SUR-INVOLL"FION OF THE UTERUS AND OF THE VAGINA.
Under the term sub-involution we understand that relaxed, congested state of the uterus and the vagina which is so often met with after labor at term and abortion. The condition is a sub-acute one, as we speak of it here, and has not become chronic, when, as will be noted, electricity should be differently used. We are dealing with a passive hyperemia. The uterus is enlarged, soft, and succulent. It is heavy, and tends to sink down in the pelvis proportionately as its ligaments and the pelvic floor are similarly relaxed and lacking in tone. There exists not alone uterine congestion but also pelvic congestion. The symptoms are intensified when the patient is in the erect or the sitting position, and these symp toms are the result of the congestion which is in turn intensified by the sagging of the uterus. Leucorrhea, menorrhagia, even metrorrhagia, are the outward manifestations of the general pelvic congestion. There is present an endometritis, but it is purely the result of hyper-secretion; it is a catarrhal endometritis, in other words, and not an endometritis char acterized by degeneration of the elements of the uterine mucous mem brane. We are thus specific in describing the nature of the local conditions, because it is essential to differentiate sub-involution from hyperplasia (chronic metritis), the method of using electricity in the one case differing essentially from that of use in the other.
In sub-involution of the uterus we aim at emptying the organ of its excess of contained blood, at causing it to contract, at rendering it lighter, so that its tendency to sag downwards will he lessened and the peri-uterine circulation in so far improved. It is at once suggestive how amply elec trization will fulfill the purpose of adjuvant to our routine measures. Of these routine measures we are able to dispense with one, and this is resort to intrauterine applications. In the endometritis accompanying simple enb-involution they are unnecessary where electricity is used. The glycerin tampon, for support and depletion, is the measure which electri city markedly supplements.
As to the variety of the current, since we aim at stimulation, at caus ing contraction, it is obviously the faradic which should be chosen. Further, we wish to stimulate the entire uterus and not to irritate it locally, and therefore faradization should be instituted with one electrode over the cervix and the other over the abdomen, instead of inserting one electrode into the uterus. This at least should be the rule at the outset while the uterus is large, heavy and succulent; later, when the organ is smaller, mild galvanization, vagino-abdominal, may be resorted to for improvement of nutrition. As for the strength of the current, it should be mild, applied for a few minutes, every other day. The result will be noted in gradual diminution in size of the organ and lessened tendency to sagging. In the absence of that factor which so commonly keeps the uterus in a state of congestion, we mean a laceration of the cervix, the result from electrization of the uterus will be marked in a few weeks.
At the end of each electrization the vagina should be carefully filled with glycerin tampons in order that in the intervals of treatment the uterus may be held at a slightly higher level in the pelvis, and thereby the uterine and the peri-uterine circulation may be equalized.
It is apparent, and we desire to emphasize this, that electricity is advocated in case of sub•involution, on account of its powerful contractile effects, as a valuable adjuvant to other means for reducing the local con gestion. It enables us to dispense with iutra-uterine applications, which have always seemed to us of questionable utility in sub-involution pure and simple, and through its relatively speedy action in diminishing local congestion and its general tonic effect on the pelvic organs, resort to pessaries, which aim at sustaining the uterus at a higher level in the pelvis and at taking strain off the suspensory ligaments, will less fre quently be necessary.
In case of sub-involution of the vagina, faradization, which is here indicated as well in preference to galvanization, may be suitably applied by means of the vaginal electrode, and since relaxation of the vaginal walls is a fairly constant accompaniment of sub-involution of the uterus, both conditions may be treated at one and the same time. Faradization of the vaginal walls improves their tone, stimulates the muscular fibres, and relieves the congestion here as elsewhere.
While in the treatment of sub-involution, as defined ny us, we have laid special stress on the faradic current, and given our reasons therefor, it is necessary to state, that observers are not strictly in agreement, some preferring galvanism, and others a combination of galvanism and faradism. Rockwell, for instance, in his recent contribution,' says that in most, if not all cases of sub-involution we must depend mainly upon the galvanic current, although the faradic is by no means useless. He would apply the negative polo internally, and he considers a strength of from twenty to forty milliamperes amply sufficient. It is possible that he has in mind cases of longer duration, more chronic, in other words, than those which we are considering. A priori it would seem to us advisable to use the faradic current in recent sub-involution, where hemorrhage and leucorrhea were predominant symptoms, and to resort to galvanization, or to galvano faradization, when the discharges have been lessened and the organ has become denser and less congested. These are questions which as yet the individual observer must settle for himself. In the specific case he will have little difficulty in making his choice of current if he only bears in mind the essential differences between the two, the faradic being contrac tile and stimulating, the galvanic, while also contractile, being chiefly absorbent and sedative.