Minor surgical gynecology : a manual of uterine diagnosis and the lesser technicalities of gynecological practice : for the use of the advanced student and general practitioner / by Paul F. Mundé.

  • Mundé, Paul F. (Paul Fortunatus), 1846-1902.
Date:
[1880], ©1880
Catalogue details

Licence: Public Domain Mark

Credit: Minor surgical gynecology : a manual of uterine diagnosis and the lesser technicalities of gynecological practice : for the use of the advanced student and general practitioner / by Paul F. Mundé. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    readily detected, the uterus replaced and retained by an ordinary pessar}r, and lo and behold! in three weeks the lady's melancholia disappeared, and she returned home well; of her continued good health I myself am a fre- quent witness. The other case was that of a lady confined to her bed for several years by an apparent paresis of the lower extremities, for which vari- ous celebrated neurologists had treated her in vain. She chanced to fall into the hands of one of our younger gynecologists, who suspected possi- ble uterine disease, examined, found a retroflexion, introduced a pessary, and in a few days the paralytic patient walked! In taking the history of a female patient complaining of sexual disease, the physician should, after the usual inquiries of name, age, residence, na- tionality, ascertain the occupation of the patient, whether it is very labori- ous, or the contrary, whether it is such as is likely to exert any particular influence on the sexual organs, such as the habitual use of the sewing- machine. Further, he should inquire if the patient is married, if so, how long, how many children she has had, how many miscarriages; how long since her last confinement or miscarriage; whether all her labors and get- tings-up were easy and natural; whether instruments were used; how long she has been in poor health; what diseases she has had; whether her parents were healthy. He should then inquire about her menstrual function, at what age it first appeared, whether it was always regular, its duration and charac- ter, its freedom from pain, or the reverse; when it last occurred. (The last question should never be omitted, as there can be no doubt that many a sound has been hurriedly passed, and an abortion thereby pro- duced, simply because the patient was not induced to tell that she had gone one, two, or more weelts over a menstrual period. True, the woman may intentionally make a misstatement on this subject; but then, at least, the physician is exonerated so long as the slight increase in size of the uterus does not enable him to detect the early pregnancy.) The patient should further be questioned as to the seat, character, duration, and per- sistency of any pain she may experience; if she is married, as to whether coition is painful; whether she has a vaginal discharge, its amount, char- acter, and duration; whether micturition is free, abundant, or painful; the condition of her bowels, whether regular, constipated, or painful; as to her appetite and digestion, and her general health; the presence of hereditary disease in the family; the suffering of the patient from chloro- sis during her early menstrual life, or the previous occurrence of perime- tric inflammation, are particularly important data. In old patients the time and character of the menopause should be inquired into. In estimating the usually long array of symptoms presented by a pa- tient suffering from sexual disease, it behooves the physician to take heed of any and all symptoms, no matter how abstract apparently, which his reading or experience have taught him to have a possible connection with the disorder for which he is consulted, and to endeavor to give them their proper origin and value. The disorders of nutrition and innervation which occur so commonly in utero-ovarian disease as to be properly considered as more or less dependent upon it—the hystero-neuroses, to use the com- prehensive and convenient term of Engelmann—are met with in almost every organ and tissue of the body, and in many cases, if still in their early stages, yield spontaneously with the improvement in the genital af- fection. Still, it will generally be found advisable, both as a comfort to the patient and a means of retaining her confidence, to treat such symp- toms in other organs as seem to require special remedies. Such hystero- neuroses are: dyspepsia, chiefly belching, cardialgia, nausea, loss of appe-