Diseases of Women

There will be a sense of fullness in the pelvis, more or less pronounced, if there be arrest of the menstrual flow, accompanied by frequent micturition and rectal tenderness. In more severe cases the symptoms are more decided. There will be dull deep seated pelvic pain, backache, and aching down the thighs, increased by motion or by the evacuation of the bladder and bowels. Slight febrile reaction will also be present. In septic cases a chill, more or less pronounced, ushers the general disturbance accompanied by a rapid and decided rise of temperature. Should the inflammation extend to the peritoneal covering (perimetritis), the phenomena of local peritonitis will be directly added; if it extend through the Fallopian tubes the evidence of salpingitis will appear, and from either of these general peritonitis may arise, or other extreme symptoms indicative of general septic absorption.

The chief physical signs are tenderness over the pubes, and tenderness of the uterus, elicited by bimanual and vaginal pressure. The cervix will be found patulous, softer, larger, and redder than natural, particularly about the external os, and exuding from it a tough, glairy, opaque secretion. When the uterine walls are affected, particularly in septic inflammation, the entire organ is enlarged and softened, and there will be noticed flowing from the thick, ichorous, bloody discharge, which may have the odor of decomposition.

Garrett, R. W. (1913). Text book of medical and surgical gynaecology for the use of students and practitioners (pp. 221-222). essay, R. Uglow.

Created by: Annika Klein, 06/17/2021

Entered by: Rachel Johnson, 08/29/2021

Amenorrhea from imperfect formation of the sexual organs may depend either upon causes which altogether prevent the performance of the menstrual function, or on such as merely interfere with the discharge of the menstrual fluid. Cases of the former kind are fortunately very rare, since, depending on the absence or defective formation of the uterus or ovaries, […]. In some of the former class of cases, […] the woman has never experienced any periodical occurrence of symptoms […], while in others the women have been liable to periodical attacks of pain in the back and loins, and to all those indications of suffering by which the menstrual flux is often attended, […]. Besides these cases, […] there are others in which the ovaries are present, and perform their functions properly, in which the uterus also exists, and the periodical hemorrhage takes place from its lining; but the effused blood finds no means of escape, owing to congenital closure of the os uteri, or to the absence or occlusion of the vagina.

[…] the premonitory symptoms, which in general usher them in, are experienced with even more than ordinary severity. […] after many months, enlargement of the abdomen becomes apparent, and increases by degrees with each periodical exacerbation of the patient’s sufferings. […] Attacks of inflammation of the sexual organs in women who have already menstruated, and have even borne children, are sometimes followed by amenorrhea […]. Again, the occurrence of serious illness of almost any kind a few months, or even a few years, before the arrival of the period of puberty, will often postpone for a long time the manifestation of its signs, and, in particular, the appearance of the menses.

[…] the girl begins to suffer from frequent head-ache and flushed face, frequent back-ache, pain in the hypogastrium and constipated bowels, a furred tongue […] At length menstruation occurs, […] at then for several months together there is no sign of its return; or perhaps, when the proper period comes round again, the bleeding, instead of taking place, as it out to do, from the womb, occurs from the stomach, or less frequently from the intestines. […] the patient becomes habitually ailing, the appetite falls off, the powers of digestion are weakened, the strength becomes unequal to ordinary exertion, the pulse grows feeble and frequent, and the face itself assumes the pallid sallow tinge whence the term chlorosis has been selected […].

West, C. (1856). Lectures on the Diseases of Women. John Churchill. Pg. 29-36.

Entered by: Ayushi Chintakayala, 7/4/2020

These are not very marked, except such as depend upon the mechanical disarrangement of parts. If great pressure be made upon the neck of the bladder or upon the urethra, retention of urine may result, but this is rare. The patient complains of some difficulty in passing urine, as well as in going to stool, but assistance is seldom required on this account (Capuron). Constipation is sometimes occasioned by the pressure upon the rectum. The patient feels a great and unusual weight in the pelvis, with a pain in the hypogastrium and at the perineum (Duges); and a sense of dragging from the loins (Naucke); all of which are greatly increased by standing or walking. Leucorrhoea sometimes occurs, and occasionally there is some irregularity in the menstrual evacuation (Nauche). If an internal examination be made, the pelvis will be found blocked up by a tolerably dense body—the uterus: the fundus will be found anteriorly, and the cervix posteriorly. If a sound be introduced into the bladder, it will impinge upon the displaced fundus, and this has given rise to a suspicion stone in the bladder (Levret). There is, however, no sound resulting from the contact, nor is the touch like that of stone.  If the displacement be not remedied, the anterior wall of the uterus generally becomes the seat of engorgement and inflammation (Nauche). There is a slighter degree of displacement in the same direction which takes place sometimes in the later months of pregnancy, and is called anteflexion or anterior obliquity. […] The symptoms, in some respects, resemble those already described (Nauche), but in themselves they are of little consequence; our main attention will be directed to the effect of this displacement in retarding labor, by “forcing down a segment of the os uteri between itself and the ossa pubis; this portion of the uterus usually becomes tumified and indisposed to dilate; and the action of the uterus grows irregular, spasmodic, and more acutely painful.”

Churchill, F. (1986). Chapter XX Displacements-1. Anteversion of the Uterus. In Outlines of the Principal Diseases of Females. Birmingham, Alabama: The Classics of Medicine Library. Pg. 262-265.

Entered by: Kate Holder, 6/14/2020

Edited by: Erin Choi, 7/15/20

In some instances, it has been found of enormous size, in others more moderate, it has given rise to a doubt as to the sex of the individual. In the majority of these cases, however, it does not exceed two inches in length. The primary symptoms, or those which arise from the mechanical disproportion of the parts, are trifling; in some cases, sexual intercourse has been impeded and in most from the situation of the part and its great sensibility it is liable to irritation from motion, and the consequences of this susceptibility form by far the most important feature of the disease. The sexual desire naturally leads to its gratification, and this again aggravates the complaint, and impels to further excess until the patient at length falls a victim to nymphomania. The hypertrophy may be congenital, or the result of inflammation. This part has also been found the seat of scirrhous deposition, most frequently connected, with a similar morbid condition of the uterus, and ultimately running into ulceration, with lancinating pain and footed discharge, but giving rise to few or none of the secondary or nymphomaniacal symptoms.

Churchill, F. (1986). Chapter VII Enlargement of the Clitoris. In Outlines of the Principal Diseases of Females. Birmingham, Alabama: The Classics of Medicine Library. Pg. 17-18.

Entered by: Kate Holder, 6/14/2020

Edited by: Bernardo Galvan, 9/7/2020

The disease is believed to begin usually in the urethra, although this is in most cases difficult to establish, as there are generally found on the first examination evidences of inflammation of all the mucous membranes of this region. There is a copious secretion of thick, yellow pus. There may be erosions of the vaginal mucous membrane, so that the parts bleed readily. Crusts form on the labia. When a view of the cervix can be obtained by means of a small speculum. This is almost invariably seen to be involved.

For the first day or two, in the most severe cases, there may be slight fever and general indisposition, but more frequently—and this is one of the most striking points of difference from the disease seen in adults—constitutional symptoms are wanting altogether. Micturition is painful, and sometimes frequent, there are also excoriations of the skin, and difficultly in walking, all these symptoms being usually more severe than in simple catarrh. In cases of gonorrheal inflammation there are found in the pus cells large masses of diplococci, these being usually the only bacteria present. It is the presence of these in large masses in the pus cells which is the characteristic feature. Nearly all the complications of gonorrhoea which are seen in the adult have been observed in young children, but the majority of them are rare. The most frequent one is conjunctivitis, infection being carried by the hands from the vaginal discharge to the eyes.

Holt, L Emmett. The Diseases of Infancy and Childhood: for the Use of Students and Practitioners of Medicine. Appleton and Co, 1897. Pg. 641-642.

Entered by: Erin Choi, 6/24/2020

 

The most distressing symptom, […] is a partial or complete retention of urine. […] If the retention have continued for some time, the distended bladder may be felt rising above the brim of the pelvis. The pressure of the fundus uteri upon the rectum more or less, completely arrests the passage of the feces through that intestine, and we find either constipation or a difficulty in going to stool (Duges Capuron). Dr. Hunter observes that all the cases he had seen “happened about the third month (of pregnancy), sooner or later, and they all brought on a difficulty and gradually a suppression, first of urine, and then of stools likewise. […] In some cases, constipation and vomiting were prominent symptoms. The patient complains of a weight and fulness in the pelvis. A dragging from the loins, and a constant effort at forcing down, resembling labor pains, and exciting fears of abortion, (Capuron.) This distressing state cannot continue long, without exciting severe and formidable constitutional suffering. The patient loses her appetite, complains of violent pain, the pulse becomes very quick, fever sets in, with thirst, loaded tongue, hot skin, restlessness, etc. The action of the intestines is sometimes inverted, and a vomiting of stercoraceous matter takes place. If the distension of the bladder be not relieved, the walls will give way, and its contents, discharged into the peritoneum will excite fatal peritonitis. But, if just so much urine escape as will prevent this frightful termination, the patient’s life may be compromised by the fever, or ultimately by inflammation of the uterus and gangrene (Capuron). If an internal examination be made, the direction of the vagina will be found to be forwards to the pubes, instead of backwards to the sacrum, the posterior wall is thrown into folds, whilst the anterior is more upon the stretch; behind the posterior wall, between it and the rectum a large tumor may be felt, continued across the pelvis, and terminating anteriorly against the pubes- this is the uterus. It is rarely possible to pass the huger beyond the lower surface of the uterus

(Capuron).Churchill, F. (1986). Chapter XXI Retroversion of the Uterus. In Outlines of the Principal Diseases of Females. Birmingham,

Alabama: The Classics of Medicine Library. Pg. 267-274.

Entered by: Kate Holder, 6/14/2020

Edited by: Bernardo Glavan, 9/7/2020

[...] the most important by far is the excessive loss of blood. Hemorrhages occur repeatedly, but irregularly as to time and quantity. The quantity lost is, in many instances, sufficient to blanch the surface of the body, and even the lips, and to induce all the consequences of anemia. […] The attack is first mistaken for excessive menstruation, and thus advice is not sought, until the constitution has severely suffered. […] The blood may be discharged in a fluid state without any smell, or it may come away in clots, some of them being accurate moulds of the polypus to which they have been applied, and when retained long in the vagina, giving forth a putrid odour calculated to lead to a wrong diagnosis. There is as much hemorrhage in many cases where the polypus is not larger than a filbert, as where it is the size of a pear; indeed, it would appear that there is sometime less hemorrhage with very large polypi than with smaller ones. […] After the removal of polypus, the hemorrhage ceases immediately and entirely. […] Another symptom of very constant occurrence is frequent vomiting; this is doubtless consequent upon the loss of blood, and partly perhaps upon the expulsive efforts of the uterus, or dragging down of the polypus. […] The patient also complains of weight in the pelvis and pressure about the vulva—of a dragging sensation about the loins and groins, of aching in the back, and weariness. […] When the tumor is large, there may be pressure upon the bladder or rectum, at once exciting desires for the evacuation of those viscera and impeding the performance.

Churchill, F. (1986). Outlines of the Principal Diseases of Females. (pp. 189-191). Birmingham, Alabama: The Classics of Medicine Library.

Created by: Erin Choi, 10/31/2021

Entered by: Rachel Johnson, 11/30/2021

Symptoms are principally mechanical, arising from the pressure of the prolapsed uterus upon other organs; from their being involved in the displacement; or from the sympathies of other organs with the uterus. It is very remarkable how little prolapse interferes with the uterine function. Menstruation, though sometimes disturbed, is perfectly regular in the majority of cases, and rarely mixed with hemorrhage; and not only is there no impediment to impregnation so long as the uterus is retained or can be returned into the vagina (Nauche), but there is more than one case on record, where impregnation was effected although the prolapse was irreducible. The degree of inconvenience caused will generally bear some relation to the amount of the displacement, although even a slight degree of descent will sometimes be marked by considerable suffering, dependent probably upon the idiosyncrasy of the patient. She complains of a sensation of fulness in the pelvis, of weight and bearing down and dragging from the loins and umbilicus (Capuron).

There is more or less pain in the back, extending round to the groins—this, with the dragging sensation, has been attributed to the stretching of the uterine ligaments. The patient suffers great distress from attempting to stand or walk, and is much worse in the evening than in the morning. If the womb descend to the external orifice, and more especially if it protrude, there is a degree of difficulty in voiding urine and feces; indeed, in some cases, the former can only be accomplished by lying down and returning the uterus to its natural situation.

All the mechanical symptoms are aggravated by the patient remaining in the upright position, but if the womb have not completely prolapsed, she will obtain immediate and complete relief by lying down. If the descent be complete, the dependent uterus will give to the patient a peculiar straggling walk. Lying down in such a case affords relief from the distressing sensation, but not from the prolapse.

It is seldom that the patient is free from leucorrhoea, though the quantity secreted will vary (Clarke); occasionally it is very profuse, manifestly diminishing the strength of the constitution. Attacks of menorrhagia occasionally occur (Clarke), but it is very rare indeed that there is any hemorrhage. From its intimate connection with the womb, the stomach soon shows signs of derangement. “The appetite becomes irregular or is totally lost; the stomach and bowels lose their tone, and there is great distension in the belly arising from air, which may be heard when moving from one part to another; the spirits flag; every employment becomes irksome, and life itself is considered as scarcely desirable: there are, however, a variety of shades in the degree of this sympathy. The diaphragm is sometimes affected by spasm, and hiccough is produced’’.

The information obtained by a vaginal examination will vary according to the degree of displacement. If there be only procidentia, the womb will be felt on passing the finger through the vaginal orifice; the os uteri will be discovered at the bottom of the tumor which fills the pelvis more or less; and the vagina will be found loose, relaxed, dilated, or thrown into folds. If the womb have prolapsed, it will be discovered on separating the thighs and turning aside the labia. It is generally of a conical form or pear-shaped, but whether the upper or lower part be the wider, depends entirely upon the time which has elapsed since the first occurrence of the displacement. If recent, the apex of the cone will be downwards, but in almost all old cases, the apex will be found at the mouth of the vagina. Occasionally, the organ is more cylindrical, and is not unlike the male organ of generation (Jourdan. Clarke). […]

In all cases of prolapse, the os uteri will be found at the lower part of the tumor, and as a cleft resembling it often exists in polypous tumors, it will be right to make sure of its being the mouth of the womb, by the careful introduction of a bougie, should there be any doubt. The protruded womb has lying on its anterior wall the bladder, the whole being covered by the everted vagina, the mucous membrane of which will be tense or thrown into rugae according to the size of the tumor and the distension of the bladder by urine. Generally, the tumor has a firm elastic feel, and anteriorly, some fluctuation may generally be detected.

The color depends upon the exposure; when frequently returned into the pelvis, it preserves its delicate pale pink hue, but when allowed to remain long exposed to the external air, its color deepens, and it becomes dark red or brown. A further effect is produced by exposure; the mucous membrane of the vagina covering the prolapsed organ, becomes converted into a kind of epithelium, with a cessation of the mucous secretion. From the situation of the prolapsed viscus, it is peculiarly exposed to irritation and pressure, giving rise to circumscribed patches of inflammation, which are very liable to run on into ulceration, more frequently superficial than profound, forming a distressing addition to the sufferings of the patient.

The ‘cul de sac’ formed, behind the prolapsed uterus and vagina, very often contains fluid, and occasionally a considerable portion of intestine. If the abdomen be very carefully manipulated it is said that it will be found flatter and more empty than ordinary.

Churchill, F. (1986). Chapter XXII Prolapsus Uteri. In Outlines of the Principal Diseases of Females. Birmingham, Alabama: The Classics of Medicine Library. Pg. 278-289.

Entered by: Kate Holder, 6/14/2020

Edited by: Bernardo Galvan, 9/7/2020

The patient first perceives a sense of heat and soreness in the vagina, varying according to the amount of inflammation, with itching of the external parts. These increase after a short time, and pain, smarting, a feeling of weight and bearing down are added, together with a sensation of tightness, as if the mucous membrane of the vaginas were swollen. If the attack be violent, weight in the lower belly and pain extending down to the thighs, will also be complained of. At first there is no discharge at all, but, in the course of a day or two, the patient perceives a more or less profuse flow of thin, colorless, and occasionally acrid fluid, which in a little time becomes whitish or yellowish, and of much thicker consistence (puriform), resembling cream, but without any diminution of the quantity until the attack subsides. […] If an examination be made at the commencement of the attack, the caliber of the vagina is found to be diminished, and the mucous membrane swollen and puffy. The heat and tenderness are considerable, but no breach of surface van be detected by the finger or speculum […] At an advanced stage of the disease, the swelling of the mucous membrane will be found to have subsided, and the heat and soreness to be much reduced.

Churchill, F. (1986). In Outlines of the Principal Diseases of Females. (pp. 22-24). Birmingham, Alabama: The Classics of Medicine Library.

Created by: Erin Choi, 09/26/2021

Entered by: Rachel Johnson, 11/30/2021