WOMB, DISEASES AND DERANGEMENT OF THE. In this article we shall not include the ailineuts of the pregnant or of the puerperal state, some of which, as phlegmasia dolens and puerperal feter, have been noticed in special articles. Many of the diseases, however, which we shall have occasion to notice may be traced to pregnancy, miscar riage, or severe delivery, that had occurred months previously. A common result of inflammation that often succeeds miscarriage or a bad delivery is to check that process of involution by which the womb ought to be restored in a few weeks to the size and condition in which it existed previous to the occurrencd of pregnancy. For a lucid de scription of the processes which act on the enlarged womb to restore it to its original state, we must refer to Dr. West On Diseases of Women, 2d ed. p. PO. How inflammation acts in interrupting these processes, is not easily explained; but after it has passed away, its effects may remain in the enlarged size and altered structure of the womb, changes which render it likely to suffer from the alternation of activity and repose to which the female generative system is liable. In this condition, the enlarged and heavy uterus is very likely to become prolapsed, or to become a seat of permanent congestion or chronic inflammation; and excessive menstruation and a feeling of weight in the pelvis are almost always present. Besides this form of enlargement, there is a far less common form in which the enlargement of the womb takes The independently of previous pregnancy, and is the result of true hypertrophy. The symptoms are, according to West, "a sense of weight in the pelvis, pain usually of a burning character, hemor rhages having gradually come on. and forced themselves by their slowly increasing severity on the patient's notice." The treatment is much the same in both these forms of enlargement—viz., the recumbent position on a hair or spring mattress, attention to the bowels, and local leeching every fortnight, to be continued for several months, together with the careful use of iron associated with small doses of iodide of potassium. Temporary separation from the husband's bed should also be insisted on. There is also a form of hypertrophy which is confined to the neck of the womb, which occasions great discomfort to the patient, and acts as a mechanical impediment to sexual union. In these eases, no relief can be afforded except by a surgical operation, which is described in West, op. cit. p. 77.
From these results of "simple errors of nutrition," leading to increased growth of the organ, we pass on to the debatable and much-trodden ground of inflammation of the womb. Acute inflammation of the unimpregnated womb may arise from unaccustomed and excessive sexual intercourse, sudden suppression of the menstrual discharge, the extension of gonorthceal inflammation, etc.; but, as it is comparatively rare, and seldom dangerous to life, we shall at once pass on to an affection which by most practitioners is regarded as one of the commonest to which woman is liable—viz., chronic inflamma tion and ulceration of the neck of the womb. It is not forty years ago since a French physician, N. Itecamier, invented an instrument—the speculum—for the application of local remedies to the neck of the womb in cancer; but the light which this instrument threw upon uterine conditions generally, led, among other results, to the conclusion, that leucorrhceal discharges (popularly known as the whites) were often derived from and associated with, various morbid appearances of the mouth of the womb, and could often be removed by remedies directed to that part. Almost ever since the speculum began to get into general use, a large number of old-fashioned practitioners raised up a cry against its employment, on the grounds of its indelicacy, its inutility, etc., and denied the very existence of various morbid conditions, which the employers of the instrument declared they saw with its use. Hence two parties have arisen—one who believe in the speculum and its revelations; and another who reject the recent modes of investigating uterine diseases, who take small account of the new facts regarding local disease which have been revealed, and who regard uterine ailments as resulting from constitutional derangements, and who therefore trust mainly to general treatment. Now, although the view that the local disease is everything., may not be universally true, the opposite view is certainly untenable; and Dr. West and other writers on this subject have pointed out that there are reasons why the womb should more frequently than perhaps any other organ be the seat of certain forms of local ailment, and should consequently require the frequent employment of local treatment. It would be out of place iu these pages to describe the characters of the ulcerations or abrasions of the month of the womb, which are so frequently revealed by the speculum, or to enter into any detail regarding the high pathological importance attached by some writers to them.
The conclusion which Dr. West draws from a prolonged investigation of this subject is, that "the condition of so-called ulceration or abrasion of the os uteri is far from infre quent, even in cases where no uterine symptoms were complained of during life; but that it is usually unassociated with other important affections of the uterus, such as may be supposed to be the effects of inflammatory action; and, further, that such affections do not seem to be readily excited by causes acting on the neck of the womb, either when displaced, or when the organ is in its natural position."—Op. cit. p. 120. Since uterine pain, disordered menstruation, and lencorthwal discharges—the symptoms usually associated with ulceration of the month of the womb—are met with by impartial observ ers almost as frequently without as with ulceration, it may be fairly inferred that this ulceration is neither a general cause of uterine disease, nor a safe index of its progress; and although the local application of caustic to the os uteri is doubtless often successful in restoring the patient to health, it must not be considered as a general rule that the attempt, by local remedies, to remove this condition is the one and all-important point in till: treatment of uterine disease. There is no doubt that, in the great majority of these cases (excepting a few of the more severe ones), temporary separation from the husband's bed, the recumbent position (which facilitates the return of blood from the womb and adjacent parts), due attention to the diet and state of the di&estive organs, and the use of injections of nitrate of silver, which may be applied by the patient, are sufficient in a few weeks to effect a cure. Chronic uterine inflammation of a more gen eral nature (as of the interior, or body of the womb), with very similar symptoms, is by no means rare. If the disease is met with in the acute form, leeches should be applied to the womb itself; in the chrot le form, which is generally observed. the pain in the luck is best relieved by a croton-oil liniment, composed, according to Dr. West's thous. of one part of croton oil to ten of the camphor liniment (of the London Pharma copeia) which should be applied (without rubbing it in) with a sponge twice a day on the back, at the sent of pain. Belladonna plaster or liniment also gives temporary relief. The irritability of the bladder, which is a common symptom, is usually asso elated with abundant phosphatic deposits in the urine, and is best relieved bya combina, Lion of ten or fifteen'minims of dilute hydrochloric acid, half a dram of tincture of henbane, and two ounces or more of decoction of pareira-brava (see CISSAIEPELOS), thine times a day; and the tepid hip-bath may be used with benefit. The same general rules as to rest, diet, etc., which have been already given, must he attended to. Under the best management, a tendency to relapse is liable to occur at each monthly period, and after several such relapses, the ,womb is found (on surgical examination) to be enlarged and hardened, and less movable than natural. This condition is best removed by the careful and prolonged use of bichloride of mercury in small doses, which, as it is a deadly poison, must only be taken by professional advice; but the pain in the groin which usually accompanies this change, may be relieved or removed by the application of a small blister. The profuse discharge—both menstrual and leucorrhceal—is best relieved by chalybeato preparations, of which the following is a useful and favorite com pound: 'rake of sulphate of iron, 6 grains; sulphate of magnesia (Epsom salts), 3 drams; dilute sulphuric acid, half e dram; syrup of orange peel, half an ounce; caraway water, sufficient to make a mixture of 6 ounces, of which 1 ounce may be taken thrice daily, after meals; or if there be much hemorrhage, a mixture of alum and sulphate of iron (4 grains of the former to 1 of the latter, dissolved in a small tumbler of water) may be taken three times a day. A hip bath, containing half a and of alum to every gallon of water, is often very useful as an astringent. It should be taken in the morning before dressing, and the patient should remain in it at least a quarter of an hour. For the first time or two, the water may have the chill just taken off. The same importance is not at present attached to vaginal injections as when it was believed that the vagina and not the womb) was the main source of leucorrhceal discharge. In a case of leu corrhceal discharge of long standing, an excellent astringent injection may be formed by dissolving two drams of tannin and half an ounce of alum in a quart of water. Special forms of female or vaginal syringes are sold for this purpose. Of the application of caustics to the mouth of the womb, we say nothing, as that is a matter which must be left solely to the medical attendant.