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Arsenic, Strychnine and .Nux Voinica are also very useful. A valuable combination of tried remedies is the Syrup. I iypophosph. Co., which may be given in A- to i dr. doses thrice daily. Hydropathic treatment is of considerable benefit in many of these cases, and probably the change of air and scene plays no inconsiderable part in assisting to re-establish the general health, and so exercise a favourable influence on the local trouble. Practically all the leading hydropathics now cater for female pelvic disease, and the patient should be sent with a note to the attending physician from her own doctor.
In many cases of chronic inflammatory disease of the adnexa I have found considerable benefit to follow the administration of small doses (say 2,000,000) streptococcal vaccine repeated at intervals of a week. This form of treatment is very useful when adhesions are likely to be present, whether due to the disease or as a result of operation.
Rest forms an important part of the treatment. As the symptoms are always aggravated by the pelvic congestion attendant on menstruation, rest in bed during the period should be insisted on, and complete abstinence from sexual intercourse should be the rule while the symptoms persist unabated.
When the ovarian trouble is not relieved by general and local treatment, or when it returns as soon as treatment is intermitted, the propriety of operative interference may be considered. What is to be done will vary, of course, according to the individual case. The operation should have as its aim the complete cure of any outstanding endometritis by curet ting', suturing a torn cervix or removing part of a hypertrophied cervix, and by closing a gaping vulva by perineorrhaphy. If a retroversion of the uterus is present, measures must be taken to remedy it by some form of suspension. Lastly, the ovary itself may be resected, a larger or smaller portion of the oophoron being removed. Complete oilphoreclonty should be discouraged, as the effects of total removal of the ovaries on a patient's mental and physical health are apt to be disastrous, and the removal of a portion of the ovary will be as beneficial as its complete excision. (Sec also under Ovarian Tumours and Pelvic Inflammation.) There is, lastly, a group of cases in which there is complaint of pain and tenderness referred to the ovary. In some of these the pain is truly a
referred one, and is due to some condition, such as erosion of the cervix, totally unconnected with the ovary. In others the ovary is smaller and firmer than normal, and is deeply scarred—a condition described as sclerotic ovary, and assumed to be due to fibrous inflammatory changes. In others the presence of small cysts either of the Graafian follicles or lutein bodies may be demonstrated. Where any obvious lesion, such as erosion, exists, its removal should be the first treatment adopted. In the class of cases where no such lesion is found the affection is often a very intractable one. It is often more or less neurasthenic in type, and should be treated on the lines laid down for neurasthenia (q.7.). is a moot question how far local treatment is likely to be of benefit. In the majority of cases it seems to do no permanent good, and may do harm by establish ing a fixed idea of incurable ovarian trouble. Operation is not to be recommended, and above all removal of the ovaries should never be practised, as this operation never relieves the pain and exposes the patient to the risks of a premature menopause. Some of these patients do well if taken into hospital, operated upon, and then put on Weir Mitchell treat ment, with the assurance that the root of the trouble has been removed and that any persisting pain will rapidly disappear. In others no good effect whatever is produced by operation, and in others the relief of the pain is merely transitory, and lasts for no more than a week or two. My feeling is that the good effect of operation in most of the cases where a good effect has been produced is due to the strong mental impression caused by it. On the other hand, the patient must not be allowed to get the idea that no treatment is being given to the ovaries either through carelessness or despair of doing good. The battery may be used. It strikes the patient's imagination, and there is no need to make use of intra-uterine or intravaginal electrodes, often very objectionable in these cases. One pole may be placed over the sacrum and the other over the ovary in front, and the constant current allowed to pass for io to rs minutes.—R. J. J.