Imperforated hymen is fully more common than that of the vagina, but is seldom discovered until the catamenia have been secreted, when great pain is produced by the distention of the uterus and vagina; and a tumour becomes perceptible above the pubes. A transverse division of it with the bis toury gives free exit to the catamenia and relieves the patient, but attention must be paid to the effects of their retention, for frequently considerable in flammation is excited, which requires active anti phlogistic treatment, with injections of warm water per vaginam. To prevent the membrane from re uniting, a rectum bougie should be inserted, either daily or every second day. In the division of the hymen the operator must guard against wounding the meatus urinarius. This membrane has been also found so rigid, as to require a similar incision. In some cases, there is great confusion of the genital parts, the vagina communicating with the urethra, the rectum terminating in the vagina, a double va gina, and even two uteri. There are also cases of the uterus being deficient.
Various species of tumours grow from the labia, nymphx and orifice of the uretha, requiring to be removed by the knife. The nymplize become some times so pendulous as to require partial removal; and the clitois so large, that when a congenital protrusion of the ovaria at the inguinal canals is combined, the sex is mistaken, or the individual is pronounced a hermaphrodite; it is also occasionally affected with cancer, and, in either case, requires amputation. In these little operations, there is commonly so considerable a degree of hemorrhage as to require the ligature or actual cautery. The clitoris, likewise, requires to be removed in nym phomania. In ascites and dropsy of the ovarium, the fluid occasionally gravitates between the vagina and rectum.
The uterus is subject to acute inflammation from cold, which often becomes chronic, although this latter stage sometimes begins a priori, and leads to dropsy, ulceration, scirrhus, cancer, ossification, atheroma, steatoma, medullary sarcoma, tubercles, polypus, moles, and hydatids: calculi, vermes, and air have been generated in the uterus. The acute is easily distinguished, and is to be treated anti phlogistically; the chronic is peculiar in this, that the patient often feels pain near the liver, and after it has continued for any time, a discharge of mucus which becomes occasionally purulent and mixed with blood, takes place: there is sometimes uterine hemorrhage, and the patient has an exsanguineous countenance. On examination, the os tincz is larger than natural, soft, and tender; and, in the hypogastric region the uterus feels swollen, and is painful to the touch. The palliative treatment in this and the other diseases is by cupping or leeches, to the pubes and groins, anodyne enemata, and in jections, per vaginam, extract of hemlock inserted in the vagina, gentle laxatives, low diet, and con finement to the horizontal position, and the admin istration of ergot internally. The radical, by ex
tirpation of the organ, as lately done with success by that profound scientific acconcheur, Dr. Blundel of Guy's Hospital. The uterus has been extirpa ted by Carpus, Laumonier, °slander, Langenbeck, Sauter, Siebold, Holscher, Wolff, Recamier, and Lizars.
There is a peculiar ulcer described by Dr. Clark, termed the corroding ulcer of the womb, and by Mr. Burns, phagedenic ulcer, which should also be treated by excision, as practiced by Lisfranc, or extirpation, by Dr. Blundel. There is another spe cies of ulceration attacking the os and cervix uteri, described by systematic writers, which, however, is merely a modification of the preceding, and should be treated in the same manner. Firm and cauli flower excrescences frequently grow from the os uteri, which should be excised. Polypous excres cences from this region may be removed either with the ligature and double canula, or the knife.
The ovarium is subject to acute and chronic in flammation, to dropsy where the fluid is contained in one or more cysts, to dropsy combined with va rious degenerations of texture, and morbid produc tions, viz. collections of hydatids, scirrhus, ossifi cation, calculi, steatoma, sarcoma, atheroma, mel liceris, hair, bones, and teeth. The ovaries, as also the fallopian tubes, are subject to congenital mal formation. These tumours grow sometimes to an • enormous size, and are then frequently compli cated with ascites, or adhesions to the abdominal parietes and viscera, when hydatids also originate from the latter. In the first stage, their pedicles are very small, and they can be removed from the one side of the abdomen to the other, and are then fa vorable for an operation, which is performed as recommended for ilcus. When the abdomen is freely laid open (the temperature of the room being at 80° Fab.) the viscera arc to be encircled in a towel that had been previously immersed in warm water at 98', the tumour held by an assistant, its pellicle secured with a ligature, both ends of which, as also the tumour, are to be cut off. If the dis ease be complicated with ascites, the case is still more favourable. if extensive adhesions are pre sent, an incision through the abdominal parietes should be made, and if these are found to exist be tween the tumour and the anterior parietes of the abdomen, a seton ought to be inserted across the abdomen and tumour, care being taken not to wound the epigastric arteries. For further infor mation on this subject the reader is referred to Li zars on _Extraction of the Orarium.