AREOLAR HYPERPLASIA AND CHRONIC ENDOMETRITIS.
It will be convenient to consider these affections together, since their treatment by electricity by modern methods is very similar. Areolar hyperplasia, the so-called chronic metritis, is ordinarily the result of sub involution. Exceptionally, however, it is met with in the unmarried and the sterile as the result of repeated congestion. We cannot better describe this condition than in the words of Thomas,' to whom we are indebted for the term which correctly expresses the chief alterations in the uterus which accompany the condition. " The condition ordinarily styled chronic metritis consists in an enlargement of the uterus due to hyper genesis of its tissues, especially of its connective tissue, which induces nervous irritability, and is accompanied by congestion. Decidedly the most frequent source of this state is interference with involution of the puerperal uterus. A very large proportion of the cases of so-called chronic parenchymatous metritis arc really later stages of sub-involution. Areolar hyperplasia is often induced in a uterus which has once under gone the development of pregnancy, by displacement, endometritis, and other conditions inducing persistent hyperemia. However produced, the condition is one of vice of nutrition engendering hyperplasia of connec tive tissue as its most striking feature, and, although attended by many of the signs and symptoms of inflammation, it in no way partakes of the character of that process." Clinically the condition is met with under two forms, according to the stage of the affection. In the one, the uterus is enlarged, heavy, more or less succulent. The symptoms are chiefly hemorrhages and lencorrhea. In the other form the uterus is dense, contracted; there is little secretion from the endometrium; instead of hemorrhage, scanty menstruation is a factor; the chief symptoms, how ever, are the varied manifestatio'ns in different parts of the body to which the term hystero-neuroses is applicable. Every gynecologist knows how intractable to treatment areolar hyperplasia is, in its advanced stages particularly, and a proof of this is furnished by calling to mind the many and the varied methods of treatment which have from time to time been proposed. Leeching, scarification, intra-uterine applications of the stronger caustics, igni-puncture, the wedge-shaped excision, etc., etc., these measures have each and all been tested, and still frequently they fall far short of effecting a cure. Revulsion, derivation, absorption, is what they all, in the main, aim at, and from what has gone before it is at once apparent that the fulfillment of this aim may be best secured by electricity. In what follows in regard to the use of this agent, we take it for granted that in the treatment of any individual case any marked irritant and promotor of the hyperplasia, such as a laceration of the cervix, will be removed before resorting to electricity.
Hitherto it has been the custom in applying electricity to the hyper plastic uterus, to use by preference the faradic, or the galvanic current, by the vagino-abdominal method, and in the experience of those who have thus utilized electricity the results obtained have very frequently been of the most marked kind. Rockwell says' " The very disagreeable symptoms that are so often associated with this intractable condition are occasionally very much ameliorated by the persistent use of the galvanic current. The intra-uterine electrode may be used. but the current must be weak and the applications short, so as to avoid unpleasant electrolytic effects. As a rule, however, extra-uterine will accomplish quite as much as intra-uterine applications. The disadvantage of the applications by the former method that it is not so direct, is more than balanced by the far greater tension of current that can be used when with a large sponge covered bulb electrode firm pressure is made around and above the os uteri." Munde says:' "As a peculiarity of this condition, which is a very common consequence of sub-involution, is an excessive formation of areolar tissue, which gradually assumes a density similar to fibrous tissue, the object of treatment should be to promote the softening and ultimate absorption of this abnormal tissue. This is best done by long and fre quent applications of the galvanic current, which should be passed through every part of the uterus as thoroughly as possible. As menstruation is usually scanty in marked cases of hyperplasia, inta-uterine galvanization is decidedly indicated, precisely the reverse from sub-involution. But as there is no disease of the female reproductive organs more difficult to care than inveterate hyperplasia of the uterus (Scanzoni, indeed, pro nounces ft incurable), it is evident that only perseverance will insure im provement. And relapses are frequent. The current should be used as strong as the patient can bear it, twelve to eighteen cells, the negative pole being internal. But it should be borne in mind that the intra uterine pole is uncovered metal, and that a milder current must be used than when the covered ball merely touches the cervix. A very strong negative current passing from a metal sound might easily cauterize or char the endometrium, and do serious injury." These quotations exemplify the methods after which it has been cus tomary to resort to electricity in case of hyperplasia, and we insert them here in order to bring nut more strongly the radical nature of the methods which are favored by Apostoli and Engelmann, which if accepted promise to revolutionize our practice in case of this affection. The importance of these methods necessitates reference to them somewhat in detail.