ENDOMETRITIS OR CATARRHAL INFLAMMATION OF THE WOMB.
_Endo_ means within, and metritis signifies _womb_ and _inflammation_,
and when all are combined, the compound term denotes inflammation of
the lining membrane of the womb, which is the affection that I am now
to consider.
It would be impossible to find a single person of middle age who has
not experienced sometime during life the discomforts of a catarrh or
cold of some part of the respiratory passages, whether in the head or
bronchial tubes.
The mucous membranes are especially sensitive to noxious influences,
and sound a timely note of warning by an _acute catarrh_, which, if
heeded, will in many instances save the person from a dangerous, if not
fatal sickness.
The adage, “Prevention is better than cure,” is one of the most
truthful sayings in the English language, and, if persons would profit
from the admonitions of a “_slight cold_,” many a fatal pneumonia or
bronchitis could be averted.
What is true of the mucous membrane that is common to both sexes is
true of that which is peculiar to the female organs alone.
There is no mucous membrane that is more liable to catarrhal
inflammations than that lining the uterus. There never was a woman
who was not some time in her life afflicted with a transient uterine
catarrh. It may have been of so mild a form that the symptoms which it
occasioned were hardly noticed, or, perhaps, ascribed to some other
ailment.
There are several varieties of endometritis; some of these are based
upon the length of time that the affection has lasted, while others
owe their classification to the anatomical division of the uterus into
body and cervix. Those that relate to the duration of the disease are
either acute or chronic.
Acute endometritis is the most common form; it has also been described
under the names of acute uterine leucorrhœa, acute uterine catarrh,
and acute internal metritis. It usually runs a rapid course, ending in
recovery or in the chronic form. It undoubtedly passes unrecognized in
many instances, and in this way many cases of painful menstruation or
suppressed menstruation are explainable.
It can be said that at each and every menstrual period there is a
_physiological catarrh_, which belongs to the natural process of the
menstrual function. During each menstruation there is a hyperæmia,
or congestion of the mucous membrane, so that the turgent blood
vessels rupture, and this constitutes the menstrual flow. Before this
congestion reaches the point of bursting the capillaries, and about
the time that the sanguineous flow ceases, there is an increased and
altered mucous secretion of the mucous membrane. If this secretion
is prolonged beyond the normal period that constitutes healthy
menstruation, or if it continues to be present at any time between
the menstrual periods, it constitutes a disease or a catarrh. Now
when we consider the close relation that the normal functions of
the womb have to those that are _abnormal_, and that the one may
be the stepping-stone to the other, we need not be surprised that
endometritis, or catarrh of the womb, is one of the most common
affections to which women are liable.
Chronic endometritis is where the disease has lasted for a long time;
some authorities consider it a rare affection, but this is a great
error. Any disease so frequent as acute endometritis must, in the very
nature of inflammatory processes, become chronic, in a large proportion
of cases.
Endometritis of the body of the womb, in contra-distinction to a
partial inflammation, located and confined to the mucous membrane of
the neck or cervix of the womb, forms another or third variety of
this affection. This disease has been described under the names of
chronic corporeal endometritis, uterine catarrh, uterine leucorrhœa,
and internal metritis, and the seat of it is confined to the lining
membrane of the cavity of the womb, without complicating the cavity of
the cervix; but there is no doubt that when either the one or the other
is the seat of a stubborn catarrh, the remaining portion of the uterus
must become sooner or later more or less compromised in the diseased
process.
Chronic cervical endometritis is where the inflammation affects the
membrane of the neck; this has been described under the names of
cervical catarrh, cervical leucorrhœa, and endocervicitis. These terms
are all derived in composition from the Latin word _cervix_, neck.
The uterus is really divided into two cavities that run into each
other; one of these is the cavity of the body, while the other is the
cavity of the cervix, a fusiform canal, measuring about one inch and
a quarter in length. The cervix partly projects into the vagina, and,
as a result, is liable to injury and irritation, to which the other
portion of the organ is not exposed. Friction and other influences
aggravate the inflammatory process, so that erosions, granular and
cystic degenerations, follicular ulcers and chronic enlargements,
become complications of the catarrhal inflammation of the cervix.
To return again to a consideration of the general aspect of catarrh
of the womb, for it is one and the same pathological process that
underlies the different forms. There is a simplicity in the relation
of cause and effect, that will strike the casual student as one of the
most instructive lessons that it is possible to learn, because it also
suggests the simplicity of the measures of which persons can avail
themselves for the prevention or cure of this affection.
From the physiological reasons that were mentioned as a cause
of endometritis, it follows, as a natural consequence, that the
predisposition to catarrh of the womb, varies greatly with the age of
persons, so that before the age of puberty, at a time when there are
no periodical congestions of the womb from the menses, it occurs very
rarely, while from the period of pubescence, and during the functional
activity of the pelvic organs, it is very prevalent, but at the
approach of the menopause and sexual decadence the predisposition is
again lost.
As far as the character and nature of uterine catarrh is concerned,
that which in technical language is termed the _pathological anatomy_
is no different from what it is in catarrhal inflammations in other
organs, so that the remarks that were made on similar affections of
other organs, apply with equal correctness to catarrh of the uterus.
There is, however, one exception of which I desire to remind the
reader, and that is a hemorrhagic or granular variety of inflammation.
In this form of the disease the mucous glands, and the blood vessels
that are distributed between these glandular tubules, increase or
multiply enormously, so that I have seen the mucous membrane in some
places a quarter of an inch in thickness. This is the most obstinate
variety to yield to ordinary remedies, and as it occasions excessive
and at times dangerous hemorrhage from the womb, it should not be
treated as conservatively as the other varieties of which I have spoken.
There is only one sure method of cure that proved in my hands a
success, and that consists in the entire removal of the diseased mucous
surface.
Dr. Düvelius of Berlin made the discovery and demonstrated the fact
that the mucous glands of the uterus project into the muscular tissue
of the organ, and that if the diseased mucous membrane is removed
or scraped off, down to the muscular layer, a healthy membrane is
regenerated from the terminal glandular ends that remain imbedded in
the muscular tissue. This seems to have been proved by experience, for
I have performed this operation in several obstinate cases of uterine
catarrh, and in several instances the woman became subsequently
pregnant, which proves at least that the regenerated mucous membrane is
capable of performing its physiological function, as though it never
had been interfered with. With proper antiseptic precautions and in
skillful hands, there is absolutely no danger in this operation, but
the technique should be thoroughly understood by the operator.
The etiology or causation of uterine catarrh resolves itself into
predisposing and exciting causes. Predispositions are defined as that
constitution or condition of the body which disposes it to the action
of disease under the application of an exciting cause. Persons who
possess a thoroughly healthy constitution may be exposed to exciting
causes without the slightest danger of contracting diseases, to which
others who are predisposed fall victims. The predisposing causes of
endometritis are a naturally enfeebled constitution; the existence of
a scrofulous or tuberculous habit; impoverishment of the blood from
chlorosis; prolonged mental depression; improper and insufficient
food; prolonged lactation; frequent parturition under unfavorable
surroundings; any indiscretion after delivery which interferes with the
regeneration of the womb; styles of dress that depress the uterus; want
of fresh air and wholesome exercise.
Professor T. G. Thomas, in his work on Diseases of Women, asks the
question why most of these influences should produce this affection
more than others. His answer is that “they do not do so.” “Sometimes
they cause chronic pneumonia; at other times granular lids, and again
at other times chronic endometritis.”
The exciting causes laid down by the same eminent authority are
“displacement of the womb; excessive or intemperate coition; the use of
intra-uterine pessaries; puerperal endometritis; exposure or fatigue
after confinement; efforts at production of abortion and prevention of
conception; vaginitis either simple or due to gonorrhœal infection;
painful obstructive menstruation; exposure during menstruation; sudden
checking of the menstrual flow; and tumors in the uterine cavity or
walls.” Some of the causes here enumerated are much more fruitful of
the disease than others. A woman whose constitution has been weakened,
and whose digestion is deranged, by habits of indolence and luxury,
whose style of dress so depresses the abdominal viscera that her uterus
is pressed down into the vagina, is particularly liable to develop a
catarrhal inflammation from connubial approaches. When these are not
without pain, then there is some predisposition that should be inquired
into and righted.
Uncleanliness is not spoken of by authorities as among the causes of
uterine catarrh, yet it is a very frequent one. I have succeeded in
curing so many catarrhal affections of the vagina and uterus by simply
advising the use of vaginal irrigations with _borated_ warm water,
that I am convinced that a lack of personal cleanliness is a very
prolific cause of this affection. The accessible generative organs,
both of the female and male, should be the object of thorough rinsings
so as to reduce the possibility of infection to the least degree.
All mucous membranes have their natural secretions, and these are on
light provocations abnormally increased. The vagina is always the seat
of more or less bacterial fermentation or decomposition, and if this
is retained for any length of time, it becomes not only putrid and
offensive, but also a direct source of infection to the mucous membrane
of the womb. This is more so in a married woman, who is exposed to the
carelessness of her male consort, who has not been apprised of the
dangers of septic infection, that may be innocently communicated to
the wife by negligence of his own person. The wife is exposed to all
and every impurity that the male has on his person, and thus she is in
constant danger of having her internal organs infected, from the outer
organs of the male.
There is no doubt that many women become infected from this source, and
that obscure and stubborn catarrhs of the vagina and womb are strictly
traceable to personal uncleanliness of the male. From the researches
of Dr. Noeggerath of New York, it would seem that in a great many
cases of pelvic diseases in women, the affections can be traced to a
_latent gonorrhœa_ in the male. This phrase means a gonorrhœa in the
male apparently cured, which even two years after the supposed cure
infects a healthy vagina, causing a discharge and a complication of the
uterine mucous membrane. I have seen some cases that fully corroborate
the views of Noeggerath, so that before we put the blame of uterine
disease solely on the shoulders of the wife, let us find out how much
the husband is to blame.
Specialists in particular, but doctors in general, often forget that
a woman has other organs besides a womb and ovaries; there is a
relation of cause and effect between valvular lesions of the heart or
diseases of the lungs, that obstruct the return of the venous systemic
circulation to the right cavity of the heart, and catarrhal diseases of
the pelvic organs.
Biliousness or an affection of the liver, that interferes with the
portal circulation, or the pressure of tumors or swellings on the
uterine veins, are also among the causes, while the accumulation of
feces or habitual constipation is often overlooked as too trivial to
deserve professional notice, and yet its removal is often the only
successful means to cure the patient.
The various eruptive and infectious diseases, like smallpox,
scarlatina, measles or typhoid fever, may excite in their course a
uterine catarrh, that will remain behind as a chronic complaint, after
the acute affection has subsided.
The acute variety of endometritis is much more prevalent as a disease
than is commonly supposed, but, owing to an absence of specific or
definite signs, pointing directly to the mucous membrane, which the
woman herself can recognize, it is generally mistaken for something
else.
The disease begins with signs of an active congestion in the pelvic
organs; such as drawing pains in the small of the back and in the
groins, and a feeling of fullness and weight at the bottom of the
pelvic floor. The urine is voided with pain and there is a sensation
of heat in some parts of the urethra. Pressure on the lower abdominal
region is painful, and the sensitiveness diminishes from the middle
towards one or the other side. In mild cases these symptoms are not
accompanied with fever, headache or a disturbance of the nervous
system; there may be diarrhœa due to reflex irritation of the rectum,
and the stools are accompanied with bearing-down pain. After three
or four days there is usually a discharge of a viscid liquid, which
in eight or ten days becomes creamy, purulent and often tinged with
blood. The fluids that are discharged from the vagina sometimes become
so acrid and irritating that, when they come in contact with the skin
of the vulva, abdomen or thighs, it becomes irritated and inflamed,
which leads to excoriations and an itching, that may spread over
the entire body. The reaction of this discharge is either acid or
alkaline, depending upon whether the discharge of the uterus or that
of the vagina predominates; as the discharge from the uterus is always
alkaline and that from the vagina always acid, there is nothing of a
practical diagnostic value in ascertaining the chemical reaction of the
secretion. The vagina will generally be found to be hot and more or
less swollen as in ordinary vaginitis. The womb itself, however, will
be enlarged and sensitive, while the cervix is gaping or open. Through
the speculum, it is seen to be red and congested, and from the gaping
mouth there issues a clear, albuminous-looking fluid or a muco-pus.
In the subacute or chronic form the symptoms are by no means always
so prominent as to indicate the existence of the affection, or they
are so marked, by some of the numerous complications, which are in
the nature of cause or effect, that its recognition will become
extremely difficult. The effect which the disease has on the general
organism varies greatly in different individuals. Some women of
robust appearance have an aggravated form of uterine catarrh without
any immediate ill effects on their nutrition or general health. Other
women lose flesh early and become weak and worn; they become pale,
and the face assumes a yellowish ashen hue with dark rings under the
eyes. Through reflex irritation from the nerves of the uterus other
nerve centers become involved, so that a general neurasthenia becomes
developed with its characteristic concomitants of neuralgia, muscular
spasms, uterine colic and hysteria.
With a third class the inflammation spreads from the lining membrane to
the substance of the womb itself, causing an enlargement of the uterus,
which induces displacements and a dragging sensation in walking, pain
in coitus and painful defecation. The inflammation does not limit
itself to the womb, but an ichorous discharge creates distressing
symptoms of vaginitis, inflammation of the bladder, and pruritus vulvæ.
When the uterine cavity is the seat of an abnormal vascular activity,
there often exist symptoms of pregnancy that may mislead the patient
or physician. Nausea and vomiting are sometimes present, the darkening
of the skin around the nipples, and an enlargement and sensitiveness
of the breasts, meteorism, or a swelling of the abdomen, caused by
the accumulation of air in the intestinal canal from reflex nervous
irritation, and when this symptom is added to the irregularity of
menstruation, it is easy to fall into the error of diagnosing pregnancy.
Sterility on the one hand, and habitual abortion on the other, should
direct attention to the probable existence of endometritis. Very often
barrenness has led to an investigation of the condition of the uterus
which disclosed the existence of the disease. A woman who conceives,
and then loses her child in the first months of pregnancy, is
afflicted, in all probability, with a chronic endometritis. In these
cases, where conception takes place, it is to be presumed that the
sensitiveness and irritability of the inflamed mucous membrane is not
suitable for the permanent fixation of the ovum, so that the slightest
shock will open the flood gates of a congested uterus, and thus the
embryo is separated from its attachment, and lost.
The cervix is sometimes the seat of a special feature of uterine
catarrh, that is due to the chronic inflammation of the cervical mucous
membrane, stimulating a growth or proliferation of its own tissue or
structure. This growth causes an enlargement and elongation of the
entire cervix, and a spreading of the lining membrane of the cervical
canal to the vaginal surface of the cervix. This encroachment of the
cervical lining on the vaginal lining is the displacement of the
pavement epithelial cells of the vaginal portion by the cylindrical or
columnar epithelial cells of the cervical canal, and this gives rise to
_erosions_ and follicular ulcers.
These erosions have a glandular arrangement, and are often mistaken for
cancerous or malignant growths. There is no doubt in my mind, that most
of the so-called successful cures of cancer were nothing but cures of
erosions.
The microscopists, whose lively imaginations make them see things
that do not exist, would make us believe that they can take a small
section of the suspected growth, and establish the existence of cancer
by microscopical examination; this is utterly impossible, because the
cancer cell is no different from normal cells, and in erosions we often
find the follicles so close to each other, and their cells so closely
packed, one on the other, that no candid mind can say whether it is a
malignant or an innocent growth.
The claim that “nests of epithelium cells,” as the stereotyped phrase
goes, constitute scientific evidence of cancer, is utterly absurd.
Such eminent authority as Professor Arnold, of Heidelberg, makes the
assertion that positive diagnosis of cancer, from a small section or
scraping, is impossible. I am myself fully convinced of the truth
of this assertion, for while I was making microscopical studies in
Germany, I had abundant evidence of the truth of this statement. It is
indeed very unfortunate, both for science and suffering humanity, that
as yet there is no absolute means of diagnosing cancer positively, and
for that reason the quacks, and those who are not quacks, will continue
to fleece their victims for supposed cancer.
I believe that the cause of cancer is either due to a _ptomaine_
or organic poison that is generated in the body, or to a specific
germ or bacillus. If it be due to the latter, and the germ theory of
disease makes that highly probable, there is no doubt that a method of
staining will soon be discovered, that will make the specific microbe
recognizable in the field of the microscope, but as yet most cancer
diagnoses by microscopy are only surmises.
TREATMENT.
Continence in sexual intercourse is one of the prerequisites to
the successful treatment of all uterine diseases. This is so often
overlooked by those giving advice in such matters, that their otherwise
appropriate suggestions for treatment are frustrated. The women who are
suffering, appreciate the value of this interdiction without further
argument, but the average man does not appear to have the common sense
to readily comprehend that the mechanical irritation incident to the
sexual act, and the accompanying physiological congestion, will surely
aggravate an inflammatory process, no matter of what nature. Men, whose
animal instincts dominate their entire being, so that reason, if they
ever had any, is dethroned, should stop to consider their immoderate
conduct, which perpetuates the suffering of their wives from ailments
which men themselves have often inflicted, and for which women are
innocent martyrs.
The acute variety of uterine catarrh is to be treated like all other
acute inflammatory diseases.
The patient should at once take to bed, so that she may keep herself
warm and quiet.
If the inflammation is due to cold or exposure during menstruation,
and the menstrual flow has been suddenly checked, then three or four
leeches, applied to the inguinal regions on both sides, will be of
decided advantage. Over the lower abdominal regions hot compresses
should be applied; these are made by wringing cloths or a large folded
towel out of hot water, over which a piece of oiled silk, rubber, or
oilcloth is laid to retain the heat and moisture. At other times, that
is, when the inflammation is not due to cold and a sudden stoppage
of the menses, the application of ice bags is preferable to the hot
compresses, in the manner elsewhere described.
The pains which are felt in different parts of the pelvis are relieved
by using the Femina vaginal capsules; say one every six to eight hours,
after a hot vaginal injection of plain water, or a hot sitz-bath.
If there is nausea or vomiting that too is often relieved from the
soothing influence of the capsule which allays the nervous irritability.
Should the stomach not be in a condition to take nourishment from
biliousness or other causes, prescription No. II on page 138 should
be taken in tablespoonful doses every four hours until the stomach is
settled and the system regulated; if any food is taken it should be
between times and of a liquid nature.
If there is straining or diarrhœa, I prefer to employ an _enema_ of
one pint of warm German chamomile tea, to which half a teaspoonful
of McMunn’s elixir of opium or laudanum is added. If the pain and
straining are very severe, one teaspoonful of either is not too much;
by requesting the patient to retain the enema for ten or fifteen
minutes, the medicine is directly absorbed, and the effect is both
soothing and healing. This may be repeated several times a day, if the
pain does not subside after the first injection.
The bowels are sometimes found to be in an opposite state, namely,
constipated; this must be relieved at once. An enema of warm soapsuds
answers the purpose, or a half-tablespoonful of warm water, in which
a half-tablespoonful of glycerine is dissolved, makes an excellent
injection for constipation.
Hot vaginal irrigations should be at once commenced, and repeated as
often as twice or three times a day. I always dissolve a teaspoonful of
powdered borax in the hot water, of which no less than half a gallon is
used at one time; this is antiseptic and healing. After six or eight
days, once a day will be sufficient.
Chronic uterine catarrh or uterine leucorrhœa does not require the
active treatment which was recommended for the acute form. It depends
quite often on causes, whose removal is absolutely necessary to the
intelligent and successful treatment of the affection.
The causes that have been enumerated must be carefully and repeatedly
reviewed, so that each individual case can be traced to its source.
Those causes that are improbable must be eliminated from those that
are probable, so that by a gradual process of exclusion we narrow the
number down to those that actually exist. This simplifies the treatment
to actual conditions that can be intelligently met.
Vaginal irrigations constitute in the chronic form of the disease an
accepted and most useful therapeutic resource. There is nothing that
will ever contraindicate a thorough cleansing of the vaginal canal,
so that the organ may not be bathed in its own morbid and irritating
secretion. It is a wholesome auxiliary to any course of treatment that
may be adopted. It avoids _self-infection_ and places the pelvic organs
in the best possible condition for the healing powers of nature to work
out a cure.
If the uterine catarrh is the result of a venous obstruction due to a
congested liver and a general derangement of the digestive apparatus,
then any local treatment will be of no avail without first removing the
hepatic derangement.
Costiveness or constipation is a very common complaint with women and a
very painful cause of womb disease, but it is so simple and ordinary in
its nature that the wise will not deign stoop to notice such trifles,
but if it required for its removal a surgical operation, for which a
handsome fee is the inspiring motive, then we should hear of it as
often as we do of lacerations or flexions of the cervix as a cause of
uterine catarrh, and its removal would then indeed become absolutely
necessary for effecting a permanent cure.
Why is it that the treatment of uterine disease has degenerated into
“professional faking” that is alike disgraceful to the profession and
a daylight robbery of the patient. A woman, for instance, is suffering
from what she supposes to be _womb disease_. She consults a doctor, or
what is still worse, a time-serving specialist, who examines her and
sees at once signs of uterine catarrh.
He at once applies a little tincture of iodine or carbolic acid diluted
with glycerine or a solution of nitrate of silver to the cervical
canal. The woman is now informed that this application must be repeated
two or three times a week, for which she must call at the office that
number of times every week, for an indefinite period. At each visit
she is subjected to the same routine humbuggery for local medication,
but does she get any better? In my early professional experience I
innocently and ignorantly tried these methods myself, and I say no!
But, as a matter of fact, this constant irritation and poking around
and into the womb will inflame any healthy uterus, and much more one
that is already slightly irritated, so that patients lose their hope
and become convinced themselves that they are no better, but feel worse
than when they first commenced treatment.
This inefficient treatment, like the examination, is conjectural and
mechanical and therefore incomplete and unscientific. The cause of her
entire trouble is never approached. The woman suffers for years from
constipation, which also inclines her to piles, because the pressure
of the hardened feces on the hemorrhoidal veins obstructs the flow
of venous blood and the same pressure on the uterine veins congests
the mucous membrane of that organ and gives rise to the symptoms of
endometritis. All these conditions should be inquired into, and many
others, before local treatment is decided on; simply running to the
doctor’s office and having these medical applications made to the
cervix or canal of the womb amount to nothing; this, as a general rule,
does only harm, and is as superfluous as if one were to take a nasal
douche of salt water or some other catarrh remedy, whenever he feels a
little cold in the head.
The proper course to pursue in this and similar cases is to prescribe
an appropriate diet, and regulate the bowels. It is precisely in this
way that women who have made the rounds of the doctors, happen to take
some patent laxative or nostrum that relieves their constipation, and
accomplishes the _wonderful cures_ of which we often hear and that
were no doubt Godsends to the sufferers that were cured, after all the
_first-class_ doctors failed. By far the greatest proportion of cases
of uterine catarrh are of a simple and transient nature and are only
intensified by probing and local treatment.
When I first began the practice of medicine, I made the same mistake in
following the advice of books and those who should have known better,
for they have had ample opportunity to be convinced of the _fallacy_
of these local measures in the great majority of cases, but some minds
are incompetent to learn from experience, for that requires close
observation, and logical reasoning.
I soon discovered that the catarrhal inflammations got worse, in
proportion to the trouble and pains I took to treat them locally,
so that I became ashamed of my ill success and abandoned the local
treatment entirely, and this I shortly discovered was the means of
curing them. Instead, I simply directed patients to rinse themselves
with quite warm salt water, that is, a tablespoonful of ordinary
cooking salt dissolved in a gallon of water. Now I prefer Femina
antiseptic lotion to the same quantity of water, which has greater
healing properties than either pulverized borax or common salt. I
particularly advised them to keep their feet and lower extremities
warm, regulating their diet and keeping their bowels open. I noticed
that the patients began to improve, and that the improvement continued
until they were fully restored to health and vigor. This method of
treatment would not keep an office overcrowded with deluded patients,
but it proved far more satisfactory to all concerned than meddlesome
measures, and illustrated one of the most common abuses to which
suffering women are liable.
In taking a _laxative_ patients must feel their way as to the proper
dose to take in their own individual case; constitutions differ very
much in this respect, so that it is impossible to lay down one and
the same rule for different persons. It is not good practice to give
medicines three or four times a day in cases of habitual constipation,
for it is liable to derange the digestion and interfere with the
appetite. The proper method is one dose at bedtime and this should be
increased or diminished until the suitable dose of the remedy has been
ascertained; when this is accomplished, the dose of the remedy should
be gradually lessened, a few drops every day, till it can be entirely
dispensed with. If the ordinary dose fails to relieve the bowels, an
additional treatment of glycerine enema at or about the time that the
stool is to take place is to be employed. One or two teaspoonfuls of
glycerine should be diluted with an equal quantity of water, and by
means of a hard rubber piston syringe thrown into the rectum. The
stimulating effect of glycerine on the nerves and mucous membrane,
materially assists in relieving the torpor of the rectum, which has
become insensitive to the irritation of its natural contents.
Patients who are costive must get into regular habits of relieving
themselves, that is, have a regular hour every day when to go to
stool, then the medicine will in time cure the most obstinate cases
of constipation, otherwise it is impossible to cure it. It takes a
constant amount of _effort to get well_, so that those who are too
indolent or think it too troublesome to exert themselves, cannot hope
to recover.
If there is great debility and impoverishment of the blood, then I
would advise prescription No. 1, which are the _iron pills_, of which
three pills should be taken three times a day. The moderate use of
wine, either claret or Riesling, with the food, instead of tea or
coffee, is very beneficial, between meals a glass of Porter to relieve
the _gone-in_ feeling, until the system has recovered sufficient
strength to do without it, that is when ordinary exertions are no
longer a burden.
The small percentage of cases that do not yield to the above treatment,
become legitimate subjects for an honest specialist, for there may be
extensive lacerations of the cervix that require surgical treatment,
or an elongated cervix that should be amputated, or a granulated
hypertrophied membrane of the uterine cavity that should be scraped
out; all these operations are without danger if the operator has
thoroughly _mastered the details_ of antiseptic surgery and has the
manual skill to do the work properly.