CHRONIC METRITIS OR CHRONIC INFLAMMATION OF THE WOMB.

When from neglected or improper treatment, the acute inflammation is not checked, so as to restore the organ to its normal condition, the inflammatory process assumes a chronic character. As inflammation is an abnormal vital activity, which results in the proliferation or building up of fibrous tissue, it must be naturally inferred that if the inflammatory process is active in an organ for a considerable length of time, the tissues of this organ must grow or increase, so as to augment its size and weight. This is indeed so, hence the other names that have been given to this disease to distinguish it from the acute or transient form, all imply tissue growth, as hypergenesis of the connective tissue, engorgement or inflammatory hypertrophy of the uterus.

The entire organ may be thus affected, or it may be limited to either one or the other anatomical divisions of the uterus, namely, the body or the neck.

Of all the different varieties of chronic inflammation of the womb, that of the neck or cervix is the most frequently met. This is due to the fact that in married women and those who have born children the cervix of the womb is exposed to mechanical injury from coition, friction against the vaginal walls in walking and from lacerations during delivery.

The body of the womb is further removed from all these mechanical agencies to which the cervix is exposed, for the body is within the abdomen of the female, and for that reason it is less liable to be injuriously affected by influences that cause inflammatory enlargement. But notwithstanding all this, it is a common disease.

A great many cases of womb complaint that do not yield to ordinary treatment are really of this nature, but owing to carelessness or incompetency are never recognized. The symptoms of this disease, which are obstinate leucorrhoea, falling of the womb or displacements, are mistaken and treated for the disease itself. Women who suffer with this complaint are extremely liable to go on for quite a while feeling comparatively well and in hopes that they are recovering, when some extra exertion or exposure to cold brings on a relapse, which lights up an acute inflammatory process. This passes into the old troublesome disease and this resumes its chronic form. After a repetition of the general routine treatment, the patient may again live under the delusion that she is going to get well only to have her hopes blasted by a sudden reappearance of the former painful symptoms, that are alike discouraging to herself and a puzzle to her friends.

The cause of inflammatory enlargement of the uterus is usually connected with parturition or abortion.

There never can be either the one or the other without more or less vascular activity, which is essential to the repair of the womb and its restoration to its physiological or healthy condition. All the uterine tissues are at this time in a high state of irritability, and if there is a natural predisposition to inflammatory diseases, then the slightest obstacle to an uninterrupted recovery will kindle an inflammatory action, that will fasten itself on the uterus. In the very nature of things this results in a deposition of inflammatory material, with a consequent increase of intermuscular fibrous tissue which increases the size and weight of the uterus.

What our mothers termed in former days “a bad getting up,” that is, when women get up from their confinement weakly and with more or less pain and dragging in the pelvis on walking or the slightest exertion, is generally owing to the above-described condition. This disease is now almost as common as ever. I can always trace these cases to a confinement or an abortion.

It is very rare that it is due to a depreciation of vital forces from improper food, over-exertion, a prolonged nervous depression or a constitutional tendency to tubercle, scrofula or some other hereditary diathesis, although these undoubtedly predispose the patient to the disease.

Abortions stand at the head of all the causes that excite this affection. When the uterus is pregnant and its natural growth is abruptly checked by the destruction of the embryo, then the organ becomes at once the seat of a congestion and great vascular activity, for the purpose of repairing the injury that the premature expulsion of the embryo or fetus inflicted.

If this congestion is delayed from improper care or treatment which fails to recognize the important fact that an abortion or interruption of pregnancy is a much greater shock to the system than a delivery at full term, it must result in arrested involution or permanent inflammatory enlargement. This most persons fail to appreciate, and, as a result, they do not take the same precautions that they would after the delivery of a living or fully-developed child.

I am well aware that criminal abortionists are in the habit of deceiving their patrons by assuring them that there is no danger or bad results to be feared from their criminal operations. This is a vicious falsehood, and, coupled with the statement that there is as yet no living being in the womb, the crime of manslaughter is added to that of malpractice. In every case of abortion, whether accidental or criminal, the same care and attention must be given to the woman as during any natural lying-in period.

There is a class of chronic inflammations that I have noticed in women who have always suffered from painful menstruations or from excessive or prolonged hemorrhage at the regular monthly period. This is complicated with some ovarian disease, which yields, however, to appropriate treatment.

There is quite a series of symptoms that denote the existence of chronic metritis; these are not all present in each particular case but quite enough of them to diagnose the disease. Some of these symptoms are in the nature of complications, which in themselves may be mistaken for an individual disease, but upon a careful inquiry they can be traced directly to a chronic metritis, which if removed disposes of all the lesser ailments.

The following are the most noted signs of this affection: painful copulation, and pain on defecation; a dull, heavy, dragging pain through the pelvis, much increased by walking; during menstruation the mammÆ are sensitive or painful; several days before the approach of the menses there is a dull pain, which lasts during the menstrual flow; around the nipples, there is pigmentation or darkening; sometimes nausea and vomiting, and dyspepsia, headache, and languor; pressure on the rectum with tenesmus and hemorrhoids; leucorrhoea from catarrh of the womb; pressure on the bladder with tenesmus or straining.

This disease may continue for years uninterruptedly, and, if there is not a cure accomplished, or successful measures for its relief are not employed, it will continue until the menopause, or change of life, which may effect a spontaneous cure.

The enlargement is most noticeable in the cervix or neck. This is sometimes so great as to extend one or two inches into the vagina, and this condition is often mistaken for falling of the womb or prolapse, which is far from a correct diagnosis. A growing of the womb from chronic inflammation is the proper explanation.

The hygienic suggestions given in a former chapter, form an important auxiliary in the treatment of this complaint, and for that reason it should be carefully studied.

The treatment of chronic metritis has been, up to within a very recent period, anything but satisfactory in its results. This was owing to an inadequate knowledge of the real nature of the disease, which was marked by so many symptoms that were in themselves obscure and hard to separate as such, from the main affection.

This confusion of the true nature of the pathological process, resulted in a great many vague therapeutical resources, so that the treatment is even yet far from uniform and thorough. Many of the recognized resources laid down in the text-books, on diseases of women, are not only useless, but absolutely injurious, and, in order to save the reader time and money, I will make a brief mention of the most prominent of them.

Depletion, or the abstraction of blood in chronic metritis, effects no permanent benefit in the inflammatory process. I am convinced that, in the long run, the patients grow worse, because this treatment lowers the vitality and reduces the recuperative forces, which are so important, in the treatment of all chronic complaints.

Scarifications or puncturing the cervix with a sharp lance or pointed knife, will not sufficiently impress the morbid process, so as to stimulate it into a healthy action.

Some authors speak very highly of cauterizations and blisters upon the neck or lips of the womb; this I have repeatedly tried, and in not a single instance was it of the slightest use, but it aggravated the symptoms, and in one case it excited a severe, acute metritis that proved almost fatal.

Specialists, as a rule, fall into routine practice, and exercise neither originality or intelligence in practice, outside of the text-book on their shelf. They inject strong fluids or caustics into the cavity of the womb with a view of checking the inflammation in that manner. This treatment is dangerous and delusive. If the patient endures the treatment, she may be stimulated for a time with the idea that something very curative is being done, but my experience has been that the disease only becomes worse, because the womb is too delicate and sensitive an organ to improve under these repeated irritating assaults.

There is a home treatment for mild cases which I recommend to my patients, with satisfactory results. It consists principally of dissolving one teaspoonful of the Femina uterine lotion in a cupful of boiling hot water, after which this should be added to a gallon of warm water of a temperature of 105 degrees F.; these irrigations are to be taken every night, and if the water can be borne hotter the temperature may be gradually increased to 107 degrees F. A napkin should be worn and the bed warmed with a hot water bag before retiring. Ten to fifteen minutes later a Femina vaginal capsule is to be introduced high up into the vagina, by first quickly dipping the capsule into warm water.

In obstinate cases I have used electricity with the greatest success. This is administered by means of a broad dispersing electrode applied on the abdomen, and another electrode, covered with a sponge, is carried up the vagina, to the womb. In this manner I employ an intensity of sixty to one hundred and fifty milliampÈres, for ten to fifteen minutes. This is repeated several times a week, and from three to six weeks, and with other hygienic treatment the patient recovers.

When women are in moderate circumstances, and can spare neither time nor money to visit the office, for the length of time that is required for the electrical treatment, I follow the plan of the Berlin clinic, which originated in Vienna, with Prof. Carl Braun, and is strongly recommended and practiced by Dr. Martin, in Berlin. This consists in an amputation of the cervix, or, in other words, the abnormally elongated and enlarged uterus is trimmed down, and the diseased membrane is scraped out. While the cervix is recovering from the operation, there is also a diminution in the size of the body of the organ, and the chronic inflammation subsides with it. This operation is not dangerous to life, and in my experience I have as yet never had a bad symptom to interrupt the recovery. In obstinate cases, it is, perhaps, one of the most useful surgical measures that was ever devised, and we owe it to the genius of Professor Braun, that all obstinate cases of this nature are amenable to successful treatment.