paper referred to had solved the problem, and the surgical 
 diseases of the approach to the womb became amenable to treatment, 
 while affections of the womb itself ceased very largely to be the oppro- 
 bria of the healing art. If McDowell’s discovery “ has added forty 
 thousand years to the sum of human life,” who can compute the sum 
 of happiness to the mind and misery averted through this discovery by 
 J. Marion Sims? The paper by him on vesico-vaginal fistula made 
 his title of “Father of American Gynecology” indisputable, and the 
 discoverv which it recorded has made surgery of the uterus and vagina 
 a wellnigh exact science. The discovery of the operation for the cure 
 of a disease previously incurable was in itself a great achievement, but 
 the discovery of a method of so distending the vagina by air as to 
 render this operation and all other necessary operations on the vagina 
 and womb possible was a greater achievement. Gynecology to-day 
 would scarcely deserve the name of a separate branch of medicine but 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 31 
 
 for Sims’s discovery. It has been appropriately said that “ it has been 
 to diseases of the womb what the printing-press is to civilization, what 
 the compass is to the mariner, what steam is to navigation, what the 
 telescope is to astronomy ; and grander than the telescope, because it 
 was the work of one man.” 
 
 While the grand results to gynecology which the genius of Sims has 
 evolved are the outcome of that careful study and constant effort which 
 are the essentials to most of such results in science as are destined to 
 live, the discovery of the fact which brought his mind in the line of 
 work which made him famous was quite purely accidental. Singular 
 as it may appear, his tastes were originally not for gynecological work : 
 he was, indeed, quite averse to treating diseases of the female sexual 
 apparatus, and even to the necessary means of examination for making 
 a diagnosis of such affections. He had, after perhaps more than the 
 usual share of vicissitudes and discouragements which beset the young 
 practitioner, and extending through an unusual length of time, suc- 
 ceeded in gaining the confidence of the community in which he lived 
 and in establishing a reputation as a general surgeon. He was one day 
 called in consultation in a case of labor in which the head had been 
 impacted for nearly three days. He delivered the woman quite readily 
 with the forceps, and she rallied well from the operation. Five days 
 later she was, however, discovered to have an extensive slough of the 
 soft parts, and was discharging both urine and feces through the vagina. 
 He had then been in practice ten years, and this was the first case of 
 vesico-vaginal fistula which he had encountered. After consulting; the 
 literature on the subject, he was convinced of the very rebellious nature 
 of the accident to treatment, and in spite of the importunities of the 
 owner of the woman (who was a slave), he refused to undertake an 
 operation for its relief. In one month from that time he was consulted 
 in reference to a vesico-vaginal fistula existing in the case of another 
 negro slave, and again, in about another month, a third case came 
 under his notice. This unusual number of cases presenting within 
 such a short time compelled his attention to the disease, and, as he had 
 established a small hospital, the three cases were placed under his care 
 in the hope that he might devise some means of relief. While per- 
 plexed with these cases he was one morning suddenly called to see a 
 lady who had been thrown from her horse. After due examination he 
 concluded that the distressing pain from which the woman suffered was 
 caused by a dislocation of the uterus. Recalling a rule for the treat- 
 ment of this accident which had been given him while a student, he 
 placed the patient on her knees and elbows, and, introducing one finger 
 into the rectum and another into the vagina, “ pushed up and pulled 
 down” according to directions. Finding that he could just reach the 
 uterus with his index finger, which was not long enough to permit him 
 
32 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 to exert any force on the organ, he introduced also the middle finger; and 
 in his effort to push the uterus back turned his hand palm upward and 
 then downward, when all at once he could feel neither the womb nor 
 the walls of the vagina. Immediately the woman declared she was 
 relieved. As she turned on her side there was a sudden explosion, as 
 though of air escaping from the bowel. He was satisfied, however, 
 that the air was not from this source, but was from the vagina, and 
 concluded that his traction on the perineum had suddenly created a 
 vacuum into which the air rushed and expanded the vagina to its fullest 
 capacity. Fired with a new idea which had just been forced upon 
 him, he hurried home in order to test it in the case of the unfortunates 
 suffering from vesico-vaginal fistula in his hospital. On his wav he 
 had stopped and bought a large pewter spoon, which he bent so as to 
 secure the necessary purchase for retracting the perineum, as he had 
 discovered he had accidentally done in the case of the woman suffering 
 from the dislocation of the womb. Selecting one of his patients, he 
 placed her on a table in the genu-pectoral position, and, placing a 
 student on each side, instructed them to lay hold of the nates and pull 
 them open. Before he could get the bent spoon-handle into the vagina 
 the air rushed in with a puffing noise, dilating the cavity to its fullest 
 extent. On making further traction with the spoon he had revealed 
 to him a sight which had never before been seen bv anv man. The 
 fistula with its edges clearly defined was plainly visible ; the wall of 
 the vagina could be seen closing in every direction ; the neck of the 
 uterus was distinct and well defined, and even the secretions therefrom 
 could be plainly seen. 
 
 He at once devised and had made for him the instruments which he 
 considered to be necessary for closing up the fistula. Among these 
 instruments was the duck-bill speculum, to which his name has been 
 inseparably attached ; and it is a singular fact that the original design 
 of that instrument has never been altered. It took him three months 
 to have the necessary instruments made, and the case which he selected 
 for the operation was an unusually bad one, the whole base of the 
 bladder being destroyed, leaving an opening between the vagina and 
 that viscus at least two inches in diameter. This was in December, 
 1845, and before the discovery of anaesthesia. He succeeded in clos- 
 ing the fistula in about an hour’s time. In order to prevent the urine 
 from dripping through into the vagina, he placed a piece of sponge in 
 the neck of the bladder, through which he ran a silk string which 
 he hoped would act as a capillary tube that would serve to turn the 
 course of the urine from the fistula. This latter device proved to be 
 a very unfortunate one. At the end of five days the patient was very 
 ill from what, in more recent times, has come to be known as blood- 
 poisoning. On attempting to remove the sponge, he found that it had 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 33 
 
 become solidified with sabulous matter from tlie mine, and lie bad 
 great difficulty in removing it. On examining the fistula, he found 
 that it had disappeared with the exception of two small openings in 
 the line of the union of its edges. Encouraged by this pronounced 
 success in healing the opening, he was confident that the small remain- 
 ing apertures could be closed bv a subsequent operation ; before per- 
 forming which, however, he operated on another of his patients, using 
 in this case a self-retaining catheter instead of the sponge. At the end 
 of seven days he removed the sutures, but discovered that though the 
 original fistula had been greatly changed in character, there still 
 remained three little openings through which the urine escaped. In 
 spite of the repeated operations, having Operated some thirty times on 
 one of the cases, extending through a period of three years, he found 
 himself unable to effect a complete closure of the fistula in any case. 
 He finally concluded that he should not perform another operation 
 until he had discovered some method of trying the suture higher up 
 in the body than he could reach. While lying in bed one night the 
 idea occurred to him to run a perforated shot along the suture to the 
 edge of the fistula, and when it was drawn tight to compress it with a 
 pair of forceps, thus making the knot perfectly secure. Elated with 
 this idea, he conducted further operations, but with scarcely any better 
 success than heretofore. He was now convinced that the cause of the 
 failure lay in the nature of the material employed for sutures — namely, 
 silk thread — and his next object was to secure some substitute. Mat- 
 tauer of Virginia had employed lead, and Sims had tried this material 
 as a suture in his cases of vesico- vaginal fistula, and had failed. At 
 this juncture, in walking from his house to his office one day, he picked 
 up a little piece of wire. Taking this to a jeweller, it served as a pat- 
 tern for some pure silver wire which he ordered. In the next opera- 
 tion the edges of the womb were denuded and brought together with 
 four sutures of wire thus prepared, the suture being closed by means 
 of the shot run upon the wire and pressed with the forceps when run 
 sufficiently far up. In using silk sutures cystitis always resulted in 
 the case of operations at the base of the bladder, the urethra being 
 always swollen and the urine loaded with thick, ropy mucus. With 
 the use of the silver suture there was a complete change in these con- 
 ditions. After a week had passed the patient was removed from the 
 bed and placed upon an operating-table, and with an anxious heart 
 the result of the use of the wire suture was examined. There lay the 
 suture apparatus just exactly as it had been placed, with no inflam- 
 mation, no tumefaction, and perfect union of the fistula. At last the 
 labors of three years had been crowned with success, and vesico-vagi- 
 nal fistula was removed from the list of incurable affections. In the 
 course of two weeks the remaining patients in the hospital 
 
 Vol. I. — 3 
 
 were 
 
34 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 operated on, and in every case the results were completely satis- 
 factory. 
 
 While it is manifestly the duty of the historian to select for his nar- 
 rative, without bias or favor, facts which he regards as the most indis- 
 putable, he ought not to be accused of exceeding his duty when he 
 notices claims which, although not disposed to concede them, he mav 
 regard as entitled to respectful consideration. The name of Sims will 
 live in the history of medicine as that of the father of American 
 gynecology, but it is only just to state that the claims of priority for 
 some at least of the achievements which have won him this proud 
 title have been disputed. Among those who have contested these 
 claims, his contemporary, Dr. Nathan Bozeman, has been prominent. 
 He was associated with Sims in the early years of their practice, and 
 became his successor at Montgomery, Alabama, on Sims’s removal to 
 New York. Unfortunately, a dispute as to the authorship of several 
 of the devices, which have made the operation for vesico-vaginal fistula 
 a success, developed in later years, and became tainted with a consider- 
 able degree of acrimony. With this dispute we have nothing to do, 
 further than to state that while history will endorse Sims’s right to all 
 that he claims in connection with the discovery and perfection of the 
 operation, it will not deny to Bozeman an important part in helping 
 to establish the foundation on which American gynecology is erected. 
 Dr. Bozeman subsequently followed Dr. Sims to New York. Among the 
 discoveries with which his name will continue to be associated are his 
 knee-chest support, his self-retaining speculum, his button sutures — 
 instruments and methods now but little used ; also his method of auto- 
 plasty by gradual approaches, and his operation for the cure of chronic 
 cystitis through the establishment of a fistula leading into the vagina. 
 This operation was also independently discovered in the same year by 
 Dr. T. A. Emmet, who was the first to give it to the profession in 1868, 
 Dr. Bozeman’s paper not having been published until 1871. 
 
 Dr. Sims’s achievements, on which what may be called American 
 gynecology is founded, were wrought out in an obscure Southern town 
 and while engaged in the commonplace duties of the country general 
 practitioner. With no prestige of college connection, and none of the 
 backing which is generally considered necessary to distinction in a spe- 
 cialty, he won for himself the proud distinction, “ Father of American 
 Gynecology.” It was necessary, however, after having thus laid this 
 essential foundation that it should become known to the profession. 
 To this end Dr. Sims determined to repair to one of the medical 
 centres, and this the precarious state of his health compelled him to 
 do sooner than he would have otherwise done. Being the victim 
 of a chronic diarrhoea, his complaint made it necessary for him in 
 1853 to remove from the scenes of his distinguished labors, and he 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 35 
 
 decided on New York as his future home. The story of his earlier 
 years in that city furnishes us a singular illustration of the jealousy 
 of the obscure practitioner on the part of the gentlemen connected with 
 the medical schools. An apparently systematic effort was made to 
 appropriate his work without credit, and the attempts of certain indi- 
 viduals in this direction reflect little credit on their memory. After 
 encountering opposition and suffering discouragements to which even 
 he, with all his enthusiasm and force of character, would have suc- 
 cumbed but for the support and cheer of an heroic wife, he was thrown 
 in the way of a Mr. Henri L. Stuart, who, being a man of great influ- 
 ence in both the financial and social world, and becoming warmly inter- 
 ested in the object of Dr. Sims’s ambition — namely, the establishment 
 of a woman’s hospital — entered heartily into the project. At Mr. 
 Stuart’s suggestion, Dr. Sims sent out notices to the general profession 
 that he would, on a certain day in May, 1854, deliver a lecture in which 
 he would call the attention of all who might attend to the work which 
 he had done. In view of the treatment which he had received at the 
 hands of the gentlemen on whom he had called personally, he was very 
 much encouraged at the size of the audience which had responded to his 
 invitation. In spite of his innate diffidence, he succeeded in not only 
 interesting the meeting, but in arousing it to a very considerable degree 
 of enthusiasm. The plan of establishing a woman’s hospital was 
 broached, and, largely through the influence of Mr. Stuart, the proj- 
 ect found favor with the public, and many prominent ladies of the 
 city became actively interested in the work. These ladies formed 
 themselves into an association, and in 1855 the object of Dr. Si ms ’s 
 ambition was realized — the woman’s hospital had become a fact. It 
 received very little encouragement from the leaders ; that is, the hospi- 
 tal-men. Dr. Sims was called by them a quack and a humbug, and 
 the hospital was pronounced a fraud. But in spite of the formidable 
 opposition from this source the work went on, the wards of the insti- 
 tution were opened to any doctor who cared to come, the operations 
 were performed in the presence of leading medical men, and the pro- 
 fession generally was welcomed to the institution. The hospital was 
 inaugurated on the 1st of May, 1855, at 83 Madison Avenue, shortly 
 after which Dr. Sims associated with himself Dr. Thomas Addis 
 Emmet, who was at that time a young man and unknown, but who 
 has since won for himself a reputation in gynecology second only to 
 that of Sims himself. The woman’s hospital in 1857 secured a charter 
 from the State, and has from that time been known as “ The Woman’s 
 Hospital of the State of New York.” This institution has been the 
 most important factor in the progress of American gynecology. Here 
 it was that a systematic method of treating the diseases peculiar to 
 women was first adopted. Until Sims’s connection with it gynecology 
 
36 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 as a specialty was unknown, he being the first to give attention to it, to 
 the exclusion of all affections not coming distinctively under its head. 
 Under his direction the facilities afforded by the Woman’s Hospital 
 were utilized to the perfection of operations on the perineum, vagina, 
 and uterus, which previous to his immortal discoveries had been 
 unknown, but which, chiefly through the knowledge disseminated 
 from that centre, are now daily performed by even general practitioners 
 in all parts of the world, to the relief of untold suffering. 
 
 In 1861, Dr. Sims visited Europe. His reputation had preceded 
 him, and his reception both by the profession and the public was in 
 keeping, and he soon found himself with such a large clientele, in 
 nearly all of the European medical centres that he afterward devoted 
 his time about equally between both sides of the Atlantic. In I860 he 
 published his Clinical Notes on Uterine Surgery, in which he embodied 
 the results of his special work, describing the operations which he had 
 devised and the improvements which he had made on the procedures 
 hitherto in vogue. This work made a very profound impression on 
 the professional mind, and it was soon translated into almost all mod- 
 ern tongues. It was, indeed, the most distinctive work on gynecology 
 which had been published, and may be said to be the basis of the spe- 
 cialty of gynecology as it exists to-day. Written in a style calculated 
 to carry conviction, it at once became the guide and gave impetus to 
 gynecological study. 
 
 On Dr. Sims’s retiracy from the Woman’s Hospital in 1862, Dr. T. 
 Addis Emmet became surgeon-in-chief, and under his charge the insti- 
 tution continued to grow both in popularity and usefulness. Following 
 the impetus given by Sims to gynecology as a specialty, a number of 
 American surgeons gave their attention exclusively to this branch of 
 work, and among those who at an early date thus devoted themselves 
 Thomas Addis Emmet, H. R. Storer, Nathan Bozeman, E. R. Peaslee, 
 T. Gaillard Thomas, James P. White, W. H. Byford, William Goodell, 
 and Robert Battey have attained marked distinction, and American 
 gynecology bears the indelible marks of their labors. Some of these 
 gentlemen are dead, and to write of them in terms of the enthusiasm 
 which their valuable work naturally arouses in a contemporary who 
 has closely watched their progress might be in keeping. It is, how- 
 ever, a delicate and very difficult task to write of the living, and it must 
 remain for a future historian to express out of the fulness of his heart 
 his estimate of those who, having done their life-work in this direction, 
 are now in the sere and yellow leaf. A bare record of their work is all 
 that is now permissible. 
 
 Dr. Emmet in 1859 withdrew from general practice, and lias since 
 devoted himself exclusively to gynecology. He has been a diligent 
 worker in the field, and has contributed freely to medical periodicals 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 37 
 
 reports of the results he has achieved. The most notable of his con- 
 tributions pertain to the subject of laceration of the cervix uteri, detail- 
 ing the etiology of the affection, its symptoms, its effects on the consti- 
 tution, and the operation for its relief. This operation is now distinct- 
 ively known as “ Emmet’s operation.” It was first described in 1869 
 in a paper read before the Medical Society of the County of New 
 York, and published in the February number (1869) of the American 
 Journal of Obstetrics. In 1874 he presented before the same society an 
 article on lacerations of the cervix uteri as a frequent and unrecognized 
 cause of disease. The writer, not wishing to anticipate the events of 
 later vears, must dismiss this subject here, but will allude to it at some 
 length when writing of the occurrences of the last-mentioned year. 
 
 In 1854, Dr. E. R. Peaslee made a valuable contribution to the 
 treatment of septicaemia following ovariotomy. His method consisted 
 in the introduction of a tube into the peritoneal cavity, through which 
 the serous sac was freely washed out. Experience with this new method 
 has done much to remove the fear which was before entertained of inter- 
 ference with the peritoneal membrane. After the lapse of a third of a 
 century this method still remains as the most reliable for the treatment 
 of one of the gravest consequences to the operation for the removal of 
 ovarian tumors. In one of Peaslee’s cases, reported at the time of his 
 introduction of this new method, intraperitoneal injections were kept 
 up for fifty-nine days, and in another for seventy-eight days, recovery 
 following in each case. 
 
 In 1856, Sims added another to his long list of brilliant achieve- 
 ments bv publishing his operation for narrowing the vagina as a means 
 of curing prolapsus of the uterus. This advice was not strictly original 
 with him, although we have no evidence to show that he had imitated 
 any of his predecessors. The operation had been performed in Europe 
 many years previously, but had fallen into desuetude. 
 
 Dr. James P. White of Buffalo during the same year reported the 
 successful reduction by taxis of an inverted uterus of eight days’ stand- 
 ing: Dr. White was a pioneer in taking the position that chronic inver- 
 sion of the uterus is, as a rule, always reducible. He is distinguished as 
 the first successful operator in the country to reduce a chronic inverted 
 uterus. E. Noeggerath in 1862 practised reduction of inverted uterus 
 by digital compression of both horns; and in 1868, Dr. T. Addis Emmet 
 reported that he had retained partial reposition of the organ by closing 
 the os externum with silver sutures. By means of this operation the 
 advance made at one sitting is not lost, and the case is thus all the 
 better prepared for future effort. 
 
 In 1861, Sims described the disease known as vaginismus, and recom- 
 mended, as a means for its relief, the removal of the remains of the 
 hymen and the section of the tissues at the perineal extremity of the 
 
38 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 ostium vagi me. This affection had been previously known to European 
 authorities, and forcible distension of the ostiimi vaginae, together with 
 alterative applications with a view to the modification of the local 
 nervous hypersesthesia, recommended for its relief. The operation pro- 
 posed by Dr. Sims was, however, an advance on the latter. 
 
 Prior to 1862 but one case of pelvic luematocele had been published. 
 In this year this subject was brought prominently to the notice of the 
 profession by the appearance of three essays, written respectively by 
 John Byrne of Brooklyn, Fordyce Barker and Emil Xoeggerath of 
 New York. 
 
 In 1866 appeared an excellent treatise on “ Vesico- vaginal Fistula,” 
 by M. Schuppert of New Orleans. It contained the history and 
 exhaustive summary of the operation, was illustrated, and embodied 
 the extensive experience of a successful operator in this department 
 of surgery. 
 
 Dr. Theophilus Parvin reported in 1867 a case of uretro-vaginal 
 fistula in which he operated by turning the displaced distal extremity 
 of the ureter into the bladder, and then closing the vaginal opening. 
 The operation proved entirely successful, and tvas original with Dr. 
 Parvin. 
 
 In 1869, H. R. Storer published a “ Method of Exploring and Ope- 
 rating upon the Female Rectum by Eversion of the Anterior Rectal 
 Wall by a Finger in the Vagina.” Since then this “method” has 
 been quite generally adopted by gynecologists in certain cases. 
 
 In the same yearV. A. Taliaferro of Georgia published an essay 
 on “ Pathological Sympathies of the Uterus,” which attracted some 
 attention. 
 
 In 1869, Dr. Julius F. Miner of Buffalo recommended, as an 
 improvement in the management of the pedicle after the removal of 
 an ovarian tumor, the stripping off from the tumor the expansion of 
 the pedicle instead of ligating and severing it. This mode of treat- 
 ing the pedicle was called by Miner “ enucleating the pedicle.” This 
 method is applicable in many eases, and when it can be applied is 
 much to be preferred to the ordinary methods of securing the pedicle 
 by clamp or ligature. 
 
 In 1870, Dr. T. Gaillard Thomas of New York removed an ovarian 
 cyst of the size of a large orange through an opening made through the 
 vagina and the cul-de-sac of Douglas. This was the first time that this 
 procedure had been deliberately adopted for this purpose. It has been 
 successfully practised since by Dr. Davis of Pennsylvania, Dr. Gilmour 
 of Alabama, Dr. Battey of Georgia, and others. In the same year an 
 important contribution to the current gynecological literature appeared 
 from the ready pen of H. R. Storer entitled “ Anal Fissure in Women." 
 In the same year appeared an article entitled “ Sudden Enlargement of 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 39 
 
 Ovarian Cysts from Hemorrhage into them,” by the late brilliant and 
 lamented John S. Parry, who afterward (1876) wrote so learnedly and 
 exhaustively on “ Extra-uterine Pregnancy.” Dr. F. D. Lente has 
 made many valuable -contributions to gynecological literature, his prin- 
 cipal article being “ Intra-uterine Medication” (1870), of which he was 
 a prominent advocate. Lente’s silver probe and platinum cup were 
 devised for the purpose of applying fusible substances, more particu- 
 larly nitrate of silver, to the uterine cavity. His method was a 
 marked improvement upon many of the other modes ot intra-uterine 
 medication. It was considered very valuable when caustics were more 
 freely and more frequently used within the cavity ot the uterus than is 
 customary at the present time. 
 
 In 1871, through the energetic efforts of Dr. A. Reeves Jackson, the 
 Woman’s Hospital of the State of Illinois was founded. For a number 
 of years he was the surgeon-in-chief, but latterly a full staff of medical 
 officers has been in charge. Dr. M. S. Buttles claims to have been the first 
 (1871) to apply the actual cautery to the uterine cavity in the treatment 
 of submucous fibroids, and to be, therefore, the originator of that 
 operation. 
 
 In 1872, Dr. Robert Battey of Atlanta, Ga., reported a case of extir- 
 pation of the ovaries, the results of which justified him in recommend- 
 ing this operation for the relief of dysmenorrhoea due to imperfect 
 ovulation and accompanied by an excessive menstrual molimen, the 
 object of the operation being to establish at once the change of life, and 
 thus prove an effectual remedy for diseases otherwise incurable and 
 dependent upon ovarian irritation. He termed the operation “ normal 
 ovariotomy.” This name is not strictly applicable, inasmuch as it 
 implies a normal condition of the ovaries, and is thus nothing more or 
 less than spaying — an operation which has been practised from time 
 immemorial for the production of sterility. The important points con- 
 nected with this subject are best described in Dr. Battey’s own words : 
 “ I have opei’ated in widely different circumstances. In one case the 
 patient had amenorrhoea, convulsions, recurrent hsematocele, repeated 
 pelvic abscesses, incipient tuberculosis from pulmonary congestion, etc. 
 Several of the cases passed under the head of ovarian neuralgia ; several 
 had intractable dysmenorrhoea with pelvic deposits of old lymph ; one 
 had ovarian insanity, etc. All had exhausted the available resources 
 to no useful purpose. I operate upon no case that any other respectable 
 medical man proposes to cure. In most of my cases the full results 
 of the operation have not yet been developed. This is the work of 
 many months, and sometimes two or three years are necessary to its 
 full and perfect realization. In no case has the patient failed to realize 
 such a degree of relief and benefit following the operation as to amply 
 compensate her for the pains and dangers incident thereto, to say 
 
40 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 nothing of the promise of full and ample recovery at the completion of 
 the physiological change. In two of my cases this change has seemed 
 to occur at once in all its completeness, but it is always my expectation 
 that it will occur gradually, extending through two or even three years 
 to its tinal completion. In my first case, now nearly three years ago, 
 the restoration to health is eminently satisfactory. It is true that she 
 is not absolutely and perfectly well, but she is fully relieved of the con- 
 vulsions, the ovarian periodical congestions, the haematoceles, the pelvic 
 abscesses, etc. for which I operated. I submit the question in all sin- 
 cerity : If I confine myself to cases where life is in danger or where 
 health and happiness are destroyed- — -cases which are utterly hopeless 
 of other remedy this side of the grave — ought the profession to demand 
 at my hands the restoration of these forlorn invalids to complete and 
 absolute health in every particular?” 
 
 The operation was originally performed by Dr. Battey in most cases 
 with the patient on the left side and by the aid of Sims’s speculum. 
 “ The cervix was drawn down to the pubes by means of a strong hook, 
 where it was held while Douglas’s cul-de-sac was opened from the vagina 
 by means of a pair of scissors. On reaching the ovary with the finger 
 as a guide it was seized by forceps or tenaculum and drawn into the 
 vagina. It was then separated by the ecraseur, or, being secured by 
 a silk ligature, it was cut off and the stump returned into the cavity, 
 the opening being left to close gradually, so as to admit of drainage.” 
 Dr. Battey does not, however, confine himself to this method of opera- 
 tion, but removes the ovaries by abdominal section as well. Battev’s 
 operation has been successfully performed by a number of practitioners 
 since his introduction of it, and a sufficient time has now elapsed to 
 permit a just estimate of its merits ; and there no longer remains any 
 doubt as to the propriety of its performance in cases which have resisted 
 all other means of treatment. The principal danger consists in it' 
 performance at the hands of unskilled persons, and in the improper 
 selection of cases, which is very apt to occur in the practice of those 
 of limited experience in the treatment of diseases peculiar to women. 
 Dr. Sims’s inferences from his experience in the performance of the 
 operation are as follows, and they are generally endorsed by those 
 qualified to pass an opinion : “ 1st. Remove both ovaries in every case; 
 2d. As a rule operate by abdominal section, because if the ovaries are 
 bound down by adhesions it is possible to remove them entire, whereas 
 by vaginal incision it is not possible ; 3d. If we are sure that there has 
 been no pelvic inflammation, no cellulitis, no hasmatocele, no adhesions 
 of the ovaries to the neighboring parts, then the operation may be made 
 through the vagina or otherwise.” Dr. Goodell of Philadelphia formerly 
 preferred the vaginal method, and if he found it impossible to remove 
 the ovaries in that direction on account of adhesions or other causes, he 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 41 
 
 would resort to the abdominal section, leaving the vaginal incision for 
 deep drainage. The timely warning of the experienced gyneologist who 
 originated it must never be forgotten by those who essay the procedure. 
 Dr. Emmet would limit the operation to the extirpation of both ovaries 
 for the arrest of hemorrhage from a fibrous tumor and in cases of threat- 
 ened insanity, epilepsy, or phthisis. 1 or nervous disturbances which 
 present more of the hysterical element he maintains that the operation 
 should never be thought of. The operation, he thinks, may be more fre- 
 quentlv necessary in the present generation than it ought to be in the 
 future, since a large number of cases calling tor it have, under inju- 
 dicious management, been already rendered incurable by other means. 
 He holds that in the future this ought not to be so, for our enlarged 
 opportunities for acquiring skill in the treatment ot uterine and ovarian 
 diseases ought to enable us to raise our patients above the necessity ot 
 such a terrible ordeal. This operation has of late come into very gen- 
 eral use, and has been performed by many operators both at home and 
 abroad. 
 
 During the year 1873 was published the eminently practical treatise 
 of Dr. D. Haves Agnew of Philadelphia on “ Laceration of the Female 
 Perineum and V esico- vaginal Fistula, History and Treatment.” The 
 profession is much indebted to this author for his earnest and valuable 
 labors in the branches of surgery of which this volume treats. 
 
 In the year above mentioned was published by the Government a 
 quarto volume entitled A Report of the. Columbia Hospital for Women. 
 This was written by Dr. J. H. Thompson, the surgeon-in-chief of the 
 hospital. The book was very widely distributed throughout the coun- 
 try. It contains much valuable matter, but it encountered a great deal 
 of adverse criticism on the part of medical editors and reviewers fol- 
 lowing its publication. 
 
 In 1873, Dr. John Ball of Brooklyn described a plan of treating 
 constrictions and irregularities of the canal of the cervix uteri from 
 flexions and versions by rapid dilatation by expanding instruments of 
 steel. His method is to first evacuate the bowels very thoroughly, so as 
 to prevent all effort in that direction for two or three days. The patient 
 is then placed on her back with her hips near the edge of the bed 
 and profoundly anaesthetized. A three-bladed, self-retaining speculum 
 is introduced to bring the os uteri into full view. The os is then 
 seized with a double-hook tenaculum and drawn toward the vulva, 
 when an ample bougie, as large as the canal will admit, is introduced, 
 and followed in rapid succession by others until the canal is dilated to 
 admit of a No. 7, which represents the size of his dilator. With this 
 instrument the cervix is stretched in every direction until it is enlarged 
 sufficiently to admit of a No. 16 bougie. A hollow gum-elastic uterine 
 pessary of that size is then introduced, and retained in position by a 
 
42 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 stem secured outside of the vulva for about a week, in which time it 
 will have done its work and is ready to be removed. The patient dur- 
 ing this time is kept perfectly quiet, usually upon her back, which is 
 generally found to be the most comfortable position. Out of between 
 twenty and thirty cases in which Dr. Ball had to resort to this pro- 
 cedure he has met with but one fatal issue. Lately, Dr. Goodell of 
 Philadelphia has published a large number of cases operated on by 
 forcible divulsion with very gratifying results. The method has come 
 into very general use. 
 
 Early in this year Emmet published an account of the cause of fail- 
 ure and a new mode of operating for complete laceration of the peri- 
 neum. Heretofore, operators had not taken into account the fact that 
 the muscular fibres of the sphincter retract more than the others. Con- 
 sequently, only the external fibres were brought together, resulting 
 often in entire or partial failure to restore the retentive powers of the 
 anus, and frequently, while the external parts would be united and the 
 operator thought he had been successful, it was common to find that a fis- 
 tula resulted. By diagrams and descriptions he showed in his written 
 articles the manner in which the denudation must be made and sutures 
 placed in order to secure apposition of the inner as well as the outer 
 fibres of the sphincter : “ If we examine carefully the extremities of 
 the lacerated muscle, we shall find a slight pit or depression at each end 
 which has been caused by contraction of a portion of its fibres. At the 
 commencement of the operation a portion of the tissues at this point 
 must be seized with a tenaculum and removed with a pair of scissors, 
 together with a narrow strip entirely around the laceration to the oppo- 
 site end of the muscle. After the edges of the muscles have been prop- 
 erly denuded the most important part of the operation is to introduce 
 the first suture in its proper relation to the edges of the divided muscle. 
 The manner in wdiich these sutures should be introduced can only be 
 shown by diagrams, and is not essential in this connection. These 
 sutures are so adjusted that the divided edges of the sphincter are 
 turned up and appear in perfect apposition.” 
 
 But he also taught the profession the importance of adjusting the 
 sutures in order to make this operation a success ; and as a result of 
 the teachings of this distinguished gynecologist his mode of operating in 
 these cases has become generally known, and is now" the common prop- 
 erty of the profession. In his very latest writings he announces that he 
 has but little to add as the result of further experience to the paper 
 which was published during this year. He states that to unravel the 
 cause of failure in this operation and to devise means of obviating it 
 have occupied his attention for many years, and that they have cost 
 him more thought than he has ever devoted to any other pi’ofessional 
 subject. 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 43 
 
 In 1873 also Dr. Thomas M. Drysdale of Philadelphia described a 
 peculiar corpuscle as characteristic of ovarian fluid, and for a time it 
 was believed that a perfect means of diagnosis of the existence of cystic 
 ovarian tumors by microscopical examination of their contents could 
 be determined ; but while Dr. Drysdale seems to have been very suc- 
 cessful in diagnosticating ovarian tumors, others have not been so suc- 
 cessful. The late Dr. Atlee attached great importance to this method 
 of Dr. Drysdale’ s, whose views upon this matter may be summed up in 
 the following words : “ I claim, then, that a granular cell has been dis- 
 covered by me in ovarian fluid which differs in its behavior with acetic 
 acid and ether from any other known granular cell found in the abdom- 
 inal cavity, and which by means of these reagents can be readily recog- 
 nized as the cell which has been described ; and further, that by the 
 use of the microscope and assisted by these tests we may distinguish 
 the fluid removed from ovarian cysts from other abdominal dropsical 
 fluids.” 
 
 In this same year (1873) a paper which has been designated as a 
 remarkable one, and which excited much adverse criticism, was pub- 
 lished by Joseph R. Beck of Indiana, entitled “ How did the Sperma- 
 tozoa Enter the Uterus ?” The patient of the doctor in whom sexual 
 orgasm could be produced by digital examination was the subject upon 
 whom his observations were made, which are reported as follows : “ The 
 cervix uteri had been firm, hard, and generally in a normal condition, 
 with the os closed so as not to admit the uterine probe without difficulty ; 
 but immediately the os opened to the extent of fully an inch, made five 
 or six successive gasps, drawing the external os into the cervix each 
 time powerfully, and at the same time becoming quite soft to the touch. 
 All these phenomena occurred within the space of twelve seconds’ time 
 certainly, and in an instant all was as before — the os was closed, the 
 cervix hardened, and the relation of the parts had become as before the 
 orgasm.” According to Flint, Jr., Sitzmann of Germany published 
 similar observations in 1846. 
 
 In 1874 one of the most important contributions to the pathology 
 and treatment of diseases of the neck of the uterus was published by 
 Dr. T. Addis Emmet. It had long been known that childbirth caused 
 lacerations of the muscular portion of the neck of the uterus, but pre- 
 vious to his description no one had seemed to recognize how uniformly 
 such lacerations had been confounded with so-called ulceration of the neck 
 of the uterus, or how commonly the ectropion at the neck of the lip 
 resulting from such tears had been mistaken for hypertrophy of the 
 tissues. Emmet, recognizing these conditions, began to devise some 
 method for their cure, and he advocated for this condition the paring 
 of the edges of the ulcerated part and the bringing of them together 
 by means of sutures. 
 
44 
 
 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 The mode of operating, as first laid down by Emmet, is to place the 
 patient on the left side in the Sims position, and by means of a Sim- 
 speculum bring the parts into view. The first step is to bring the flaps 
 together in apposition, and while they are lifted up by means of a double 
 tenaculum in the hands of an assistant a uterine tourniquet is slipped 
 over the cervix below the point of vaginal junction, and tightened, 
 the object of this being to control hemorrhage during the operation. 
 The surfaces of the laceration are then freshened either with scissors 
 or scalpel, after which they are brought together by means of silver 
 sutures. One of the essentials to the success of the operation consists 
 in the complete removal of cicatricial or other adventitious tissue during 
 the freshening of the parts. 
 
 Since the introduction of Emmet’s operation and the publication 
 by its author of the technique of the operation, other gynecologists 
 have adopted different means to accomplish the same results. The 
 uterine tourniquet is not deemed requisite to control hemorrhage, nor 
 is it the universal custom to place the patient in either the left or right 
 semi-prone position. It is no longer deemed a prerequisite to success 
 that silver wire must be invariably used, or that no other speculum 
 than Sims’s will suffice. Hot water will control hemorrhage. The 
 dorsal — or, more commonly, the exaggerated lithotomy position, or 
 the position of Simon — is chosen by many. Silk, or catgut properly 
 prepared, is more easily introduced than silver, and is less liable to 
 cut tissues. The silkworm-gut suture is preferred by some. Some 
 of those who have used Simon’s speculum a number of times prefer 
 it to Sims’s. This procedure is now generally known as “ Emmet’s 
 operation.” It is the belief of most American gynecologists — in 
 which the writer fully concurs — that this operation marks one of the 
 greatest advances in modern gynecology. At the same time, it is an 
 operation which is liable to many and great abuses. Owing to the fact 
 that so many neurasthenic women, as well as those suffering from neur- 
 algias from the imprisonment of nervules in the cicatricial tissue of the 
 torn uterine neck, have been relieved by this operation, many superficial 
 observers have resorted to it wfith such frequency as to often bring it into 
 disrepute. Many of our foreign brethren have also attempted to ridi- 
 cule the operation, but, in spite of all, the fact still remains that no one 
 operation or procedure of equal importance for the relief of suffering 
 women has been devised in the last quarter of a century. 
 
 In March of this same year (1874) Emmet, during an operation for 
 a submucous fibroid tumor of the uterus, discovered the value of trac- 
 tion during enucleation in producing a denuded pedicle. His mode 
 of operating was with scissors around the base of the tumor, and to his 
 surprise the raw surface thus left seemed much smaller than the orig- 
 inal base of the tumor. The value of traction was several years before 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 45 
 
 insisted upon by him, but not until March, 1874, was he able to 
 demonstrate clearly that the attenuated pedicle was the effect of the 
 traction, and not an accident. In a case operated upon at that time he 
 was able to encircle the broad basis of the tumor with his fingers and 
 feel the process of pedunculation going on, as strong contraction was 
 produced by traction, the contraction beginning at the fundus and run- 
 ning down in an oblique direction. On this account the traction should 
 be made as near the fundus as possible. In this case a base of three 
 inches in diameter became a pedicle of the size of a common lead-pencil, 
 and the point of attachment after removal was reduced to a small pit, 
 thus leaving an almost infinitesimal surface, comparatively speaking, 
 for the possible absorption of septic matter. 
 
 In the year 1874 there were two papers in the Boston Medical Jour- 
 nal upon pelvic drainage after ovariotomy, by Dr. Gilman Kimball of 
 Lowell, Mass., a distinguished pioneer in ovariotomy. Dr. Montrose 
 A. Pallen of N ew York published a description of the operation as a 
 substitute for amputation of the neck of the uterus in certain forms of 
 intravaginal elongation, which he termed vaginal cervi plasti. 
 
 In the same year Dr. Marion Sims contributed a valuable paper to 
 the New York Medical Journal upon the enucleation of intra-uterine 
 fibroids. 
 
 In this year also appeared a small work, written in a powerful stvle 
 by Dr. Edward H. Clark of Boston, entitled Sex in Education. No 
 work upon medical topics or any kindred subject in modern times suc- 
 ceeded better in attracting the attention of the people for whose benefit 
 it was written to the influence of the habits of modern life on the 
 sexual organs. 
 
 In 1875 a valuable and interesting paper appeared by Dr. J. R. 
 Chadwick of Boston in the American Journal of Obstetrics upon injec- 
 tion of nutritious or cathartic fluid into the intestines through the 
 abdominal walls by means of an aspirator needle when the stomach 
 proves entirely intolerant. 
 
 In this year Dr. Xoeggerath of Xew York published in the Ameri- 
 can Journal of Obstetrics an interesting paper upon “ Yesico- vaginal 
 and V esico-rectal Touch — a New Method of Examining; the Uterus 
 and Appendages.” 
 
 In the Transactions for 1875 of the American Medical Association 
 is a paper by Dr. Byford of Chicago upon “ The Treatment of Uterine 
 Fibroids bv Ergot.” This method, for the purpose of causing atrophy 
 ot uterine fibroids, was first suggested by Hiklebrandt, but Byford seems 
 to have been tire first to advocate the use of this remedy in sufficiently 
 large doses to cause expulsion in addition to the atrophy. 
 
 In this same year was published a valuable and very interesting 
 paper by Dr. H. F. Campbell of Georgia upon “ Position, Pneumatic 
 
46 
 
 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 Pressure, and Mechanical Appliance in Uterine Displacements.” This 
 gentleman has from time to time written several papers bearing upon 
 the same subject. He advocated replacement of uteri, if posteriorly 
 displaced, by the patient assuming the knee-chest position, and the 
 introduction of a glass tube into the vagina while this position is 
 maintained. This position, by favoring the gravitation of the viscera 
 forward, together with the introduction of air into the vagina through 
 the glass tube, will often effect reposition of the displaced organ. 
 
 In this same year an interesting paper was contributed to the Rich- 
 mond and Louisville Medical Journal by Dr. Goodman of Louisville 
 upon “ Menstruation and the Law of Monthly Periodicity.” Dr. 
 Brickell of Hew Orleans contributed also an article upon “ Rupture 
 of the Perineum, with a Description of a Hew Operation.” 
 
 In 1875, Alexander Skene of Brooklyn performed the operation of 
 laparo-ely trotomy, with a result never before attained. The patient was 
 a dwarf with a rachitic pelvis, who had been three times delivered — 
 twice by premature delivery and once by craniotomy. In her fourth 
 pregnancy Dr. Skene allowed it to advance to the full term, and then, 
 after labor had begun, he performed the operation, saving the mother, 
 and a healthy child of ten pounds’ weight. This operation might more 
 properly be designated as one pertaining to obstetrics, and yet we cannot 
 forbear alluding to it here. It is one that had attracted the attention 
 of obstetricians in our own country and in Europe at different times, 
 and had been essayed by Skene in 1874, but first by T. Gaillard 
 Thomas in 1870, who states that he did it without a knowledge of the 
 fact that he been anticipated in the procedure by Baudeloque. In Dr. 
 Thomas’s case the patient died in one hour, and the child, premature 
 and imperfectly developed, also almost simultaneously. 
 
 The year 1876, being termed the “Centennial year,” as it was the 
 year in which this country celebrated its hundredth anniversary as an 
 independent nation, was rich in gynecological work. It also marks 
 the beginning of a very important epoch in American gynecology — 
 namely, the formation of the American Gynecological Society. In 
 response to a summons issued May 24th a number of gynecologists 
 from various parts of the United States came together at the hall of 
 the Academy of Medicine in the city of Hew York for the purpose of 
 forming a society for the advancement of the special department of 
 medicine in which they were chiefly interested. The meeting was 
 called to order by Dr. Chadwick of Boston, who had taken the most 
 active part in the formation of the society, and was organized by the 
 election of Dr. E. R. Peaslee of Hew York as chairman and Dr. 
 Chadwick as clerk. Remarks was made by Dr. Peaslee upon the 
 importance of such a society, and by Dr. Chadwick, who said that 
 “ the call to which you have responded by your presence here to-day 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 47 
 
 was addressed to a limited number of recognized gynecologists after 
 consultation with several of the prominent men of Boston, New York, 
 Philadelphia, and the West. It was not intended to include all those 
 whose labors in this field of medicine would fully entitle them to an 
 honored place in our ranks, but simply to form a nucleus around which 
 gynecologists of the country should cluster. It seems a most fitting 
 tribute to our national greatness that those who have striven to advance 
 the noble cause of humanity, of science, of art in any of their depart- 
 ments should take steps in this Centennial year to prosecute their labors 
 in the coming century with renewed vigor and under more favorable 
 circumstances.” These remarks apply with more than common force 
 to the branch of medicine in which America can justly claim to stand 
 pre-eminent. There were at this inaugural meeting the following gen- 
 tlemen : Drs. Fordyce Barker, E. R. Peaslee, T. A. Emmet, T. G. 
 Thomas, J. M. Sims, I. E. Taylor, E. Noeggerath, W. T. Lusk, P. 
 F. Munde, of New York ; John Byrne, A. J. C. Skene, of Brooklyn ; 
 A. D. Sinclair, G. H. Bixby, J. R. Chadwick, of Boston ; W. Goodell 
 of Philadelphia ; J. D. Trask of Astoria, N. Y. ; T. Parvin of Indian- 
 apolis; W. H. Byford of Chicago; and Ed. W. Jenks of Detroit, Mich. 
 
 Letters were read from Drs. D. H. Storer, C. E. Buckingham, G. 
 H. Lyman, W. L. Richardson, of Boston ; W. L. Atlee, R. A. F. 
 Penrose, E. Wallace, A. H. Smith, T. M. Drysdale, J. V. Ingham, 
 of Philadelphia; S. C. Busey of Washington; E. Van de Warker 
 of Syracuse ; J. P. White, of Buffalo ; R. Battey, of Rome, Ga. ; 
 J. C. Reeve, of Dayton, O. ; and G. J. Engelmann, of St. Louis. On 
 motion these gentlemen were added to the list of Fellows', and were 
 considered as founders of the society. 
 
 A committee consisting of Drs. Trask, Sinclair, Jenks, Noeggerath, 
 and Lusk was appointed by the chair to nominate a list of officers for 
 the first annual meeting. The following list of officers was reported, 
 and the gentlemen unanimously elected : President, Fordyce Barker ; 
 A ice-Presidents, A\ . L. Atlee, TV . H. Byford ; Council, J. M. Sims, W. 
 Goodell, T. Parvin, G. H. Lyman; Secretary, J. R. Chadwick ; Treas- 
 urer, P. F. Munde. 
 
 The first annual meeting ol the society was held in the same place 
 Sept. 13, 14, and 15, 1876, at which twenty-eight Fellows were pres- 
 ent. This society has since its organization, although not numbering 
 among its Fellows all of the able gynecologists of our country, really 
 represented the progress of American gynecology. Its annual volumes 
 ol Transactions have shown the rapid progress made in this specialty, 
 and have given evidence of much original work, and each year its list 
 ol Fellows has been augmented by the election of new members, and, 
 although many of its founders have passed away, the character of the 
 society’s work has continued to be of the highest. 
 
48 
 
 HISTORICAL SKETCH OF AM ERIC AH GYNECOLOGY. 
 
 Dr. Lyman of Boston published a paper on the theory entitled “ A 
 Theory of the Cause of Menorrhagia/’ with a list of cases treated with 
 success by dilatation, which reads substantially as follows : “ Dilatation 
 of the cervix for surgical and diagnostic purposes is an old procedure, 
 but that it should be followed by arrest of hemorrhage, although 
 observed by some, was not publicly noticed until 1869 by Dr. Sims.” 
 In 1876, Dr. Lyman of Boston reported a short list of eases in which 
 he had used dilatation with success in menorrhagia, and advanced the 
 following theory : “ In menorrhagia there is constriction of the vessels 
 at the internal os, giving rise to congestion of the tissues above : such 
 constriction doubtless is due to some morbid condition beneath the 
 mucous membrane. Hence this operation is beneficial, although the 
 opening through the canal be apparently sufficiently large. Precaution 
 is to be taken that the hemorrhage is not due to malignant disease, and 
 that there is no cellulitis nor peritonitis.” 
 
 In this same year a valuable paper was published by Dr. Skene on 
 the principles of gynecology as applied to obstetrical operations. 
 Although not wholly original or the first time that many of his 
 theories were enunciated, it is well worthy of mention in a history 
 of American gynecology. Dr. Skene advocated the use of Sims’s 
 speculum in performing craniotomy and in using the cephalotribe, 
 perforation being recommended to precede the use of that instrument. 
 The use of Sims’s speculum also facilitates the carrying out of Thom- 
 as’s method of replacing a prolapsed cord ; also the introduction of 
 Barnes’s dilators. He also recommended the use of the speculum in 
 applying the tampon for arrest of hemorrhage and in the use of the 
 curette or the scoop in removing the ovum. 
 
 In 1876, also, Dr. Xoeggerath of Hew York read a paper at the 
 American Gynecological Society upon latent gonorrhoea, especially with 
 regard to its influence on fertility in woman. This was his first paper 
 in the English language upon the subject, as the one in 1872 was pub- 
 lished in the German language in Bonn. This paper has given rise to 
 much discussion, favorable and unfavorable, and frequent allusion to it 
 has been made in home and foreign journals. The paper and the 
 author’s conclusions are certainly unique, and we cannot forbear to 
 allude to the latter, which he summarizes as follows : 
 
 “ 1st. Gonorrhoea in the male, as well as in the female, persists for 
 life in certain sections of the organs of generation, notwithstanding its 
 apparent cure in many instances. 
 
 “ 2d. There is a form of gonorrhoea which may be called latent gon- 
 orrhoea, in the male as well as the female. 
 
 “ 3d. Latent gonorrhoea in the male, as well as in the female, may 
 infect a healthy person either with acute gonorrhoea or gleet. 
 
 “ 4th. Latent gonorrhoea in the female, either the consequence of an 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 49 
 
 acute gonorrhoeal invasion or not, if it passes from the latent into the 
 apparent condition manifests itself as acute, chronic, recurrent peri- 
 metritis or ovaritis, or catarrh of certain sections of the genital organs. 
 
 “ 5th. Latent gonorrhoea in becoming apparent in the male does so 
 by attacks of gleet or epididymitis. 
 
 “ 6th. About 90 per cent, of sterile women are married to husbands who 
 have suffered from gonorrhoea, previously to or during married life.” 
 
 In 1876, Dr. Jenks of Detroit published the result of his observa- 
 tions on the use of Viburnum prunifolium in the treatment ot diseases 
 of women. This remedy had a limited use for some years as a preven- 
 tive of abortion, it having been first introduced by Dr. Phares ot Mis- 
 sissippi. The writer advocated the use of this remedy in all forms of 
 dysmenorrhcea attended with profuse menstruation. It is not sufficiently 
 sedative, if given alone, to fully relieve the sufferings of spasmodic 
 dysmenorrhcea. It is, however, a valuable adjuvant to sedative and 
 antispasmodic remedies. In dysmenorrhcea with menorrhagia caused 
 by fibroid growths viburnum, in combination with ergot, has proved 
 much more valuable than either remedy given without the other. The 
 writer gave, as a general statement concerning the uses of viburnum, 
 “ that it is serviceable in all uterine disorders characterized by loss of 
 blood.” Since Dr. Jenks’s paper was published the remedy has come 
 into more general use, and the results have shown that too much Avas 
 not said in its praise. 
 
 In this year also the first ten cases of Battey’s operation by Dr. 
 Battey Avere published, the folloAving results being claimed for the 
 operation in the cases reported : Complete relief, 3 ; temporary relief, 2 ; 
 life prolonged, 1 ; no benefit, 2 ; death, 2. 
 
 In the same year there AA'as published by Henry C. Lea of Philadel- 
 phia a small volume entitled A Century of American Medicine, Dr. T. 
 G. Thomas contributing the chapter on obstetrics and gynecology. No 
 one except those Avho have had occasion to search through the A'olumes 
 and periodicals for historical matter can fully appreciate the labor 
 Avhich such an able paper must haA’e cost its author. It contains a 
 summary of everything of importance that had been previously done 
 in these departments by the profession of this country. 
 
 In 1877 a paper Avas published by Dr. Brickell of XeAV Orleans on 
 the diagnosis and treatment of pehdc effusions. Three cases are 
 reported by Dr. George H. Bixbv, one by Dr. Byforcl, treated bA' 
 aspiration either through the abdominal Avails or per vaginam, the 
 latter site being preferred. The history of these cases is aM liable as 
 showing the progress in the diagnosis of pelvic effusions and the relief 
 afforded by this mode of treatment. Dr. Brickell considers the remoA'al 
 of a collection of serum in the cellular tissue as necessary as the removal 
 of a collection of pus. 
 
 Vol. I.— 4 
 
50 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 A paper was read before the American Gynecological Society by Dr. 
 Goodell on the subject of vaginal ovariotomy. This operation was 
 first performed by Washington L. Atlee, but the first premeditated 
 vaginal ovariotomy was, as previously stated, performed by Dr. T. G. 
 Thomas in 1870. Dr. Goodell, in discussing the subject, concludes 
 that while this operation can never rival the ordinarv operation, it is 
 preferable in rare cases — namely, where a small polycyst lodges in 
 Douglas’s pouch or an unadherent monocyst protrudes into the pelvic 
 cavity. The difficulties met with in this operation are from prolapsus 
 of the intestines and unforeseen adhesions. In this same vear Dr. Paul 
 F. Munde made a valuable report on the treatment of ovarian tumors 
 by electrolysis. Dr. Yon Ehrenstein claims to be the originator of this 
 method, and, although this claim is disputed, he has at least had a 
 larger experience than any other in its use. It was brought more 
 prominently into notice by an announcement in 1875 of Dr. Semelleder 
 of Mexico. Dr. Munde, from his own experience and that of others, 
 draws the following conclusions regarding the operation : That this 
 method is most apt to be beneficial in cases where the tumor is mono- 
 cystic, and yet so small as not to demand the radical operation ; or a 
 poly cyst with thin walls and fluid contents, and absence of large and 
 solid masses ; or a large unilocular or multilocular tumor, in which 
 adhesions are so extensive as to render ovariotomy dangerous. 
 
 Although it has long been known that mental aberrations may be 
 caused by the sexual disturbance occurring at the time of puberty, 
 menopause, during pregnancy, the puerperal state, and lactation, the 
 idea of connecting this abnormal mental state with disease of a non- 
 gravid uterus is modern. The first in this country to call attention to 
 the causative relations of uterine and ovarian disease to mental dis- 
 turbances in women were Dr. Fordyce Barker of New York and Dr. 
 H. R. Storer of Boston. The former published an article upon this 
 subject in 1872, and the latter a monograph upon the same subject in 
 1871, while both had promulgated their ideas by lectures some years 
 previously. 
 
 In 1877, Dr. George J. Engelmann made a valuable collection of 
 facts concerning hystero-neurosis. These show that neuroses of the 
 brain, pharynx, -larynx, eye, stomach, intestines, bronchii. and joints 
 of severe and misleading character are frequently produced by non- 
 development or disease of the uterus or ovaries, or both, or by peri- 
 uterine disease. That the apparent disease of the organs named was a 
 neurosis was proved by its disappearance upon removal of the abnor- 
 mal condition of the uterus. 
 
 In 1878 there appeared a paper on the causes of vesico- vaginal fis- 
 tula bv Dr. T. A. Emmet, in which he exonerated the forceps from 
 the charge that has been laid to them of frequently causing such lesions, 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 51 
 
 and attributed the frequency of fistula rather to delay in delivery and 
 the neglect to use the catheter before instrumental delivery. 
 
 In this same year appeared in the New York Medical Journal a very 
 valuable contribution from the facile pen of Dr. T. G. Thomas on the 
 most effectual method for controlling the high temperature occurring 
 during ovariotomy. Dr. Thomas’s method is as follows : Upon a 
 Kibbee fever-cot a folded blanket is laid, so as to protect the patient’s 
 bodv from cutting by the cords of the netting. At one end is placed 
 a pillow covered with india-rubber cloth, and a folded sheet is laid 
 across the middle of the cot to about two-thirds of its extent. Upon 
 this the patient is now laid : her clothing is lifted up to the armpits 
 and the body enveloped by the folded sheet, which extends from the 
 axil he to a little below the trochanters. The legs are covered by flan- 
 nel drawers and the feet by warm woollen stockings, and against the 
 soles of the latter bottles of warm water are applied. Two blankets 
 are then placed over the patient and the application of water is made. 
 Turning the blankets down below the pelvis, the physician now takes a 
 large pitcher of water at from 70° to 80° F., and pours it gently over the 
 sheet. This it saturates, and, percolating the network of the cot, it is 
 caught by the india-rubber cloth beneath, and, running down the gutter 
 formed by this, is received in a tub placed at its extremity for that pur- 
 pose. Water at a higher or lower temperature than this may be used. 
 As a rule, it is better to begin with a high temperature, 85° to 90°, and 
 gradually diminish it. The patient now lies in a thoroughly soaked sheet 
 with warm bottles to her feet, and is covered up carefully with dry blank- 
 ets. Neither the portion of the thorax above the shoulders nor the infe- 
 rior extremities are wet at all. The water is applied only to the trunk. 
 The first effect of the affusion is to elevate the temperature, but the 
 next, when the application is practised for an hour, usually brings it 
 down. The water collected in the tub at the foot of the bed, having- 
 passed over the body, is usually eight or ten degrees warmer than 
 when poured from the pitcher. This mode of procedure has been 
 modified by others, but still it is to Dr. Thomas that we are indebted 
 for this effective means of reducing the temperature. 
 
 In this same year Dr. E. Van de Varker of Syracuse, N. Y., con- 
 tributed a valuable paper containing some original opinions upon the 
 treatment of adhesions and indurations. The objects of treatment in 
 this case are — 1st, to allay pain : 2d, to produce absorption. For the 
 first object anodynes — namely, opium or opium combined with Vibur- 
 num prunifolium — are valuable. More important, however, though act- 
 ing less quickly, are rest, postural treatment, hot fomentations, and an 
 occasional blister. Swinging in a hammock admirably 1 combines a 
 soothing feeling, from the gentle motion, with relaxation of the abdom- 
 inal muscles and elevation of the hips. The continuous current, ten 
 
52 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 to sixteen cells, indirectly through the system and through the indura- 
 tion, is also important. The agents for producing absorption are less 
 direct, but still more valuable — viz. the galvanic current directlv 
 through the mass, one electrode being placed in the vagina and one on 
 the abdomen. The internal use of ammonium chloride markedly less- 
 ens the size of the mass, producing absorption, probably by its effect 
 upon the portal circulation. Careful handling at a later stage not only 
 hastens absorption, but also tends to reduce the tenderness. The best 
 method is by bimanual manipulation, a gentle to-and-fro motion given 
 the mass by rolling it between the hands, one of which is placed against 
 the vaginal and the other against the abdominal side. If the mass ls 
 situated in the iliac fossa, then the bone affords sufficient internal sup- 
 port, and but one hand is used. 
 
 In 1878, Dr. Henry J. Bigelow of Boston reported a number of 
 cases operated upon by a method which he had devised for crush- 
 ing and removing the fragments of stone in the male bladder. He 
 demonstrated that tolerance by the bladder of protracted manipula- 
 tion is greater than heretofore recognized, and that the operation of 
 lithotrity can be done at one sitting. The article of Dr. Bigelow is of 
 great importance, and even more applicable to the female bladder when 
 no cystitis or thickening exists. 
 
 In 1879, Dr. Edward W. Jenks of Detroit published, in the Amer- 
 ican Journal of Obstetrics, a paper upon perineorrhaphy, in which he 
 described a method devised bv himself for denuding the mucous sur- 
 faces with but little loss of blood. His method, given in his own 
 words, is as follows : 
 
 “ The patient being etherized, I begin by cutting with a scissors the 
 anterior margin of surface to be denuded at the juncture of integument 
 and mucous membrane. Next I introduce two fingers of the left hand 
 into the rectum, while assistants hold the labia apart, it being important 
 that they are held uniformly tense. I use scissors slightly curved and 
 sharp-pointed to denude the mucous membrane. I use neither tenacu- 
 lum nor tissue-forceps, but with the parts tense snip a hole in the 
 mucous membrane in the median line close to the integument, and 
 then, inserting the scissors with a cutting motion into the small hole 
 made, I continue to dissect the mucous membrane away from adjacent 
 tissues without removing the scissors, first going up the septum as far 
 as desired, and then laterally, first on one side and then on the other, 
 without removing the scissors or once bringing their points out from 
 beneath the mucous membrane. Then with blunt-pointed scissors I 
 cut away the dissected flaps. The advantages of this method are — a, 
 the rapidity with which it can be done ; b, the absence of hemorrhage 
 in the vagina, as no blood escapes at the locality where the scissors enter 
 beneath the mucous membrane ; c, the ability with which the operator 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 53 
 
 ran make complete denudation, as the discoloration beneath the mucous 
 membrane marks the route the scissors have taken. This mode of 
 operating is only applicable where there is redundancy of the tissues, 
 and not where there has been g'reat loss ol substance, as in cases where 
 the septum has been torn to any great extent.” 
 
 The same author describes also in the same paper a new method of 
 securing the sutures in the operation of kolpo-perineorrhaphy. 
 
 In this same year there was a valuable contribution on the subject 
 of ovarian diseases made by Dr. Mund6, entitled “ Prolapsus of the 
 Ovaries.” In this paper he gave points in diagnosis and modes of 
 treatment. Mention, however, had been made of this subject in the 
 Journal of the Gynecological Society of Boston in 1872 by Storer, 
 Warner, and Blake. In this publication, covering the results of his 
 observations, Munde calls attention to the fact that uncongested ovaries 
 may become prolapsed, and in turn prolapsus leads to congestion. He 
 calls attention to points now well known, that many of these cases were 
 undetected, and directs attention to the physical and mental derange- 
 ments to which they lead. He also directs attention to the value of 
 the genu-pectoral position and Sims’s speculum as aids in their replace- 
 ment. In the discussion which followed this paper, which was read 
 before the American Gynecological Society, Dr. Barker recommended 
 suppositories of iodide of lead if painting the vaginal roof with iodine 
 produced too much irritation. Drs. Bozeman and Munde had found 
 iodoform useful in these cases for the relief of the hypenesthesia. Dr. 
 Albert H. Smith advised examination by rectum for diagnostic pur- 
 poses, and Dr. Skene alluded to the pain during and after defecation as 
 a diagnostic symptom. Dr. Taliaferro of Atlanta, Ga., was the first to 
 suggest packing the vagina with cotton tampons to support prolapsed 
 ovaries. In April, 1878, Dr. Taliaferro, in a paper read before the 
 Medical Association of Georgia, advocated pressure by the tampon as a 
 therapeutic in the treatment of uterine and periuterine diseases. 
 
 In 1880 a paper was written by Dr. Chadwick advocating the use 
 of hot rectal douches in the treatment of pelvic inflammations. 
 
 At the meeting of the American Gynecological Society in 1880, 
 C. D. Palmer of Cincinnati read a full and instructive paper entitled 
 “ Laparotomy and Laparo-hysterotomy, their Indication and Statistics 
 for Fibroid Tumors of the Uterus.” 
 
 In this year also a paper was read by Dr. A. Reeves Jackson of 
 Chicago, at a meeting of the American Gynecological Society, on 
 “ Uterine Massage ” as a means of treating certain forms of enlarge- 
 ment of the womb, which, although not wholly original with the writer, 
 gave rise to some considerable discussion in home and foreign medical 
 journals. 
 
 In 1881 an interesting paper was published by Dr. Van de Warker 
 
54 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 in which he recommends forcible elongation of pelvic adhesions in cases 
 where they cause pain during defecation or other straining efforts. 
 
 In this year Dr. Thomas published a paper upon “ Laparotomy com- 
 plicated by Expansion of the Bladder over the Surface of Abdominal 
 Tumors, and its Attachment to them or to the Abdominal Walls.” He 
 made a collection of reports and cases, and offered the following mode 
 of procedure : “As diagnosis even by the sound is difficult, if it is not 
 impossible, this complication is not perceived until the abdominal 
 incision is made or the bladder laid open. If it happens to be 
 attached to the abdominal parietes, the bladder should be separated 
 by digital detachment. If adhesion is too close, then incise the ante- 
 rior wall of the bladder ; if incision has not already been made, with 
 two fingers in the bladder as a guide the adhesions can be cut. Then 
 clamp the edges of incision between the lips of the abdominal wound, 
 and close by silver sutures.” 
 
 An interesting paper by Dr. William Goodell of Philadelphia was 
 published on “ Bursting Cysts of the Abdomen,” in which the author 
 alludes to the great difference, as far as danger is concerned, between 
 parovarian and ovarian cysts, the contents of the former usually being 
 limpid and innocuous, and the fluid eliminated frequently bv the kid- 
 neys, intestines, or skin, and is usually rapidly taken out. In case of 
 the bursting of ovarian cysts the danger is much greater. He alludes 
 to a case seen by Dr. Sims in 1856 which burst three times, the fluid 
 being eliminated by each of the three channels mentioned — one entirely 
 by the kidneys, another entirely by the intestines, and the remaining 
 one wholly by the skin. 
 
 In 1882, Dr. Emmet brought to the notice of the profession his new 
 method of exploration and treatment of the urethra by the “ butt< >n- 
 hole incision,” as he designates it. He first essayed this method in 
 1879. It consists of a buttonhole incision in the urethra extending 
 from near the meatus to a short distance from the neck of the bladder, 
 the greatest length being on the vaginal mucous membrane. Retention 
 is not impaired, and diagnosis and treatment are greatly facilitated. The 
 special advantage of this method is the facility which it offers to the 
 diagnosis and treatment of polypi or other growths about the neck of 
 the bladder. After the cure is effected the opening is easily closed. 
 
 In this year Dr. J. C. Warren of Boston offered a new method of 
 operation for laceration of the perineum involving the sphincter and 
 rectal wall. The operation consists in dissecting a butterfly flap from the 
 posterior vaginal wall above the rent, and a similar flap from above down- 
 ward, leaving plenty of attachment around the entire edge of the rup- 
 tured rectal wall and sphincter. The flap is turned downward, cover- 
 ing the rectal rent. The freshened edges of the sphincter are brought 
 together over the flap, which hangs out of the anus like a small liemor- 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 55 
 
 rhoicl. All freshened surfaces are then brought in coaptation, the flap 
 being laid in folds. The part hanging from the anus if not too long 
 will draw up as cicatrization takes place. 
 
 In January of this year Dr. Christian Fenger of Chicago recorded 
 the first successful operation of kolpo-hysterectomy for uterine cancer, 
 at which time he also advocated the operation as a justifiable one. Dr. 
 O. Stroiusky of Chicago in this year reported a novel operation for 
 traumatic rupture of the bladder : while removing a fibroid polypus 
 from the bladder by twisting he made a rent into the anterior Avail, 
 inverted the whole bladder through the dilated urethra, repaired the 
 rent by three sutures, and replaced the bladder. The result Avas 
 recovery. 
 
 In 1883, Dr. C. C. Lee read before the American Gynecological 
 Society a paper on the injuries of the gravid uterus as a complication 
 of laparotomy. From a study of a necessarily small collection of cases 
 both at home and abroad, the first occurring in 1856, Dr. Lee con- 
 cludes that — 1st, the gravid uterus may be Avounded Avithout neces- 
 sarily producing abortion ; 2d, abortion seems to depend upon opening 
 the ovisac ; 3d, if the uterine contents are injured Caesarean section is 
 indicated, after Avhieh drainage may be maintained through the dilated 
 cervix ; 4th, if the uterine contents are uninjured, the wound is to be 
 treated on general principles — namely, exact coaptation by carbolized 
 sutures. 
 
 In this year, too, Emmet describes a new operation for so-called 
 laceration of the perineum. It is considered particularly useful where 
 there are large rectoceles. In this paper he holds that the loss of sup- 
 port following the laceration produced by childbirth is not due to the 
 injury of the perineal body. In fact, he denies the existence of any 
 such body, and claims that the injury is due rather to the detachment 
 of perineal muscles and the perineal fascia. The description of this 
 operation by the author is by no means lucid, but it substantially con- 
 sists in a semilunar form of denudation, wholly within the A'agina, 
 of such extent that AA’lien the edges are brought together by means 
 of sutures the “ slack ” in the posterior Avail is entirely taken up or 
 made to disappear, and yet the ostium vaginae is in no way denuded or 
 directly interfered Avith. The advantages claimed are — great diminu- 
 tion in the discomfort folloAving immediately after the operation, and 
 the perfect juxtaposition of the anterior and posterior vaginal Avails, as 
 in the non-parous Avoman. 
 
 In the Transactions of the American Gynecological Society for 1883 
 appears a paper by Dr. E. W. Jenks describing a new mode for operat- 
 ing for fistula in ano. In the same volume is a paper of Dr. Emmet’s, 
 in which he alludes to having performed the operation in the same 
 manner, neither gentleman having been aAvare of the fact that the other 
 
56 
 
 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 had performed the operation. Dr. -Jenks’s first operation was on March 
 31, 1881. The operation consists in incising the fistulous tracts after 
 the usual method, dissecting out the so-called pyogenic membrane and 
 all lardaceous and cartilaginous substances along the route of the fistula, 
 and also cutting away all portions of thin livid skin of low vitality. The 
 incised parts are maintained in perfect apposition by means of deep and 
 superficial sutures until adhesion is effected. 
 
 In this year Dr. \\ . H. Byford published an interesting paper upon 
 chronic abscesses of the pelvis, and the following points are made 
 prominent : When the surface of a pelvic abscess is identical with that 
 of an external ulcer, granulations may be exuberant or freely movable 
 and flabby or firm and vigorous. When the granulations are exuberant, 
 forming large projections into the abscess-cavity, its surfaces should be 
 curetted. The same operation is also indicated when early suppuration 
 takes place in pelvic htematoceles, in order to remove the clots which 
 suppuration cannot dispose of. As granulations disappear and cicatri- 
 zation takes place the contents of the abscess undergo changes. Serum 
 exudes, macerating and finally disintegrating the pus-corpuscles and 
 causing them to disappear. Osmosis going on through the cicatricial 
 membrane converts the contents into simple serum. There then results 
 an encysted tumor containing serum-like fluid. 
 
 It is believed that Dr. Charles K. Briddon was the first in the United 
 States to perform laparotomy after rupture of the foetal sac in tubal 
 pregnancy. This lie did in October, 1883. 
 
 Dr. Matthew D. Mann was the first to publish a successful operation, 
 performed in February, 1883, in which he removed a small subperitoneal 
 fibroid tumor of the uterus through the anterior wall of the vagina. 
 
 In this year an operation for the cure of retroversion of the uterus 
 was described by J. B. Hunter of New York. Dr. O. E. Herrick of 
 Michigan had also performed and reported the same operation, each 
 gentleman working independently. The latter, however, it is believed, 
 is entitled to the credit of being the first to perform the operation. 
 The operation consists of a denuded surface upon the posterior lap of 
 the uterus which is united bv sutures to a similarly denuded surface 
 upon the posterior vaginal wall. 
 
 In the January number of the American Journal of Obstetrics of this 
 year Dr. Garrigues of New York published a paper upon laparo- 
 elytrotomy. In tin’s paper he alluded to the place of incision and the 
 position of the ureters, and pointed out how they might be avoided 
 during operations. Dr. Polk of New York had written upon the sub- 
 ject the previous year, and Dr. Garrigues had himself investigated it 
 in 1878. Drs. Polk and Garrigues agree, from experiments made upon 
 the cadaver, that in the operation of laparo-elytrotomy the ureter is 
 safer from injury if it remains below rather than above the incision. 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 57 
 
 In November of this year Dr. B. Bernard Brown of Baltimore per- 
 formed a new operation for the reduction of an inverted uterus. An 
 incision was made in the fundus of the uterus, through which he passed 
 one of Sims’s large dilators up through the cervix, expanding the lat- 
 ter to the fullest extent. He then passed through hard-rubber dila- 
 tors, and having assured himself, by means of the finger, that no 
 adhesions existed, the incision of the fundus was sutured, and with 
 some manipulation the fundus was easily pushed up through the now 
 dilated cervix, and the operation was complete. 
 
 In 1884 a valuable paper was published by Dr. Palmer of Cincin- 
 nati, entitled “Abdominal Section, its Value and Range of Application 
 as a Means of Exploration and Treatment.” This paper was read 
 before the American Gynecological Society, and gave rise to much 
 valuable discussion. In this year an instructive paper by Dr. Thomas 
 appeared, entitled “ Management of the Placenta after Laparotomy in 
 Abdominal Pregnancy at Full Term or Beyond.” 
 
 An unique and interesting article from Dr. Isaac E. Taylor of New 
 York was published upon physiognomy of the vulva following anal 
 diseases. Dr. Taylor had made observations in this connection which 
 may be considered as very useful in diagnosis. He directs attention to 
 anal diseases causing changes in the appearance of the vulva as painful 
 affections, coming under the head of — 1st, spasmodic contractions of 
 the anus ; 2d. neuralgia or hysterical hyperesthesia ; 3d, irritability or 
 indolent fissure in that locality. 
 
 An interesting article was published in the American Journal of 
 Obstetrics of November, 1883, to March, 1884, by Dr. H. R. Bigelow, 
 entitled “ Gastrotomy for Myo-fibromata of the Uterus.” It is one of 
 the most valuable contributions to our knowledge of the subject up to 
 that time. He alludes to the publication in 1853, by W. L. Atlee, of 
 a paper entitled “Surgical Treatment of Certain Fibrous Tumors of 
 the Uterus ” as the beginning of a movement in the treatment of ute- 
 rine fibroids. Until 1863 a few surgeons at home and abroad, like 
 Atlee, Burnham, and Kimball, on opening the abdomen for ovarian 
 tumors, having found a uterine tumor, ventured to remove it. Burnham 
 made a supravaginal hysterectomy June 26, 1853, and the patient recov- 
 ered. This was the first successful case in America. Afterward Koeberle 
 of Strasburg was the first to deliberately open the abdomen for the purpose 
 of removing uterine fibroids and fibrous cysts, which he did by ligature 
 if pedunculated, or by the performance of hysterectomy if they were 
 intramural or sessile. Dr. Storer was among the first in America to 
 deliberately follow in his footsteps. Dr. Kimball of Lowell with equal 
 boldness operated about the same time as Koeberle. 
 
 In writing of early operators Bigelow states that “ Kimball and 
 Koeberle seem to be the only ones whose operations were based upon a 
 
58 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 correct diagnosis.” The present status of such a treatment of myo- 
 fibromata of the uterus was concisely set forth in this year by Dr. 
 If. S. Sutton of Pittsburg in an article on “ Non-malignant Tumors 
 of the Uterus and several American writers on uterine fibroids give 
 Dr. Goodell the credit of being the first in the United States to remove 
 ovaries to prevent further growth in uterine fibroids, but the date of his 
 operation we are unable to state. 
 
 Dr. H. A. Kelly of Philadelphia reports a successful operation for 
 sessile cervical fibroids above the vaginal roof by abdominal incision. 
 Free hemorrhage was checked by the use of Paquelin’s cautery applied 
 deep in the peritoneal cavity. The first successful case of laparotomy 
 for pelvic abscess in this country was made by Dr. R. S. Sutton in 
 June, 1884. 
 
 A very interesting address was made at the meeting of the American 
 Gynecological Society in 1885 by Dr. Wm. T. Howard upon encysted 
 tubercular peritonitis. He had collected from various sources six cases 
 in which there was interference : one of these was aspirated, three tap- 
 ped, two operated upon as in ovariotomy, and all died. One case was 
 simply treated by hygienic and therapeutic measures, and recovered. 
 Some of his clinical conclusions are that tubercular peritonitis appears 
 in early life. Its development is rapid, varying from six weeks to 
 eight months. Being rarely a local affection, we should search for 
 indications of the disease in other parts of the body. A number have 
 observed that a red blush of the central anterior part of the abdom- 
 inal wall is characteristic of tubercular peritonitis. 
 
 At the meeting of the Gynecological Society of this year (1885) quite 
 a lengthy discussion was held upon modifications of Emmet’s operation 
 upon the cervix uteri, called forth bv a paper of Dr. Sutton’s. The 
 majority of the members participated in this discussion, and the fact 
 was clearly demonstrated that the mechanical ingenuity of the different 
 gynecologists is of the highest order. 
 
 Dr. Goodell reported this year having observed a form of parotitis 
 following operations upon the female genital organs which was not of 
 septic origin. That such diseases might occur is owing to the relation- 
 ship which is known to exist between the sexual organs of the adult 
 and the cervical and salivary glands. The inflammation observed by 
 Goodell closely resembles mumps, and usually ends in resolution unat- 
 tended with an}* of the signs of septicaemia, such as frequency of the 
 pulse or glassy apearance of the eye. This variety of parotitis lasts 
 longer than mumps. Instead of the patient failing as in septic inflam- 
 mation, she gains pari passu with the continued enlargement of the 
 glands. His first case was reported to the Obstetrical Society of Phil- 
 adelphia in October, 1884. 
 
 In this same year Dr. Alfred C. Post of New York reported a new 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 59 
 
 form of operation for lacerated perineum, which may be briefly described 
 as follows : An incision of half an inch in depth is made upon each side 
 of the vagina in such a manner as to make upper and lower segments. 
 The upper segments are turned up to form the floor of the vagina and 
 secured by a roAV of catgut sutures passed through the subcutaneous tis- 
 sues. A row of silver sutures is passed beneath the bottom of the 
 incision. The lower edges are also united by flue sutures. 
 
 In the New York Medical Journal of this year Dr. John Scott of 
 San Francisco reports a case of chronic pelvic abscess treated by 
 abdominal incision. After the abscess-cavity was washed out a drain- 
 age-tube was passed through the incision into Douglas’s cul-de-sac and 
 through into the vagina. The abdominal incision was then closed ; 
 recovery. 
 
 In June of this year Dr. B. E. Haclra of San Antonio, Texas, read 
 a paper before the section of Diseases of Women at the American 
 Medical Association, entitled “ Intraperitoneal Adhesions in Relation 
 to Tait’s Operation.” He calls attention to the marked relief in some 
 cases after Tait’s operation in which disease of the tubes and ovaries 
 was not extensive. This fact he considers due rather to the breaking 
 up of adhesions — namely, of the intestines to the fundus or sides of the 
 uterus ; also extra-pelvic adhesions, especially adhesions between the 
 omentum and parietal or visceral peritoneum. He advocates laparot- 
 omy for a new purpose — namely, to free the peritoneum throughout its 
 entire area. 
 
 In a paper on vulvar and vaginal enterocele, read before the New 
 York Academy of Medicine in 1885, Dr. T. G. Thomas advocated a 
 new method of treatment for vaginal enterocele in cases not amenable 
 to the ordinary measures — namely, laparotomy and dragging up the 
 hernial sac and fastening it to the abdominal wound. He reports one 
 case in which this plan was partially pursued with successful result. 
 
 In a series of articles in the American Journal of Obstetrics in 1885, 
 entitled “ Studies in Endometritis,” Dr. Mary Putnam-Jacobi further 
 develops the cyclical theory of menstruation which was first enunciated 
 in 1878 by Dr. Goodman of Louisville. The theory which she sets 
 forth is substantially as follows : The endometrium above the os inter- 
 num, the mucosa of the Fallopian tubes, and the cortex of the ovaries 
 are designated as the “ germinative membrane.” “The epithelium and 
 subepithelial cells of this membrane are directly derived from the ger- 
 minal epithelium of the embryonic hvpoblast. which covers the repro- 
 ductive eminences of the pleural-peritoneal cavity.” . . . . “ In all the 
 elements of germinative membranes persists the embryonic property 
 of indefinite growth.” This process is changed from continuous to 
 cyclical through the mechanical obstructions which are encountered 
 after a certain point in growth is reached. Dr. Jacobi, like Dr. Good- 
 
60 
 
 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 man, separates ovulation and menstruation as far as cause and effect arc 
 concerned. Ovulation and menstruation are usuallv synchronous. The 
 former does not cause the latter, but both are produced by the same 
 cause — namely, growth of embryonic tissue. 
 
 In 1885, Dr. Baird of Texas advocated a new method for the treat- 
 ment of pelvic cellulitis for arresting exudation and pain, and applies 
 the galvanic current. He reports a case also where pus had formed, 
 which he evacuated by aspiration, and then injected the cavity with 
 salt water, and applied a galvanic current to the cavity, with the result 
 of speedy contraction of the abscess and radical cure. 
 
 In 1886, Dr. Sarah E. Post published in the American Journal of 
 the Medical Sciences an exhaustive resume upon the subject of kolpo- 
 hvsterectomy, which comprises a collection of all cases on record, with 
 a short history and description of each of the various modes of ope- 
 rating. 
 
 Dr. H. Marion Sims of New York read this same year, before 
 the New York Obstetrical Society, a paper on ventral hernia following 
 ovariotomy, in which he advocates a radical operation for its cure. In 
 a patient who suffered very much pain on account of the hernia, the 
 hernial ring being ten inches in diameter, he excised an elliptical piece 
 of skin, and then united the peritoneum by Lembert sutures. Then 
 the muscles and fasciae were united separately with catgut and silver 
 wire. The result was a perfect recovery. 
 
 Dr. Polk of New York reported to the Obstetrical Society of New 
 York a case of pelvic abscess which was operated upon outside of the 
 peritoneum bv means of an incision made as in that for ligating the 
 iliac artery, the patient recovering. 
 
 January 20th of this year the first annual meeting of the Alumni As- 
 sociation of the Woman’s Hospital of the State of New York, composed 
 of former medical officers and house-surgeons, was held. A permanent 
 organization was effected, and Dr. J. B. Hunter was chosen president. 
 At this meeting many interesting papers were read and discussed, most 
 of which have been published in medical journals ; a history of the 
 institution was also read, it being altogether a meeting of the alumni. 
 
 In mentioning the historical points heretofore the writer has aimed 
 to pursue a chronological order, but there are some items relating to 
 gynecological history which, being matters of development, can hardly 
 be spoken of as pertaining wholly to any one year, and therefore will 
 now be alluded to. 
 
 In this connection attention is directed to the use of electricity in 
 t he treatment of uterine fibroids. Among those who have investigated 
 this subject and experimented and published their results may be men- 
 tioned Dr. J. N. Freeman of Brooklyn, Dr. Engelmann of St. Louis, 
 Dr. Everett of Clyde, O., Dr. Martin of Chicago. These gentlemen 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 61 
 
 have written upon electrolysis in the treatment of snbperitoneal and 
 intramural fibroids. Drs. Thomas, Munde, Vanderveer, and Semelleder 
 of Mexico have experimented and written upon electrolysis in the treat- 
 ment of ovarian tumors. Dr. Munde gives a report of fifty-one cases 
 which he has collected from various sources, of which there were nine 
 deaths and fourteen failures, the remainder being benefited or cured. 
 
 In 1874, Dr. Gilman Kimball published in the Boston Medical 
 Journal a paper entitled “ Treatment of Uterine Fibroids by Electrol- 
 vsis or Galvanism.” In 1878, Ephraim Cutter reported fifty cases of 
 uterine fibroids treated by electrolysis by Kimball and himself. These 
 cases were treated during the period extending from 1871 to 1877, with 
 the following results : Hon-arrests, 7 ; death, 4 ; arrests, 32 ; relieved, 
 3; cured, 4. Writing of these cases nine years later (in 1887), Cutter 
 shows that time has served to strengthen rather than weaken the posi- 
 tion which he and Kimball took as pioneers of this method, for the 
 present resume of those same fifty cases now stands thus : Xon-arrests, 
 7 ; fatal, 4; arrests, 25; relieved, 3; cured, 11. 
 
 Dr. Robert Newman of New York is the veteran advocate in America 
 of the electrolytic treatment. He reported the results of some of his 
 labors in this direction as early as 1867. Reports of successful cases 
 of electrolysis in extra-uterine pregnancy have been made by Drs. A. 
 D. Rockwell, T. G. Thomas, E. G. Landis, X. Bozeman, Garrigues, J. 
 C. Reeve, William T. Lusk, and others. 
 
 Hot water, which is so generally made use of in the treatment of 
 diseases peculiar to women, and has had such an ardent advocate in 
 Dr. Emmet, was first brought to the attention of the profession as a 
 haemostatic during surgical operations by the late Dr. Pitcher of Detroit 
 in 1859. 
 
 A valuable contribution to gynecology has been made by Dr. IT. 
 Coe, the pathologist of the Woman’s Hospital of Xew York. His 
 published observations of certain conditions of the ovaries have been 
 revelations to many who believed that anything appearing like a cyst 
 upon the ovary indicates disease demanding removal. Some of his 
 conclusions are as follows : Laparotomists often judge of ovarian dis- 
 eases by — 1st, thickening of the cortex of ovaries : such thickening is 
 perfectly normal in the senile organ or after frecpient ovulation ; 2d, by 
 the appearance of a “ cystic ” degeneration, which is often only hydrops 
 folliculorum, and, according to Olshausen, “ the stroma of the ovary 
 in these cases is intact and most of the vesicles are normal.” This con- 
 dition seldom attains any clinical importance, because the changes pro- 
 duce no symptoms. Dr. Coe states the case of a perfect ovum found 
 within a Graafian vesicle as large as a marble. Of a large number of 
 tubes removed by different operators which Coe has examined, only one- 
 fifth had true pyosalpinx. A less number were affected with hydro- 
 
62 
 
 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 salpinx, and only one with hsematosalpinx. An acute catarrhal sal- 
 pingitis had been found in women who had died from acute peritonitis 
 following extension of acute purulent endometritis. Chronic catarrhal 
 salpingitis he has not found. Thickening of the fibroid muscular tis- 
 sue without evidence of inflammation is rare. This condition has been 
 designated pachysalpingitis. Coe gives this as a rule : Unless pus is 
 found there is no pyosalpinx. 
 
 In 1882, Dr. Baker of Boston originated the cone-shaped excision 
 of the neck of the uterus for cancer, the apex of the cone being carried 
 far above the os internum. Dr. Baker has also cured a case of con- 
 genital malposition of the ureter. The ureter opened into the vagina 
 near the meatus urinarius. He dissected up a portion of the misplaced 
 ureter, made an opening in the original bed near the neck of the blad- 
 der, and turned the stump through it and closed the vaginal wall over 
 it. About a year after he was obliged to open the bladder and remove 
 a stone which had probably formed as the result of leaving a raw sur- 
 face in the bladder. Phosphates are often deposited upon such surfaces. 
 
 In 1 886, at a meeting of the American Medical Association, Dr. A. 
 F. Pattee reported great success for many years with potassium chloride 
 in the treatment of anaemia, exudations from pelvic cellulitis in ovarian 
 neuralgia, menstrual headache with wakefulness, he having found the rem- 
 edy more advantageous than potassium bromide or ammonium chloride. 
 
 Dr. Byrne of Brooklyn in the October and December numbers of the 
 New York Medical Journal for 1878 published a new method of redu- 
 cing; inversion of the uterus by means of an instrument consisting; of a 
 curved stem, to the end of which is attached a cup for receiving the 
 inverted uterus. The stem is traversed by a rod which is affixed to 
 a disk forming a false bottom of the cup. Counter-pressure upon the 
 abdomen is maintained by means of an open bell-shaped cup, through 
 the ceutre of which passes a screw provided at the lower end with a 
 conical plug of hard rubber, and on the opposite or lower extremity a 
 flat knob for a handle. 
 
 Heretofore, in speaking of the mechanical treatment of uterine dis- 
 placements, credit has been given to Dr. Hodge for his ingenuity, but 
 American ingenuity has been taxed to its utmost in the invention of 
 pessaries, the most valuable of which are some form or modification of 
 the one originally invented by Hodge. Among those most worthy of 
 mention are the pessaries of Thomas, Emmet, and Albert H. Smith. 
 Gehrung of St. Louis has devised various forms — one particularly 
 useful in anteversion or procidentia accompanied by anteversion or 
 cystocele — and so has Cutter. All forms of gynecological instru- 
 ments have been devised, and there is scarcely an operator but has 
 originated or modified some form of instrument, to which his name 
 is attached. 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 63 
 
 One of the improved pessaries is the block-tin pessary devised by 
 Sims about 1859. He recognized the necessity of having a pessary fit 
 the canal in which it Avas to be placed, and devised pessaries from that 
 material to accomplish this purpose. 
 
 Prior to Dr. Sims’s book most of the works published in this coun- 
 try upon diseases of women were either foreign Avorks edited by Ameri- 
 can physicians or were treatises chiefly upon diseases of the puerperal 
 state. In 1826 Avas published the treatise on Diseases of Females , by 
 William P. Dewees. This book reached its tenth edition. From 1852 
 to 1855 the clinical lectures of Dr. G. S. Bedford Avere published in 
 medical journals, after which they were published in book form. The 
 Avorkof Dr. C. D. Meigs, published in 1850, which ran through seA'eral 
 editions and Avas written in the most charming manner, was in no degree 
 a representative of modern gynecology. In 1860 Avas published Dis- 
 eases Peculiar to Women, including Displacements of the Uterus, by Hugh 
 L. Hodge. The first edition of Bvford’s work upon medical and sur- 
 gical treatment of Avomen AA’as in 1865. Dr. Marion Sims’s book, en- 
 titled Clinical Notes on Uterine Surgery, was published in 1866. In 
 1868 a treatise upon vesico-vaginal and \ T esico-rectal fistulas, by T. A. 
 Emmet, AA’as published. In 1868 Avas published a book by T. Gail- 
 lard Thomas entitled Practical Treatise upon the Diseases of Women. 
 This Avork Avas the fullest and most systematic treatise that had eA’er 
 emanated from an American author. As early as 1880, so great had 
 been the demand for this book, it had run through four editions, and 
 the fifth Avas published, much revised and enlarged. Especially note- 
 Avorthy are the chapters entitled respecth’ely “An Historical Sketch 
 of Gynecology ” and “ The Anatomy, Physiology, and Pathology of 
 the Female Perineum.” The former is a concise and most interesting 
 article on gynecology, dating back to ancient times. The latter, an 
 ably-written chapter, lias especial reference to the functions of the 
 perineal body and the necessity of restoring it after rupture, even 
 though incomplete. 
 
 The first journal devoted to obstetrics and gynecology appeared in 
 1868, edited by Dr. B. F. DaAvson, to AA’hose energy and untiring efforts 
 chiefly this journal OAves its origin. It first appeared as a quarterly. 
 After some years Dr. DaAvson AA T as succeeded by its present able editor, 
 Dr. Munch}. The first journal deA'oted especially to gynecology Avas 
 the Journal of the Gynecological Society of Boston, edited by Drs. H. 
 R. Storer, G. H. Bixby, and W. LeAvis. It first appeared in 1869, 
 and exercised no inconsiderable amount of influence. 
 
 In 1872, Dr. E. X. Chapman, a former professor of obstetrics 
 and diseases of women in the Long Island College Hospital, pub- 
 lished his work on Diseases and Displacements of the Uterus, which 
 met Avith rather rough usage at the hands of reA’ieAvers, although 
 
64 
 
 HISTORICAL SKETCH OF AMERICAS GYNECOLOGY. 
 
 possessing considerable merit. The book never reached its second 
 edition. 
 
 In 1872, Dr. John Byrne’s (of Brooklyn) monograph, entitled Clin- 
 ical Notes on the Electric Cautery in Uterine Surgery , was published. 
 Notwithstanding this gentleman’s enthusiastic advocacy of the electric 
 cautery and the good showing of his clinical reports, this mode of 
 treatment is not at the present time held in the high esteem it once 
 was by leading American gynecologists. 
 
 In 1872 was published by Appletons the truly classical work On 
 Ovarian Tumors, by Edmund R. Peaslee, Avhich was dedicated “ To 
 the memory of Ephraim McDowell, M. D., the father of ovariotomy, 
 and to Thomas Spencer Wells, Escp, the greatest of ovariotomists.” 
 Of this great work his friend and biographer, Professor Fordyce 
 Barker, writes for the third volume of the Transactions of the Amer- 
 ican Gynecological Society : “ No work has been published in this coun- 
 try on any special subject of medical science of higher merit than his, 
 as regards its plan of arrangement, its artistic excellence of execution, 
 its literary finish, its learned, impartial, historical research, its sound- 
 ness in pathology, its keen analytical teaching of diagnosis, its wise, 
 prudent, practical, and thorough directions as regards treatment, both 
 in the medical and surgical aspects of the subject.” This work will lie 
 “ an imperishable monument to his name.” 
 
 Soon after Peaslee’s book was published appeared another work (in 
 1873) on Ovarian Tumors, which had been announced, and the publi- 
 cation of which had been eagerly anticipated by all interested in the 
 operation of ovariotomy in the United States. The work referred to 
 was written by Washington L. Atlee, who up to this date had made 
 more ovariotomies than any other American. This truly valuable book 
 differs widely from Peaslee’s, as it is more purely clinical and personal, 
 showing as it does the many years of its author’s labors as a pioneer 
 ovariotomist. The twenty-fourth chapter of this volume, entitled 
 “ Dropsical Fluids of the Abdomen, their Physical Properties, Chem- 
 ical Analysis, Microscopic Appearance, and Diagnostic Value, based on 
 the Examination of Several Hundred Specimens,” was contributed by 
 Dr. Thomas M. Drysdale. 
 
 In 1876 appeared the first volume of the Transactions of the Ameri- 
 can Gynecological Society, which have appeared from year to year since 
 that time. Allusion has herein before been made to the organization 
 of this society and the influence which it has exerted on the progress 
 of gynecology in this country. Xor has this influence been confined to 
 the United States alone, but has been felt in foreign countries. After 
 the appearance of the sixth volume of the Transactions the following 
 introduction to a translation of one of its articles by the distinguished 
 Prof. Kleinwachter appeared in the Deutsches Archiv fur Geschichte dcr 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 65 
 
 Med. u Med. Geog., in which the translation was published. After 
 writing at some length in a commendatory manner of the foundation 
 of the society and its founders and Transactions, he says : “ Up: to the 
 present time six volumes have appeared, which are an ornament to our 
 libraries of special sciences and contain an abundance of highly inter- 
 esting and valuable contributions, as would be expected, for amongst 
 the co-workers may be enumerated such men as Washington Atlee, 
 Fordyce Barker, William By ford, Thomas Addis Emmet, George En- 
 gelmann, William Goodell, Charles Carroll Lee, William Lusk, Paul 
 Munde, Emil Hoeggerath, Randolph Peaslee, the universally-known 
 and celebrated Dr. J. Marion Sims, T. Gailiard Thomas, and others 
 whose scientific reputation is everywhere known and recognized.” 
 Aside from the scientific interest which the Transactions possess, 
 Ivleinwachter considers the medico-historical characteristics note- 
 worthy : “ The previous volumes contain full biographies of Simon 
 (of Heidelberg), Charles Buckingham, Randolph Peaslee, Marmaduke 
 B. Wright, and others. The fifth volume contains an extensive paper, 
 illustrated with numerous cuts, upon midwifery among the various 
 peoples of the globe, by Engelmann, and in the sixth is a noticeable 
 contribution from the pen of Edward W. Jenks entitled ‘ The Prac- 
 tice of Gynecology in Ancient Times.’ ”....“ If the English and 
 French cultivate the history of medicine, we need be less surprised, for 
 both of these nations possess a famous history of more than a thousand 
 years, and such a one doubtless stimulates historical research. The 
 Americans are without an ancient national culture, and therefore with- 
 out an ancient history, and yet we see them fostering the history of 
 medicine. With this people y.a.z iqoyfv of the present, necessitv has 
 compelled it to make a path for itself, in order to learn what the 
 ancients knew and did, in order not to be too one-sided — in other 
 words, more fully to comprehend the spirit of medicine than it is 
 possible by the modern methods of so-called exact investigation.” 
 
 In 1878 was established the Obstetric Gazette, published in Cincin- 
 nati and edited by Edward B. Stevens ; it has also a department 
 devoted to diseases of women. 
 
 Dr. Skene’s book, entitled Diseases of the Bladder and Urethra of 
 Women, first came out in 1878. This volume is the only one of its 
 kind which has been published in this country, and its intrinsic value 
 has greatly served to establish and extend the justly-deserved reputa- 
 tion of its author as an authority on the disorders of which it treats. 
 
 In 1879, Emmet published his work entitled Principles and Practice 
 of Gyncecology. This work is a clinical work, and is totally unlike the 
 systematic treatise of Thomas. Owing to the author’s long connection 
 with the Woman’s Hospital of the State of Hew York, first as assistant 
 to Dr. Sims, next as surgeon-in-chief for many years, and later as one 
 
 VOL. I. — 0 
 
66 HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 
 
 of the surgeons of the staff, his experience has given him great advan- 
 tages in the way of clinical observation, of which his book bears an 
 abundant evidence. This book has passed through several editions, 
 the last one being practically a new book, so much has been rewritten 
 and added since the first edition appeared. 
 
 In 1879 was published the clinical lectures of Dr. Win. Goodell of 
 Philadelphia, entitled Lessons in Gyncecology. 
 
 In 1881 a new edition of By ford’s work was published on the dis- 
 eases of women, but so changed from the first edition as to be practi- 
 cally a new work, fully abreast of the times and worthy of its indus- 
 trious author. 
 
 In 1880, Munde published a work entitled Minor Surgical Gyne- 
 cology. The second edition appeared in 1885 — a work of great use 
 to the younger members of the profession, for whom chiefly it is 
 written. 
 
 Obstetrical societies were formed man}' years ago in a few of the larger 
 cities, but the first gynecological society organized was the Gynecolog- 
 ical Society of Boston, established in 1869. Its Transactions, pub- 
 lished monthly, exerted a widespread influence on the interests of 
 gynecology, which was due chiefly to the labors of Dr. H. R. Storer 
 and a few of his colleagues. Although the journal has been discon- 
 tinued, Dr. Storer having been compelled to withdraw from active 
 work by reason of his illness, the society continues to hold its stated 
 meetings. 
 
 Other obstetrical and gynecological societies have been established 
 quite universally. Where obstetrical societies exist, gynecology shares 
 with obstetrics in the attention which is devoted to it. Gynecological 
 societies exist in Washington, Chicago, Detroit, Baltimore, and sev- 
 eral other cities, while the principal part of the work of the obstetri- 
 cal societies of ISjfew York, Philadelphia, and some other cities seems 
 to be gynecological. 
 
 In 1870 the American Medical Association passed resolutions recom- 
 mending that the establishment of chairs of gynecology separate from 
 that of obstetrics be more generally adopted by medical colleges and 
 schools throughout the country. The direct cause of these resolutions 
 was a memorial presented to the association by the Boston Gynecolog- 
 ical Society. The Medical College at Castleton, Yt., was the first one 
 in which special attention was given to the diseases of women, Dr. 
 Woodward lecturing upon gynecology as well as upon obstetrics. Prob- 
 ably the first college to found a full professorship of gynecology was 
 Dartmouth, Dr. Peaslee being its incumbent. About the same time Dr. 
 H. R. Storer gave a fidl course of lectures on gynecology in Berkshire 
 Medical College, Massachusetts, of which institution he was professor 
 of obstetrics and diseases of women. 
 
HISTORICAL SKETCH OF AMERICAN GYNECOLOGY. 67 
 
 As early as 1871 there were thirteen medical colleges in the United 
 States in which there were full professorships of gynecology and of 
 obstetrics. Of this number, there were seven schools with full profes- 
 sorships of the diseases of women, incumbents teaching nothing else — 
 namely, the Albany Medical College, E. R. Peaslee ; Long Island Hos- 
 pital College, A. J. C. Skene ; St. Louis College of Physicians and 
 Surgeons, M. A. Pallen ; University of Louisville, T. Parvin ; the 
 Medical College of Ohio, C. D. Palmer; University of Pennsylvania, 
 Win. Goodell ; Detroit Medical College, Edward W. Jenks ; and there 
 were eight professorships of gynecology and the diseases of children 
 combined — namely, University of New York, F. D. Lente ; Medical 
 College of Virginia, J. S. D. Cullen ; University of Maryland, W. D. 
 Howard ; Washington University, Baltimore, M. P. Scott ; Miami 
 Medical College, B. F. Richardson ; Indiana Medical College, T. B. 
 Harvey ; Medical College of Evansville, D. Morgan ; Louisville Med- 
 ical College, J. A. Ireland. Since then the authorities governing 
 medical schools and colleges, realizing the importance of gynecology, 
 have in almost every instance added a separate professorship of that 
 specialty. 
 
 The foregoing historical sketch of the rise and progress of gynecology 
 in America, imperfect though it necessarily be, can scarcely fail to 
 impress the reader with a sense of the important part which this 
 country has borne in the development of this division of medicine. 
 The profession of America has, in what it has already accomplished, 
 both demonstrated a peculiar aptness in this particular field and given 
 a guarantee for the future. With the increasing facilities which 
 increasing wealth, and its accompaniment of growing freedom from 
 the mere money-getting obligations resting on physicians, and the 
 enthusiasm in their work which seems to an extent to be peculiar to 
 workers in this field, the future of gynecology in this country is big 
 with hope and promise. It is but fitting that the land which furnished 
 the pioneers should furnish also those who shall carry on to its fullest 
 possible perfection the work so auspiciously begun. The mantles of 
 McDowell and Sims and Peaslee and the Atlees have fallen on worthy 
 shoulders, and coming generations will accord to many now living 
 places beside the pioneers who have rested from their labors. 
 
THE DEVELOPMENT OF THE FEMALE 
 GENITALS. 
 
 By HENRY J. GARRIGUES, A. M., M. D., 
 New York. 
 
 As in other departments of the history of the development of the 
 human body, so our knowledge of the earliest stages of development 
 of the female genitals is chiefly derived from the study of the develop- 
 ment of the corresponding parts in animals, especially the chicken and 
 the rabbit. 
 
 The Wolffian Ducts. 1 
 
 The first organs belonging to the genital sphere which appear in 
 the male and female are the Wolffian ducts. In the chicken embryo 
 they appear during the latter half of the second day. There is one 
 on either side. It begins at the level of the fourth or fifth proto ver- 
 tebra, and extends rapidly backward, so that at the beginning of the 
 third day it reaches the last protovertebra. At first it is a solid column, 
 which later, by the formation of a cavity in its interior, is transformed 
 to a tube. On cross-section of embryos it makes its first appearance 
 as a small protuberance from the lateral plates where they come together 
 with the protovertebral columns. 
 
 The posterior end of the Wolffian duct opens into that part of the 
 allantois which is situated within the body of the embryo, and com- 
 municates with the cloaca, and later, after the separation between the 
 intestinal and urogenital canal has taken place, into the urogenital 
 sinus described below. 
 
 In the rabbit the Wolffian duct appears at the end of the eighth or 
 the beginning of the ninth day, and is developed in the same way as 
 in the chicken. On the eleventh day it opens into the urogenital sinus. 
 Fig. 1 shows its situation between the protovertebral column, the lat- 
 eral plate, and the descending aorta. On one side it is yet a solid 
 string, on the other it has begun to be changed into a canal. In Fig. 
 2 we see it open into the urogenital sinus. Its lower end lies on either 
 side of the body, imbedded in a ridge which Waldeyer has denominated 
 plica urogenitalis. According to the same author, the Wolffian duct is 
 
 1 Casper Friedrich Wolff, Theoria General innis, Berlin, 1759; “On the Development 
 of the Intestine,” in Nov. Comment. Acad. Pelropol.. 1708-69. 
 
 68 
 
AUTHORS’ INDEX 
 
 [See also lists of Literature referred toon pp. 93. 278, 548, 568, 586, 593, 599, 61S, 635.] 
 
 A. 
 
 Adelon, 445 
 
 Agnew, D. H., 28, 41, 725 
 Aikman, John, 252 
 Albucasis, 22 
 Andral, 695 
 
 Apostoli, 387, 399, 400, 403 
 Appleton, 22 
 
 Aran, 377, 568, 664, 677, 696, 707, 723, 727, 
 752, 769 
 
 Arcliigenes, 676 
 Aetius, 20, 676 
 Atlee, J. L., 27 
 Atlee, W. L., 27, 28, 64 
 Atthill, 568, 580, 653, 664 
 
 B. 
 
 Baird, 60 
 
 Baker, W. H„ 62, 261 
 Balfour, 86, 176 
 Ball, John, 41, 433, 765 
 Bandl, 163, 219, 707, 736, 739, 741, 745, 
 755, 756, 760, 761, 762, 765, 768 
 Barbour, 101 
 
 Barker, Fordvce, 38, 395, 484, 5S1 
 Barnes, Robert, 568, 581, 583, 722, 736, 
 : , 738, 740, 742, 750, 755, 756, 768 
 Barstellberger, 263 
 Battey, Robert, 36, 38, 39, 49 
 Beard and Rockwell, 385 
 Beck, Jos. R., 43, 433, 765 
 Beck, Snow, 639, 646, 738, 745, 755 
 Becquerel, 727 
 Bedford, G. D., 30, 63, 738 
 Beliier, 709 
 
 Beigel, 70, 167, 738, 765 
 Bell, 24 
 
 Bennet, 377, 568, 571, 573, 576, 581, 661, 
 738 
 
 Bernutz, 568, 677, 687, 688, 689, 691, 693, 
 694, 695, 696, 700, 704, 715, 717, 727, 
 735, 736, 737, 739, 740, 742, 752, 755, 
 760, 765, 766, 767, 768 
 Bigelow, Henry .J., 52 
 Bigelow, H. R., 57 
 Biliinger, J., 27 
 Billroth, 712 
 Bird, 547 
 Bischoff, 409 
 Bixby, G. H., 63, 725 
 
 Boehm, C., 93 
 Boerner, 600 
 Boisin and Duges, 447 
 Boisin, Mad., 157 
 Bouchnt, 69S 
 Boynham, Wm., 28 
 Bozeman, Nathan, 34, 36, 445 
 Brandt, 616 
 
 Braun, C., 568, 738, 755 
 Breisky, 260 
 Brickell, 46, 49 
 Briddon. Charles K., 56 
 Broca, 100 
 
 Browne, B. Bernard, 57 
 Budin, P., 93, 119 
 Bumstead, 593 
 Burns, 640 
 Buttles, M. S., 39 
 
 Bvford, W. PI., 36, 45, 56, 63, 66, 542, 568, 
 581, 723, 725, 728, 733 
 Byrne, John, 38, 62, 64, 738 
 
 C. 
 
 Cadiat, 124 
 Campbell, H. F., 45 
 Carrard, 477 
 Carreau, J. D., 6S1 
 Carrington, 224, 225 
 
 Chadwick, J. R., 45, 46, 53, 198, 199. 480, 
 692 
 
 Championniere, 554, 679, 680 
 
 Channing, W alter, 30 
 
 Chapman, E. N., 63 
 
 Chauvau, 93 
 
 Clirobak, 135, 141 
 
 Chromel, 641. 661 
 
 Churchill, Fleetwood, 640, 676, 738 
 
 Clark, 29 
 
 Clark, Alonzo, 30 
 
 Clark, C. M., 531 
 
 Clark, Edward H.. 45 
 
 Coe, H. C., 61, 336, 69S, 699 
 
 Coen, 242 
 
 Coleman, J. D., 259 
 Cooper, Astley, 4S3 
 Cornil, 91, 519 
 
 Courtv, A., 91, 93, 445, 554, 568, 581, 641, 
 664, 680, 681, 709, 715, 723, 740. 746, 
 763. 766 
 Crede, 738 
 
 771 
 
772 
 
 A UTHORS ’ INDEX. 
 
 Creighton, 178 
 Cruveilhier, 252 
 Cullerier, 593 
 
 Cnllingworth, C. J., 691, 722 
 
 D. 
 
 Dalton, 178 
 Davies, Gorner, 258 
 Davis, E. Y., 515 
 Dawson, B. F., 63 
 Deces, 742 
 Delore, 756 
 Delrand, 515 
 Denouviliers, 737 
 Deralz, 740 
 Dewees, Wm. P., 63 
 Dohrn, E., 72, 93, 262 
 Dolbeau. 741, 757 
 Doran, 180 
 Douglass, 22 
 Doutrelepont, 519, 523 
 Drysdale, Thomas M., 43, 64 
 Duhring, 534 
 
 Duncan, Matthews, 252, 465, 519, 520,527, 
 657. 677, 688, 694, 695, 705, 722, 723. 
 738' 
 
 Dunglison, 588 
 Dunlap, A., 27 
 Duparque, 593, 641 
 Duverney, 746 
 
 E. 
 
 Edis, 542, 568, 637 
 Elischer, 175 
 Ellinger, 433 
 Ellis, 189, 198, 224, 231 
 Emmet, T. A., 34, 35, 36, 37, 41, 42, 43, 44, 
 50, 54, 55, 63, 65, 199, 234, 252, 337, 
 338, 530, 597, 667, 680, 699, 704, 707, 
 714, 718, 720, 721, 722, 729, 738, 742, 
 743, 750, 768 
 
 Engelmann, 50, 141, 331, 387, 400, 403, 
 409 
 
 Erich, 499 
 Eustache, 476 
 
 F. 
 
 Fallopio, Gabriele, 87 
 Farre, 169 
 Fayrer, 525 
 Fenger, Christian, 55 
 Fenwick, Bedford, 529 
 Finn, 646 
 Fischel, W., 93 
 Forster, 593 
 Fort, C. H., 263 
 
 Foster, Frank P., 102, 118, 228, 233. 234, 
 362, 554, 698 
 Foulis, 84, 93 
 Franck, 737 
 
 Frankenhauser, 146, 762 
 Frarier, 709 
 Freund, 708 
 
 Frey, 121 
 Friedlander, 141 
 
 Fritsch, 154, 354, 561, 568. 688, 701, 707, 
 716,727 
 
 G. 
 
 Galabin, 527, 653, 662 
 Gallard, 735, 736, 737, 759, 761 
 Gantillon, 377 
 
 Garrigues, 56, 140, 192, 210, 228, 706, 719 
 
 Gartner, Herman T., 70, 93 
 
 Geigel, E., 70, 93 
 
 Gendrin, 377 
 
 Gillette, 531 
 
 Gilmour, 3S 
 
 Giraldez, 75 
 
 Girault, 475 
 
 Goodell, Wm., 36, 40, 42, 50, 54, 58, 66, 
 359, 433, 517, 530, 568, 617 
 Goodman, 46 
 Goupil, 687 
 Graaf, Begnier de, 80 
 Grandin. Egbert H., 667 
 Green, T. Henry, 536, 679 
 Greenhalgh, 356 
 Grobe, 236 
 Gross, 26,431 
 
 Guerin, Alph.. 217, 709, 715 
 Gussenbauer, 109 
 Gusserow, 155, 761 
 Gurlt, 537 
 
 H. 
 
 ITadra, B. E., 59 
 Hagemann, 93 
 Harrison, 738 
 
 Hart, D. Berry, 682, 686, 724 
 Hart and Barbour, 101, 106, 109, 112, 125, 
 131, 132, 154, 167, 168, 188, 212, 222, 
 227, 228, 229, 233, 568, 602, 638, 644, 
 688, 708, 751, 761, 762, 764 
 Heath, 224, 229 
 Heath, W. H„ 483 
 Hedenius, P., 93 
 Heear, 149, 578, 617 
 Helie, 135, 137 
 
 Henle, 121, 142, 172. 1S7, 188, 189, 230 
 
 Hening, 137, 163, 169 
 
 Hennig, 536, 56S, 582 
 
 Heppner, 269 
 
 Hermann, 107 
 
 Herrick, O. E., 56 
 
 Herzfelder, 738 
 
 Heschl, 600, 645, 746 
 
 Hewitt, Graily, 622, 654, 663, 73S 759 
 
 Heyer, 738 
 
 Heywood, 478 
 
 Hicks, Braxton, 694 
 
 Hildebrandt, 498, 499, 515, 537, 539 
 
 His, W., 94 
 
 Hodge, H. L., 29, 63, 599 
 Hodgen, 487 
 Hoggan, 643 
 Holden, 187, 497 
 Holyoke, 22 
 
AUTHORS’ INDEX. 
 
 77b 
 
 Howard, Wm. T., 58 
 Huguier, 113, 511, 736, 737,741 
 Hunter, 33 
 Hunter, J. B., 56 
 Hutchinson, 523, 527 
 Hyatt, H. O., 264 
 Hyrtl, 198, 266, 516 
 
 I. 
 
 Ill, J. E„ 444. 
 
 Imbert, G., 94 
 
 J. 
 
 Jackson, A. Reeves, 39, 53, 536, 616 
 Jacobi, 643, 644, 646, 647, 652 
 Jacobi, Mary Putnam, 59, 410, 437, 602, 
 638, 641, 647, 662 
 Jacobson, L., 94 
 Jenks, Edward W., 52, 55, 513 
 
 K. 
 
 Kaltzenbach, 578 
 Kammerer, 377, 454, 462 
 Kaposi, 527 
 Kaschkaroff, 660 
 Ivehrer, 421, 441, 462, 617 
 Kelly, H. A., 58 
 Kennedy, 536, 580 
 Kerkring, 239 
 Kidd, 580 
 
 Kimball, Gilman, 45, 61 
 King, John, 28 
 Kirmisson, 534 
 
 Kiwisch, 511, 542, 547, 599, 638 
 Klebs, 268, 271, 738 
 Klein, 121, 139, 142, 164, 172, 176, 190 
 Klemm, 582 
 
 Ivlob, 534, 539, 542, 546, 574, 599, 601, 
 608, 637, 645, 649, 650, 660 
 Ivobelt, 104, 109, 112 
 Koch, 519, 523, 530 
 Kocks, J., 71, 94 
 
 Kolliker, A., 69, 73, 79, 83, 84, 85, 91, 94, 
 237 
 
 Konig, 219, 723 
 Krause, 104 
 Ivreiger, 738 
 Kuhne, 766, 767 
 Kundrat, 409 
 Kussmaul, 247 
 Kustner, 539 
 
 L. 
 
 Lallemand, 581 
 Lamballe, J. de, 377 
 Langenbeck, 242 
 Langier, 737 
 
 Langlade and Cummen, 239 
 
 Lazarewitch, 655 
 
 Le Bee, 123, 131, 146, 687 
 
 Lebeeleff, 261 
 
 Lee, C. 0., oo, / 08, / 40 
 
 Lefort, 243 
 Lenoir, 737 
 
 Lente, F. D., 39, 578, 581. 
 
 Leopold, 129, 140, 141, 172, 409, 554, 643, 
 644, 679, 680, 687 
 Lever, 640 
 Levy, 454 
 Lewis, W., 63 
 Lindgren, 142 
 Lisfranc, 599, 638 
 Lister, 165, 339 
 Litzman, 443 
 Lott, 141 
 Louis, 261 
 Lowenthal, 309 
 
 Luschka, 102, 121, 132, 169, 186, 188, 193, 
 221 
 
 Lusk, 101, 107, 142, 492, 536, 651, 711, 713 
 Lyman, Geo. H., 28, 48, 731 
 
 M. 
 
 McCarthy* Justin, 705 
 i McClintock, A., 532, 677, 707, 711,728, 
 735, 736, 738, 750, 752 
 McCormick, 758, 768 
 McDowell, 23, 29, 30 
 Madge, 738, 740, 755, 762 
 Mann, Matthew D., 56, 127, 131, 334, 339 
 Mapother, 447 
 Marchal, 676, 677 
 Marrotte, 761 
 Marsh, Howard, 727 
 Martin, 648 
 
 Martin, Franklin H., 365, 617, 666 
 
 Mason, 477 
 
 Massot, 532 
 
 Mayer, 243, 527, 538 
 
 Meadows, 736, 738, 739, 742, 761, 769 
 
 Meigs, C. D., 29, 63, 502, 654 
 
 Meniere, 405 
 
 Meyer, 1L, 77, 94, 271 
 
 Meyer, Leopold, 236 
 
 Miller, Henry, 377, 581 
 
 Milne, Edwards H., 70, 94 
 
 Minor, Julius F., 3S 
 
 Mitchell, Weir, 610, 633 
 
 Monod, 737 
 
 Morel, 237 
 
 Morris, 722 
 
 Muller, J., 85 
 
 Munde, 50, 53, 66, 250, 327, 398, 405, 443, 
 444, 480, 528, 554, 561, 578, 666, 679, 
 681 
 
 N. 
 
 Nandier, 710, 715 
 Nega, 242 
 
 Nelaton, 735, 736, 737, 745, 747 
 Newman, Robert, 61 
 Nickles, 663 
 
 Noeggerath, E., 37, 38, 45, 48, 431, 459, 
 460, 571, 599, 608, 617,' 638, 660, 691 
 Nona, 767 
 I Nonat, 627, 677 
 
774 
 
 AUTHORS’ INDEX. 
 
 Nott, J. C., 30, 377, 516, 518 
 Is y lander, 141 
 
 O. 
 
 Olshausen, 209, 23G, 617, 652, 713, 738, 765 
 
 Oribasius, 676 
 
 Orne, 22 
 
 Osgood, 22 
 
 Ott, 737 
 
 P. 
 
 Paget, 527, 552, 731 
 Palfvn, 261 
 
 Pallen, Montrose A., 45, 443 
 Palmer, C. D., 35, 57 
 Pare, Ambroise, 22 
 Parry, John S., 39 
 Parvin, Theophilus, 38 
 Pattee, A. F., 62 
 Paulus JEgineta, 21 
 Pauly, 742 
 
 Peaslee, 36, 37, 64, 243, 245, 377 
 Peuch, 737 
 
 Peuch, A., 94, 236, 237, 255, 743 
 
 Pfluger, 176, 409 
 
 Phillips, 758 
 
 Physick, 26 
 
 Pick, 524 
 
 Pirogoff, 212, 488, 683 
 Playfair, 568, 580, 633 
 Polk, Wm. M., 56, 60, 192, 193, 210, 212, 
 215, 682, 688, 698, 699, 717 
 Pooley, J. H., 261 
 Post, Alfred C., 58 
 Post, Sarah E., 60 
 
 Poncet, 737, 740, 749, 751, 754, 756, 765, 
 766 
 
 Priestley, 542 
 Prochownick, 239 
 Prost, 737 
 Puzos, 676 
 
 Q. 
 
 Quain, 94, 105, 107, 112, 136, 224 
 
 R. 
 
 Raciborski, 740 
 Rainey, 159 
 
 Ranney, 101, 102, 105, 108, 113, 131, 141, 
 218, 228, 233 
 Rasch, 759 
 Recamier, 22, 30, 581 
 Reinmann, 547 
 Reyer, 525 
 Richard, 476 
 Richardson, W. L., 719 
 Richet, 740 
 Ricard, 593 
 Rieder, Carl, 72, 94 
 Rindfleisch, 748 
 Ringer, Sidney, 365, 562 
 Robert, 737 
 Robin, C. H., 124, 707 
 Rogers, D. L., 27 
 Rokitansky, 248, 546, 743 
 Rose, Cooper, 245 
 
 I Rosenmiiller, 75 
 Rouget, 139 
 Routh, 477, 568 
 Ruge and Veit, 143, 587 
 Ruysch, 737 
 
 S. 
 
 Sanderson, 678 
 Sanger, 536 
 
 Savage, 98, 99, 108, 109, 121, 135. 140. 157, 
 183, 186, 188, 189. 210, 226, 229, 684^ 
 701, 723, 724 
 
 i Scanzoni, 377, 516, 541 , 547, 568, 599, 637, 
 641, 652, 661, 664, 722, 73S, 740, 745 ' 
 Schafer, 216 
 
 | Schroeder, 118, 354, 477, 480, 528, 542, 
 568, 617, 644, 646, 654, 705, 722, 738. 
 746 
 
 Schuller, 180 
 Schultz, 654 
 Schultze, 718 
 Schuppert, M., 38 
 Schuregius, 515 
 i Schwimmer, 524 
 Scott, John, 59 
 Scultetus, 22 
 Sedgwick, 86 
 Serdukopf, Ar., 655 
 Shatz, F., 94 
 Silvestre, 749 
 
 Simon, 29, 1S7, 617, 709, 710, 715 
 Simpson, A. R., 653, 724 
 Simpson, Jas., 377, 511, 516, 536, 568, 637, 
 638, 640, 641, 644, 646, 661, 664. 727. 
 732, 738, 769 
 
 Sims, J. Marion, 30, 34, 36, 37, 39. 45, 60, 
 63, 475, 514 
 Sinclair, 600 
 
 Sinetv, L. de, 91, 94. 116, 117, 124. 125, 
 140, 143, 167, 475, 587, 644. 647. 652 
 Sircday, 752 
 
 Skene, Alex., 46, 48, 65, 71, 94, 185, 1S8 
 
 Smellie, 23 
 
 Smith, A. G., 27 
 
 Smith, N., 27 
 
 Smith, Tyler, 568, 739 
 
 Smyly, 759 
 
 Spiegelberg, 607, 686, 6S8 
 Stearns, 26 
 Steurer, 706 
 
 Storer, H. R., 36, 3S, 63, 450 
 j Strieker, 140 
 I Stroinsky, O., 55 
 Surgus, Damien, 496 
 Sussdorff, 322 
 
 T. 
 
 Tait, Lawson. 169, 172, 180. 267. 409. 503, 
 505, 509, 519, 688, 691,695, 701. 704. 
 705, 722, 724, 729, 730, 73S, 742, 752. 
 766, 769 
 
 Taliaferro, V. A.. 38 
 Tardieu, 262. 741 
 
 Taylor, I. E., 28, 57, 241. 259, 519. 567 
 Thin, 520, 527, 
 
AUTHORS' INDEX. 
 
 775 
 
 Thomas, T. G., 28, 36, 38, 49, 51, 54, 59, 
 63. 118, 355, 486, 510, 518, 542, 567, 
 568, 580, 599, 617, 638, 643, 660. 661, 
 664, 677, 705, 710, 727, 732, 738 
 Tilt, 738, 739 
 Tripier, 396, 764, 765 
 Trousseau, 562, 710, 742, 743 
 Turner, 141 
 Turnipseed, E. B., 263 
 
 U. 
 
 Ulrich, 738 
 
 V. 
 
 Van Buren, Wm. H., 678 
 
 Van de Warker, E., 51, 53, 132 
 
 Veit, 723 
 
 Velpeau, 677 
 
 Vidal, 527, 582 
 
 Vigues, 737 
 
 Virchow, 237, 520, 527, 547, 675, 678, 701, 
 705, 738, 741 
 
 Voisin, 737, 738, 739, 743, 748, 751, 755 
 Von Haselberg, 583 
 Von Preuschin, 124 
 Von Recklinghausen, 706 
 
 AV. 
 
 Waklever, W., 68, 84, 86, 94, 172, 237, 270, 
 678 
 
 Walker, H. 252 
 
 Warren, J. C., 27, 54 
 
 Wassilieff, M., 72, 94 
 
 Watts, R., 72 
 
 Webster, E. II., 340 
 
 Wells. Spencer, 168, 480, 742 
 
 Wernick, 443 
 
 West, 568, 677, 716 
 
 White, J. C., 523 
 
 White, J. P., 36, 37 
 
 Whittaker, J. T., 242 
 
 Williams, 141, 144, 155, 409, 759 
 
 Wilson, Ellwood, 667, 672 
 
 Wiltshire, 760 
 
 Winckel, T., 94, 186, 236, 445. 461, 488, 
 491, 497, 530, 537, 678, 723, 740 
 Wolff, Casper Friedrich, 68 
 Wunderlich, 694, 702 
 Wylie, G., 135 
 
 Z. 
 
 Zweit'el, 515, 536, 538 
 
INDEX TO VOLUME I 
 
 A. 
 
 Abdomen, examination of, 306 
 inspection of, 306 
 mensuration of, 307 
 palpation of, 307 
 
 Abdominal section in pelvic peritonitis, in- 
 dications for, 7 04 
 
 Abdomino-rectal examination, 301 
 Abortion, treatment of hemorrhage after, 
 419 
 
 Abscess, chronic pelvic, 56, 60 
 pelvic, 721 
 aspirating sac, 731 
 diagnosis of, 726 
 opening sac, 728 
 pathological anatomy, 722 
 sinuses, 732 
 treatment of, 727 
 Acute eczema of vulva, 503 
 metritis, 546 
 
 Adenitis, periuterine, 680, 759 
 Adeno-lymphangitis, 680, 759 
 Adhesions, pelvic, treatment of, 51-54 
 Air, fresh, importance of, 622 
 Alcoholics, use of, 624 
 Alexander’s operation, 160 
 Alopecia of vulva, 500, 501 
 Amenorrhoea, 411 
 electricity in, 391 
 treatment of, 364, 413 
 Amputation of cervix, high, 150 
 in metritis, 617 
 Anaesthesia in operations, 338 
 Angeioleucitis, 680 
 Angioma of vulva, 536 
 AnteHexion. cause of dysmenorrhcea, 423 
 of uterus, 256 
 Antisepsis, agents for, 329 
 
 in gynecological operations. 328 
 Antiseptic injections in childbed, 662 
 Antiseptics in lupus, 523 
 Anus, fissure of, causing dyspareunia, 453 
 Apoplexy of ovary, 745 
 Appendages, uterine, 161 
 
 disease of, complicating dysmenor- 
 rhoea, 420 
 
 Applications, intra-uterine, agents, 381 
 by applicator syringe, 578 
 by ingestion, 577 
 
 Applications, intra-uterine method, 380 
 topical, in endometritis, 559 
 Applicator, cotton-wrapped, 577 
 hard rubber, 564 
 Sims’s, 580 
 
 Applicator syringe, 578, 5S1 
 Arbor vitse uterina, 134, 137 
 Arsenic, use of, in metritis, 612 
 value of, 372 
 Arteries of ovaries, 179 
 uterus, 143 
 
 Artificial impregnation, 475 
 Aspermatism, 453 
 Aspiration for diagnosis, 326 
 Aspirators, 326 
 Assistants in operations, 340 
 Astringents in congestion, 563 
 Atresia ani vaginalis, 261 
 of hymen, 262 
 of uterus, 253 
 of vagiua, 257, 458 
 of vulva, 267 
 treatment of, 478 
 Atrophy of uterus, 599 
 treatment of, 618 
 
 Auscultation and percussion of abdomen, 
 306 
 
 B, 
 
 Bacillus tuberculosis in lupus, 519 
 Bartholin, glands of, 1 13. (See Vulvo-vaginal 
 Gland.) 
 
 Bathing in uterine disease, 621 
 Baths, hip, in subinvolution, 663 
 sun, 621 
 
 Battey’s operation, 39-49 
 Battey on removal of ovaries, 39, 49 
 Belladonna, action of, 370, 373 
 Bimanual examination, method, 298 
 Bladder, anatomy of, gross, 188 
 minute, 190 
 
 diseases of, works on, 65 
 ligaments of, 207 
 relations and attachments, 191 
 sphincter of, 1S9 
 supports of, 225 
 symptoms, importance of, 291 
 Bleeding, local, in chronic metritis, 613 
 Boils on vulva, 494 
 
 J Bowels, attention to function of, 370, 626 
 
 777 
 
INDEX TO VOLUME I. 
 
 Broad ligaments, 207 
 contents of, 209 
 in pregnancy, 208 
 Bromides, value of, 365, 374 
 Bulb of ovary, 180 
 Bulbs of vagina, 112 
 of vestibule, 112 
 Bursting cysts of abdomen, 54 
 Buttle’s spear, 613 
 Buttonhole incision of urethra, 54 
 
 C. 
 
 Cancer as a cause of metrorrhagia, 417 
 of cervix, excision fox', 62 
 of vulva, 537 
 
 pelvic, diagnosis from hsematocele, 761 
 Cai'bolic acid in dysmenorrhcea, 428 
 Carcinoma of vulva, 539 
 Caruncles of urethra causing dyspareunia, 
 451 
 
 electricity in, 404 
 Carunculse myrtiformes, 118 
 Cases, rational history of, 284 
 Catgut for sutures, 339 
 Catheter, passing the, 115, 197 
 Cedron as tonic, 369 
 Cellulitis, pelvic, 705 
 diagnosis, 714 
 from fibroids, 718 
 from haematocele, 717 
 electi'icity in, 404. 
 etiology, 706 
 exudation, seat of, 715 
 pathology, 708 
 prognosis, 718 
 pus in, 710 
 symptoms, 710 
 lion-puerperal, 713 
 puerperal, 711 
 treatment of, 60 
 curative, 719 
 prophylactic, 718 
 remarks on treatment of, 220 
 Centennial year, 46, 49 
 Cervical protector, Wylie’s, 428 
 Cervix, amputation of, in metritis, 617 
 anatomy of, 587 
 
 appearances of, in Sims’s speculum, 314 
 congestion of, glycerin and boro-gly- 
 cerides in, 562 
 cystic degenei'ation of, 591 
 falsfe ulceration of, 587 
 forcible dilatation of, 41. (See also 
 Dilatation.) 
 
 granular degeneration of, 589 
 high amputation of, 150 
 in laceration, 149 
 in old age, 149 
 
 lacerations of, causing subinvolution, 651 
 operation for lacerated, 58 
 history of, 37 
 
 pathological anatomy of, 588 
 pelvic peritonitis following operations 
 upon, 698 
 
 shape and size of, 133 
 
 Cervix, stenosis, dangers of incision for, 
 151 
 
 syphilitic ulceration of, 593 
 true ulceration of, 593 
 Chadwick’s table, 295 
 Change of life, 436. (See Menopause.) 
 Chloral, use of, 374 
 Chromic acid as application, 566, 580 
 Chronic eczema of vulva, 514 
 metritis, 602 
 
 hot douche in, 613 
 quinine in, 630 
 sponge tents in, 616 
 pelvic abscess, 56, 60 
 peritonitis, 696 
 Clinic, first gynecological, 30 
 Clitoris, anatomy of, 106 
 attention to, necessai'y, 621 
 hypertrophy of, 447 
 treatment, 477 
 malformations of, 266 
 Cocaine, use of, 381 
 Coccyodynia, 516 
 
 causing dyspareunia, 452 
 Nott on, 30 
 
 Coccyx, neuralgia of, 516 
 removal of, 518 
 Coflee, use of, 624 
 
 Coitus during menstruation, effects of, 743 
 excessive, as cause of subinvolution, 652 
 hindrances to, from malformations, 446 
 impossible, causes of, 446 
 painful, 448 
 
 spasm in, fi-om vaginismus, 515 
 Colica scortoi'um, 701 
 Columbia Hospital, report of, 41 
 Condyloma, examination, 298 
 syphilitic, of vulva, 531, 534 
 venereal, of vulva, 537 
 Congestion, use of astringents in, 563 
 Conjoined examination, 298 
 Connective tissue, pelvic, 215, 684 
 continuity of, 219 
 
 practical deductions on anatomy of, 
 219 
 
 Constipation, treatment of, 390, 627 
 Constitutional treatment of chronic uterine 
 disease, 363, 619 
 
 Constriction at os internum, 152, 421 
 Contraction of os, 561 
 Corpus luteum, hemorrhage from, 745 
 Counter -indications of hot douche, 559 
 Course of chronic metritis, 601 
 of subinvolution of uterus, 659 
 Cowper’s glands, analogues of, 113 
 Cumulus ovigerus, 83 
 Cupping the uterus, 614 
 Curette, in endometritis, 596 
 forceps, of Emmet, 597 
 Becamier’s, 596 
 sharp, use of, 567 
 Simon’s spoon, 361, 597 
 Sims’s, latest form of, 41S 
 Thomas’s, 360, 596 
 used for diagnosis, 324 
 varieties of, 324 
 
INDEX TO VOLUME I. 
 
 779 
 
 Curetting, method of, 598 
 the cervical canal, 567 
 Current, electrical, strength, 387 
 Cyst of parovarium, 75 
 of round ligament, case of, 4S8, 535 
 Cystic degeneration of cervix, 591 
 Cystocele, definition of, 4S7 
 Cystotomy, 126 
 
 Cysts, bursting, of abdomen, 54 
 of Gartner’s canal, 72, 535 
 of round ligament, 488 
 case of, 535 
 of vulva, 534 
 
 of vulvo-vaginal gland, 534 
 sebaceous, of vulva, 535 
 
 I>. 
 
 Dagget’s examining-table, 296 
 Decidua, uterine, 140 
 Defecation, importance of, as a symptom, 
 292 
 
 Denudation in plastic operations, 346 
 Depletion, local, 562 
 
 in chronic metritis, 613 
 uterine, value of, 379 
 Depressor, Sims’s, 311 
 Diagnosis, artificial prolapse of uterus in, 
 325 
 
 gynecological, 283 
 of chronic metritis, 606 
 of early pregnancy, 149, 151 
 of endometritis, chronic cervical, 554 
 corporeal, 574 
 of masturbation, 478 
 of pelvic cellulitis, 705 
 hsematocele, 757 
 differential, 763 
 from cellulitis, 717 
 from hsematoma, 761 
 haematoma, 766 
 peritonitis, 697 
 from hsematocele, 759 
 of periuterine inflammation, 658 
 of phlegmon of broad ligament from 
 pelvic hsematocele, 763 
 of retroflexion of gravid uterus, 758 
 of sterility, 464 
 
 of subinvolution of uterus, 655, 659 
 of tumors from subinvolution, 658 
 position of uterus in, 300 
 use of microscope in, 327 
 Diaphragm, pelvic, 223 
 Diet, importance of, in disease, 622 
 Dietetics, directions for, 368 
 Digestion, attention to, 625 
 Digital examination in left lateral position, 
 310, 315 
 method, 298 
 
 Dilatation of cervix, advantages of differ- 
 ent methods, 357 
 by sounds, 359 
 dangers of, 359 
 for diagnosis, 319 
 for surgical purposes, 354 
 forcible, 41, 153 
 
 Dilatation of cervix, in dvsmenorrhoea, 
 427, 433 
 
 Dilators, uterine, Emmet’s, 321 
 Fritsch’s, 358 
 Goodell’s, 319 
 Hanks’s, 320 
 Molesworth’s, 320, 322 
 Nott’s, 358 
 Palmer’s, 320, 560 
 Peaslee’s, 559 
 Schultze’s, 358 
 Sims’s, 427 
 
 Dimensions of uterus, 132, 152 
 Diphtheritic vulvitis, 492 
 Discharge, vaginal, as a symptom, 292 
 Discus proligerus, 83 
 
 Disorders of menstruation, electricitv in, 
 388 
 
 Displacements cause subinvolution, 653 
 genu-pectoral position in, 46, 129 
 uterine, electricity in, 390 
 Divulsion in dysmenorrhoea, 429 
 Dorsal position in examination, 297 
 Double uterus, pregnancy in, 252 
 relation to superfoetation, 253 
 vagina, 259 
 
 Douche, hot-water, 379, 414 
 counter-indications, 559 
 in cervical endometritis, 556 
 in chronic metritis, 613 
 in endometritis, 545 
 in pelvic peritonitis, 754 
 indications, 558 
 mode of use, 557 
 Douglas, folds of, 210 
 Douglas’s pouch, anatomy of, 211 
 boundaries of, 683 
 dangers of wounding, 127 
 depth of, 214 
 
 intestines in, 147, 212, 488 
 Drainage in ovariotomy, 45 
 Drainage-tubes, Wylie’s intra-uterine, 429 
 Dress, importance of attention to, 621 
 rules for, 610 
 Ducts, Gartner’s, 70 
 Mullerian, 85 
 Skene’s, 71 
 Wolffian, 68 
 
 Duverney, glands of, 113. (See Vulvo- 
 vaginal. ) 
 
 Dysmenorrhoea, 419 
 caused by retroflexion, 423 
 causes of, 421 
 classes most liable to, 424 
 complications of, 420 
 divulsion in, 429 
 electricity in, 390 
 forcible dilatation in, 433 
 glycerin and boro-glycerides in, 426 
 membranous, 434 
 pessaries in, 434 
 treatment of, 425 
 by dilatation, 427 
 by divulsion, 429 
 by sounds, 433 
 by sponge tents, 433 
 
780 
 
 INDEX TO VOLUME I. 
 
 Dyspareunia, causes of, 448-452 
 caused by lacerations of cervix, 458 
 
 E. 
 
 Eczema of vulva, 503 
 chronic, 514 
 
 Electrical current, dangers from, in extra- 
 uterine pregnancy, 406 
 strength of, 387 
 
 in extra-uterine pregnancy, 406 
 in uterine fibroids, 402 
 Electricity, in amenorrhoea, 391, 414 
 in chronic pelvic inflammation, 404 
 in diseases of menstruation, 388 
 in dysmenorrhoea, 390 
 in extra-uterine pregnancy, 405, 406 
 in fibroid tumors, 399 
 in hyperplasia uteri, 404 
 in menorrhagia, 391 
 in ovarian tumors, 398 
 in ovaritis and ovarian neuralgia, 393 
 in periuterine hematocele, 397 
 in subinvolution of uterus, 393 
 in subinvolution of vagina, 672 
 in superinvolution of uterus, 395 
 in uterine displacements, 396 
 in uterine stenosis, 405 
 note on use of, 632 
 use of, in gynecology, 373, 383 
 Electrization, localized, method of, 385 
 Electrodes, covering of, 387 
 size of, 388 
 
 Electrolysis in fibroids, 399 
 electrodes in, 404 
 in ovarian cysts, 50 
 pain in, 401 
 results in, 403 
 strength of current in, 402 
 Elephantiasis Arabum, 524 
 distinguished from fibroma difiusum, 527 
 Emmenagogues, 366, 414 
 Emmet’s needle-holder, 348 
 operation, invention of, 37 
 Enehondroma of vulva, 536 
 Endocervicitis, silver nitrate in, 564 
 use of zinc in, 565 
 Endometritis, acute, 541 
 
 as a cause of subinvolution, 652 
 caused by gonorrhoea, 542 
 chronic, 548 
 cervical, 549 
 cause, 551 
 complications, 554 
 diagnosis, 554 
 frequency, 549 
 hot douche in, 556 
 pathology, 550 
 physical signs, 553 
 prognosis, 555 
 symptoms, 552 
 treatment, 555, 560 
 corporeal, 56S 
 cause, 570 
 diagnosis, 574 
 frequency, 568 
 
 Endometritis, chronic corporeal, pathol- 
 ogy, 569 
 prognosis, 575 
 symptoms, 572 
 treatment, 575 
 ingestion, 577 
 local method, 577 
 general, 568 
 fungoid, 574 
 curette in, 596 
 hot douche in, 545, 556 
 septic, 545 
 silver nitrate in, 581 
 Enucleation of fibroids, 44, 45 
 of pedicle, 38 
 Epispadias, 265 
 treatment of, 477 
 Epithelioma of vulva, 537 
 Erectile organs of female, 10S 
 Ergot, action of, on sexual organs, 371 
 discovery of, 26 
 in uterine fibroids, 45 
 Erysipelas of vulva, 504 
 Erythema of vulva, 503 
 Esthiomene, 518 
 
 Etiology of chronic metritis, 602 
 of dysmenorrhoea, 421 
 of dyspareunia, 448. 
 of pelvic cellulitis, 706 
 hematocele, 73S 
 hematoma, 765 
 peritonitis, 690 
 
 of periuterine inflammation, 677 
 of sterility, 467 
 of subinvolution of uterus, 649 
 of vagina, 669 
 Examination, bimanual, 298 
 digital in dorsal position, 298 
 in erect position, 316 
 in genu-pectoral position, 316 
 in left lateral position, 310, 315 
 in Sims’s position, 310 
 dorsal position in, 297 
 in diagnosis, 296 
 in sterility, 466 
 of abdomen, 306 
 of rectum, 318 
 rectal, 301 
 
 recto-abdominal, 301 
 specular, 304, 313 
 vaginal, method of, 29S 
 vesico-rectal, 302 
 Examining-tables, 294 
 Excision of cervix for cancer, 62 
 Exercise, importance of, 620 
 Exploration, rectal, 29 
 External genitals, anatomy of, 96 
 os, 133 
 
 Extra-uterine pregnancy, cause of liamia- 
 tocele, 746 
 
 dangers from electrical current in, 406 
 distinguished from hematocele, 759, 
 763 
 
 electricity in, 405, 406 
 operations for, 28 
 Exudation in pelvic cellulitis, 715 
 
INDEX TO VOLUME I. 
 
 781 
 
 F. 
 
 Fallopian tubes, anatomy of, 161 
 catarrh of, 163 
 development of, 87 
 hemorrhage from, 642, 746 
 malformations of, 237 
 mucous membrane of, 164 
 permeability by fluids, 582 
 by probe, 152 
 Faradization, general, 384 
 Fecundation, conditions of, 441 
 Fibroid tumors cause hemorrhage, 416 
 of uterus, electricity in, 399 
 uterine, removed through anterior vag- 
 inal wall, 56 
 
 Fibroids diagnosed from cellulitis, 718 
 from hasmatocele, 761, 763 
 electricity in, 60 
 of uterus, enucleation of, 44 
 removed by laparotomy, 57 
 Fibroma and fibro-myoma of vulva, 529 
 diffusum of vulva, 526 
 Fibrous tumors of uterus, Atlee on, 28 
 Fissure of vulva, 494 
 
 of anus, causing dyspareunia, 453 
 Fistula, artificial vesico-vaginal, history 
 of, 34 
 
 in ano, operation for, 55 
 urethro-vaginal, Parvin's operation for, 
 3S 
 
 vesico-vaginal, history of, 30 
 operation for, 30, 50 
 Floor, pelvic, anatomy of, 222 
 Follicular vulvitis, 492 
 Food, care in diet, 622 
 value of, in pelvic disease, 369 
 Forceps, tissue, 345 
 twisting, for wire, 352 
 vulsellnm, 342, 349 
 
 Forcible dilatation in dysmenorrhcea, 433 
 Formulae for constipation, 629 
 for pruritus vulvse, 508 
 for tonics, 626, 631 
 Fourchette, anatomy of, 102, 105 
 Fungoid degeneration of endometrium, 594 
 Fungosities, uterine, 594 
 Furunculosis vulvse, 494 
 
 G. 
 
 Galvanometer, necessity for, 387 
 Gangrene of vulva, 496 
 Gartner’s ducts, 70, 181 
 Gaseous tumor of vulva, 536 
 Genu-pectoral position for displacements, 
 46, 129 
 Geodes, 139 
 
 Gestation, incapacity for, 461 
 treatment, 472 
 Giraldez’s body, 75 
 
 Gland, Skene’s, of urethra, 71, 180, 185, 
 796 
 
 of Bartholin. (See Vulvo-vayinal Gland.) 
 vulvo- vaginal, catarrh of, 499 
 Glands, utricular, 140 
 
 Glycerin and boro-glycerides in dysmenor- 
 rhoea, 426 
 to vagina, 414 
 as a depleting agent, 380 
 in chronic metritis, 615 
 in congestion of cervix, 562 
 Gold, chloride of, action of, 372 
 Gonorrhcea, cause of endometritis, 542 
 pelvic inflammation, 691 
 warts of vulva, 536 
 latent, 48, 691 
 
 cause of sterility, 460 
 Gonorrhoeal vulvitis, 492 
 Graafian follicles, anatomy of, 17 6 
 development of, 82 
 Gravid uterus, injuries of, 55 
 j Granular degeneration, like cancer, 590 
 Greek gynecology, review of, 18 
 Gutheris’s muscle, 186 
 Gymnastic exercises, value of, 376 
 Gynecological diagnosis, 283 
 examining-table, 294 
 Society, American, 46, 64 
 Gynecology, chairs of, 66 
 first American article on, 22 
 history of, 17 
 works on, 63, 65, 66 
 
 H. 
 
 Haematocele and haematoma, 736 
 
 caused by extra-uterine pregnancy, 746 
 distinguished from extra-uterine preg- 
 nancy, 759 
 first essays on, 38 
 pelvic, 735 
 
 bloody urine in, 754 
 boundaries of sac, 748 
 causes, 738 
 contents of sac, 749 
 contrast with haematoma, 748 
 diagnosis, 757 
 
 from cellulitis, 717 
 from haematoma, 761 
 of source of blood, 760 
 differential diagnosis, table, 763 
 history, 737 
 
 mobility of uterus in, 759 
 pathology, 743 
 symptoms, 750 
 temperature in, 750 
 termination of, 755 
 tumor in, 754 
 
 ulceration of cyst-wall, 756 
 peritonitis following, 747 
 periuterine, electricity in, 397 
 Haematoma of ovary, case of, 749 
 of vulva, 497 
 pelvic, 764 
 anatomy, 764 
 causes, 765 
 diagnosis, 766 
 prognosis, 766 
 symptoms, 766 
 treatment, 767 
 Haemostatics, 418 
 
782 
 
 INDEX TO VOLUME I. 
 
 Hair, inversion of, on labia, 502 
 Headache, treatment of, 634 
 Hemorrhage after abortion, treatment of, 
 419 
 
 from corpus luteum, 745 
 from Fallopian tubes, 642, 746 
 from vulva, 115 
 Heredity, importance of, 286 
 Hermaphrodism, 267 
 
 case of Carl Hohmann, 273 
 spurious, 277 
 Hernia, inguinal, 482 
 labial, anterior, 482 
 perineal, 487 
 pudendal, 486 
 uterine, 257 
 vaginal, 483 
 ventral, 60 
 Herpes of vulva, 502 
 History of gynecology, 17 
 rational, of cases, 284 
 Hohmann, C., the hermaphrodite, 273 
 Hook, counter-pressure, 349 
 Hot-water douche. (See Douche.) 
 
 Hot water, history of use of, 61 
 Hottentot apron, 267 
 Houston, valve of, 267 
 Hydatids of Morgagni, 238 
 Hydrocele, 488 
 
 case of forming large cyst, 535 
 Hymen, anatomy of, 117 
 atresia of, 262 
 development of, 92 
 examination of, 125 
 forms of, 118 
 malformations of, 262 
 medico-legal importance of, 118 
 of negro race, 263 
 resisting, 447 
 
 Hyoscine, hydrobromate of, 373 
 Hypersemia, uterine, 599 
 Hyperesthesia of vulva; cause of dyspa- 
 reunia, 450 
 
 Hyperplasia, areolar, of uterus, 599 
 electricity in, 404 
 Hypertrophy, uterine, 599 
 of clitoris, 447 
 treatment, 477 
 Hypospadias, 265 
 treatment of, 477 
 
 Hysterectomy, vaginal, position for, 128 
 Hystero-neurosis, 50 
 
 I. 
 
 Ice, use of, after operations, 333 
 Impregnation, artificial, 475 
 Incontinence of urine after dilatation of 
 urethra, 196 
 
 Induration, pelvic treatment of, 51 
 Inflammation of vulvo-vaginal gland. 500 
 Inflammatory exudations, cause of dyspa- 
 reunia, 451 
 Inguinal hernia, 482 
 Injections, intra-uterine, 582 
 of hot water. (See Douche.) 
 
 Injections, parenchymatous, 616 
 Injuries and wounds of vulva, 479 
 Insemination, incapacity for, 442 
 Inspection of abdomen, 306 
 of vulva, 297 
 
 Instruments, mode of cleaning, 330 
 operating, 340 
 
 Intercourse, sexual. (See Coitus.) 
 
 Internal os, 134 
 Intra-uterine applications, 381 
 injections, 582 
 counter-indications, 585 
 to prevent dangers of, 584 
 medication, 578. (See also A pplications . ) 
 Lente on, 39 
 value of, 377 
 medicator, Palmer’s, 579 
 Wylie’s, 428 
 
 scarification, knife for, 614 
 Inversion of inverted uterus, operation 
 for, 57, 62 
 
 Inverted uterus, reduction of, by White 
 and others, 37 
 
 Iodine, Churchill’s tincture of, 564 
 in chronic metritis, 615 
 Iodized phenol, 580 
 Iodo-tannin, 564 
 Iron as a tonic, 364 
 
 in chronic metritis, 612 
 Irrigation, antiseptic, in operations, 330, 
 331 
 
 of uterus, 332 
 
 J. 
 
 Journal of Obstetrics, A merican, 63 
 
 Iv. 
 
 Knife, Emmet’s ball-and-socket, 345 
 for scarification, 614 
 Ivolpo-hyslerectomv, first case of, 55 
 
 L. 
 
 Labia, hvpertrophv of, obstacle to coitus, 
 447 
 
 inversion of hair of, 502 
 majora, anatomy of, 9S 
 anatomy, gross, of, 100 
 minute, of, 101 
 minora, anatomy of, 101 
 arteries of, 104 
 malformations of, 266 
 treatment of hypertrophy of, 477 
 oozing tumor of, 531 
 Labial hernia, anterior. 482 
 Lacerations of cervix, cause of dyspareu- 
 nia, 450 
 
 cause of subinvolution, 651 
 operation for, 43 
 Laparo-elytrotomy, 46, 56 
 Latent gonorrhoea, 48, 691 
 Lateral displacement of uterus, 148 
 I Left lateral position, description of, 30S 
 digital examination in, 310 
 
1XDEX TO VOLUME I. 
 
 783 
 
 Left lateral position, objections to, 
 309 
 
 speculum in, 310 
 Leptothrix vaginalis, 500 
 Levator ani muscle, 220 
 spasm of, 515 
 
 Ligament, infundibulo-pelvic, 79 
 Ligaments, round, 157 
 of bladder, 207 
 saero-uterine, feel of, 127 
 uterine, 213 
 anatomy of, 207 
 support the uterus, 221 
 Ligatures, silk, mode of cleaning, 330 
 Lipoma of vulva, 530 
 Literature, lists otj 93, 278. tSee note in 
 Index of Authors for other pages, i 
 Local treatment of uterine disease, 370 
 Lupus, antiseptics in, 523 
 bacillus tuberculosis in, 519 
 of vulva, 518 
 perforans, 521 
 prominens, 521 
 serpiginosus, 521 
 treatment of, 523 
 Lymphangitis, adeno-, 080. 759 
 Lymphatics of uterus, anatomy of, 139, 0S6 
 
 M. 
 
 Malformations, hindrances to coitus, 410 
 of clitoris, 260 
 of hymen, 262 
 of ovaries, 235 
 of uterus, 23S 
 of vagina, 257 
 of vulva, 264 
 Massage, general, 632 
 uterine, 53, 616 
 value of, 375 
 
 Masturbation, diagnosis of, 478 
 Melanoma of vulva, 536 
 Membrana granulosa, formation of, 84 
 Membranous dysmenorrhcea, 431 
 pathology, 435 
 treatment, 435 
 Menopause, 436 
 symptoms referred to, 293 
 treatment of, 437 
 Menorrhagia, electricity in, 391 
 theory of, 4S 
 
 Menstruation, absence of, 411 
 disorders of, electricity in, 38S 
 excessive, 115 
 normal, 108 
 theories of, 409 
 painful, 419 
 questioning about, 287 
 scanty, 413 
 theory of, 59 
 vicarious, 415 
 
 Mensuration of abdomen, 307 
 Mental disease due to sexual disease, 50 
 Mercury, action of, on disease of sexual 
 organs. 372 
 
 Mesosalpinx, development of, 79 
 
 Mesovarium, development of, 77 
 Metritis, acute, 516 
 chronic, causes, 002 
 diagnosis, 006 
 
 glycerin and boro-glvceride in, 
 *615 
 
 iron in, 612 
 parenchymatous, 599 
 quinine in, 630 
 sponge tents in, 616 
 stages of, 601 
 symptoms, 605 
 treatment, 609 
 general, 610 
 special medication, 611 
 varieties, 601 
 
 Metrorrhagia, cancer as cause of, 417 
 curetting in. 418 
 fibroids as cause of, 416 
 treatment of, 417 
 Microscope in diagnosis, 327 
 Mineral waters, value- of, 010, 627 
 Mitchell’s, Weir, treatment, 610, 633 
 Mons Veneris, anatomy of, 97 
 Moral treatment, 635 
 Morgagni, columns of, 198 
 hydatids of, 238 
 
 Mucous membrane, uterine, 110 
 of cervix, 142 
 of the new-born, 91 
 of uterus, 136, 110 
 Mullerian ducts, development of, 85 
 Muscles, levator ani, 220 
 of pelvic floor, 225 
 of perineum, 230 
 Myoma of vulva, 529 
 Myrtiform caruncles. 118 
 Myxoma of vulva, 530 
 
 X. 
 
 Needle-holder, Emmet’s, 34S 
 Needles, mode of use, 317 
 varieties of, 347 
 Negro race, hymen of, 263 
 Nerve-sedatives, 372 
 Nerve-tonics, 364, 372 
 Nerves of clitoris, 109 
 
 and vessels of perineum, 232 
 of uterus, 143, 155 
 of uterus, 140, 142, 146 
 of vagina, 124 
 of vulva, 100 
 
 Nervousness, treatment of, 634 
 Neuralgia of coccyx, 516 
 ovarian, electricity in, 393 
 Neuroma, case of. causing dvspareunia, 
 452 
 
 of vulva, 536 
 
 New growths of vulva, 518 
 Nitrate of silver within the uterus, 5S1 
 Nitric acid as application, 565, 5S0 
 Nuck, canal of, 158, 160, 236 
 cyst in, 488 
 
 Nymphse, anatomy of, 101. (See Labia 
 Minora.) 
 
784 
 
 INDEX TO VOLUME I. 
 
 O. 
 
 Obstetric Gazette, 65 
 CEderna of vulva, 75, 495 
 O'idium albicans, cause of pruritus, 506 
 Ointments for intra-uterine use, 581 
 Oozing tumor of labia, 531 
 Operation for lacerated cervix, 58 
 for perineal rupture, 54, 55, 59, 234 
 for retroversion, 56 
 Operations during pregnancy, 334 
 plastic, 346 
 
 preparatory treatment, 336 
 two at once safe, 385 
 when to be done, 333 
 Opium in pelvic inflammation, 374 
 use of, in operations, 333 
 Orgasm, effect on uterus, 443 
 Os, contraction of, 561 
 external os tincse, 133 
 internum, 134 
 Osteoma of vulva, 536 
 Ova, formation of, 80 
 number of, 84 
 Ovarial tubes, 174 
 Ovarian corpuscle, Drysdale’s, 43 
 disease and dysinenorrhoea, 419 
 neuralgia, electricity in, 393 
 tumors, diagnosis from haunatocele, 7-: 
 electricity in, 398 
 works, writers on, 64 
 Ovaries, absence of, 236 
 anatomy of, 107 
 gross, 169 
 minute, 172 
 blood-supply of, 179 
 color of, 169 
 descent of, 78 
 development of, 76 
 indications for removal of, 40 
 malformations of, 236 
 position of, 1 67 
 
 practical deductions from anatomy c 
 181 
 
 prolapse of, 53 
 
 relations and attachments of, 168 
 to the tubes, 79 
 removal of, Battey on, 39, 49 
 rudimentary, 237 
 size of, in children, 85, 169 
 supernumerary, 236 
 Ovariotomist, McDowell the first, 24 
 Ovariotomists, early American, 27 
 Ovariotomy, drainage in, 45 
 euneleating the pedicle in, 38 
 high temperature after, 5 1 
 Lyman on, 28 
 septicaemia following, 37 
 vaginal, 40, 50 
 Thomas on, 38 
 Ovaritis, electricity in, 393 
 Ovary, apoplexy of, 745 
 bulb of, 180 
 
 epithelium covering, 172 
 hsem atom a of, 749 
 prolapse of, 37, 181 
 
 Ovary, prolapse of, in dyspareunia. 451 
 Oviducts. (See Fallopian Tabes.) 
 
 Ovula Nabothii, 143 
 Ovule, non-maturation of, 459 
 obstruction to passage of, 461 
 Ovulation, incapacity for, 458 
 Ovum, anatomy of, 177 
 primordial, 84 
 
 P. 
 
 Pachydermia of vulva, 524 
 Pachysalpingitis, 167 
 Packing the vagina, 53 
 Pain as symptom of uterine disease, 259 
 Palpation of abdomen, 307 
 Papilliform plexus, 180 
 hemorrhage from, 745 
 Papilloma of vulva, 530 
 Paradidymis, 76 
 Parametritis (see Cellulitis), 705 
 Parenchymatous metritis, chronic, 599 
 Parotitis following operations on genitals, 
 58 
 
 Parovarian cyst, cause of, 7 5 
 Parovarium, 75, 180 
 
 Pathology of endometritis, chronic cer- 
 vical, 550 
 
 chronic corporeal, 569 
 of membranous dysinenorrhoea. 435 
 of pelvic cellulitis, 70S 
 hsematocele, 743 
 peritonitis, 689 
 
 of subinvolution of vagina, 668 
 Pedicle, enucleating the, 38 
 Pediculosis pubis, 505 
 Pelvic abscess. (See Abscess.) 
 chronic, 56, 60 
 cellulitis, electricity in, 404 
 pus in, 710 
 exudation in, 715 
 connective tissue, anatomy of, 215 
 disease, physical signs of, 293 
 effusions, Brickell on, 49 
 floor, anatomy of, 222 
 muscles of, 225 
 physics of, 233 
 projection of, 234 
 spasm of muscles of, 511 
 lnvmatoma, 764 
 induration, treatment of. 51 
 inflammation caused bv gonorrhoea, 691 
 use of opium in, 374 
 peritoneum, anatomy of, 204, 682 
 peritonitis, 687 
 
 complicating dysinenorrhoea, 420 
 electricity in, 404 
 hot douche in, 754 
 sinuses from abscess, 732 
 vessels, enlargement of, 156 
 obstructions in, 155 
 Pencils, gelatin, 563 
 Perimetritis (see Peritonitis. Pelric), 68< 
 Perineal body, anatomy of, 22S 
 function of, 233 
 hernia, 487 
 
INDEX TO VOLUME I. 
 
 785 
 
 Perineal rupture, operation for, 54, 55, 59, 
 234 
 
 Perineorrhaphy, Jenks on, 52 
 Perineum, 229 
 
 failure in operations for rupture of, 42 
 muscles of, 230 
 nerves and vessels of, 232 
 primary operation for rupture of, 481 
 rupture of, operation for, 42, 54, 55, 59, 
 234 
 
 veins of, 103 
 Peritoneum, pelvic, 6S2 
 anatomy of, 204, 682 
 
 changes in pregnancy, 206 
 folds of, 207 
 
 Peritonitis, encysted tubercular, 58 
 hsemorrhagica, 741 
 following haematocele, 747 
 pelvic, 687 
 
 abdominal section in, 704 
 cause of, 690 
 chronic form, 696 
 
 common form of pelvic inflammation, 
 700 
 
 complicating dysmenorrhoea, 420 
 diagnosed from hoematoeele, 759 
 diagnosis, 697 
 electricity in, 404 
 exacerbations in, 695 
 following operations on cervix, 698 
 minor forms, 698 
 pathology of, 689 
 physical signs, 696 
 prognosis, 701 
 septic form of, 694 
 symptomatology, 693 
 treatment, 702 
 tumors in, 606 
 tubercular, 58, 692 
 
 Periuterine adenitis and angeioleucitis, 680 
 luematocele, electricity in, 397 
 inflammation, 675 
 definition, 675 
 diagnosis, 658 
 etiology, 677 
 history, 675 
 
 Permanganate of potash, 365 
 Pessaries, invention of, 62 
 in dysmenorrhoea, 434 
 Pessary, Hodge’s invention of, 27 
 Phenol, iodized, 580 
 
 I'lilegmon of broad ligament. (See Cel- 
 lulitis.) 
 
 diagnosed from pelvic luematocele, 
 763 
 
 Phlegmonous vulvitis, 493 
 Phosphates as nerve-tonics, 364 
 Phosphorus, use of, 373 
 Physical signs of pelvic disease, 293 
 Pityriasis versicolor of vulva, 504 
 Placenta, retained, causing subinvolution, 
 653 
 
 Plicae palmata?, 137 
 Plica urogenitalis, 68 
 Position, dorsal, 297 
 erect, examination in, 316 
 Vol. I. — 50 
 
 Position, genu-pectoral, examination in, 
 315 
 
 in gynecological diagnosis, 296 
 left lateral, examination in, 310 
 of uterus in diagnosis, 300 
 Post-partum hemorrhage, causing subinvo- 
 lution, 653 
 
 Practical deductions on anatomv of ovaries, 
 181 
 
 of pelvic connective tissue, 219 
 of pelvic peritoneum, 213 
 of rectum, 202 
 of urinary organs, 193 
 of uterus, 147 
 of tubes, 165 
 of vagina, 125 
 of vulva, 114 
 Precocity, 239 
 
 Pregnancy, early diagnosis of, 149, 151 
 in double uterus, 252 
 operations during, 334 
 treatment of cervix during, 567 
 tubal, 56 
 
 Preparatory treatment to operations, 336 
 Primordial ovum, 84 
 Probe, Emmet’s flexible, 315 
 introduction of, 315 
 
 Prognosis of endometritis, chronic cervi- 
 cal, 555 
 
 chronic corporeal, 575 
 of pelvic cellulitis, 718 
 hsematoma, 766 
 peritonitis, 701 
 of sterility, 468 
 
 Prolapse, artificial, of uterus for diagnosis, 
 325 
 
 of ovary, 53, 181 
 Sims’s operation for, 37 
 Prurigo of vulva, 503 
 Pruritus of vulva, 505 
 treatment of, 507 
 caused by oidium albicans, 506 
 Pudendal hernia, 486 
 sac, 230 
 
 I J udendum. (See Vulva.) 
 
 Pus in pelvic cellulitis, 710 
 
 Q- 
 
 Quinine, use of, 373 
 
 after operations, 333 
 in chronic metritis, 630 
 in menstrual disorders, 367 
 
 R. 
 
 Rectal examination, methods, of, 301 
 Simon’s method of, 302 
 exploration, 29 
 by eversion, 38 
 Rectocele, definition of, 487 
 Rectum, anatomy of, 197 
 gross, 198 
 minute, 250 
 examination of, 318 
 
 practical deductions on anatomy of, 202 
 
786 
 
 INDEX TO VOLUME I. 
 
 Kectum, relations and attachments of, 201 
 sphincter of, 199 
 symptoms, importance of, 291 
 Remedies acting on pelvic organs, classifi- 
 cation of, 368 
 
 Rest as a therapeutic agent, 619 
 Retroflexion as cause of dvsmenorrhcea, 
 423 
 
 of gravid uterus, diagnosis, 756 
 Retroversion, operation for, 56 
 Roman gynecology, history of, 20 
 Rosenmiiller’s organ, 75 
 Round ligaments, cyst of, 488, 535 
 of uterus, 157 
 Rudimentary uterus, 242 
 Rupture. (See Hernia.) 
 
 of perineum, failure in operation for, 42 
 operation for, 54, 55, 59, 234 
 
 S. 
 
 Sarcoma of vulva, 537 
 Scarification, knife for, 614 
 Scissors, Emmet’s, 344 
 Sclerosis, uterine, 599 
 Sebaceous cysts of vulva, 535 
 Sedatives, nerve, 372 
 Semen without spermatozoa, 453 
 Senile changes in vagina, 120 
 Septic wounds, treatment of, 332 
 pelvic peritonitis, 694 
 Septicaemia following ovariotomy, 37 
 Serpiginous vascular degeneration, 509 
 Sexual sense in women, 444 
 Shield, Sims’s, 352 
 
 for twisting sutures, 352 
 Silk for sutures, 339 
 
 ligatures, mode of cleaning, 330 
 Silver nitrate in endocervicitis, 564 
 in endometritis, 581 
 suture, invention of, 33 
 sutures, 339 
 
 application of, 348 
 shouldering of, 351 
 twisting of, 351, 352 
 Simon’s speculum, 341 
 spoon curette, 361, 597 
 Simpson’s sound, 302 
 use of, 303 
 
 Sims’s depressor, 311 
 position, description of, 308, 340 
 sharp curette, old model, 597 
 shield, 352 
 
 speculum, objections to, 310 
 tenaculum, 314 
 Sinus, urogenital, 69, 88, 89 
 Sinuses, pelvic, from abscess, 732 
 Skene, glands of, in urethra, 71, 180, 185, 
 796 
 
 Skin diseases of vulva, 501 
 Societies, gynecological, 66 
 Solid uterus, 242 
 Sound, best form of, 302 
 
 care in use of, in pelvic liaematocele, 753 
 Simpson’s, 302 
 the uterine, 302 
 
 Sounds, graduated, 357 
 Spasm of muscles of pelvic floor, 511 
 Spear, Buttle’ s, for cervix, 613 
 Specula, cylindrical and plurivalve, 304 
 Speculum, Brewer’s, 305 
 Fergusson’s, 305 
 Hunter-Erich’s, 310 
 invention of, 20-22 
 Mann’s, 312 
 Munde’s, 313 
 Nott’s, 306 
 Simon’s, 341 
 
 Sims’s, advantages of, 306, 311, 340 
 invention of, 31 
 mode of use, 313, 340 
 Spermatozoa, absence of, in semen, 453 
 destruction of, in cervix, 454 
 impediments to progress of, 455 
 mode of entry into uterus, 43 
 progress of, 445 
 Sphincter recti, 199 
 of bladder, 189 
 of urethra, 186 
 third, 198 
 uteri, 135 
 
 Sponge-holder, Sims’s, 343 
 Sponges, mode of cleaning, 330 
 Spoon, Simon’s sharp, 361, 597 
 Spurious hermaphrodism, 277 
 Stem, intra-uterine, for drainage, Wylie’s, 
 429 
 
 Stenosis of cervix, dangers of incision for, 
 151 
 
 uteri, electricity in, 405 
 Sterility, 441 
 
 abnormal conditions of, 463 
 
 caused by latent gonorrhoea, 460 
 
 diagnosis of, 464 
 
 examination in, 466 
 
 hidden causes of, 467 
 
 prognosis, 46S 
 
 subjective symptoms of, 462 
 
 table of abnormal conditions in, 463 
 
 treatment, 468 
 
 Strychnia, value of, as a tonic, 364 
 Subinvolution, electricity in, 393 
 non-puerperal, 601 
 operations on vagina in, 673 
 of uterus, 599, 637 
 caused by tumors, 652 
 course and results, 659 
 diagnosis, 655 
 
 diagnosis from chronic metritis, 659 
 differentiation, 657 
 etiology, 649, 653 
 exciting causes of, 650 
 histology, 642 
 history of, 63S 
 local treatment, 664 
 mechanical treatment, 666 
 operative treatment, 666 
 physical signs 656 
 symptoms of, 655 
 treatment, 661 
 of vagina, 667 
 cause, 669 
 
INDEX TO VOLUME I. 
 
 787 
 
 Subin volution of vagina, pathology, 668 
 treatment, 671 
 
 post-partum hemorrhage causing, 653 
 Sun-baths, 621 
 
 Superfcetation, relation of, to double uterus, 
 253 
 
 Superinvolution, electricity in, 395 
 Supports of (he uterus, 221, 534 
 of bladder, 225 
 
 Sutures, materials for, 338, 339 
 removal of, 353 
 Symptoms, importance of, 288 
 of chronic metritis, 605 
 of pelvic peritonitis, 693 
 of sterility, subjective, 462 
 of subinvolution of uterus, 655 
 Syphilitic ulceration of cervix, 593 
 condyloma of vulva, 534 
 warts of vulva, 534 
 Syringe, applicator, 581 
 
 T. 
 
 Table of abnormal conditions in sterility, 
 463 
 
 of differential diagnosis of pelvic hsenia- 
 tocele, 763 
 operation, 337 
 
 Tables, gynecological examining-, 294 
 Tampon, lampwick for, 362 
 vaginal, 361 
 
 Temperature, high, after ovariotomy, 51 
 Tenaculum, Emmet’s, 314 
 double, 342 
 Mann’s, 312 
 operating, 345 
 self-retaining, 577 
 Sims’s, 314 
 
 Tents in treatment of endometritis, 560 
 laminaria, 321, 356 
 mode of use, 323, 356 
 sponge, 321, 355 
 sponge in chronic metritis, 616 
 tupelo, 322, 356 
 
 Therapeutics, general uterine, 363, 619 
 Thrombus of the vulva, 497 
 Tissue-forceps, 345 
 Tonic, strychnia, value of, 364 
 Tonics, use of, 630 
 
 Touch, vesico-vaginal and vesico-rectal, 45 
 Treatment, constitutional, of chronic ute- 
 rine disease, 363, 619 
 moral, 635 
 
 of atresia vulvas, 478 
 of atrophy of uterus, 618 
 of cervix during pregnancy, 567 
 of chronic metritis, 609, 610, 611 
 of constipation, 390, 627 
 of disorders of menopause, 437 
 of dysmenorrhcea, 425 
 of endometritis, chronic cervical, 555 
 corporeal, 575 
 of epispadias, 477 
 of headache, 634 
 
 of hypertrophy of labia minora, 477 
 of hypospadias, 477 
 
 Treatment of lupus, 523 
 of membranous dysmenorrhcea, 435 
 of metrorrhagia, 417 
 of nervousness, 634 
 of pelvic abscess, 727 
 adhesions, 51-54 
 amenorrhoea, 364, 413 
 cellulitis, 60 
 hfematoma, 767 
 induration, 51 
 peritonitis, 702 
 of pruritus vul vae, 507 
 of septic vulva, 332 
 wounds, 332 
 of sterility, 468 
 
 of subinvolution of vagina, 671 
 of uterus, 661, 664, 666 
 preparatory to operations, 336 
 Weir Mitchell’s, 610, 633 
 Tubal pregnancy, operation in rupture of 
 sac, 56 
 
 Tube, Fallopian (See Fallopian Tube.) 
 anatomy of, 161 
 anatomy of, minute, 164 
 development of, 87 
 malformation of, 237 
 practical deductions from anatom v of, 
 165 
 
 surgical relations of, 167 
 Tubercular peritonitis, 58, 692 
 Tubes, ovarial, 174 
 Tumor of labia, oozing, 531 
 Tumors, diagnosis from subinvolution, 658 
 in pelvic peritonitis, 606 
 of uterus, causing subinvolution, 652 
 ovarian, diagnosis from hsematocele, 758 
 I Twisting forceps for wire, 352 
 
 U. 
 
 Ulceration of cervix, 587 
 syphilitic, 593 
 of vulva, 494 
 Urachus, 88 
 
 Ureter, malformation of, 261 
 Ureters, anatomy, 192 
 catheterization of, 195 
 surgical relations of, 196 
 Urethra, anatomy of, 183 
 gross, 185 
 minute, 186 
 button-hole of, 54 
 Skene’s glands of, 70 
 sphincter muscle of, 186 
 vesical opening of, 187 
 Urethral caruncles as a cause of dyspareu- 
 nia, 451 
 
 Urethro-vaginal fistula, Parvin’s opera- 
 tion, 38 
 
 Urinary organs, anatomy of, 183 
 
 practical deductions from anatomy of, 
 in pregnancy, 193 
 Urogenital sinus, 69, 88, 89 
 Uterine appendages, 161 
 
 disease of, complicating dysmenor- 
 rlioea, 420 
 
788 
 
 INDEX TO VOLE ME I. 
 
 Uterine decidua, 140 
 depletion, value of, 379 
 disease, pain as a symptom of, 259 
 displacements, electricity in, 390 
 fibroids removed through anterior va- 
 ginal wall, 56 
 fungosities, 594 
 hypersemia, 599 
 hypertrophy, 599 
 massage, 53, 616 
 sclerosis, 599 
 sound, 302 
 subinvolution, 599 
 therapeutics, 363, 619 
 Uterus, abnormal communication, 257 
 anatomy, gross, 134 
 minute, 137 
 
 anteflexion as malformation, 256 
 areuatus acordiformis, 247 
 arrest of development of, early, 240 
 later, 254 
 
 artificial prolapse for diagnosis, 325 
 
 atresia of, 253 
 
 atrophy of, 599 
 
 attachment to vagina, 150 
 
 bicornis acollis, 244 
 
 bipartitus, 243 
 
 bleeding from external coat, 153 
 cavity of, 134 
 development of. 87 
 didelphys, 245 
 dimensions, 132, 152 
 double, in pregnancy, 252 
 relation to superfoe tuition, 353 
 duplex separatus, 244 
 excessive development of, 239 
 foetalis or infantilis, 254 
 gravid, injuries of, 55 
 hernia of, 257 
 
 hyperplasia of, electricity in, 404 
 incudiformis, 255 
 lymphatics of, 139, 686 
 malformations of, 238 
 in development, 256 
 massage 53, 616 
 mobility, 147 
 
 in pelvic hsematocele, 759 
 of mucous membrane of, 136, 140 
 of cervix, 142 
 nerves of, 140, 142, 146 
 obliquity of, 256 
 os internum, construction of, 152 
 parts of, 133 
 
 parvicollis and acollis, 256 
 position, 131 
 
 as regards symptoms, 351 
 in diagnos : s, 300 
 
 practical deductions from anatomy of, 
 147 
 
 in pregnancy, 193 
 piubescens, 255 
 
 relations to surrounding parts, 147 
 round ligament of, 157 
 rudimentary, 242 
 septus, 248 
 
 softening of tissues, 151 
 
 solid, 242 
 sphincter of, 135 
 stenosis, electricity in, 405 
 subinvolution of, 637 
 subseptus, 249 
 unifolis, 250 
 supports of, 221 , 534 
 ulceration of cervix, 154 
 unicollis, 246 
 
 vaginal extirpation of. 156 
 vessels and nerves, 143, 155 
 Utricular glands, 140 
 
 V. 
 
 Vagina, arteries and veins of, 122 
 atresia of, 257 
 
 as obstruction to coitus, 458 
 blind canals of, 260 
 development of, 87, 92 
 double, 259 
 
 faulty communications, 260 
 malformations of, 257 
 nerves of, 124 
 
 operations on. in subinvolution 673 
 packing the, 53 
 
 practical deductions from anatomv of, 
 125 
 
 relations of, 124. 128 
 
 senile changes in. 120 
 
 shortness as cause of dyspareunia, 450 
 
 stenosis as cause of dyspareunia, 449 
 
 subinvolution of, 667 
 
 veins of, 105 
 
 walls of, 119 
 
 Vaginal discharge as symptom, 292 
 examination, method of, 298 
 extirpation of uterus, 156 
 hernia, 483 
 
 hysterectomy, position for, 128 
 ovariotomy, 40, 50 
 tampon, 361 
 Vaginismus, 51 1 
 as cause of dyspareunia, 449 
 superior, 515 
 Valve of Houston, 198 
 Varicose veins of vulva. 497 
 Vascular degeneration, serpiginous, 509 
 Veins, air in, from injections, 583 
 of perineum, 103 
 of vagina, 105 
 
 Venereal condyloma of vulva, 537 
 warts of vulva, 531 
 Ventral hernia, 60 
 Vesico-rectal examination, 302 
 touch, 45 
 
 Vesico-uterine pouch, 214 
 Vesico-vaginal fistula', operation for, 30, 50 
 touch, 45 
 
 Vessels of the uterus, 143 
 pelvic, enlargement of, 156 
 obstructions in, 155 
 of vagina, 122 
 and nerves of perineum, 232 
 of uterus, 143, 155 
 Vestibule, anatomy of, 110 
 
INDEX TO VOLUME I. 
 
 789 
 
 Vestibule, bulbs of, 112 
 Viburnum prunifolium, 49 
 Vicarious menstruation, 415 
 Vulsellum forceps, 342, 349 
 Vulva, alopecia of, 500, 501 
 anatomy of, 96 
 angeioma, 536 
 atresia of, 267 
 treatment, 478 
 cancer, carcinoma, 539 
 epithelioma, 537 
 cancer of, 537 
 cysts of, 534 
 development of, 92 
 eczema, acute, 503 
 chronic, 514 
 enchondroma, 536 
 erysipelas of, 504 
 erythema, 503 
 
 fibroma and fibro-myoma of, 529 
 fibroma diffusum of, 526 
 gangrene of, 496 
 gaseous tumors of, 536 
 hnsmatoma of, 497 
 hemorrhage from, 1 15 
 herpes of, 512 
 injuries and wounds of, 479 
 from coitus, 480 
 labor, 480 
 lipoma of, 530 
 lupus of, 518 
 malformations of, 264 
 melanoma, 536 
 myoma of, 529 
 myxoma of, 530 
 nerves of, 100 
 neuroma, 452, 536 
 new growths of, 518 
 oedema, 75, 495 
 osteoma of, 536 
 papilloma of, 530 
 pediculosis pubis of, 505 
 pityriasis versicolor of, 504 
 pointed condyloma of, 531 
 
 Vulva, practical deductions from anatomy 
 of, 114 
 
 prurigo of, 503 
 pruritus of, 505 
 sarcoma, 537 
 skin diseases of, 501 
 syphilitic warts of, 534 
 thrombus of, 497 
 ulceration and fissure, 494 
 varicose veins of, 497 
 warts of, 530, 531, 534 
 Vulvitis as cause of dyspareunia, 449 
 diphtheritic, 492 
 follicular, 492 
 gonorrhoeal, 492 
 phlegmonous, 493 
 simple, 490 
 
 Vulvo-vaainal glands, anatomy of, 116 
 cysts of, 534 
 gland, catarrh of, 499 
 inflammation of, 500 
 of duct, 499 
 
 W. 
 
 Warts of vulva, 530, 531, 534 
 vulva caused by gonorrhoea, 536 
 Water, hot-, douche. (See Douche.) 
 
 mineral, value of, 610 
 Weir Mitchell treatment, 610, 633 
 White line in pelvis, 226 
 Wolffian bodies, development of, 73 
 ducts, development of, 68 
 Wounds of vulva, 479 
 septic, treatment of, 332 
 Woman’s Hospital of State of New York, 
 Alumni Association of, 60 
 foundation of, 35 
 
 Z. 
 
 Zinc as nerve-tonic, 373 
 chloride in endocervicitis, 565 
 Zona pellncida, 84, 177 
 
 END OF VOLUME I.