METRITIS OR INFLAMMATION OF THE WOMB.
THIS is an inflammation of the entire substance of the womb, which,
like all inflammatory processes, is _acute_ or _chronic_.
Inflammation does not always affect the whole body of the womb, but
it is quite oftener limited to one or the other layer or membrane
that enters into its architectural whole. Then, again, there is the
anatomical division of the organ into a body or _corpus_, and a neck or
cervix; of these either one may be affected, without the other, so that
inflammation of the cervix should be the subject of a separate inquiry.
Most of the diseases of the womb are due to inflammation. This was the
opinion of J. H. Bennett, of London, as long ago as 1845, in which
year the first edition of his work on “Inflammation of the Uterus” was
published. Up to that time, the subject had never been practically
pursued to the same logical conclusions, so that the opinions of the
leading professional minds were far from unanimous on this question.
But the vigor and energy with which the young author defended his
views, forced attention and conviction upon the greater part of the
profession, in this country and Europe.
He started out with a view to prove: “1. That inflammation is the
_primum mobile_ in uterine affections, and that from it follow, as
results, displacements, ulcerations and affections of the appendages.
2. That menstrual troubles and leucorrhœa are merely symptoms of this
morbid state. 3. That in the vast majority of cases, inflammatory
action will be found to confine itself to the cervical canal and not to
affect the cavity of the body.”
Since the appearance of the first edition of Dr. Bennett’s work, which
is now forty-six years ago, there have been many careful and clever
observers in this field of pathology, but there is yet to appear a
successful contradiction of the truth of his inflammatory doctrine.
Twenty-six years after Dr. Bennett wrote the above book, he read a
paper before the British Medical Association on the same subject,
in which there is no modification of his first conclusions on the
importance of inflammatory lesions. He says: “1. Uterine displacements
are by many too much studied _per se_ (by themselves) independently of
the inflammatory diseases that complicate and often occasion them. 2.
That the examinations made to ascertain the existence of inflammatory
complications are often not made with sufficient care and minuteness,
as evidenced by the fact that I constantly see in practice cases in
which inflammatory processes have been entirely neglected, and the
secondary displacements alone treated. 3. That inflammatory lesions
are often the principal cause of the uterine displacements through
the enlargement and increased weight of the womb, or a portion of its
tissues, which they occasion. 4. That when such inflammatory conditions
exist, as a rule they should be treated and cured and then time given
to nature to absorb morbid enlargements before mechanical and surgical
measures are resorted to.”
If these propositions could be engrossed and a copy sent to every
doctor in the land, as a safe and sure guide in his treatment of
diseases of women, it would prove a great boon to the suffering women
of this country. One of the notorious abuses of the profession, is
the penchant for the employment of mechanical means, either by means
of instruments or the surgeon’s knife. Women are wantonly subjected
to painful and tedious treatments which in many cases only aggravate
their original suffering, while a few simple rules of hygienic
treatment would not only restore them to health and vigor, but would
save them the privation of paying fees to incompetent, unscrupulous
or avaricious doctors, who have only one ambition, that is, to get the
patient’s money. I have known an instance where this barbarous course
under the guise of scientific treatment, broke up the home of a once
happy and prosperous couple, and finally when the resources were so
low that the expense incident to housekeeping and a nurse could no
longer be defrayed, the household effects were disposed of, and, as a
last resort, the overdoctored woman was taken to a hospital, where her
last hopes were lulled into an artificial sleep, while the surgeons
performed an operation from which her depleted body and squandered
vitality could never recover. She died.
I am convinced from observations in large female clinics in Berlin,
and from my own studies in the pathological laboratory while a student
abroad, that Dr. Bennett’s conclusions are corroborated by actual
facts. The freedom with which dangerous operations are undertaken for
comparatively trivial complaints is degenerating into a license that is
criminal and which in some cases is nothing less than murder. In the
absence of a high moral sentiment which should control the profession,
but does not, the State must step in and say who shall practice
medicine and surgery, and by limiting competition, the evil propensity
to make the most of one’s opportunities will not be elevated into a
fine art, and men, although unscrupulous, may be at least indifferent
honest.
Acute metritis comes on suddenly, and this occurs quite often during
the menstrual period. Women as a rule are altogether too careless
during menstruation; they seem to forget that at this time the womb
is congested and swollen, and that if the natural flow of the blood
is interfered with, this congestion will turn into an inflammation.
Exposure to cold, or getting the feet damp, or inordinate exercise
that overheats the system, will bring this about. Sometimes there may
be a tumor or swelling in the womb which occludes the cervical canal,
so that the menstrual fluid cannot escape; this will also cause
inflammation. A stricture of the cervical canal, occasioned by the womb
being flexed, will interfere with the egress of the menstrual flow, and
this also may give rise to inflammation. Vaginal injections either too
hot or too cold, and particularly immediately after copulation, when
the pelvic organs are still in a high state of congestion, is quite
liable to excite metritis. Gonorrhœal infection is another source of
inflammation, but this is invariably preceded by an _endometritis_,
which I will consider separately.
Large, ill-fitting pessaries worn in the vagina for a supposed
retroflected or prolapsed uterus, or a stem pessary, are fruitful
causes of metritis.
Other causes are criminal abortion, complicated with blood poisoning
from the unclean probes or instruments, that the abortionist has
employed on previous operations without thoroughly cleansing and
disinfecting them; the application of strong caustics to the cervix
of the womb, as well as injections into the cavity of the uterus.
Meddlesome doctoring by means of the unskillful and unnecessary use of
instruments, like the probing of the womb without proper antiseptic
precautions, or the scraping, stretching or operating on the womb
without the essential antiseptic precautions which a scientific
comprehension of the subject demands, has frequently caused this
affection.
It occurs very often as a part of the general inflammation produced by
the absorption of putrid or septic matter during the childbed period.
This indicates a lack of cleanliness on the part of the attendants
during confinement; inflammations of this nature constitute one of the
types of _puerperal_ or childbed fever.
The most prominent symptom is pain. This is greatly aggravated on the
slightest pressure, or on moving or turning in bed. Upon a digital
examination, the womb is found enlarged or swollen, and when the organ
is tilted up on the examiner’s finger, there is a sharp lancinating
pain radiating from it in all directions.
The first symptoms of pain are always accompanied with fever, and
this may have been ushered in or alternated with a chill. The pain
may be first felt rather deeply in the pelvis, and this is increased
by a frequent desire to pass urine and a straining of the rectum. It
may further become complicated with a looseness of the bowels, or an
obstinate constipation. Nausea and vomiting is a frequent symptom
during the course of the disease, and if the metritis is developed
during menstruation, the flow may suddenly stop, but, on the other
hand, the hemorrhage may become alarmingly profuse. Standing, walking,
coughing and straining at stool excite the most excruciating pain, so
that a recumbent quiet position is the only comfortable way for the
patient to maintain herself, with the head as low as possible to insure
the most easy recumbency.
The treatment for acute metritis depends somewhat on the cause in each
individual case. There are, however, two indications that require to be
met, and these are common to all inflammations, namely, to relieve the
pain and check the inflammatory process.
The former is quickly relieved by introducing into the vagina a
Femina vaginal capsule in the usual manner; repeating every six to
eight hours, until the pain is sufficiently alleviated to occasion no
suffering; then one capsule should be employed every night until cured
or until restlessness requires that something must be done to calm the
patient.
If the metritis is due to suppressed or checked menstruation from
cold or exposure, then, and only then, are hot fomentations over the
entire abdomen the most appropriate application, and if the patient is
plethoric, I advise a half-dozen leeches to the inguinal region of one
or both sides to be of unequaled value for checking the disease.
Until my experience and observation in German hospitals, I was in
the habit of employing hot applications for all acute inflammations
of the abdominal organs. These were either in the form of hot-water
fomentations or flaxseed poultices. Hot applications undoubtedly
give relief, but I doubt whether they ever cut short or abridge the
inflammatory process in any case. I am inclined to believe that in a
great many instances hot fomentations have the tendency to encourage
suppuration, and that an abscess is often the result of their use. I
have seen decidedly better results from _cold applications_, and the
colder the better, so that I now employ them universally in all acute
inflammations of the pelvic organs except in the noted exception in
which the inflammation is due to a sudden check of the menses from
exposure. As a preventive of inflammations, after delicate operations
on the uterus, I apply the _rubber_ ice bag with invariable success.
The most suitable rubber bag for this purpose is a size of six by
twelve inches; it should be filled with broken pieces, and then
securely tied. I prefer to envelop the bag in a thin layer of flannel,
so as to take off the cold, clammy sensation which the rubber imparts
to the skin. There should be two of these bags, in case of accidentally
tearing one, and so that the reserved one may be in readiness when
the other is removed. The cold does not only check and control the
inflammation, but it also benumbs the nerves, so that it greatly
relieves pain. I keep these ice bags applied over the region of the
womb, until all the acute symptoms disappear. The vagina, however,
should be irrigated with medium hot borax water, once a day, so as to
remove any irritating discharge from the uterine cavity.
The digestive derangements that so often accompany acute metritis; the
nausea and vomiting of this and kindred diseases, are alleviated by
this formula:—
NO. IX.
Take: Subcarbonate of bismuth 2 drams
Bicarbonate of sodium 2 drams
Tr. of opium, deodorized 2 drams
Tr. of nux vomica 1 dram
Simple syrup 1 ounce
Peppermint water, sufficient to make 6 ounces
Mix, and take a tablespoonful every one or two hours, until relieved;
to allay the thirst and dryness, take small pieces of ice. Constipation
of the bowels should be relieved by taking a Femina laxative tablet
every six hours until the stools are freely moved; after that one
should be taken every night or perhaps every other night, so as to keep
the system regulated.
Some persons suffer from costiveness because they do not drink enough
water, and when taking medicines to correct this disorder it is always
well to drink a large tumblerful of water at the same time, and
especially at bedtime, three or more hours after supper, and early
in the morning is another good time for drinking water and taking a
laxative.