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SECTION Ⅰ．ANATOMY1

CHAPTER 1 ANATOMY OF THE FEMALE PELVIS AND PERINEUM3

Pelvis3

Perineum4

Anal Region (Anal Triangle)4

Urogenital Region (Urogenital Triangle)9

Pelvic Cavity25

Peritoneum25

Extraperitoneal Tissue27

Pelvic Viscera27

Urinary and Digestive Organs27

Urinary Bladder，Urethra，and Ureters27

Sigmoid Colon，Rectum，and Anal Canal29

Genital Organs31

Uterus31

Vagina34

Fallopian Tubes36

Ovaries39

Endopelvic Fascia and Ligamentous Supports42

Vessels and Nerves of Pelvis and Perineum54

Arteries55

Veins65

Lymphatic Vessels and Glands65

Nerves69

Muscles of Pelvis77

CHAPTER 2 EMBRYOLOGY OF THE GENERATIVE ORGANS80

SECTION Ⅱ．PHYSIOLOGY (Exclusive of the Endocrine Glands)93

CHAPTER 3 FUNCTIONS OF THE GENITALIA95

CHAPTER 4 THE PERIODS OF A WOMAN＇S LIFE100

Infancy and Childhood100

Adolescence100

Sexual Maturity or the Reproductive Period102

The Menopause (Climacteric；Change of Life)102

Genital Senility105

SECTION Ⅲ．THE ENDOCRINES107

CHAPTER 5 THE ENDOCRINE GLANDS109

The Pituitary Gland109

The Follicle-Stimulating and Luteinizing Gonadotropic Hormones112

The Lactogenic Hormone (Prolactin)115

The Adrenotropic (Corticotropic) Hormone115

The Growth and Thyrotropic Hormones115

The Posterior Lobe of the Pituitary Gland115

The Adrental Hormones116

The Ovarian Hormones116

Relaxin119

The Androgenic (Male) Hormone120

CHAPTER 6 MENSTRUATION (THE MENSTRUAL CYCLE)122

Cyclic Changes in the Endometrium122

The Mechanism of Menstruation126

Clinical Characteristics of Menstruation126

Hygiene at the Time of Menstruation129

CHAPTER 7 CYCLIC CHANGES IN THE OVARIES AND OTHER GENITALIA131

CHAPTER 8 CLINICAL ENDOCRINOLOGY138

Hormonal Assays139

Estrogens139

Progestin139

Androgens140

Gonadotropic Hormones140

Other Diagnostic Aids141

Endometrial Biopsy and Curettage141

Vaginal Smears142

Basal Temperature Records142

Principles of Endocrine Therapy142

Estrogens143

Progesterone145

Androgens145

Gonadotropins147

Thyroid Substance148

Vitamin and Nutritional Therapy in Endocrine Disturbances148

Management of the Menopause148

SECTION Ⅳ．HISTORY AND EXAMINATION153

CHAPTER 9 THE GYNECOLOGICAL PATIENT PRESENTS HERSELF155

The History155

The Examination158

SECTION Ⅴ．INFECTIOUS PROCESSES165

CHAPTER 10 GONORRHEAL DISEASE OF THE FEMALE GENITALIA167

Pathology and Diagnosis167

1．Gonorrheal Disease of the External Genitalia and Cervix167

Source and Onset of the Infection169

2．Gonorrheal Disease above the level of the Cervix176

Special Factors in Ascent of the Infection176

Progress of the Disease177

Diagnosis of Acute Gonorrheal Disease of the Tubes185

Diagnosis of Chronic Gonorrheal Disease of the Tubes186

Treatment of Gonorrheal Disease188

Sulfonamide Therapy189

Penicillin Therapy189

Non-specific Management and Surgical Treatment190

Treatment of Persistent Infection of the Lower Genital Tract and Lesions Resultant from Infection191

Treatment of Gonorrheal Disease Above the Level of the Cervix194

Treatment of Acute Adnexal and Peritoneal Infection194

Treatment of Persistent Adnexal and Peritoneal Infection and Lesions Resultant from Infection (Residues of Infection)196

CHAPTER 11 GONORRHEAL DISEASE IN FEMALE CHILDREN202

CHAPTER 12 THE＂CELLULITIS GROUP＂OF PELVIC INFECTIONS205

1．Postabortive Infection205

Introduction205

Etiologic Factors206

Pathology207

Diagnosis of Postabortive Infection209

2．Puerperal Infection211

Bacteriology of Puerperal Infection212

Pathology of Puerperal Infection (from a Gynecological Viewpoint)214

Diagnosis of Puerperal Infection215

Diagnosis of Acute Puerperal Infection215

Diagnosis of Chronic Puerperal Infection and Its Sequelae216

3．Pelvic Cellutitis of Other Etiology216

Treatment of the＂Cellulitis Group＂of Pelvic Infections (Postabortive Infection，Puerperal Infection，and Pelvic Cellulitis of Other Etiology)218

Treatment of Acute Pelvic Cellulitis219

Treatment of Chronic Pelvic Cellulitis，Its Sequelae and Complicating Associated Lesions221

CHAPTER 13 GENITAL TUBERCULOSIS225

Diagnosis229

Treatment230

CHAPTER 14 SYPHILIS233

Syphilis of the External Genitalia233

Syphilis of the Internal Genitalia235

CHAPTER 15 ＂NONSPECIFIC＂INFECTIONS239

1．Infections Resembling Gonorrhea239

2．Ulcus Vulvae Acutum240

CHAPTER 16 CHANCROIDAL INFECTION (SOFT CHANCRE)241

CHAPTER 17 GRANULOMA INGUINALE245

CHAPTER 18 LYMPHOGRANULOMA VENEREUM (LYMPHOPATHIA VENEREUM，LYMPHOGRANULOMA INGUINALE，SUBACUTE INGUINAL LYMPHOGRANULOMATOSIS，CLIMATIC BUBO)249

SECTION Ⅵ．TUMORS OF THE UTERUS255

CHAPTER 19 UTERINE MYOMAS (FIBROIDS)257

Etiology257

Pathology257

Diagnosis269

Differential Diagnosis274

Treatment277

CHAPTER 20 CARCINOMA OF THE CERVIX294

Etiology294

Pathology296

Cancer of the External Cervix296

Cancer of the Endocervix299

Histology299

Diagnosis303

Differential Diagnosis313

Treatment315

Introduction315

Nonoperative Management316

Surgical Adjuncts to Radiation Therapy321

Operative Treatment322

Ureteral Transplantation327

Relief of Suffering－Management of Hopeless Cases327

Prognosis329

CHAPTER 21 CARCINOMA OF THE BODY OF THE UTERUS332

Etiology332

Pathology334

Diagnosis339

Differential Diagnosis341

Treatment342

CHAPTER 22 OTHER TUMORS OF THE UTERUS AND HYPERTROPHY OF THE UTERUS346

Polyps of the Cervix and Endometrium346

Placental Rests and Polyps350

Hydatiform Mole351

Chorio-epithelioma355

Sarcoma of the Uterus361

Cysts of the Uterus372

Hypertrophy of the Uterus373

Diagnosis376

Treatment377

SECTION Ⅶ379

CHAPTER 23 TUMORS OF THE OVARY381

Classification382

Ovarian Cysts382

Inflammatory Cysts in or Near the Ovary382

Small Multiple Cysts385

Follicular Cysts385

Inclusion Cysts387

Corpus Luteum Cysts387

Theca Lutein Cysts387

Ovarian Cystomas388

Papillary Fibromas (Surface Fibromas) and Warty Ovaries388

Fibroadenoma and Cystadenofibroma389

Mesonephric Cysts and Tumors389

Endometrioma392

Cystadenomas393

Malignant Degeneration of Cystadenomas397

Brenner Tumors (Oophoroma)407

Dermoid Cysts and Teratoma411

Carcinoma of the Ovary418

Primary420

Secondary423

Connective Tissue Tumors427

Fibroma427

Sarcoma429

Parovarian Cysts (Broad Ligament Cysts)429

Dysgerminoma (Seminoma)431

Granulosa Cell Tumor433

Theca Cell Tumor (Thecoma)440

Arrhenoblastoma444

Luteinoma or So-Called Adrenal-Like Tumor of the Ovary448

CHAPTER 24 TUMORS OF FALLOPIAN TUBES，LIGAMENTS AND PELVIC CELLULAR TISSUES458

Tumors of the Fallopian Tubes458

Benign Epithelial Growths458

Primary Carcinoma460

Secondary Carcinoma461

Tumors of the Ligaments and Pelvic Cellular Tissues462

Tumors of the Round Ligaments462

Tumors of the Uterosacral Ligaments462

Tumors of the Broad Ligaments and Pelvic Cellular Tissues463

SECTION Ⅷ．DISPLACEMENTS AND RELAXATIONS467

CHAPTER 25 PATHOGENESIS OF CHILDBIRTH INJURIES (DIAGNOSIS AND SURGICAL INDICATIONS)469

CHAPTER 26 RETRODISPLACEMENTS OF THE UTERUS475

Pathology476

Diagnosis478

Differential Diagnosis479

Treatment480

Indications for Operation483

Intra-abdominal Operations487

Other Operations489

CHAPTER 27 URETHROCELE，CYSTOCELE AND UTERINE PROLAPSE491

Diagnosis495

Treatment497

Nonsurgical Measures497

Choice of Operative Procedure500

Notes on Operative Technic502

After-treatment504

CHAPTER 28 PERINEAL LACERATIONS AND RECTOCELE518

Repair of Complete Laceration of the Perineum521

Repair of Simple Lacerations (Perineorrhaphy)524

Repair of Laceration with Rectocele525

SECTION Ⅸ．DISTURBANCES OF FUNCTION533

CHAPTER 29 DYSMENORRHEA535

Etiology and Pathology535

Secondary or Acquired Dysmenorrhea535

Primary or Essential Dysmenorrhea537

Management of Secondary Dysmenorrhea538

Diagnosis and Treatment of Primary Dysmenorrhea538

CHAPTER 30 UTERINE HEMORRHAGE544

Etiology and Pathology546

Constitutional and Systemic Causes546

Complications of Pregnancy546

Benign Tumors of the Uterus547

Malignant Tumors of the Uterus549

Other Diseases of the Uterus550

Tumors and Inflammations of the Ovaries551

Endocrinopathic or Functional Bleeding551

Diagnosis and Treatment553

Bleeding Ascribable to Demonstrable Pathology553

Endocrinopathic and Functional Bleeding554

CHAPTER 31 AMENORRHEA558

Endocrinopathic Amenorrhea559

Dystrophia Adioposogenitalis (Frohlich＇s Syndrome)559

Simmonds＇ Disease559

Cushing＇s Syndrome559

Adrenogenital Syndrome560

Primary Ovarian Deficiency560

Diagnosis of Amenorrhea560

Treatment560

CHAPTER 32 STERILITY562

Etiology and Pathology562

Physiological Factors in Sterility562

The Body of the Uterus in Relation to Sterility563

The Cervix in Relation to Sterility564

The Fallopian Tubes in Relation to Sterility565

The Ovaries in Relation to Sterility566

The Endocrines in the Etiology of Sterility566

Diagnosis567

Treatment572

Physiologic Considerations572

Routine Management573

Endocrine therapy574

Operative Intervention574

SECTION Ⅹ579

CHAPTER 33 ENDOMETRIOSIS581

Etiology581

Pathology586

Diagnosis594

Treatment595

Surgical Indications595

CHAPTER 34 ECTOPIC PREGNANCY599

Etiology599

Pathology601

Diagnosis609

Treatment613

CHAPTER 35 LEUKORRHEA616

Etiology616

Pathology619

The Cervix619

The Vulvovaginal Tissues620

The Uterus622

Treatment622

Routine Care623

Trichomonas Vaginalis Vaginitis624

Senile Vaginitis624

Mycotic (Fungus or Yeast) Infections624

Skene＇s Duct Infection625

The Diseased Cervix625

Intractable Cases627

CHAPTER 36 GENITAL FISTULAS629

Vesical Fistulas (Vesicovaginal，Vesicocervicovaginal，and Urethrovaginal Fistulas)630

Ureteral Fistulas636

Rectovaginal Fistulas637

CHAPTER 37 BACKACHE641

Backache from Nongynecological Conditions641

＂Gynecological＂Backache641

Recognition of the Lesion which Causes Backache642

CHAPTER 38 DISTURBANCES OF THE PELVIC VEINS644

Thrombophlebitis of the Deep Pelvic Veins644

Femoral Thrombophlebitis (Milk-leg，Phlegmasia Alba Dolens)644

Venous Thrombosis645

Treatment of Pelvic and Femoral Thrombophlebitis and venous Thrombosis645

Broad Ligament Varicocele and Passive Congestion of the Pelvic Veins648

CHAPTER 39 ENDOMETRITIS650

Acute Endometritis650

Etiology650

Pathology and Diagnosis650

Treatment651

Chronic Endometritis651

SECTION Ⅺ653

CHAPTER 40 LESIONS OF THE CERVIX655

Cervical Erosions655

Leukoplakia of the Cervix657

Lacerations of the Cervix657

Cervicitis660

Papilloma of the Cervix663

Cervical Stricture．Obstructions of the Uterus and Their Complications664

Mesonephric Remnants in the Cervix667

CHAPTER 41 PRURITUS VULVAE672

CHAPTER 42 LEUKOPLAKIA VULVAE AND KRAUROSIS VULVAE676

CHAPTER 43 CARCINOMA OF THE VULVA680

CHAPTER 44 OTHER TUMORS OF THE VULVA AND VAGINA685

CHAPTER 45 ELEPHANTIASIS693

CHAPTER 46 VAGINISMUS AND DYSPAREUNIA694

CHAPTER 47 ATRESIA OF THE GENITAL CANAL698

CHAPTER 48 INVERSION OF THE UTERUS700

CHAPTER 49 CONGENITAL MALFORMATIONS705

Hymen and Vagina705

Imperforate Hymen706

Congenital Absence of Vagina708

Uterus710

Fallopian Tubes and Ovaries713

Hermaphrodism714

SECTION Ⅻ717

CHAPTER 50 THE EARLY MONTHS OF PREGNANCY (FROM A GYNECOLOGICAL ASPECT)719

The Early Diagnosis of Pregnancy719

Complications of Early Pregnancy and Their Management722

Toxemias of Pregnancy723

Threatened Abortion723

Habitual Abortion725

Inevitable or Incomplete Abortion725

Missed Abortion725

Technic of Therapeutic Abortion；Technic of Curettage725

CHAPTER 51 THE APPENDIX AND LARGE INTESTINE IN RELATION TO GYNECOLOGY728

The Appendix728

Pelvic Adhesions728

Diverticulitis728

Perforation of the Large Intestine730

Mucous Colitis730

Carcinoma730

Nonmalignant Conditions of the Rectum and Anus731

CHAPTER 52 URINARY TRACT PROBLEMS IN GYNECOLOGY732

The Urethra732

Urethral Caruncle732

Other Benign Tumors of the Urethra734

Prolapse of the Urethral Mucosa735

Diverticula and Abscess Pockets736

Urethral Stricture737

Carcinoma of the Female Urethra737

Vesical and Urethral Distress737

Trigonitis and Urethritis737

Pressure Upon the Bladder739

Incontinence Without Demonstrable Pathology739

Cystocele and Urethrocele739

Residual Urine740

The Ureters742

CHAPTER 53 RADIOTHERAPY744

Radium744

Radium in the Treatment of Uterine Hemorrhage744

Radium in the Treatment of Uterine Myomas747

Radium in the Treatment of Carcinoma of the Uterus747

Roentgen Rays748

CHAPTER 54 OPERATIVE MANAGEMENT AND POSTOPERATIVE CARE750

Preparation of the Patient750

Anesthesia752

Avoidance of Introducing Infection753

Prophylaxis of Backache754

The Abdominal Incision and Exposure754

Operative Technic755

Postoperative Care758

Routine Measures758

Paralytic Ileus and Intestinal Obstruction762

Pulmonary Complications763

INDEX767