METRITIS OR INFLAMMATION OF THE WOMB.

This is an inflammation of the entire substance of the womb, which, like all inflammatory processes, is acute or chronic.

Inflammation does not always affect the whole body of the womb, but it is quite oftener limited to one or the other layer or membrane that enters into its architectural whole. Then, again, there is the anatomical division of the organ into a body or corpus, and a neck or cervix; of these either one may be affected, without the other, so that inflammation of the cervix should be the subject of a separate inquiry.

Most of the diseases of the womb are due to inflammation. This was the opinion of J. H. Bennett, of London, as long ago as 1845, in which year the first edition of his work on “Inflammation of the Uterus” was published. Up to that time, the subject had never been practically pursued to the same logical conclusions, so that the opinions of the leading professional minds were far from unanimous on this question. But the vigor and energy with which the young author defended his views, forced attention and conviction upon the greater part of the profession, in this country and Europe.

He started out with a view to prove: “1. That inflammation is the primum mobile in uterine affections, and that from it follow, as results, displacements, ulcerations and affections of the appendages. 2. That menstrual troubles and leucorrhoea are merely symptoms of this morbid state. 3. That in the vast majority of cases, inflammatory action will be found to confine itself to the cervical canal and not to affect the cavity of the body.”

Since the appearance of the first edition of Dr. Bennett’s work, which is now forty-six years ago, there have been many careful and clever observers in this field of pathology, but there is yet to appear a successful contradiction of the truth of his inflammatory doctrine. Twenty-six years after Dr. Bennett wrote the above book, he read a paper before the British Medical Association on the same subject, in which there is no modification of his first conclusions on the importance of inflammatory lesions. He says: “1. Uterine displacements are by many too much studied per se (by themselves) independently of the inflammatory diseases that complicate and often occasion them. 2. That the examinations made to ascertain the existence of inflammatory complications are often not made with sufficient care and minuteness, as evidenced by the fact that I constantly see in practice cases in which inflammatory processes have been entirely neglected, and the secondary displacements alone treated. 3. That inflammatory lesions are often the principal cause of the uterine displacements through the enlargement and increased weight of the womb, or a portion of its tissues, which they occasion. 4. That when such inflammatory conditions exist, as a rule they should be treated and cured and then time given to nature to absorb morbid enlargements before mechanical and surgical measures are resorted to.”

If these propositions could be engrossed and a copy sent to every doctor in the land, as a safe and sure guide in his treatment of diseases of women, it would prove a great boon to the suffering women of this country. One of the notorious abuses of the profession, is the penchant for the employment of mechanical means, either by means of instruments or the surgeon’s knife. Women are wantonly subjected to painful and tedious treatments which in many cases only aggravate their original suffering, while a few simple rules of hygienic treatment would not only restore them to health and vigor, but would save them the privation of paying fees to incompetent, unscrupulous or avaricious doctors, who have only one ambition, that is, to get the patient’s money. I have known an instance where this barbarous course under the guise of scientific treatment, broke up the home of a once happy and prosperous couple, and finally when the resources were so low that the expense incident to housekeeping and a nurse could no longer be defrayed, the household effects were disposed of, and, as a last resort, the overdoctored woman was taken to a hospital, where her last hopes were lulled into an artificial sleep, while the surgeons performed an operation from which her depleted body and squandered vitality could never recover. She died.

I am convinced from observations in large female clinics in Berlin, and from my own studies in the pathological laboratory while a student abroad, that Dr. Bennett’s conclusions are corroborated by actual facts. The freedom with which dangerous operations are undertaken for comparatively trivial complaints is degenerating into a license that is criminal and which in some cases is nothing less than murder. In the absence of a high moral sentiment which should control the profession, but does not, the State must step in and say who shall practice medicine and surgery, and by limiting competition, the evil propensity to make the most of one’s opportunities will not be elevated into a fine art, and men, although unscrupulous, may be at least indifferent honest.

Acute metritis comes on suddenly, and this occurs quite often during the menstrual period. Women as a rule are altogether too careless during menstruation; they seem to forget that at this time the womb is congested and swollen, and that if the natural flow of the blood is interfered with, this congestion will turn into an inflammation. Exposure to cold, or getting the feet damp, or inordinate exercise that overheats the system, will bring this about. Sometimes there may be a tumor or swelling in the womb which occludes the cervical canal, so that the menstrual fluid cannot escape; this will also cause inflammation. A stricture of the cervical canal, occasioned by the womb being flexed, will interfere with the egress of the menstrual flow, and this also may give rise to inflammation. Vaginal injections either too hot or too cold, and particularly immediately after copulation, when the pelvic organs are still in a high state of congestion, is quite liable to excite metritis. Gonorrhoeal infection is another source of inflammation, but this is invariably preceded by an endometritis, which I will consider separately.

Large, ill-fitting pessaries worn in the vagina for a supposed retroflected or prolapsed uterus, or a stem pessary, are fruitful causes of metritis.

Other causes are criminal abortion, complicated with blood poisoning from the unclean probes or instruments, that the abortionist has employed on previous operations without thoroughly cleansing and disinfecting them; the application of strong caustics to the cervix of the womb, as well as injections into the cavity of the uterus. Meddlesome doctoring by means of the unskillful and unnecessary use of instruments, like the probing of the womb without proper antiseptic precautions, or the scraping, stretching or operating on the womb without the essential antiseptic precautions which a scientific comprehension of the subject demands, has frequently caused this affection.

It occurs very often as a part of the general inflammation produced by the absorption of putrid or septic matter during the childbed period. This indicates a lack of cleanliness on the part of the attendants during confinement; inflammations of this nature constitute one of the types of puerperal or childbed fever.

The most prominent symptom is pain. This is greatly aggravated on the slightest pressure, or on moving or turning in bed. Upon a digital examination, the womb is found enlarged or swollen, and when the organ is tilted up on the examiner’s finger, there is a sharp lancinating pain radiating from it in all directions.

The first symptoms of pain are always accompanied with fever, and this may have been ushered in or alternated with a chill. The pain may be first felt rather deeply in the pelvis, and this is increased by a frequent desire to pass urine and a straining of the rectum. It may further become complicated with a looseness of the bowels, or an obstinate constipation. Nausea and vomiting is a frequent symptom during the course of the disease, and if the metritis is developed during menstruation, the flow may suddenly stop, but, on the other hand, the hemorrhage may become alarmingly profuse. Standing, walking, coughing and straining at stool excite the most excruciating pain, so that a recumbent quiet position is the only comfortable way for the patient to maintain herself, with the head as low as possible to insure the most easy recumbency.

The treatment for acute metritis depends somewhat on the cause in each individual case. There are, however, two indications that require to be met, and these are common to all inflammations, namely, to relieve the pain and check the inflammatory process.

The former is quickly relieved by introducing into the vagina a Femina vaginal capsule in the usual manner; repeating every six to eight hours, until the pain is sufficiently alleviated to occasion no suffering; then one capsule should be employed every night until cured or until restlessness requires that something must be done to calm the patient.

If the metritis is due to suppressed or checked menstruation from cold or exposure, then, and only then, are hot fomentations over the entire abdomen the most appropriate application, and if the patient is plethoric, I advise a half-dozen leeches to the inguinal region of one or both sides to be of unequaled value for checking the disease.

Until my experience and observation in German hospitals, I was in the habit of employing hot applications for all acute inflammations of the abdominal organs. These were either in the form of hot-water fomentations or flaxseed poultices. Hot applications undoubtedly give relief, but I doubt whether they ever cut short or abridge the inflammatory process in any case. I am inclined to believe that in a great many instances hot fomentations have the tendency to encourage suppuration, and that an abscess is often the result of their use. I have seen decidedly better results from cold applications, and the colder the better, so that I now employ them universally in all acute inflammations of the pelvic organs except in the noted exception in which the inflammation is due to a sudden check of the menses from exposure. As a preventive of inflammations, after delicate operations on the uterus, I apply the rubber ice bag with invariable success.

The most suitable rubber bag for this purpose is a size of six by twelve inches; it should be filled with broken pieces, and then securely tied. I prefer to envelop the bag in a thin layer of flannel, so as to take off the cold, clammy sensation which the rubber imparts to the skin. There should be two of these bags, in case of accidentally tearing one, and so that the reserved one may be in readiness when the other is removed. The cold does not only check and control the inflammation, but it also benumbs the nerves, so that it greatly relieves pain. I keep these ice bags applied over the region of the womb, until all the acute symptoms disappear. The vagina, however, should be irrigated with medium hot borax water, once a day, so as to remove any irritating discharge from the uterine cavity.

The digestive derangements that so often accompany acute metritis; the nausea and vomiting of this and kindred diseases, are alleviated by this formula:—

NO. IX.

Mix, and take a tablespoonful every one or two hours, until relieved; to allay the thirst and dryness, take small pieces of ice. Constipation of the bowels should be relieved by taking a Femina laxative tablet every six hours until the stools are freely moved; after that one should be taken every night or perhaps every other night, so as to keep the system regulated.

Some persons suffer from costiveness because they do not drink enough water, and when taking medicines to correct this disorder it is always well to drink a large tumblerful of water at the same time, and especially at bedtime, three or more hours after supper, and early in the morning is another good time for drinking water and taking a laxative.