ABDOMINAL AND UTERINE PAINS.
Abdoniinal, Lumbar, and Inguinal Pains.
These pains, to which Cazeaux has particularly called attention, hardly appear before the last months of pregnancy. They are generally circum scribed and limited to the lower part of the thorax, to the origins and insertions of the abdominal muscles or the groins. The pains are due, aa Tarnier says, and as Beau had already remarked, to lumbo-abdominal neu ralgia, and we may find the maximum point, as in all neuralgias, by fol lowing the course of the fierves. They generally yield to hypodermic morphine injections. Again, there are cramps or severe pains in the thighs and the legs. These may be due to compression of the sacral plexus by the fcetal head, but as Tyler Smith says, there are cases in which this explanation does not serve. They are then attributed to irri tation of the large intestine or of the uterus, and are considered reflex.
In some cases the uterus itself is the seat of pains which come on at variable intervals, and the nature of which e,an not be discovered. Now continuous, now irregularly intermittent, they occur in paroxysms which are excited by pressure, a cough or by fcetal movements. They are almost always the manifestation of a uterine contraction which is appreciable to the touch. Finally, in some cases, the sensibility of the uterus is exag gerated by incessant, violent fcetal movements. This sensibility is some times so extreme that each fcetal movement is accompanied by acute pains, the repetition of which greatly exhausts the patients.
Uterine Rheumatiem.
Cazeaux and Gauthier have particularly called attention to this disease. Cazeaux considers it true rheumatism, but Gauthier regards it as identi cal with uterine neuralgia, which may also occur aside from pregnancy. Gestation produces modifications, however, in its course. Spiegelberg and Braun do not believe in uterine rheumatism and consider it as a re sult either of endometritis or of metritis.
twenty-nine cases collected by Gauthier, eighteen commenced during pregnancy, before labor, and eleven began during parturition. The attack is never sudden. Before the appearance of
uterine pain the patient complains of pains and contractions in the limbs and the trunk, of vertigo, palpitations and of syncope. Shortly after ward, or at the same time, a continuous, dull pain, of variable intensity, is felt in the sacrum, the hypogastrium and the lateral abdominal regions. This pain is exaggerated by movements of the mother or of the fo3tus. At the end of a few hours or days, the pain becomes suddenly violent, sharp, lancinating, and lasts from a few seconds to several hours, begin ning at the uterus, radiating into the lower limbs, and extending to the bladder and rectum. On applying the hand to the abdomen, we find that its walls are not the seat, and that the pain is ut,erine and not so limited as in ordinary neuralgias. Almost always one of the surfaces or sides of the uterus is the chief seat of the pain. The pain is generally fixed, but may be mobile, the fundus uteri being usually less affected than the other regions. The women experience a sensation of spasmodic constric tion, due to uterine contraction, and perceived by the patients and the obstetrician during the earlier months. The uterus, in fact, grows hard. Sometimes it is smooth and sometimes nodular, from partial contractions. When the organ is large, we can appreciate these changes in form, which may, in certain cases, produce an annular transverse constriction. The latter may be partial, and involve different parts of the uterus, including the cervix, and may occasion, according to the c,ase, either rigidity or rapid dilatation of the cervix.
Gauthier admits two forms, one acute, febrile, and one chronic, apyretic form. The former may succeed the latter or may present momentary acute. exacerbations. Uterine rheumatism occurs most frequently at term and during labor, at which time it may become the cause of dystocia. It may be developed after labor, either immediately or after a few hours. It then causes spasmodic uterine contractions, which lead to retention of the placenta. Finally, it may occur later yet, after fifteen days, as in a case of Neucourt.