Irritation and residues of inflammation in the genitals of women, the nervous system of whom is healthy, do not give rise to marked nervous phenomena; but when present in women where the nervous system is more or less diseased, they cause the most marked, varied and hardly describable morbid phenomena of the nervous system. This accounts for the more marked reaction upon the nervous system, in individuals of the higher classes, who are more prone to neuropathic conditions than the lower classes.
Hysterical women are more affected by simple gynecological examina tion than women with a healthy nervous system. We know a large num ber of women in whom simple examination may cause hiccough, vomiting, tonic or clonic spasms, coma, catalepsy, etc., with slight or no changes in their genitals. Careful examination can not reveal any irritation of the genitals, weakening of the central •or peripheral inhibitory nervous system; but if we inquire closely into the history of patients suffering from such severe nervous paroxysms, we frequently learn that some mem ber of their family has suffered from severe nervous diseases.
The points from which the irritation is transmitted to the nervous system are numerous: The inner surface of the uterus has lost its epithe lial covering, and the nerve ends are bare; the wall of the uterus has become hard and the nerves are pressed upon; the body of the uterus is retroflexed and causes pressure. The parametric tissue, especially around the diseased cervix, has become dense. The broad ligaments are contracted and press upon and pull the nerves. The ovaries are frequently enlarged, diseased and hard, and traction is made on their nerves, or, what we con sider of more importance, these organs are adherent by pseudo-membranes to the broad ligament and parametrium, causing pressure and retraction of the nerves.
The course of the nervous irritation varies according to the locality and extent of the residues. They may be limited to the pelvic branches of the intimately connected lumbar and sacral plexuses, or the irritation follows the course of the sympathetic, and may also, through its connection with the vagus or phrenic nerves, travel along their course, or to mention one main track, by the anastomosing branches of the sympathetic ganglia with the lumbar nerve travel along the spinal cord, and even to th brain.
The irritation transmitted to a nervous centre by the peripheral nerves in and around the genitals, affects also other organs connected with the same centre. In this way the so-called reflex neuroses, in parts remote from the sexual organs, are produced.
Reflex most frequent and demonstrable forms of in flammatory residues, reflecting upon the nervous system, are those limited to the pelvis and its immediate neighborhood. The most frequent com plaints in these cases are: constant pressure, burning and painful sensa tion in the sacrum; a sensation of burning, either symmetrical or only on one side, situated deep in the pelvis or in the epidermis in the lower part of the abdomen, or on the external genitals. Further, motor and sensory disturbances in a lower extremity are often observed correspond ing to the seat of a residue, and the same may hold true of the upper half of the body Distinct reflex neuroses are in almost every case observed only when local symptoms are present in the pelvis and its neighborhood. The con nection between this kind of neurosis with genital disease, its dependence upon the same, after careful examination, can not be denied in neuras thenic individuals. It is proved by many phenomena; the nervous attacks may be preceded by an aura arising from the genitals; or may be caused by mechanical pressure, or traction made upon parametric cicatrices, or upon peritoneal, or ovarian residues connected with them; or the symp toms may be caused to disappear by reposition of a retroflexed uterus. Such cases are frequently observed; for instance, I was able to demon strata several cases in one week, in which nervous attacks could be pro duced by pressure made on perimetric residues.
There are also cases in which a connection between the two affections exists, but can not be proved with certainty; for instance, there is no doubt that the nervous phenomena in neurasthenic women are aggravated or otherwise modified by endometritis of the cervix or corpus uteri, by erosions, etc., but this connection can only be suspected and not made certain before the symptoms of endometritis disappear, together with the nervous phenomena.