CHRONIC METRITIS OR CHRONIC INFLAMMATION OF THE WOMB.
WHEN from neglected or improper treatment, the acute inflammation is
not checked, so as to restore the organ to its normal condition, the
inflammatory process assumes a chronic character. As inflammation is
an _abnormal vital activity_, which results in the proliferation or
building up of fibrous tissue, it must be naturally inferred that if
the inflammatory process is active in an organ for a considerable
length of time, the tissues of this organ must grow or increase, so
as to augment its size and weight. This is indeed so, hence the other
names that have been given to this disease to distinguish it from the
acute or transient form, all imply _tissue growth_, as hypergenesis of
the connective tissue, engorgement or inflammatory hypertrophy of the
uterus.
The entire organ may be thus affected, or it may be limited to either
one or the other anatomical divisions of the uterus, namely, the body
or the neck.
Of all the different varieties of chronic inflammation of the womb,
that of the neck or cervix is the most frequently met. This is due
to the fact that in married women and those who have born children
the cervix of the womb is exposed to mechanical injury from coition,
friction against the vaginal walls in walking and from lacerations
during delivery.
The body of the womb is further removed from all these mechanical
agencies to which the cervix is exposed, for the body is within the
abdomen of the female, and for that reason it is less liable to be
injuriously affected by influences that cause inflammatory enlargement.
But notwithstanding all this, it is a common disease.
A great many cases of womb complaint that do not yield to ordinary
treatment are really of this nature, but owing to carelessness or
incompetency are never recognized. The symptoms of this disease, which
are obstinate leucorrhœa, falling of the womb or displacements, are
mistaken and treated for the disease itself. Women who suffer with
this complaint are extremely liable to go on for quite a while feeling
comparatively well and in hopes that they are recovering, when some
extra exertion or exposure to cold brings on a relapse, which lights
up an acute inflammatory process. This passes into the old troublesome
disease and this resumes its chronic form. After a repetition of
the general routine treatment, the patient may again live under the
delusion that she is going to get well only to have her hopes blasted
by a sudden reappearance of the former painful symptoms, that are alike
discouraging to herself and a puzzle to her friends.
The cause of inflammatory enlargement of the uterus is usually
connected with _parturition_ or _abortion_.
There never can be either the one or the other without more or less
_vascular activity_, which is essential to the repair of the womb and
its restoration to its physiological or healthy condition. All the
uterine tissues are at this time in a high state of irritability, and
if there is a natural predisposition to inflammatory diseases, then
the slightest obstacle to an uninterrupted recovery will kindle an
inflammatory action, that will fasten itself on the uterus. In the very
nature of things this results in a deposition of inflammatory material,
with a consequent increase of intermuscular fibrous tissue which
increases the size and weight of the uterus.
What our mothers termed in former days “a bad getting up,” that is,
when women get up from their confinement weakly and with more or less
pain and dragging in the pelvis on walking or the slightest exertion,
is generally owing to the above-described condition. This disease is
now almost as common as ever. I can always trace these cases to a
confinement or an abortion.
It is very rare that it is due to a depreciation of vital forces from
improper food, over-exertion, a prolonged nervous depression or a
constitutional tendency to tubercle, scrofula or some other hereditary
diathesis, although these undoubtedly predispose the patient to the
disease.
Abortions stand at the head of all the causes that excite this
affection. When the uterus is pregnant and its natural growth is
abruptly checked by the destruction of the embryo, then the organ
becomes at once the seat of a congestion and great vascular activity,
for the purpose of repairing the injury that the premature expulsion of
the embryo or fetus inflicted.
If this congestion is delayed from improper care or treatment which
fails to recognize the important fact that an abortion or interruption
of pregnancy is a much greater shock to the system than a delivery
at full term, it must result in arrested _involution_ or permanent
inflammatory enlargement. This most persons fail to appreciate, and, as
a result, they do not take the same precautions that they would after
the delivery of a living or fully-developed child.
I am well aware that criminal abortionists are in the habit of
deceiving their patrons by assuring them that there is no danger or bad
results to be feared from their criminal operations. This is a vicious
falsehood, and, coupled with the statement that there is as yet no
living being in the womb, the crime of manslaughter is added to that of
malpractice. In every case of abortion, whether accidental or criminal,
the same care and attention must be given to the woman as during any
natural lying-in period.
There is a class of chronic inflammations that I have noticed in
women who have always suffered from painful menstruations or from
excessive or prolonged hemorrhage at the regular monthly period. This
is complicated with some ovarian disease, which yields, however, to
appropriate treatment.
There is quite a series of symptoms that denote the existence of
chronic metritis; these are not all present in each particular case but
quite enough of them to diagnose the disease. Some of these symptoms
are in the nature of complications, which in themselves may be mistaken
for an individual disease, but upon a careful inquiry they can be
traced directly to a chronic metritis, which if removed disposes of all
the lesser ailments.
The following are the most noted signs of this affection: painful
copulation, and pain on defecation; a dull, heavy, dragging pain
through the pelvis, much increased by walking; during menstruation
the mammæ are sensitive or painful; several days before the approach
of the menses there is a dull pain, which lasts during the menstrual
flow; around the nipples, there is pigmentation or darkening; sometimes
nausea and vomiting, and dyspepsia, headache, and languor; pressure on
the rectum with tenesmus and hemorrhoids; leucorrhœa from catarrh of
the womb; pressure on the bladder with tenesmus or straining.
This disease may continue for years uninterruptedly, and, if there is
not a cure accomplished, or successful measures for its relief are not
employed, it will continue until the menopause, or change of life,
which may effect a spontaneous cure.
The enlargement is most noticeable in the cervix or neck. This is
sometimes so great as to extend one or two inches into the vagina, and
this condition is often mistaken for falling of the womb or prolapse,
which is far from a correct diagnosis. A growing of the womb from
chronic inflammation is the proper explanation.
The hygienic suggestions given in a former chapter, form an important
auxiliary in the treatment of this complaint, and for that reason it
should be carefully studied.
The treatment of chronic metritis has been, up to within a very recent
period, anything but satisfactory in its results. This was owing to
an inadequate knowledge of the real nature of the disease, which was
marked by so many symptoms that were in themselves obscure and hard to
separate as such, from the main affection.
This confusion of the true nature of the pathological process, resulted
in a great many vague therapeutical resources, so that the treatment
is even yet far from uniform and thorough. Many of the recognized
resources laid down in the text-books, on diseases of women, are
not only useless, but absolutely injurious, and, in order to save
the reader time and money, I will make a brief mention of the most
prominent of them.
Depletion, or the abstraction of blood in chronic metritis, effects no
permanent benefit in the inflammatory process. I am convinced that,
in the long run, the patients grow worse, because this treatment
lowers the vitality and reduces the recuperative forces, which are so
important, in the treatment of all chronic complaints.
Scarifications or puncturing the cervix with a sharp lance or pointed
knife, will not sufficiently impress the morbid process, so as to
stimulate it into a healthy action.
Some authors speak very highly of cauterizations and blisters upon the
neck or lips of the womb; this I have repeatedly tried, and in not a
single instance was it of the slightest use, but it aggravated the
symptoms, and in one case it excited a severe, acute metritis that
proved almost fatal.
Specialists, as a rule, fall into routine practice, and exercise
neither originality or intelligence in practice, outside of the
text-book on their shelf. They inject strong fluids or caustics into
the cavity of the womb with a view of checking the inflammation in
that manner. This treatment is dangerous and delusive. If the patient
endures the treatment, she may be stimulated for a time with the idea
that something very curative is being done, but my experience has been
that the disease only becomes worse, because the womb is too delicate
and sensitive an organ to improve under these repeated irritating
assaults.
There is a _home treatment_ for mild cases which I recommend to my
patients, with satisfactory results. It consists principally of
dissolving one teaspoonful of the Femina uterine lotion in a cupful of
boiling hot water, after which this should be added to a gallon of warm
water of a temperature of 105 degrees F.; these irrigations are to be
taken every night, and if the water can be borne hotter the temperature
may be gradually increased to 107 degrees F. A napkin should be worn
and the bed warmed with a hot water bag before retiring. Ten to fifteen
minutes later a Femina vaginal capsule is to be introduced high up into
the vagina, by first quickly dipping the capsule into warm water.
In obstinate cases I have used electricity with the greatest success.
This is administered by means of a broad dispersing electrode applied
on the abdomen, and another electrode, covered with a sponge, is
carried up the vagina, to the womb. In this manner I employ an
intensity of sixty to one hundred and fifty milliampères, for ten to
fifteen minutes. This is repeated several times a week, and from three
to six weeks, and with other hygienic treatment the patient recovers.
When women are in moderate circumstances, and can spare neither time
nor money to visit the office, for the length of time that is required
for the electrical treatment, I follow the plan of the Berlin clinic,
which originated in Vienna, with Prof. Carl Braun, and is strongly
recommended and practiced by Dr. Martin, in Berlin. This consists in
an _amputation of the cervix_, or, in other words, the abnormally
elongated and enlarged uterus is trimmed down, and the diseased
membrane is scraped out. While the cervix is recovering from the
operation, there is also a diminution in the size of the body of the
organ, and the chronic inflammation subsides with it. This operation
is not dangerous to life, and in my experience I have as yet never
had a bad symptom to interrupt the recovery. In obstinate cases, it
is, perhaps, one of the most useful surgical measures that was ever
devised, and we owe it to the genius of Professor Braun, that all
obstinate cases of this nature are amenable to successful treatment.