Psychic Disturbances of a mild character are frequently observed in women with genital disease, but this is not always the only cause, although it can not be denied that prolonged inflammatory diseases in the pelvic organs, and their results, may to a greater or less degree, affect the mind. The patients become depressed, dissatisfied, melancholic or hypochon driac, very irritable; they cry often from slight cause; many can not rid themselves of the thought that they have a cancer, consider themselves doomed, express weariness of life, and sometimes threaten to commit suicide.
Such psychic disturbances occur usually in connection with reflex , neuroses of the stomach and intestinal canal, and are the only ones which may be observed for many years. That these psychic changes should develop into real mental disease, or into " hysteria " with severe nervous attacks, is a supposition not sustained by our observations. Out of the many women we have treated for years, not one has committed the threatened suicide, become markedly hysterical, or the inmate of an insane asylum.
If the inmates of an insane asylum are examined gynecologically we must necessarily find the same percentage of inflammatory residues in their genitals as is in the generality of women. The coexistence of in sanity and genital disease is accidental, but probably the latter aggravates the former, and therefore should be considered in the treatment.
Treatment.—The tissue changes caused by inflammation, the para metric and peritoneal cicatrices, and the pseudo-membranous adhesions between the pelvic organs, can not be removed by any medical treatment. Surgical interference is also not in every case successful, for even if we remove the ovaries, tubes and parts of the broad ligaments, those para metric cicatrices which exert the most pressure on the nerves and give rise to the grave symptoms, may be left in the deeper parts of the pelvis. Still we do not question but that with the removal of a dropsical or pus containing tube and diseased ovaries a constant danger is disposed of.
Cure of Endometrilis.—Since these diseases usually originate in the uterus, and the tissue changes are gradually developed by frequently re curring inflammations, we must pay great attention to the inflammatory processes in the genital tract when they appear for the first time, and to the epithelial losses left by them. Curing the diseased mucous membranes
of the genital tract is the best prophylactic against parametric processes and their frequent recurrence.
Hot Vaginal Irrigations (90° to 93° F.) —When these are administered to the patient on her back the water distends the vagina and causes con traction of the genital tract and of the muscular structures. If used for a long time hey often have a good result.
Massage, as a means for stretching the accessible cicatricial bands, has - often a good result upon the local symptoms as well as upon the radiating pains and sometimes also upon the reflex neuroses. We may mention the favorable influence of stretching cicatrices in the treatment of vesico vaginal fistulme. By stretching the upper edge of the parametrically fixed fistula the pain gradually disappears. A disadvantage of this treatment is its uncertainty, for very frequently nerves are bound down by cicatrices in such localities where it is impossible to stretch them This procedure may also become dangerous when swellings of the tubes are present by causing their rupture or infection from them. Bi-manual stretching, using only a pair of forceps or tenaculum to fix the uterus, is to be preferred to all other methods, for in this way we can best exert direct traction upon the cicatrices. We will illustrate our method with the report of two cases: A woman aged thirty two years had suffered for twelve years from an old exudation in the parametrium which fixed the cervix to the left, binding the left ovary to the broad ligament. First I steadied the cervix by in troducing a finger into the vagina and with the aid of the external hand pulled it in a direction opposite to the cicatrix; later I steadied the uterus with a tenaculum and stretched the tense cicatricial tissue. I continued this procedure every third or fourth day for six weeks; the pain disap peared a year ago and has not yet returned. In another case of six years' standing I used in addition to stretching the cicatrices, hot vaginal irriga tions, and without applying any instrument I succeeded in stretching the cicatrices and in the course of twelve weeks the pain gradually disappeared. Since this time the patient has given birth to one child.