The sensation known as ovaralgia in hysterical women, to which Schutzenberger and Charcot called attention, seems also to have its cause in slight, not appreciable, pseudo-membranous connections of the ovaries with their surroundings. Peritoneal residues on the ovaries and tubes alone, forming swellings of the size of an egg or larger, are frequently found after endometritis and metritis colli, in girls and multiparm, and canoe slight or no pain if extensive parametral residues do not coexist. Just as unpleasant and painful is the condition when the uterus has be come anteverted, retroverted or retroflexed by pars, and perimetric residues, especially when with the latter, as is frequently the case, the tubes and ovaries are more or less matted together, and fixed to a greater or less extent to the walls or floor of Douglas's cul-de-sac. In attempting reposition pain is produced by the traction made on the cicatrized tissues. The patients suffering from this condition constantly worry about their complaint, cohabitation causes pain, and finally the act causes disgust.
The psychical condition is decidedly influenced to a greater or less degree by this state, and here again we find an explanation of the con nection between genital diseases and nervous and psychical affections.
Recurrent Inflammatory Attacks.—According to our observation these usually originate from a lacerated cervix or from an existing endometritis colli or uteri.
Women having residues of inflammation in their genital organs do not always suffer pain; they may for months or years be exempt, and follow their occupation without complaint. As we have been attending patients in the same place for many years, we know a considerable number of girls and women who have suffered for eight, ten, or twelve years from more or less extensive inflammatory processes in their genital tract. These patients return often only after the lapse of one or two years, complaining of severe leucorrhcea, menorrhagia or localized pain in the pelvis. A new inflammatory process has occurred in a uterus changed by former inflam mation. Careful examination of the cervix nearly always reveals either by hyperemia of its tissues, by greater tension of the same, or by reddening of the cervical mucous membrane, or reddening about the external os, or by markedly red erosions, or by marked reddening of the cervical mucous membrane at its everted portion, or by slight hemorrhage when touched with the sound, or by increased secretion, or by turbidity of the former hyaline secretion, that the cervix has become the starting-point of a new slight inflammation without febrile disturbance, or of a more severe one accompanied by moderate febrile symptoms. These recurrent inflamma tory processes of the uterus and its adnexa terminate, under proper treat ment, in a short time, the patient enjoying relative good health until by some injurious influence, such as infection, stagnant secretions, dirty fingers or instruments, gonorrhoeal poison and prolonged applications, a new inflammatory process is produced. During ten or twelve years we
have seen inflammations recur five to ten or even thirty times. These so frequently recurring phenomena are often wrongly ascribed to changes in the axis or in the position of the uterus resulting from former inflamma tions.
Sometimes a recurring inflammation, an account of the more severe infectiqn, runs a rather unfavorable course; under its influence the con tents of the distended tube, which are nearly always present with residues of inflammation in the adnexa, undergo suppuration; the hydrosalpinx, even as a Bartolin cyst, may become an abscess, is changed into a dangerous' pyosalpinx which may rupture, evacuate its contents, and cause death; but this is of rare occurrence. These recurring inflammations very fre quently appear during menstruation, because the wounded cervical canal and portio vaginalis are more sensitive to infection at this time.
A few authors are of the opinion that the recurrent inflammations are dependent upon difficult ovulation from the diseased ovaries. Others refer them to the diseased tubes, assuming that they contain a noxious secretion which escapes at times and causes the recurrent attacks.
We do not doubt that recurring inflammation may be produced in these two ways; certainly the existence of diseased ovaries and tubes renders a recurring pelvic peritonitis process more severe and dangerous, their contents being changed and increased, and the organs easily rupture, and set up the so-called perforation peritonitis.
Symptoms from the Bhtdder.—These are present only in a small number of cases. They are frequently referred to changes in the position and axis of the uterus, especially anteversion, but as these changes are often found markedly developed without interfering with the function of the bladder, we must believe that vesical symptoms are produced by inflammatory residues or by inflammatory processes still remaining between the uterus and bladder, or by irritation of and traction on the vesical nerves. The vesical symptoms vary; in one case there is tenesmus, in another difficult micturition; the patient may lose control over the function of the bladder, or different varieties of catarrh may be present. The occurrence of the latter may be explained by incomplete emptying of the bladder, or if the ureters are narrowed by an existing pyelitis, or by frequent examination or catheterization. The vesical symptoms usually appear late in the disease, frequently only at the climacteric period.