A TEXT-BOOK OF DISEASES OF WOMEN BY CHARLES B. PENROSE, M.D., PH.D. Formerly Professor of Gynecology in the University of Pennsylvania; Surgeon to the Gynecean Hospital, Philadelphia With 225 Illustrations _SIXTH EDITION, REVISED_ PHILADELPHIA AND LONDON W. B. SAUNDERS COMPANY 1908 Set up, electrotyped, printed, and copyrighted July, 1897. Revised, reprinted, and recopyrighted May, 1898. Reprinted December, 1899. Revised, reprinted, and recopyrighted December, 1900. Revised, reprinted, and recopyrighted July, 1901. Reprinted January, 1902. Revised, reprinted, and recopyrighted, June, 1904. Reprinted August, 1905. Revised, reprinted, and recopyrighted March, 1908. Copyright, 1908, by W. B. Saunders Company. PRINTED IN AMERICA PRESS OF W. B. SAUNDERS COMPANY PHILADELPHIA PREFACE TO THE SIXTH EDITION. I have carefully revised this book for the sixth edition, and have made those changes and additions that have been rendered necessary by the increase of our knowledge of gynecology. CHARLES B. PENROSE. 1720 SPRUCE STREET, PHILADELPHIA. March, 1908. PREFACE. I have written this book for the medical student. I have attempted to present the best teaching of modern gynecology, untrammelled by antiquated theories or methods of treatment. I have, in most instances, recommended but one plan of treatment for each disease, hoping in this way to avoid confusing the student or the physician who consults the book for practical guidance. I have, as a rule, omitted all facts of anatomy, physiology, and pathology which may be found in the general text-books upon these subjects. Such facts have been mentioned in detail only when it seemed important for the elucidation of the subject, or when there were certain points in the pathology that were peculiar to the diseases under consideration. I am indebted to Dr. H. D. Beyea for several pathological drawings, and to Dr. Wm. R. Nicholson for the preparation of the Index. CHAS. B. PENROSE. CONTENTS. CHAPTER I. PAGE THE GENERAL CAUSES OF DISEASES OF WOMEN 15 CHAPTER II. METHODS OF EXAMINATION 19 Examination of the Abdomen, 19.--Examination of the External Genitals and Pelvic Structures, 22.--Vaginal and Bimanual Examination, 23.--Examination of the Rectum, 33.--Examination of the Bladder, 34.--Antisepsis, 35. CHAPTER III. DISEASES OF THE EXTERNAL GENITALS 36 Vulvitis, 36.--Inflammation of the Vulvo-vaginal Glands, 38.--Suppuration of the Vulvo-vaginal Gland, 39.--Cysts of the Vulvo-vaginal Glands, 40.--Pruritus Vulvæ, 42.--Kraurosis Vulvæ, 44.--Varicose Tumors of the Vulva, 46.--Hematoma of the Vulva, 46.--Papilloma, 46.--Elephantiasis, 47.--Adhesions of the Clitoris, 48. CHAPTER IV.