が
​1880
UNIV
OF
EATON
DISEASES
OF
WOMEN
1819H
E 14
B 477009

.4
ARTES
1837
SCIENTIA
VERITAS
LIBRARY
OF THE
UNIVERSITY OF MICHIGAN
E PLURIBUS UNUM
TULBUR
QUAERIS PENINSULAM AMOENAMU
CIRCUMSPICE
HOMOEOPATHIC
LIBRARY
1
:..
E14
(2)
1'819 H
:
1
}
•
2427

B
FEMALE PELVIS.
*
Ernim
lein, blee. 1281-
A
TREATISE
ON THE
Finmard..
72430
MEDICAL AND SURGICAL

DISEASES OF WOMEN,
WITH THEIR
HOMEOPATHIC TREATMENT.
Fully Illustrated.
BY
MORTON MONROE EATON, M. D.,
CINCINNATI, OHIO.
BOERICKE & TAFEL,
NEW YORK,
145 Grand Str.
PHILADELPHIA,
635 Arch Str.
TRÜBNER & CO.,
LUDGATE HILL, E. C.
1880.
LONDON, ENG.
COPYRIGHT SECURED,
AND ALL RIGHTS UNDER IT RESERVED,
BY THE AUTHOR.
"
PREFACE.
IN conformity to custom, the Author presents some of
the reasons which have induced him to present this work to
the homoeopathic medical profession.
First. Because he has been for several years repeatedly
urged to do so, by prominent homoeopathic physicians of
several States, including representative men in the cities of
Chicago, St. Louis, New Orleans, Boston, Louisville and
Cincinnati.
Secondly. Because homoeopathic colleges have been
obliged to recommend, and homoeopathic physicians and
students have been obliged to provide themselves with,
allopathic works upon these diseases; thereby giving a certain
amount of sanction to the treatment therein advocated, and
causing the use (among otherwise good homoeopathic phy-
sicians) of caustics, scarifications, etc., applied to the uterus,
to become so common among them as to bring a blush of
shame to the face of the true homoeopath. In the use of
pessaries and drugs, the homoeopathic profession have also
inadvertently been following, in part, their old-school breth-
ren's treatment; because they largely have been obliged to
IV
PREFACE.
The homoeo-
study the description, etiology, diagnosis, pathology, and
prognosis of these diseases from their books.
pathic books which we have had upon the diseases of
women, though written by gentlemen of high standing, do
not seem to meet all the requirements of the profession,
though excellent, so far as they go.
Thirdly. Because it seems time that homoeopathists
should have complete text books on all branches of medical
education; the large increase in the number of homoeopathic
physicians from year to year justifying the expectation, that
erelong we may rival the old school in numbers, as we now
do in the intelligence and wealth of our patrons.
Fourthly. Because the homoeopathic physicians of Illinois.
and Ohio, in their State societies, and of the North-west, in
the Western Academy, have honored him with their con-
fidence, and shown their respect by giving him prominence
in regard to these diseases, and because he has had a large
experience in their treatment for over twenty years, in
hospital and private practice (allopathic and homoeopathic).
He has endeavored to make this work as complete as
possible. How far he has succeeded, the profession must
judge. He believes the works upon the diseases of women,
by Thomas and Emmet, of the old school, are ordinarily
considered complete; but he finds that Prof. Thomas omits
in his index, Lacerations of the Cervix Uteri; and Prof.
Emmett omits Areolar hyperplasia of the uterus, Hydatids of
the uterus, Rectocele, Sterility, Inflammation of the uterus, in
all forms, except as he refers to congestive hypertrophy, Abor-
tion, Pudendal hemorrhage and Pudendal hæmatocele. And
† Emmet's Prin. and Prac. of Gyn.
*Thomas' Diseases of Women.
PREFACE.
V
both Profs. Thomas and Emmet omit Hysteralgia, Puerperal
fever, Puerperal phlebitis, Mammary Abscess, Cervicitis,
Sympathetic Affections, and Nymphomania, as well as Puer-
peral mania. He is hopeful that this work will not be found
less complete.
Neither Dawson's improved Sims' speculum nor Wocher's
bi-valve speculum are mentioned in either of these works, or
those of any other author on Diseases of Women (so far as
he is aware), and they need but to be seen to be appre-
ciated as decided improvements. Cutler's suture cutter and
forceps, his own improvement of the London Abdominal
Supporter, his needle holder, and wire holder and twister, for
vaginal fistulæ, have not heretofore been presented to the
profession.
He has spared no pains or expense to have his illustra-
tions perfect and complete. In this he is greatly indebted to
Mr. John H. Bogart, designer and engraver, of this city.
He has not attempted to make a Materia Medica, but has
named such remedies as he has found beneficial, and given
the prominent homoeopathic indications for their use in each
disease, gleaning somewhat from other authors, as well as
his own experience.
The Author, in conclusion, would express his thanks to
Drs. S. R. Beckwith, of Cincinnati; W. H. Hunt, of Cov-
ington, Ky.; M. B. Pearman, of St. Louis; T. P. Wilson,
of Ann Arbor, and others, for valuable suggestions.
Respectfully,
CINCINNATI, O.,
U. S. A.
M. M. EATON.
TABLE OF CONTENTS.
INTRODUCTION,
CHAPTER I.
PAGE.
17
CHAPTER II.
GENERAL DIAGNOSIS,
21
CHAPTER III.
NORMAL MENSTRUATION, AND AMENORRHŒA, .
CHAPTER IV.
31
MENORRHAGIA AND METRORRHAGIA,
41
CHAPTER V.
DYSMENORRHOEA, OR PAINFUL MENSTRUATION,
46
CHAPTER VI.
VICARIOUS MENSTRUATION,
56
CHAPTER VII.
INFLAMMATION OF THE FEMALE GENITALIA,
60
CHAPTER VIII.
METRITIS,
CHAPTER IX.
AREOLAR HYPERPLASIA OF THE UTERUS; OR, CHRONIC PARENCHYMA-
TOUS METRITIS,
77
87
VIII
TABLE OF CONTENTS.
CHAPTER X.
PERI-METRITIS-PELVIC CELLULITIS-PELVIC ABSCESS,
PAGE.
110
CHAPTER XI.
CHILD-BED FEVER PUERPERAL PERITONITIS, PUERPERAL METRITIS,
METRO-PHLEBITIS, AND PERITONITIS,
126
CHAPTER XII.
HOMEOPATHIC REMEDIES,
137
CHAPTER XIII.
INSTRUMENTS,
CHAPTER XIV.
INDURATION AND HYPERTROPHY OF THE CERVIX UTERI-VAGINISMUS
AND DYSPAREUNIA,
CHAPTER XV.
ULCERATION OF THE OS UTERI,
•
CHAPTER XVI.
VAGINITIS-ADHESIONS IN THE VAGINA FROM INFLAMMATION-DIPH-
THERITIC INFLAMMATION OF THE VAGINA-PERI-VAGINITIS PHLEG-
MONOSA DISSECANS,
•
CHAPTER XVII.
IMPERFORATE HYMEN-ATRESIA OF THE HYMEN (CONGENITAL AND
ACQUIRED)-HEMATOMETRA, ETC.,
CHAPTER XVIII.
UTERINE HEMORRHAGE,
142
162
179
186
197
201
CHAPTER XIX.
CERVICITIS AND ENDO-CERVICITIS, OR CATARRH OF THE CERVIX,
211
CHAPTER XX.
ENDO-METRITIS,
218
CHAPTER XXI.
LEUCORRHOEA-WHITES,
240
TABLE OF CONTENTS.
IX
CHAPTER XXII.
PAGE.
BARRENNESS AND STERILITY,
249
CHAPTER XXIII.
DISEASES OF THE OVARIES,
265
CHAPTER XXIV.
OVARIAN TUMORS, .
275
CHAPTER XXV.
OVARIOTOMY,
312
CHAPTER XXVI.
UTERINE FIBROMA-MYOMA-FIBROUS TUMORS OF THE UTERUS,
342
CHAPTER XXVII.
UTERINE POLYPI VEGETATIONS OF THE ENDOMETRIUM UTERINE
HYDATIDS-VASCULAR POLYPI-PLACENTAL AND GRANULAR POL-
YPI, ETC.,
CHAPTER XXVIII.
MOLES IN THE UTERUS, .
CHAPTER XXIX.
CATARRH OF THE UTERUS AND VAGINA,
CHAPTER XXX.
352
375
380
HERNIA OF THE OVARY-HERNIA OF THE UTERUS, OR HYSTEROCELE, 385
CHAPTER XXXI.
PROLAPSE OF THE VAGINA, CYSTOCELE, RECTOCELE, ENTEROCELE, AND
OVARIOCELE,
•
389
CHAPTER XXXII.
PAPILLARY TUMORS OF THE UTERUS AND OVARIES, AND COCCYGODYNIA, 395
CHAPTER XXXIII.
CANCER AND CAULIFLOWER EXCRESCENCE OF THE UTERUS CARCI-
NOMA, SARCOMA, ETC.,
400
CHAPTER XXXIV.
FEMORAL HERNIA, INGUINAL HERNIA, LABIAL HERNIA, VAGINAL
5
Hernia, and Hydrocele,
404
TABLE OF CONTENTS.
X
CHAPTER XXXV.
HYDROMETRA-PRURITUS VULVÆ-ABSCESS OF THE LABIA-CYSTS OF
THE VAGINA-FIBROIDS OF THE VAGINA-POLYPI OF THE VAGINA-
PROLAPSE OF THE OVARIES,
PAGE.
·
406
ABORTION,
CHAPTER XXXVI.
CHAPTER XXXVII.
CYSTS OF THE BROAD LIGAMENT AND DISEASES OF THE FALLOPIAN
TUBES,.
•
CHAPTER XXXVIII.
DISEASES OF THE URETHRA-URETHRITIS, CARUNCLES OF THE URE-
THRA, IRRITABLE URETHRAL CARUNCULE, ULCERATION, FISSURES
oF THE NECK OF THE BLADDER, OR MEATUS URINARIUS INTERNUS,
LACERATIONS OF THE URETHRA FROM DILATATION, PROLAPSE OF
THE URETHRA, URETHRAL POLYPI, ETC.,
421
437
445
CHAPTER XXXIX.
TUBERCULOSIS OF THE VAGINA-STENOSIS OF THE UTERUS,
451
CHAPTER XL.
CYSTITIS IN WOMEN,
CHAPTER XLI.
STONE IN THE BLADDER AND URETERS,
•
CHAPTER XLII.
SYMPATHETIC EFFECTS OF DISEASES OF THE UTERUS AND ITS APPEND-
AGES,
CHAPTER XLIII.
PUDENDAL HEMORRHAGE-PUDENDAL HÆMATOCELE-THROMBUS-RUP-
TURE OF THE BULBS OF THE VESTIBULE,
CHAPTER XLIV.
PUBERTY-AND THE CLIMACTERIC PERIOD,
CHAPTER XLV.
455
462
472
490
494
ATRESIA OF THE VAGINA, AND CERVIX UTERI HÆMATOMETRA, ETC., 502
I
TABLE OF CONTENTS.
XI
CHAPTER XLVI.
FISTULA-VESICO-VAGINAL FISTULA-RECTO-VAGINAL FISTULA-RECTO-
VESICAL FISTULA-VESICO-CERVICAL FISTULA-URETHRO-VAGINAL
FISTULA-INTESTINO-VAGINAL FISTULA-URETO-VAGINAL FISTULA—
VESICO-UTERINE FISTULA-PERITONEO-VAGINAL FISTULA-PERINEO-
VAGINAL FISTULA-BLIND VAGINAL FISTULA-FISTULA IN ANO, .
PAGE.
511
CHAPTER XLVII.
LACERATIONS OF THE CERVIX UTERI,
CHAPTER XLVIII.
DISPLACEMENTS OF THE UTERUS, .
CHAPTER XLIX.
DIFFERENT FORMS OF DISPLACEMENTS OF THE UTERUS-INVERSION OF
THE UTERUS,
CHAPTER L.
RETRO-VERSION AND RETRO-FLEXION OF THE UTERUS,
539
552
563
578
CHAPTER LI.
ANTE-VERSION AND ANTE-FLEXION OF THE UTERUS,
598
CHAPTER LII.
PROLAPSUS UTERI AND PROCIDENTIA,
605
•
CHAPTER LIII.
LACERATION OF THE VAGINA-LACERATION OF THE PERINEUM-ULCER-
ATION (TUBERCULOUS, CANCEROUS, AND SYPHILITIC),
CHAPTER LIV.
EXTRA-UTERINE GESTATION,
•
CHAPTER LV.
STRANGURY, DYSURIA, ISCHURIA, RETENTION OF URINE, SUPPRESSION
OF URINE, ENURESIS, ETC.,
CHAPTER LVI.
629
642
646
GONORRHOEA IN WOMEN,
650
CHAPTER LVII.
SYPHILIS IN WOMEN,
655
CHAPTER LVIII.
DISEASES AND DIFFICULTIES OF PREGNANCY,
660
XII
TABLE OF CONTENTS.
CHAPTER LIX.
VOMITING IN PREGNANCY,
CHAPTER LX.
PUERPERAL MANIA,
CHAPTER LXI.
PAGE.
. 672
DISEASED AND DEFORMED NIPPLES-MILK FEVER-ABSCESS OF THE
BREAST TUMORS OF THE BREAST, CANCER, AND AMPUTATION OF
THE BREAST,
688
692
CHAPTER LXII.
PHLEGMASIA DOLENS-PUERPERAL PHLEBITIS, OR MILK LEG,
705
CHAPTER LXIII.
HYPERTROPHY, AND SUB-INVOLUTION OF THE UTERUS,
709
CHAPTER LXIV.
HEMATOCELE, PELVIC HEMATOMA, THROMBUS, ETC.,
CHAPTER LXV.
716
ELEPHANTIASIS, OR HYPERTROPHY OF THE CLITORIS, LABIA MAJORA,
AND LABIA MINORA, HERMAPHRODITES, NON ENTITIES, TUMORS OF
THE LABIA, ETC.,
•
723
CHAPTER LXVI.
EXTIRPATION OF THE UTERUS-ABLATION OF THE UTERUS, HYSTER-
OTOMY, ETC.,
CHAPTER LXVII.
HYSTERALGIA — NEURALGIA UTERI· IRRITABLE UTERUS-ASCITES IN
WOMEN,
CHAPTER LXVIII.
BATHING-VAGINAL WASHES STOMATITIS MATERNA,
CHAPTER LXIX.
NYMPHOMANIA (The "Fureur Utérine" of the French)—ATROPHY AND
HYPER-INVOLUTION OF THE UTERUS-ABSENCE OF THE UTERUS—
MALFORMATION OF THE UTERUS-ANÆSTHETICS,
D
HYSTERIA,
CHAPTER LXX.
727
736
744
750
757
ILLUSTRATIONS.
Alphabetically Arranged.
ABSENCE of the uterus,
Ante-version of the uterus,
Ante-flexion
((
Antiseptic spray apparatus,
Applicator sponge tent,
"
(C
•
uterine, Emmet's,
Palmer's,
Artery forceps,
Ashton's perineum needle,
Aspirator, Tiemann & Co.'s,
CL
Dieulafoy's,
Atresia of the vagina,
BABCOCK supporter,
Battery, Faradic,
((
combination,
Bed swing,
•
•
Bi-valve speculum, vaginal,
แ
Bony pelvis, female,
urethral,
•
Bozeman's teuaculum,
•
•
•
PAGE.
opp. 723 Clamps for pedicle of ovarian tu-
" 598 mors,
599 Clamp, Thomas',
Dawson's improved,
" 156
PAGE.
opp. 161
161
. 321
Spencer Wells' original, opp. 161
new (three figs.)," 161
.366
366
•
715| Clitoris, hypertrophy of,
723
322 Combination battery,
38
opp. 156 Complete procidentia uteri,
•
•
opp. 611
({
153
66
(
154
inversion of the uterus, " 563
Counter pressure hook, .
.521
503
Curved scissors,
.530
•
((
Bozeman's,
523
(4
long, .
146
•
"
(C
Emmet's, .
726
opp. 146
38, 160, 714
•
.38 Cutler's suture cutter and forceps, . . 535
339
•
opp. 143
.446
opp, title-page.
curved scissors,
straight scalpel, .
DAWSON'S pedicle clamp, improved, 321
Sims' speculum,
Depressor, vaginal,
opp. 158 Dieula foy's aspirator,
. 523 | Dilator, uterine, .
. 636
CALLENDER'S drainage canula, opp. 158
•
sponge tent,.
vaginal,
Double tenaculum forceps,
Canula drainage,
333, and "
158
(C
Catheter, reversible, .
self-retaining,
•
.457
opp. 158
•
uterus,
cervix uteri,.
•
•
opp. 142
•
522
opp. 154
147
"153
145
. 323
•
754
.755
uterus and vagina,
. 503
333, and opp. 158
144
. 527
opp. 145
145
Cervix uteri, hypertrophy of,
،،
elongation of,.
(C
·
162 | Drainage tubes, .
opp. 609 Dressing forceps, uterine,.
amputated (two figs.),
double,.
Chair examination,
Civiale's lithotriptor,
•
169
755 EATON'S needle-holder in use,
22
opp. 147
wire holder and twister,.
XIV
ILLUSTRATIONS.
Eaton's wire holder and twister,
((
applied,
•
improved London sup-
porter,
•
Ecraseur, Edwards',
Edwards' Ecraseur,
Elastic pessaries,
•
•
·
abdominal supporters,
Electrode, intra-uterine,
•
Electrolysis needles (one fig.),
((
(C
•
(seven figs.),
Elevation of the uterus,
•
•
•
PAGE.
Front view of uterine organs,
opp. 145 Furguson's mirror speculum,
157 GREENHALGH'S forceps,
•
369
•
•
369 HÆMATOCELE, recto-vaginal,
149 Hæmatometra (two figs.),
opp. 157 Hermaphrodite,
•
714 Hypertrophy of the uterus,
of the clitoris,
•
PAGE.
•
opp. 17
แ
143
. . 208
opp. 718
503
opp. 723
. 710
opp. 723
. 160
•
. 370
"(
labia majora,
(C
726
opp. 718
(( 159
،،
(
66
"L
minora,
cervix uteri,
725
. 162
•
opp. 144
(6 144
159 Hysterotome, White's,
Elevator, Elliott's uterine,
Elliott's uterine elevator,
Elongation of the cervix uteri,.
Emmet's sponge tent applicator, 597, 366
curved scissors,
609
((
726
Simpson's,
IMPROVED London abdominal sup-
porter,.
sponge dilator,
•
opp. 153
opp. 157
แ
CC
holder,
326
Imp'd Peaslee perineum needles,
"( 145
(
"
counter pressure hook,
speculum,
Enlargement of the clitoris,
Enucleators, Sims' (three figs.), .
Endoscope, urethral, .
Examination chair,
Exploring trocar,
Extirpated uterus,
•
FARADIC batteries,
Female form,
•
pelvis, bony,
•
Fibroma of the uterus, .
•
•
•
521
Inflatable pessary, .
. 149
•
•
635
Inhaler, Lente's modified,
·
•
opp. 723
Intra-uterine electrode,.
365
Inversion of the uterus,
opp. 156
.714
opp. 563
•
446
22
opp. 154
LACERATION of the perineum,
•
. 635
of the perineum, adjusted, 638
•
733, 734
((
((
"L
sutures placed, 635
(
(C
cervix, .
•
uterine, subserous,
(( submucous,
t
((
Fibroids, syringe for injecting,
Fistulæ, vaginal,
แ
((
Forceps, vulsellum,
" Nelaton's tumor,
pedicle,
straight lithotomy,
524, 526, 527
แ
•
opp. 535
((
แ
154
•
Lente's inhaler,
38, 160, 714 | Ligature cutter, .
opp. title page. | Ligatures,
•
((
343, 352, 354
Lithotomy forceps,
Lithotriptor,
343
•
343
Little's antiseptic spray apparatus,
trocar,.
►
343 London abdominal supporter (old),
352, 354
แ
•
"(
•
opp. 147
،،
147
156
159
157
improved,
157
146
trocar,
" (uterine),
•
125
•
. 510
. 150
171 Long curved scissors,
opp. 156
.535
169, 346
"L
((
needle,
•
((
artery,.
•
66
double tenaculum,
66
แ
แ
แ
uterine dressing,
66
Greenhalgh's,.
Cutler's suture,
•
•
156 M'INTOSH'S supporter,
365 Mirror speculum, .
opp. 147 Mucous polypi, uterine,
526
opp. 143
. 352
322 NEEDLE HOLDER, Eaton's, 527, opp. 145
323
แ
แ
184
"
(
•
opp. 144
. 208 Needles, Pease's, .
•
. 535
suture, curved,
Sims',
curved,
straight,
.526
•
•
opp. 145
•
*
. 526
148
opp. 158
ILLUSTRATIONS.
XV
PAGE.
PAGE.
Needles, suture, full curved,
perineum,
แ
(C
((
•
•
•
158 RECTO - VAGINAL hæmatocele, opp. 718
((
156 Repositor, White's uterine,
((
Ashton's,
"Peaslee's improved, “
open-eyed,
electrolysis,.
156 Retractor, Emmet's vaginal,
156
Retro-version of the uterus,
"
326
Retro-flexion
•
•
160
(seven figs.),. . 370
Nelaton's pedicle forceps, .
(( tumor forceps,
Nelson's tri-valve speculum,
Nonentity,
•
Nott's depressor,
OLD WOMAN'S uterus,
(6
vagina,
·
(6
Reversible catheter,
Round elastic pessary, .
•
365
opp. 156
143
SCALPEL, Bozeman's,
Scissors,
•
"
แ
723
curved, .
•
.573
.635
•
opp. 578
'
580
. 457
. 149
. . 636
. 523
•
530, 726
•
•
opp. 158
522 Self-retaining catheter,
Side view of uterine organs,
Sims' uterine elevator,
enucleators (three figs.),
opp. 21
27
27
!
needle holder,
Old London abdominal supporter, opp. 157
Open-eyed needle, .
Operating tables,
•
326
€ 319, 703
"L
folding
ti
แ
Operation for lacerations of perineum, 635
"vesico-vaginal fistula, opp. 535
CC
፡፡
"C
"524, 526, 527
Original speculum, Sims', . . . opp. 142
clamp, Spencer Wells', . "
London supporter,.
Os uteri, virgin, .
66
old woman's,
161
(4
157
26
27
►
•
•
159
365
. 526
•
opp. 142
142
142
(6
145
•
€ 326
•
opp. 153
•
347
opp. 144
144
PALMER'S uterine dilator,.
CC
applicator, .
Penslee's perineum needles,
Pease's needle (perineum), .
Pedicle clamps (four figs.), .
66
•
•
original speculum,
Dawson's imp.
vaginal dilator,
sponge holder,
sponge dilator,
enucleators,
Simpson's sound,
CC
hysterotome,
Skene's sound,
(C
·
urethral endoscope, .
opp. 147 | Sound, steel, ..
CC
•
Speculum, urethral bi-valve,
Skene's, .
Sims' (three figs.), .
Wocher's bi-valve,
Nelson's tri-valve,
Furguson's mirror, .
Emmet's vaginal,
·
•
. 515
·
opp. 156
(6
Simpson's,
Skene's, .
148
Pelvic hæmatocele,
Pelvis, female, bony,.
Pessary, inflatable,
opp. 161
Dawson's improved,. . 321
opp. 718
opp. title page.
66
149
elastic ring,
149
•
•
•
Spencer Wells' trocar,
·
eration of,
635
(C
D
•
artery forceps,
66
144
•
446
•
opp. 144
66
144
CC
144
•
446
446
opp. 142
Perineum, operation for restoring lac-
restored after laceration of, 638
Polypi, mucous uterine,
CC
fibrous uterine, .
Procidentia uteri, .
CC
352
*C
143
(C
•
143
66
143
•
. 635
320
322
"pedicle clamp (orig'l), opp. 161
40 CC
343, 352, 354 | Sphygmograph,
•
new, (three figs.), " 161
•
. 161
•
opp. 609 Sponge tents,
. 150
complete,
((
611
Sponge tent applicator, .
. 366
opp. 605 and 710
opp. 606
CC
CC
holder,
597
dilator,
opp. 153
(C sponge holder,
Subserous fibroid of uterus, .
•
326
•
1313
•
QUILL, suture, adjusted, .
638 Submucous ((
343
Prolapsus uteri, .
Co
66
608
X VI
ILLUSTRATIONS.
((
Swing, bed,.
Sub-involution of the uterus,
Supporter, Babcock's,
(
old London abdominal,
impr'd Lond. abd'l, Eaton's,
silk elastic,
M'Intosh's,.
Suture cutter and forceps,
PAGE.
•
339 Uterine polypi (mucous),
PAGE.
352
. 710
66
•
•
•
CC
157
opp. 146
157 Uterus, hypertrophy of,
(fibrous),
dilator, Palmer's, .
352, 354
opp. 145
162, 710
(C
sub-involution of,.
710
CC
•
157
virgin,
•
26
150
((
•
old woman's,.
27
•
535
((
double,
.
503, 754
(6
needles, curved,
opp. 158
extirpated (two figs.),. . 733, 734
({
(6
half curved,
.
(( 158
elevation of, .
•
•
Sutures in cervix uteri (two figs.), . . 169
Syringe for injecting uterine fibroids, 171
opp. 718
li
prolapse of,
•
opp. 605, 606, 609
TABLES, operating,
Tenaculum, Bozeman's,
แ
double,
Thomas' pedicle clamp,
Tiemann & Co.'s aspirator,
Trocar, common,
66
exploring,
•
""
long curved,.
(C
(6
uterine,
•
Spencer Wells',
(4
Little's,
Tri-valve speculum, Nelson's, .
Tumor forceps, Nelaton's, .
((
UTERINE organs, normal posi-
•
opp. 142
(6 143
Vulsellum forceps,
tion,..
opp. 17, 21
WELLS' artery forceps,
26
opp. 154, 535
322
،،
dressing forceps, .
184, opp. 144
pedicle clamps (4 figs.), opp. 161
elevator, Elliott's,
(6
159
trocar,
Sims', .
"
159 White's uterine repositor,
320
573
(6
repositor, White's,
•
(6
fibroids (three figs.),
343
61
•
573 | Wire holder and twister, Eaton's, opp. 145
syringe for injecting, . 171 Wocher's bi-valve speculum,
applied, 145
" 143
•
319, 703
opp. 158
.
. 323
opp. 161
(6
drawn out in sight,.
153
391
VAGINA, old woman's,
opp. 154
. 125
((
atrophy of,
atresia of, .
•
510
((
double,
CC
versions of,
flexions of,
procidentia of,
absence of,
•
•
opp. 710
•
•
opp. 578, 598
580, 599
609, 611
•
opp. 723
"535
. 27
opp. 723
. 503
320 Vaginal dilator,
opp. 159
•
opp. 143
66
. 365
opp. 156
(C
pessaries,.
specula (three figs.), .
CC
Virgin os uteri, .
66
. 503
opp. 145
. 149
PLATE I.

FRONT VIEW OF UTERINE ORGANS IN THEIR NORMAL POSITION.
THE
DISEASES OF WOMEN.
CHAPTER I.
INTRODUCTION.
TO-DAY the diseases peculiar to women are daily brought
to the attention of the general practitioner of medicine. It
is a fact that these diseases are on the increase to an alarming
extent, and bid fair to seriously affect coming generations,
physically and morally.
The world has a right to look to the members of the med-
ical profession for advice on matters of this kind, and I judge
the profession would come short of its duty did it fail to point
out, and seek to remedy, the causes which have led to, and
are increasing, this great amount of female suffering and dis-
ease, thereby enfeebling the offspring which are to come for-
ward on the stage of action, in a few years from now, as the
business men, statesmen, and those who must fill the posts of
responsibility.
May we not, then, in view of the necessities of the times,
spend a short time in consideration of the causes that have
produced this increase of the diseases peculiar to women?
First, the advancements of civilization, so called, have
caused a life of luxury and ease to supplant that of toil and
exercise. The necessity of exercise is as imperative with the
female as the male. Strong muscle, active digestion, and as-
similation are not the result of indolence, but of activity.
Again, our food of late years has been too fine. Pastries,
18
EATON ON DISEASES OF WOMEN.
fine flour, and highly seasoned food have driven out of use,
almost, the plain bread and milk and mush and milk of our
fathers.
Again, the fashion of lacing the chest and upper part of
the abdomen has been, perhaps, the most fruitful cause of the
long train of women's ailments and weaknesses. By con-
tracting the thorax the action of the heart is impeded, the
lungs are prevented from a full expansion, the blood is con-
tinually charged with too large a quantity of carbonic acid
gas. Oxygen is not received into the blood in sufficient quan-
tities to stimulate healthy nerve action, and the result, of
course, is lassitude, debility, and disease.
Another injury resulting from lacing the upper part of the
abdomen is, that the abdominal organs are thereby displaced
downwards, and press heavily upon the uterine organs. These
are thereby displaced and inflamed, producing not only the
symptoms resulting directly from these conditions, but an
immense amount of trouble through reflex action on the cer-
ebro-spinal and sympathetic nervous systems, thereby derang-
ing all the normal functions of the body, and sometimes the
mind as well.
The wearing of clothing suspended from the hips aids in
producing all the ills just mentioned, as resulting in greater
or less degree from lacing. Thin clothing, especially upon the
extremities, in winter, conjoined with the previously men-
tioned customs, is not to be forgotten as one cause of female
suffering.
And, finally, the cause which, we must recollect, is the
great curse of the American ladies is to be found in those
means used to prevent pregnancy and produce abortion.
The disinclination of so many married ladies to become moth-
ers has led them to adopt means for the prevention of concep-
tion that have had the effect of producing diseases in them-
selves of a serious nature. The various means used to pro-
duce abortion have entailed on many a lady life-long suffering.
INTRODUCTION.
19
These remarks may be sufficiently explicit in this connection.
(See chapter on Abortion.)
These causes have led to so many ailments, directly and
through reflex action, that the general practitioner seems
obliged to become conversant with the diseases of women,
and we think he should be better informed in regard to these
ailments than any other, because they are more delicate to
manage, and it is not always that the patient will volunteer
information in regard to them. And when investigation is
thought to be necessary by the physician the patient shrinks
from it, and purposely misleads the physician in describing
her symptoms, so as to convince him that the difficulty is in
the head, liver, back, or stomach, when it is clear that all the
symptoms are due to uterine disease or displacement.
Let me recommend that the student, before entering upon
the study of diseases of women, become very familiar with the
anatomy of the female genitalia, and the arrangement of the
sympathetic ganglia throughout the entire system. Let him
read well the physiology of the healthy female, that devia-
tions from health may be readily recognized, recollecting,
however, that there are some exceptions to general rules.
That some women may normally menstruate every two or
three or five weeks; that the flow may with some be three
times in amount of what others would discharge, and still
they might only have this idiosyncrasy, and be not diseased
at all. By the study of the healthy subject he will learn that
owing to the varying lengths of the vagina in different women
the position of the uterus that would in one case be partial
prolapse would in another be normal. Hence, it will be
seen, that the greater the knowledge we have of the peculiar-
ities of different women, as well as the general knowledge of
the normal conditions, the greater will be our opportunities
to judge correctly of the cases we may have to treat, and the
more correct will be the diagnosis which we will form (if the
diagnosis of the case is all that is asked of us).
20
EATON ON DISEASES OF WOMEN.
It may be well to mention that the early introduction into
society of girls of tender age, the desire of mothers to make
young ladies of their girls when they should be considered
children, requiring them to refrain from that active exercise
that is so necessary for the full development of muscle and
strength; the early marriages so frequently consummated,
together with the constitutional debility inherited from moth-
ers already affected with weaknesses dependent upon errors
of their diet, clothing, and exercise in early life,-all tend
to enfeeble the constitution and develop special weaknesses
and diseases.
PLATE II.

SIDE VIEW OF FEMALE PELVIC ORGANS IN NATURAL POSITION.
GENERAL DIAGNOSIS.
21
CHAPTER II.
GENERAL DIAGNOSIS.
Ir is not every patient with uterine disease that will come
to the physician and announce that she is suffering with such
an ailment; that is, they do not go to the general practitioner
in this way (though the acknowledged gynecologist has the
advantage in this respect, as the patient's presence in his
office is an announcement of some such ailment, and he is at
liberty to suppose his patient has been convinced that she is
suffering from some disease of the female generative organs,
and has come for examination and advice); hence, it becomes
necessary that the general practitioner look for indications of
these ailments among the symptoms given by the patient.
Some of these symptoms, that may point to uterine difficul-
ties, are, pain in the occiput, or top of the head, burning heat
in top of head and soles of feet, hot flashes of long standing,
too frequent or painful micturition, persistent constipation,
bleeding piles, pain in small of back and thighs, nausea, loss of
appetite, indigestion, etc. Either of these symptoms, alone,
would not assure you of uterine disease; but either of them
gives you cause to investigate further. First, note how long
these symptoms have existed, how much treatment they have
had with a failure to obtain relief; inquire further, and ascer-
tain if we have two or three, or more, of these symptoms in
the same case; also, if there is dysmenorrhoea, amenorrhoea,
menorrhagia, or leucorrhoea-if so, of how long duration,
noticing all the peculiarities of each case in these regards.
Take into account the age of the patient, whether married or
single, widows or spinsters, mothers or barren.
When all these things are considered, and the difficulty
22
ΕΑΤΟΝ ΟN DISEASES OF WOMEN.
has been of long standing, and we feel assured that our
patient's sufferings are caused from uterine disease, we are
justified in requesting a physical examination, per vaginam.
This does not contemplate any exposure of the patient, and
consists of a digital examination, and taking note of the
dryness or moisture of the vagina, heat, size of neck of
uterus, whether smooth, nodulated, or fissured; also, its posi-
tion in the vagina, etc.,-all this may be determined with the
patient standing.

FIG. NO. 1.-EXAMINATION CHAIR.
(Mitchell, Rammelsberg & Co., Cincinnati, O.)
Very chronic and severe cases, of course, will demand
more careful examination with the uterine sound, and some-
times we may need the aid of the vaginal speculum as well, in
aid of diagnosis. I value the uterine sound much more highly
than the vaginal speculum. In many cases, as I have hinted,
neither of these instruments is needed. Introducing the vagi-
nal speculum in all cases, as has become the routine habit of
some gynæcologists, is not to be commended or followed.
Its use may be required in treatment much more frequently
GENERAL DIAGNOSIS.
23
than in diagnosis. To make a vaginal examination I prefer to
have the patient sit in a regular examination chair. (See Fig.
No. 1.) It is less embarrassing to the patient; it seems more
modest; it is more convenient for the physician. Let the
cover be thrown over her lap while sitting in the chair, and
then gently tip the chair backwards. The patient is thus
placed in the reclining posture without scarcely realizing the
fact. Some gentle examination of the size of the abdomen,
with slight percussion external to the cover, to ascertain if
there is much tympanites or tenderness, tends to assure the
patient, when we may gently slip the clothing upwards with-
out disturbing the cover, and pass the extended palm of the
hand over the abdomen, first over one or two thicknesses of
clothing, then in direct contact with the flesh. By this exam-
ination we have determined the presence or absence of ten-
derness, heat, and tympanites and have, in many cases, deter-
mined whether or not we have ovarian tumors of large size,
pregnancy of several months' duration, or any large fibroids
of the uterus.
I do not mean to say that this external examination will be
conclusive as to the diagnosis of any of these conditions, except
regarding tenderness, tympanitis, and heat; but I do say that
this manipulation will materially assist in the special diagnosis
which I will explain in detail under the proper special heads.
This examination gives further advantage, viz., that our patient
has by this time become somewhat accustomed to manipula-
tion, and, being assured by this method of examination under
the cover, that she is not to be exposed or rudely handled,
we will have little difficulty to proceed in making a digital
examination per vaginam, following that by examination with
the uterine sound, and finally with the speculum, if need be.
Gentleness, and the most respectful demeanor, will win
the confidence of our patient, and greatly promote the success
of the treatment used; for, without the confidence and respect
of his patient, the physician will fail in receiving that careful
24
EATON ON DISEASES OF WOMEN.
attention to his directions and co-operation in the treatment
which is so essential for success in any disease, but more es-
pecially in those peculiar to women, as, owing to their deli-
cacy, it is necessary that much of the treatment be carried
out by themselves. The physician has not the opportunity to
frequently examine the case, or apply treatment, as in other
ailments.
The general appearance of the patient is to be studied, and
the diathesis noted. The cancerous cachexia, which is indi-
cated by the sallow, brownish yellow complexion, combined
with the anxious, wearied, sunken countenance, is to be rec-
ognized at a glance. The tuberculous cachexia is indicated
by the shrunken features, the bright, glassy eye, the hectic
cheek, emaciation, with the hopeful condition of mind of the
patient, conjoined with the slight or severe cough, which the
patient always insists is but a slight cold. The location of
the tuberculous matter may be in the lungs, liver, bowels,
brain, or other parts of the system. But if we have the
tuberculous or cancerous cachexia clearly defined, we must,
of course, address the treatment to the general condition of
the patient, being assured that unless we are able to bring
the system to a better standard of health we will have little
reason to hope for a favorable termination of the case, what-
ever special ailment the patient may have. To what extent
these conditions or diatheses may be removed with proper
remedies I will state under their proper chapters.
A question may arise in the mind of the physician as to
the propriety of suggesting a physical examination in case
the patient is an unmarried lady. Some seem to think these
cases should never be subjected to physical examination, and
let them suffer on. Now, while I would not propose a phys-
ical examination of the virgin as soon as I would in the case
of a patient that had been married, and would try to avoid
the necessity of making an examination, still, if the case
seemed to require it very urgently, on account of the long
GENERAL DIAGNOSIS.
25
duration of the difficulty, or the intensity of the suffering, I
would proceed to make the examination without hesitation.
I will relate two or three cases only, as examples of many
that have come under my notice and treatment, that will
show how great the necessity for an examination that some-
times exists in these cases, that the patient's life may be
saved, not to mention the saving of suffering and impairment
of constitution by neglect.
In 1870 a young lady from a town some thirty miles dis-
tant, whose age was about twenty-eight years, consulted me
about a persistent ague, as she called it, of two years' dura-
tion. On inquiry, I learned that her chills were nervous,
clearly; that she had hot flashes at irregular intervals; had
much back-ache, constipation, severe dysmenorrhoea, with
much nausea and excruciating headaches, heat in the top of
her head, cold feet and hands. She had taken every medicine
that three physicians of different schools could suggest, and
found no relief. I suspected uterine displacement as the
cause of her ailments; made an examination per vaginam at
once, found retroversion of the uterus, restored the organ,
gave her Nux 3 three times a day, and she was soon well,
every symptom having disappeared.
CASE SECOND.-A young lady, aged about thirty years.
was brought to me, four years since, by her sister, whom I
had previously treated, and I found her complaining of a
fish-bone in her throat. I examined carefully, even using the
probang, and finding no obstruction in the throat or oesoph-
agus; and, learning that the trouble had existed over three
years, and had been treated by several good physicians with-
out benefit, I concluded this symptom must result from
reflex uterine irritation, though the patient would acknowl-
edge no other symptom to corroborate my diagnosis. I asked
for, and insisted upon, a vaginal examination, which was re-
luctantly consented to, when I found a prolapsus almost
amounting to complete procidentia! I restored the organ by
26
EATON ON DISEASES OF WOMEN.
appropriate treatment, and within three days she ceased to
complain of the fish-bone in her throat. Some little attention
to maintain the womb in situ was all the case required, and a
complete cure was the result.
CASE THIRD.—A miss, aged about twenty-three years, con-
sulted me, about four years since, as to her cough, that had
existed some three years, and resisted all treatment. On
inquiry, I found that menstruation had been getting more and
more scanty for three or four years, until it was entirely
absent for some six months past. I made, or rather at-
tempted to make, a vaginal examination, and found an imper-
forate hymen completely closing the vaginal orifice. (There
must have formerly existed a small opening, that had grad-
ually closed by adhesive inflammation.) I operated on the
case, assisted by the late and honored Dr. Troyer, of Peoria,
Ill., removed a small amount of retained menstrual flow (the

FIG. NO. 2.-VIRGIN OS UTERI.
small amount being due to her emaciated condition), and suc-
ceeded, by proper remedies, in restoring normal healthy men-
struation. In a few months my patient was fully recovered
from her cough, and had become rosy and fleshy.
I might go on relating numbers of cases as striking as
these occurring in my private practice; but I do not think a
work on diseases of women should be very much cumbered
general DIAGNOSIS.
27
with the detail of cases, and should be only mentioned in
sufficient number to demonstrate the principle under con-
sideration.
It will be seen that we fully believe that it is sometimes
imperatively necessary to make vaginal examinations in virgin
patients. In examining the virgin per vaginam, we can gen-
erally introduce but one finger. This should be well smeared
with some oily substance. I prefer vaseline, as its healing
properties make it desirable in case of some slight laceration
of the hymen, which will usually occur.
The virgin os uteri is small, round, and smooth, projecting
into the vagina about an inch. (See cut No. 2.) It should
be found a little posterior to the center of the vagina, about
three or three and a half inches from the hymen, or mouth
of the vagina.
The opening into the virgin uterus is so small it may
require careful feeling to detect the dent or fissure. In case
of those ladies who have borne
children the vagina is capable
of receiving two fingers, and
we can make a much more
satisfactory examination with
two than with one. In these
cases we find the neck of
the uterus larger, the opening
more distinct.

In the aged the os is sit-
uated normally at the upper
extremity of the vagina, and
projects into the vagina little.
or none at all. The anterior,
posterior, and sometimes the FIG. NO. 3.-OLD WOMAN'S OS UTeri.
lateral walls of the vagina are shrunken into bands or tendon
like cords, that give the upper portion of the vagina a rough,
irregular, tendonous feel, which we might mistake for dis-
28
EATON ON DISEASES OF WOMEN.
ease did we not know this change was peculiar to women
after the climacteric period has been passed several years.
Finally, I will agree with Professor Byford in saying that
a tender uterus is a diseased uterus. Normally, it is not
tender. It should give no pain to make a thorough examina-
tion, either digital or with the speculum or sound. If a care-
ful examination gives pain we may be assured that something
is wrong; that is, always understanding that a suitable sized
speculum is used. A speculum of no considerable size should,
of course, be introduced into the virgin vagina.
For these examinations I prefer the uterine sound in-
vented by Simpson, though I desire two or three sized probes
always at hand. The bi-valve speculum manufactured by
Max Wocher & Son, of Cincinnati, is the speculum I gen-
erally use; but in some cases we must have the tri-valve.
Nelson's is, perhaps, the best. I find little use for the com-
mon glass instrument recommended by Furguson. Occasion-
ally a case can best be examined with the aid of Sims'
slit speculum, but its use requires the aid of an experienced
assistant. (See chapter on Instruments.)
The diagnosis of diseases of women has been greatly aided
during the past twenty-five years by our distinguished coun-
trymen, Drs. Ludlam and Byford, of Chicago; Sims' of New
York; also, Simpson, of England; Kiwisch, in Germany;
Huguier, in France; and Ziemssen, of Bavaria; though the
uterine sound and vaginal speculum were known to the
ancients, Soranus having mentioned their use.
Conjoined manipulation seems to have been well under-
stood by Puzos, as far back as 1750. In the excavations of
Pompeii a speculum was found, the three blades of which
were expanded by a screw; but, so far as we can learn, its
use was not appreciated until within the last quarter of a
century.
Anæsthesia is to be employed in cases that can not be
well diagnosed without its use such cases are those who
GENERAL DIAGNOSIS.
29
suffer from extreme tenderness of the vagina or abdomen,
and where we feel in doubt of the existence of ovarian tumors
or tumors of the uterus, owing to the rigidity of the abdom-
inal muscles. Schroeder* mentions two cases which were
sent him for ovariotomy, where he found not only no ovarian
disease, but did not even find a circumscribed abdominal
tumor.
A lady was sent me from Kentucky, last year, for ovari-
otomy, who had no disease of the ovary, but a dead foetus in
the uterus, which I removed, though it presented many
symptoms calculated to lead one to suppose she had disease
of the ovary. These mistakes might have been avoided by
placing the patient under an anesthetic while making the
examination. I need scarcely remark that in examinations,
as well as operations, a competent assistant should administer
the anaesthetic.
No physician should be so careless of his reputation as to
attempt to administer any anæsthetic to a patient without
the presence of a friend. A lady's imagination is so much
affected, in some instances, by the anaesthetic that the physi-
cian might be accused wrongfully by her of improper familiar-
ities, had he not a friend present to prove his innocence.
In conclusion of this subject I will say, that in case the
patient refuses to submit to as thorough an examination as
the physician thinks necessary, he is perfectly justified in
not prescribing for the case. By attempting to prescribe for
cases with an imperfect knowledge of them, the physician
is almost sure to lose reputation, and the patient loses valua-
ble time in many cases. By being decided about the matter,
the physician generally commands the respect of the patient,
and his success will be the means of more extended usefulness.
Conjoined manipulation, previously mentioned, is made
by introducing one or two fingers of one hand into the va
gina until the cervix uteri is felt, and then pressing the
*Ziemssen's Cyclopædia, Vol. X.
30
•
EATON ON DISEASES OF WOMEN.
fingers of the other hand down into the pelvis from above,
pressing just above the pubis, and carrying the abdominal
walls downwards before the fingers into the pelvis. In this
way the position and diseases of the uterus may sometimes
be diagnosed.
In cases of enlargement of the uterus from tumors, or in
pregnancy, the extended palm of the hand is laid upon the
hypogastric region, in making this examination, instead of
pressing down into the pelvis. Rectal examination is some-
times necessary to determine the diagnosis of disease in the
pelvis. This is especially the case in the diagnosis of retro-
version, cellulitis, recto-vaginal hæmatocele, and some of the
diseases of the ovary. The student should also bear in mind
that hemorrhoids, fissures of the anus, tumors in the rectum,
prolapsus of the bowel, etc., may simulate uterine disease or
displacement. The second finger should ordinarily be used
in making a rectal examination, as it is longer than the other
fingers and consequently enables us to reach higher up in the
bowel. The finger should, of course, be well smeared with
vaseline or some oleaginous substance, as in making a vaginal
examination. In making a rectal examination the patient
should lie upon her side, with the thighs flexed upon the
abdomen. Over the patient should be thrown a cover. There
is no need of any exposure of the person in these examinations
unless we have reason to suspect fissures of the anus from
having hemorrhage from the rectum and finding no hemor
rhoids, and then the parts can be seen through the slit in the
cover. In the office we have a cover always at hand about
two-thirds as large as a sheet, with a slit about five inches
long in its center. A slight opening may be made in a sheet
and be kept at the house by the patient when we make visits
to her there, in cases requiring frequent examination. An
ordinary sheet may be used for a cover in an emergency.
MENSTRUATION.
31
CHAPTER III.
NORMAL MENSTRUATION, AND AMENORRHEA.
THE term amenorrhoea signifies the absence of the usual
monthly menstrual flow in women of proper age, where the
suppression is not due to pregnancy.
The menstrual flow, or
catamenia, commences with girls in this country usually from
the fourteenth to the sixteenth year of their age, though
some instances of the appearance of the flow at ten or twelve
years of age are observed, especially in the Southern States.
Isolated cases have occurred of menstruation at even an ear-
lier period. The age when the menses cease is called the
climacteric period, and occurs at about forty or fifty years
of age, though exceptional cases have been known of their
cessation permanently as early as twenty-eight or thirty years
of age—these cases of early cessation being those who com-
menced exceptionally early. Still, as a general rule, the girl
commences to menstruate at about fourteen years of age, and
continues to menstruate each twenty-eight days till reaching
the age of about forty-five or forty-eight years. Sometimes
the commencement of menstruation is delayed till the age of
seventeen or eighteen is reached; seldom, however, without
showing evidences of impaired health, causing the propriety
of denominating the case one of amenorrhoea. It may com-
mence at the proper time, and continue for months or years
regularly, and cease from various causes. This complete
amenorrhoea usually produces grave effects on the system.
Again, we may have only a slight show at each monthly
period. This condition is called partial amenorrhoea.
The quantity of menstrual flow and its duration varies
greatly in different women, some only soiling three or four
32
EATON ON DISEASES OF WOMEN.
napkins, others ten or twelve; some have the flow to last
only two or three days, others six or eight; hence, a condition
that would be amenorrhoea in one woman, would be a full
menstruation in another. The physician should learn the
peculiarity of his patient in this regard at first, if possible,
that he may better judge the proper amount that should be
discharged. The interval also varies much; some menstruate
every three weeks, others every six weeks, and are healthy;
but these are exceptional cases. Another class of exceptional
cases are those who never menstruate, and are still in good
health. This class is exceedingly small.
Symptoms.
In addition to the absence of the usual menstrual flow,
we have various symptoms manifesting themselves in amenor-
rhoea. First, pain in the back and loins at about the time the
menses should occur; nausea, produced from sympathetic.
nerve action, occasioned by the congested condition of the
uterus, resulting from the failure of menstruation; acute or
chronic inflammation of the uterus; anæmia, sometimes result-
ing from the vitiated sanguification produced from the general
derangement of the digestive and assimilative process; head-
ache, dizziness, lassitude, the white tongue, palpitation of the
heart, shortness of breath, loss of appetite, and a general
atonic condition of the system. This latter condition is
known as chlorosis.
Another symptom which has been too little recognized by
authors is congestion of the lungs, and is so frequently a con-
dition resulting from amenorrhoea, that I am surprised that
more has not been written on the subject. I have frequently
been consulted in cases that were supposed to be phthisis,
without any doubt (cases which had been so diagnosed by sev-
eral physicians), where the cough and emaciation had gradually
increased for two or three years, and, in one instance I recall
now to my mind, over six years, where I found the history
AMENORRHEA.
33
of the case showed that amenorrhea had been the cause of
all this trouble, and not a result of this cough and chlorosis;
and I believe, in every case of this kind that I have had the
treatment of fully, I have succeeded in establishing men-
struation, and obtaining entire relief from the cough, with
great increase in flesh and an entire restoration of strength
and health. Hence, I would be emphatic in calling the atten-
tion of the physician to the congestion of the lungs as one of
the prominent symptoms of amenorroeha. I believe many
a young lady has filled her grave prematurely for the want
of proper attention to the cause of her ailments, where they
have been supposed to be constitutional, and were really
caused from amenorrhoea. Why authors have failed to make
more prominent this resultant symptom of amenorrhoea is
more strange from the fact that many physicians, in conversa-
tion and in society meetings, have expressed the same expe-
rience. The length of time that is necessary for the amenor-
rhoea to exist before these symptoms of the general system,
lungs, and stomach manifest themselves varies greatly in dif-
ferent cases. Some will manifest active symptoms of this
kind at once on the suppression of the discharge, while with
others the symptoms are delayed several months. More
generally we have, within a few weeks, backache, pain in
the iliac and hypogastric regions, loss of appetite, dullness,
languor, sometimes extreme nervousness, fever, etc., indicat-
ing active inflammatory action. This is more likely to be the
case if the suppression has been the result of cold at or about
the last menstruation. A sense of weight in the pelvis is
complained of, with tenderness over the lower part of the
abdomen in some instances. In other cases the symptoms
are not active, but more moderate in their manifestation.
We have the headache and backache only, or dizziness is
complained of, with torpid bowels and want of appetite.
Other cases show congestion of the lungs as one of the first
symptoms, being decided at first and gradually becoming less.
3
34
EATON ON DISEASES OF WOMEN.
severe, and still some irritation remaining, with some cough
and slight expectoration, increasing from month to month.
In cases of entire absence of menstruation, where the flow has
never been established and the patient has reached the age
of maturity, we usually have the symptoms of general decline
well marked, with less prominent symptoms in the pelvis.
The digestion and assimilation generally are most impaired in
this class of cases, and a general anæmia is often diagnosed
carelessly, when the true understanding of the case shows
that the retention in the blood of the menstrual fluid, with the
consequent irritation in the ovaries and uterus, have caused
this apparent anæmia, and the true treatment is to bring on
the menstrual flow-not filling the system with iron, how-
ever, as has been the practice of the old school for a century
past. Absence of menstruation during lactation is not con-
sidered amenorrhoea, but is a normal condition. Anomalous
cases, where menstruation is entirely absent, and no injurious
effect is produced on the general system, are to be let alone
as a general rule. Loewy relates a case where a woman had
six children previous to her menstruation, which first appeared
at the thirty-first year of her age. We have in these cases,
generally, all the external evidences of puberty, with the
exception that the breasts are rudimentary; but, as this is
also observed in many who menstruate regularly, it is not
peculiar to this class of women. We sometimes have what is
termed vicarious menstruation, which indicates a flow of blood
from some other part of the body, as the nose, stomach, or
bowels. Again, we have a copious leucorrhoeal discharge,
which seems to take the place of the regular catamenia.
Etiology.
The most frequent cause of amenorrhoea is doubtless cold.
Getting the feet wet, or being exposed to cold with insufficient
clothing at about the time of the menstrual flow, will often
cause amenorrhoea, from a sub-acute inflammatory action set
AMENORRHEA.
35
up in the uterine organs, especially the lining membrane of
the uterus. This may cause suppression by means of the
temporary occlusion of the neck of the uterus, from the
swollen condition of its lining membrane; or the inflammatory
action may cause an indurated or thickened condition of the
endometrium, or the exudation of a semi-plastic material may
prevent the menstrual flow.
Doubtless, an anæmic condition sometimes causes delayed
menstruation in the young, and may cause suppression as
well, as we see in cases of typhus and typhoid fevers, and
other diseases of debility tending to impoverished blood-
especially is this the case in advanced stages of tuberculosis.
Psychical influences sometimes produce amenorrhoea.
Thus great mental depression or great fright may produce
suppression. (See Parvin on the "Influence of the Mind
over Menstruation.") Raciborski and Bohata mention cases
of amenorrhoea which may occur from great fear of preg
nancy, in cases of unmarried girls, or women who have been
led astray or forcibly violated, and have reason to stand in
extreme dread of pregnancy. Again, as Ziemssen mentions.
(on page 328, Vol. X), it seems possible for the period to
be delayed or fail altogether in women who eagerly desire the
occurrence of pregnancy, and who look for the appearance of
the menses with great mental agitation, from fear of being
barren. Some cases of amenorrhoea seem to result from an en-
tire absence of sexual strength, there being no sexual passion.
This want of strength, or torpidity, of the sexual functions
seems to result from close confinement in convents, the asso-
ciation with females only, hard study, so as to divert all the
nerve force to the head at the expense of the sexual system.
The imperforate hymen, atresia of the vagina, or cervix
uteri, absence of vagina, uterus, and ovaries, of course would
prevent menstruation.
These malformations and accidentally acquired or congeni
tal deformities may exist, and the physician be in ignorance of
36
EATON ON DISEASES OF WOMEN.
them for a time, as he is not justified in making a physical
examination of a young lady patient suffering from amenor-
rhoea, until some remedies have been used to establish the
function. After they fail to produce menstruation when
given for a considerable length of time, and the health of our
patient is greatly impaired, we may proceed to make a phys-
ical examination of the generative organs. Some patients
suffering from this difficulty are troubled with severe neu-
ralgia, not only affecting the uterus and ovaries, but the head,
face, and sometimes the stomach; and some have hysterical
convulsions. These conditions are usually considered results
of the amenorrhoea; but the nerve symptoms, as well as the
amenorrhoea, may be due to spinal difficulty, meningeal or
otherwise.
Prognosis.
The prognosis of these cases is usually favorable, though
it is grave and unfavorable when occurring in connection with
a case of phthisis. We are to bear in mind, however, that
the symptoms of phthisis are sometimes resultant from the
amenorrhoea, and may disappear by curing the suppression, if
there be not actual disorganization of the lung substance.
If the case shows only chronic bronchitis, we make a favor-
able prognosis if the amenorrhoea preceded the cough. Much
must depend upon the complications of the case as regards
prognosis.
Treatment.
The treatment of amenorrhoea must be adapted to the va-
rious conditions of the particular case in hand. Recent cases
of suppression, caused from cold, generally require Aconite.
Bell. is indicated if there is much weight and pressure in
the lower abdomen.
Arsenicum Alb., if there is alternating heat and chilly
feelings, with thirst.
Puls., if there is pain in the uterus and ovaries of an
intermittent character.
AMENORRHEA.
37
Cimicif., if the pain is in the ovaries or runs down the
thighs.
Bryonia, if the pains are sharp and darting, and worse
on motion. These remedies, conjoined with the warm foot
and hip bath, repeated daily, are generally efficient in restoring
the flow. Cases that exhibit great debility, especially after
severe illness, will generally require China, Merc., Nux, etc.
Macrotine is sometimes useful in chronic cases.
Where the difficulty has been of several months' standing
in married ladies, and also in case we may have any reason
to suspect pregnancy, in married or unmarried, the physician
should be careful to make a clear diagnosis of the absence of
this condition before continuing treatment. When fully con-
vinced there is not pregnancy, we may proceed to use elec-
tricity, placing the positive electrode over the pelvis, and the
negative to the spine, passing it up and down the lower part
of the back for five or ten minutes, using only a mild current;
or we may introduce directly into the uterine cavity a me-
tallic electrode, made much like the ordinary uterine sound of
Simpson, to which is attached the positive pole of the bat-
tery, the negative applied to the spine as before. (See cut of
uterine electrode, in chapter on Hypertrophy of the Uterus.)
This may be repeated, if necessary, in three or four days,
using always a very mild current of electricity.
Mustard sinapisms to the small of the back and over the
hypogastric region are often very efficient. In those cases
that are obstinate I would rely upon Puls. 3* or Macrotine
3º every three hours, giving occasionally, for a day or two,
China, Merc., or Ars., while we interrupt the Puls. or Mac.
for that length of time.
Cases caused by fright, I may say, always demand
Aconite, except in a few that show decided tendency to
twitching of the muscles and restlessness, where we may find
Ignatia, or Verat. alb., indicated. In case of imperforate hy-
men, of course, we should proceed to make an incision, and
38
EATON ON DISEASES OF WOMEN.
evacuate the menstrual blood that has accumulated in the
vagina. This is a simple operation, and requires no special
remarks, except, perhaps, that we must remember to insert.
into the opening we have made a wad of lint or cotton
smeared with vaseline, so as to prevent the reuniting of the

LEMMIN
PHILAD
TALBO
ELPHIA
07
FIG. No. 4.-COMBINATION BATTERY.
This is a combination of a thirty-cell Galvanic Battery and a No. 3 Faradic Battery. The
above cut shows the method of putting the Battery in action by raising the cells. In application
either the slow or the rapid interrupter of the Faradie apparatus can, by simply moving a switch,
be made to act as an Automatic Rheotome, for interrupting the Galvanic current. In certam in-
stances this combination of the two Batteries in one case is of great advantage.
incised hymen. The adhesions in the neck of the os uteri
may sometimes be broken up with the uterine sound. When
this can not be done, we may insert into the neck of the
uterus, through the os, if it is perceptible, or, if not, then
where it should be, a curved trocar, passing it in till we are
AMENORRHŒA.
39
sure we have reached the cavity of the body of the uterus,
being careful not to go too far, when, upon withdrawing the
stylet, we will generally have a flow of menstrual fluid
through the canula. I would advise the leaving of the canula
in the uterus two or three days, having the patient main-
tain the recumbent position. The canula may be retained
by means of a wad of cotton placed against the end of the
canula in the vagina, and retained with a T bandage. Of
course, these wads of cotton should be removed, and replaced
with fresh ones, three or four times a day. In about three
days remove the canula, and daily pass the uterine sound
through the opening, having it well smeared with vaseline
before it is introduced. This should be continued a week or
SO. In case of absence of the uterus, or ovaries, we can do
nothing.
Fortunately these cases show small indications of woman-
hood, being angular in build, with rudimentary breasts, a
coarse voice, and generally suffer little, or none at all, from
the absence of menstruation; but in cases of well-formed
uterus and ovaries, with occlusion of the neck, attresia of the
vagina, or imperforate hymen, it is quite different.
Some cases of delayed menstruation show no signs of
general derangement of the system. On the contrary, they
appear as healthy as any one; and we are consulted by the
mother for fear of serious consequences. Generally, in such
cases, I would recommend Puls. 3, a powder three times a
day, with horseback riding, change of air, etc., which generally
will set the matter right in a short time. Should there be
any serious symptoms arising-such as slight cough, shortness
of breath, dyspeptic symptoms, and the like-the case should
receive careful attention till the menstruation is established;
for until then our patient is in imminent danger. The prepa-
rations of iron I would not recommend, as I have found the
remedies already suggested much the more efficient. In fact,
I never observed good effects from Iron in these cases.
The
40
EATON ON DISEASES OF WOMEN.
leucorrhoea, that sometimes seems to take the place of the
menstruation, is not to be stopped by astringent vaginal injec-
tions, as is so often done by the allopaths; but we are to
consider that the leucorrhoea is a symptom of the inflamed
condition of the endometrium, or vagina, and that remedies
to relieve the inflammation will not only restore the mens-
trual flow, but will also cure the leucorrhoea as well. Warm
clothing, especially to the lower extremities, is to be insisted
upon; suitable bathing and exercise are not to be forgotten.
Going into society is sometimes beneficial. Changing the res-
idence from city to country, or vice versa, stopping hard study,
using sea-bathing or rowing, and having cheerful company,
etc., with assurance of speedy relief, will do much to restore
the normal flow. In those cases where the fear of pregnancy
seems to be the cause of the suppression, I know of no rem-
edy more efficient than blanks of sugar of milk, with the
assurance of the physician that they will certainly bring on
menstruation (if the patient has confidence in her physician,
and pregnancy does not really exist). Hysteria in these
cases is treated as in others, coupled with the proper remedies
to relieve the suppression.
Cantharides is sometimes a useful remedy in amenor-
rhœa, given in low dilutions. The indications for its use in
these cases are weakness, irritation of the bladder or urethra,
and especial weak sexual strength, absence of all sexual
desire, stinging pain in micturition, etc.
MENORRHAGIA AND METRORRHAGIA.
41
CHAPTER IV.
MENORRHAGIA AND METRORRHAGIA.
THE excessive loss of blood at the menstrual period is
called menorrhagia. In these cases we have, generally, not
only an excess of quantity, but also excess in the duration
of the flow. It comes on usually without pain; but if the
patient is much exposed to cold during the first part of the
flow, we may have a temporary cessation, followed by some
forcing-down pains to expel clots that have formed in the
uterine cavity. The patient is generally much exsanguined,
and shows evidences of debility..
In menorrhagia we may have, and usually do have, vari-
ous complications, such as tenderness over the hypogastrium
and one or both iliac regions, a sense of weight in the pelvis,
pain in the small of the back, nausea, headache, etc. These
symptoms are common, however, to most uterine difficulties,
and are not pathognomonic of this particular disease. Here
the excess of flow at the menstrual period is almost the only
distinctive pathognomonic symptom. If the flow occurs at
short, irregular intervals, occurring between the periods of
menstruation, it is termed uterine hemorrhage, or metror-
rhagia―a difference of name, with no great difference of con-
dition; but it is well always to draw careful lines in medical
nomenclature, as it is only in this way that one physician
can, by a name, communicate to another the condition of his
patient. We must bear in mind that a free menstrual flow is
a conservator of health, and realize that nature is a wise
physician, and makes no mistakes, and always tries to rectify
those of others. Hence, we should be slow to interfere with
active agents to suppress the discharge that is, at best, but a
42
EATON ON DISEASES OF WOMEN.
symptom of other ailments, though given, by common con-
sent, a distinctive name.
Etiology.
The excessive flow in menorrhagia is due, in some in-
stances, to overwork; again, from a too sedentary life, caus-
ing impoverishment of the blood. An inflamed condition of
the uterus, in its sub-acute form, tends to promote this
difficulty. This is favored by miscarriages, and we often find
this disease as a sequela of abortion. Neglected catarrh of the
vagina and uterus also favors menorrhagia. Small granula-
tions in the neck of the uterus, as well as all forms of uterine
polypi and uterine fibroids, tend to produce excessive flow at
the regular period. The anæmic condition of the blood, as
well as great fatigue of body or mind, may greatly aggravate
the difficulty. My esteemed friend, Prof. Ludlam,* says:
"In the early stages of phthisis we sometimes meet with
cases of troublesome, and sometimes dangerous, menorrhagia.
As a rule, however, it is more liable to occur in the advanced
stages of the disease.'
""
This does not accord with my experience, and I have taken
some pains to obtain the experience of others, and they agree
with me that, in the advanced stages of phthisis, we uniformly
have amenorrhoea, instead of menorrhagia; and we think that
if a profuse menstrual flow should be present in any excep-
tional case of the advanced stages of phthisis, it would proba-
bly be due to uterine polypus or cancer. We have never seen
this complication of a case of phthisis.
The capillary congestion that is necessary to the produc-
tion of menorrhagia may be produced from such a variety of
causes that we always have to go back of the excessive flow to
the undue capillary congestion, and again back to the cause of
this congestion.
The cold, that in the first instance produced amenorrhoea,
"Clinical Lectures on Diseases of Women," R. Ludlam, p. 48.
MENORRHAGIA AND METRORRHAGIA.
43
may secondarily produce menorrhagia, from the irritation
which is left in the mucous membrane of the uterus in some
instances.
Treatment.
The first point in the treatment of menorrhagia is to enjoin
and insist upon absolute rest, in the recumbent posture. This
will greatly aid us in the treatment, and without it we will
generally fail.
The
Cold compresses, in the form of cool, wet cloths, applied
to the hypogastrium, and frequently changed, and cool water
vaginal injections, may be used with benefit in some cases.
The tampon in the vagina may be demanded in those cases
that resist ordinary treatment, still it will be seldom that we
will see cases of such severity as to demand it, unless the
cause is uterine polypi, or a single polypus. We are not to
expect to very often see cases that demand these severe
measures, and, if the history of the case shows us that the
flow has been coming on at times in the intervals of the reg-
nlar periods, we may know that we have something more se-
rious to attend to than ordinary excess of menstruation.
flow should not be arrested simply because it is large, for some
plethoric, full-blooded women lose a large amount, and find
it consistent with good health. Treatment is only to be used
when the general health seems to be seriously affected, or the
exhaustion at each flow is so great as to necessitate remedial
measures. In the treatment we have also to bear in mind
that the excessive flow coming on for the first time may indi-
cate a threatened abortion. The particular condition of the
general system, and the local condition of the womb, in each
particular case, are to be studied in the treatment of each
Very often cases, following after confinement or abor-
tion, have a relaxed condition of the uterus and uterine ves-
sels, which require Secale cor., in twenty-drop doses of the
fluid extract, given in a drink of warm water, and repeated
every twenty minutes till three or four doses have been
case.
44
EATON ON DISEASES OF WOMEN.
taken. This treatment is applicable also in those cases where
polypus is present.
This remedy (which to my mind is much preferable to ice
in the vagina, or ice to the back or abdomen) may act suffi-
ciently in one dose, and, if so, no more need be given.
Should a threatened abortion be suspected, and there be
present some labor-like pains, Secale 3 or 6 will generally
stop the contractions of the uterus and moderate the flow.
X
Viburnum Prunifolium 1, given in tea-spoonful doses
every half hour, is an efficient remedy in true menorrhagia.
Ipecac, China, Ferrum, Nux, are remedies that are calcu
lated to relieve the case if due to debility, general atony, or
anæmia.
Aconite, Gelsem., or Ars., are the remedies to be studied
and used, according to the totality of the symptoms, in those
cases, of a congestive or inflammatory character, which are
acute.
We will do well, in all cases of menorrhagia, to be sure
of the nature of the case. A thorough examination is often
necessary, though we are justified in omitting it, in recent at-
tacks, in some instances. We find the sponge tent to be of
great service in some cases. It acts as an efficient tampon,
arresting the flow, and, by dilating the cervical canal, we may
find the cause to be a polypus, or small granulations in the
neck of the uterus. If granulations, their vitality is destroyed
by the tent, and they generally will fall off with the use of
very little force, and sometimes with none at all. This effect
of the sponge tent is very evident in those cases where
it is allowed to remain for eighteen or twenty hours, and
another immediately inserted and allowed to remain for
the same length of time. The tampon most convenient to
be used in the vagina I have found to be the elastic rubber
bag, with tube and stop-cock (English or French manu-
facture). The American rubber has very often disappointed
me in leaking the air and collapsing. Of course, the vagina
MENORRHAGIA AND METRORRHAGIA.
45
may be tamponed with old cloths or wads of cotton, but
the rubber bag, or colpeurynter, is much the most convenient
and desirable.
The use of the colpeurynter, or air bag, is called colpeu-
rysis. Dr. Carl Braun,* assistant physician at the lying-in
clinic at Vienna, is the inventor of this tampon. The colpeu-
rynter, as invented by Dr. Braun, consisted of a vulcanized
gum elastic bag, fitted into a small, hollow cone of horn. It
has since been modified so that the elastic bag is attached to.
and is continuous with a tube of the same material 18 inches
or more in length. To this tube a stop-cock is attached, which
retains the air. The length of the tube makes it more easily
inflated, and more convenient than the original instrument.
(See works on Materia
Merc., Iod., Bry., Cal. carb., Cimicif., Hamamel., Phos.,
Trillium, etc., may sometimes be homoeopathically indicated
in menorrhagia or metrorrhagia.
Medica for special indications.)
must, of course, be removed.
Uterine polypi, if present,
*"Klinik der Geburtshilfe and Gynækologie," Vol. I, page 126.
46
EATON ON DISEASES OF WOMEN.
た
​CHAPTER V.
DYSMENORRHEA, OR PAINFUL MENSTRUATION.
DYSMENORRHOEA is a term used to signify painful men-
struation; but it is not all pain occurring at or about the
menstrual period that should be called dysmenorrhoea. Neu-
ralgia of the ovaries is a notable instance; here we have
severe pain in the ovaries, one or both; it occurs in some
instances only at the menstrual epoch, still is neuralgia, and
should be so designated. The true dysmenorrhoeal pain is in
the uterus, coming on in paroxysms, as a general rule, simu-
lating the pains of threatened abortion, while the ovarian neu-
ralgia is continuous and darting. The throbbing, tense pain
is indicative of ovaritis, and is located in the iliac regions.
I
Authors generally seem to consider that the condition of
the uterus in dysmenorrhoea is one of inflammation, either in
the uterine muscular tissues or in the internal membrane.
differ somewhat, and claim that more cases of dysmenorrhoea
are caused from retro- or ante-flexion, stenosis, or partial atresia.
of the cervical canal, than from any other causes; though it is
true that the inflammation in some cases, without doubt, pro-
duces the pain in the expulsion of the menstrual flow. It also
tends to the formation of false membrane, that is formed in
some cases, and thrown off at each menstruation from the mu-
cous membrane lining the uterus, called nidation. Generally,
the pain
commences several hours, and in some cases two
days, before any flow is established. The agony suffered in
some of these cases is terrible.
Besides the severe pains in the uterus, we may have, in
addition, pain in the ovaries, great tenderness over the hypo-
gastric region, and sometimes this tenderness extends over
the entire abdomen. This is the case where there is present
DYSMENORRHEA.
47
peri-metritis. The poor patient can not sleep or eat. If food
is taken into the stomach, it is generally rejected very soon.
The headache accompanying these cases is very distressing.
Pain in the back is also often a distressing symptom. Cold
hands and feet, with great restlessness and an irritable tem-
per, are generally symptoms in these cases.
Dysmenorrhoea is peculiar to women who are sterile or
unmarried, except in a very few instances, and in those ex-
ceptional cases it is less severe than in the barren woman ;
for after the uterus has contained a child or foetus of consid-
erable size, it is more tolerant of the presence of the effused
fluid, and the stricture produced in the neck of the uterus
by flexions is not so tight. The nervous symptoms are more
prominent in some cases than others, but are doubtless de-
pendent upon the temperament of the patient, and are not to
be considered as a separate or peculiar form of the disease,
if I may so speak, for I consider dysmenorrhoea only a symp-
tom of other difficulties causing these peculiar symptoms.
Differential Diagnosis.
The only troubles likely to be confounded with dys-
menorrhoea are, threatened miscarriage and some cases of
uterine polypi. The history of the case will generally show,
that the menses have been suppressed for a time, wholly or
in part, in cases of pregnancy. This suppression, however,
may have been months before, and may have continued three
or four months, and the flow become again established and
appear regularly, though usually too profuse and long contin-
ued, till the seventh or ninth month arrives from the time the
suppression commenced, or, in other words, till complete ges-
tation would have been accomplished had the foetus lived.
But the history of the case shows that a partial detachment
of the placenta had occurred early in the pregnancy, causing
the death of the foetus, but that it was retained in the uterus
till full term had arrived.
48
EATON ON DISEASES OF WOMEN.
Such cases may have a history of pain similar to that our
patient is now suffering, at a few preceding menstrual periods;
but we will note that it was not so, previous to the suppres-
sion. Some uterine polypi cause much suffering at the men-
strual period. These cases may be recognized by having had
easy menstruations at some early period of their lives, gener-
ally up to within two or three years, and by physical examin-
ation we discover the presence of the polypi, and clear up the
diagnosis.
Etiology.
It is probably a fact, that a less number of cases of dys-
menorrhoea are cured than of most other ailments peculiar to
women. This is accounted for, in my mind, from the fact
that I have found the cause of this pain in menstruation to be
flexions of the uterus, or stenosis, in many cases. They may
be either ante- or retro-flexed; either condition may cause the
difficulty. This is explained in the fact that the flexion
causes almost the closure of the cervical canal at the point
where the flexion is most abrupt. There is generally a point
in these cases of flexion where the canal turns almost at right
angles. Flexion also tends to produce irritation, tenderness,
and abnormal congestion at the menstrual period. I say
abnormal, because a slight increase of the turgescence or vas-
cularity of the endometrium is a normal condition at the
menstrual epoch.
But when this normal congestion is increased by previ-
ously existing increased vascularity, we have, as a result,
considerable thickening of the mucous membrane of the uter-
ine canal, and this tends to obstruct more fully the cervical
canal at the point where the flexion had nearly closed it.
Consequently, when the body of the uterus becomes filled
with menstrual flow, the uterus naturally takes on contractile
action, and we have the intermittent pains of true dysmen-
orrhoea. These contractile pains of the uterus that is flexed,
tender, and congested, are very severe, and continue, till the
DYSMENORRHEA.
49
constriction is forced open, and the contents of the uterus is
forced out. This consists often of clots (the retention of the
effused blood having caused them to form), and their presence
adds to the necessity for severe expulsive pains to force them
out. So we may see that the process corresponds very nearly
to that of ordinary miscarriage, and is often more severe.
Again, in the membranous form, the cause of the pain we have,
is the necessity of severe enough uterine contractions to rup-
ture the membrane, and peel it off from the intra-uterine
surface; this process is termed denidation, or nidation. The
student will readily comprehend the cause of the severe pain
previous to the discharge of any menstrual fluid in these pa-
tients. In some cases the flow commences moderately, with
little pain, and, after a day or so, the pain commences severely.
These pains are produced by the contractions necessary to
expel the membrane, the blood in the slight amount that has
been already expelled having passed out between that portion
of the membrane already detached and the intra-uterine
surface.
The investigations of Engelmann show that this mem-
brane is the upper layer of the proliferated mucous mem-
brane in a state of fatty degeneration, that is exfoliated, and
thereby a hemorrhage is occasioned; hence we have more
liability to the formation of clots in these cases than in nor-
mal menstruation. This process is termed denidation by Dr.
Aveling, and he compares it to parturition, and terms the
membrane thrown off the nidal decidua.
Chronic ovaritis may be a cause of pain at this period,
producing not only more sensitiveness in the organs, but from
slow inflammatory action causing a thickening and tough-
ening of their fibrous coat, and consequently more difficult
ovulation. Or we may have a rheumatic condition of the
general system, which may so affect the ovaries as to pro-
#Strickler's "Med. Jahrb," page 135.
† Obstet. Jour. of Great Britain and Ireland, July, 1874.
4
50
.
EATON ON DISEASES OF WOMENWOMEN.
duce painful menstruation; but I am inclined to the belief
that in the great majority of cases displacements of the
uterus, with some degree of endo-metritis and stenosis of the
cervical canal, are the main causes of dysmenorrhoea.
Prognosis.
This must depend much upon the willingness of the pa-
tient to submit to proper treatment. As the patients usually
feel tolerably well during the interval between the men-
strual periods, they are very often disinclined to pursue the
necessary treatment. In this case an unfavorable prognosis
is the best we can make. But, in case we may have
several months to treat the case, the prognosis may be favor-
able. We are usually justified in prognosing sterility, if let
alone, in cases that are severe; with proper treatment we
may, in most cases, expect that pregnancy will be possible.
Treatment.
Whoever achieves success in the treatment of this diffi-
culty, may feel that he is equal to the task of treating almost
any of the diseases of women, for to be successful, the phy-
sician must show power of careful discrimination in diag-
nosis, decision of character and will, in proceeding to do that
for the case which it seems to demand. Perseverance in
treatment, proper encouragement to the patient (that he may
have her full co-operation), is necessary. This is all impor-
tant, as it is generally the case that the patient enjoys quite
a good degree of health in the intervals between the men-
strual periods, and it is absolutely necessary that the treat-
Much
ment be continued thoroughly during these intervals.
care and judgment need to be exercised in the selection of
the remedies, and in the surgical or mechanical treatment
used. Hence I deem the skill demanded in these cases equals
any that is required in any case of gynaecology. These cases
are the more embarrassing on account of their being found
DYSMENORRHEA.
51
mostly in those women who have either never been married,
or have never borne children, and hence are more averse to
the making of the necessary vaginal examination, and are
much more troublesome to treat, even if they consent to an
examination. They are likely to be careless about regular
calls upon the physician, and as this class of patients are
usually desirous of concealing from the public, and some-
times even from friends, the fact of their having any ailment
whatever, they are very annoying, and, as I said before,
require all the skill at any one's command to carry them to
a successful issue.
Remedies During the Attack.
When called to a case of severe dysmenorrhoea the in-
tensity of the sufferings demands something that will at once.
relieve the pain and vomiting. For this purpose, perhaps
the most efficient remedies are the inhalation of Sulph. Ether,
or Chloroform, with warm foot and hip baths-of course,
using the Ether or Chloroform after the patient has taken
the bath, and is nicely wrapped in bed, as anaesthetics are
never to be given to any one while in the erect or semi-erect
posture. The hypodermic injection of pure water in the
arm or limb will sometimes give instant relief, and is prefer-
able to the use of Morphia in any manner.
Sometimes Puls. 3 gives relief; again, Secale 3*, or Vi-
burnum 1*, will be most efficient. Secale or Viburnum being
indicated for those pains that are entirely confined to the
uterus, of an intermittent character, while Puls. is indicated
in cases where the ovary is also largely affected.
Cimicif. Rac. gives, usually almost instant relief to the
ovarian pains and tenderness, which sometimes continue after
the contractile pains of the womb have ceased, and the flow
has been established. These remedies, as indicated, will re-
lieve, giving Aconite, Ars., or Bell., according to their general
indications so well understood, in these cases, which are due,
52
ΕΑΤΟΝ ΟN DISEASES OF WOMEN.
evidently, from their history, and all we can learn, to an acute
congestion of the uterus, which sometimes occurs, and produces
severe menstrual colic; but they are not cases of true dys-
menorrhoea as generally understood, any more than a slight
cold in the head is catarrh. Attacks of menstrual colic,
from acute congestion, will be cured with these remedies, the
same as such cases are cured where there is no menstrual
colic, and we may expect little trouble with this class of
cases. If the history of the patient shows the attack to be
probably due to acute congestion, we may have no occasion
to make a physical examination. The remedies I have indi-
cated will cure the case promptly and efficiently. But the
case whose history shows years of monthly suffering, will not.
be cured with these remedies; we must use other measures
and remedies, or have a failure.
If flexion of the uterus is the cause, we will only be
able to detect it, in most cases, with the uterine sound.
When discovered, of course, it is to be rectified as in other
cases of flexions, but in these dysmenorrhoeal patients we
have more trouble in introducing the sound, as here we will
find a narrowing of the neck of the uterus at some point,
generally at the internal os. Much patience may be neces-
sary to accomplish the introduction of the sound, and, in some
cases, it will be found impossible. The next thing to do, on
failing to introduce the sound, is to introduce into the cervix
uteri a sponge tent, and follow by another in about six hours,
keeping the patient in bed. In introducing the tents press
upon them for some minutes, that they may follow the
crooked canal, and as they dilate expand the portion that
is constricted, and enable us on the removal of the second
tent, to introduce the sound into the body of the uterus, and
detect the flexion, if one exists; and, if there be no flexion,
and we find the uterus in situ, we will have prepared the
uterus for further treatment in the way of curing the dis-
ease of the internal surface of the organ that has caused the
DYSMENORRHŒA.
53
dysmenorrhoea, by exfoliating the dysmenorrhoeal membrane,
or obstructed the natural outlet of the body of the womb by
the congested condition of the endometrium. This diseased
condition of the endometrium is usually present and needs
treatment in these cases, whether we have a flexion or not.
Hence, it will be seen that I consider the use of tents to
be very necessary in the treatment of most cases of true
obstructive dysmenorrhoea.
The incision of the neck of the uterus, as some recom-
mend, is to my mind very objectionable, and as I have never
found it necessary in over twenty years of practice in this
line, during which time it has been my lot to treat very
many cases, I feel that possibly incisions of the cervix uteri
may be abandoned. Incisions, in order to be successful
at all, must be followed by dilatation by some means; if
not by tents, then forcibly and abruptly, by means of in-
struments. It seems our Creator has made the cervical
canal in such a manner as to be expanded without danger,
even to immense proportions, as seen in parturition. In
abortion it also has to dilate, which it often does with but
little pain.
The sponge tent seems to me to act the most in confor-
mity to the process nature has established; that is, it causes
gradual dilatation. Should we incise the neck of the uterus,
and simply leave it to heal without any attempt at dilatation,
the circumference of the canal will be lessened instead of
increased; its dilatability will be diminished on account of
the cicatrix left.
From the wounds made by incision we have danger of the
absorption of pus or muco-purulent matter, which is abun-
dant in some of these cases. Besides, I see nothing to be
gained by incisions, and much greater danger is incurred than
with the use of the sponge tent.
54
EATON ON DISEASES OF WOMEN.
Subsequent Treatment.
After a good degree of dilatation of the entire cervical
canal is accomplished, I proceed to apply directly to the
intra-uterine surface a Solution of Iodine, making it with five
grs. Iod. Res., fifteen grs. Potass. Iodid., to one oz. of water.
This should be further diluted with water if it produces any
considerable amount of smarting. This is conveniently ap-
plied with Palmer's uterine applicator. These applications
I repeat once in three days, keeping the cervix dilated by
passing a large bougie daily through the cervical canal.
Omit the treatment four or five days previous to the time for
the commencement of the next menstrual period. Vaseline,
or Bell. ointment, may be used through the applicator in
some cases with advantage.
Internal Medication.
!
Probably there is no remedy so efficient as Phos., given
in the 2 or 3 attenuation twice a day, and continuing the
treatment for several months; especially is this efficient in
the membranous form of dysmenorrhoea.
Prof. Carl Schroeder, of Bavaria, says: ።። 66 The fact that
membranous dysmenorrhoea has been observed in poisoning
by phosphorus, favors the view that a profound fatty degen-
eration, even in a normal mucous membrane, may bring about
the membranous exfoliation."
Cal. carb., Graf., Iod. of Merc., Phytolac., Cocculus, or
Caulophyllum, etc., may sometimes be of much service, when
used in accordance with the totality of the symptoms.
Treatment of Rheumatic Dysmenorrhœa.
In the rheumatic condition of the system we will do well
to try the effect of Bry. or Rhus, Colch., Kali hyd.,
etc., according to the peculiarities of the case and the homoeo-
pathic indications for their use.
* Ziemssen's Cyclopædia, "Diseases Female Sex. Organs,” p. 335.
DYSMENORRHEA.
55
1
Besides giving Phos. in the membranous variety of dys-
menorrhoea, we must bear in mind that the exfoliation of
membrane is the result of inflammatory action, and endeavor
to rectify any cause producing this irritation, and treat the
case very much the same as we would if purely a case of
chronic endo-metritis.
Remedies Occasionally Indicated.
Bell., Coff., Cham., Coloc., Graph., Plat., Sulph., Ignat.,
Nux v.
Belladonna is indicated in dysmenorrhoea with flushed
face, dullness of the mind, fullness over the eyes, intolerance
of light, pain in moving the eye-ball, feeling as if the contents
of the pelvis would pass out of the vagina, severe bearing
down in the pelvis, etc.
Coff., where the flow is full but painful; loss of appetite,
sleeplessness, nervousness, irritation of the bladder, etc.
Cham., where there is colic in the bowels, as well as pain
in the uterus; discharge comes in clots, restlessness; breasts
are tender and swollen.
Graphites, where there is chilliness, with dull headache,
heartburn, constipation before, and diarrhoea after, the menses.
Platina, where the ovaries are enlarged or tender, with
extreme nervousness, depression of spirits, severe cutting,
labor-like pains, dark-colored menstrual flow, etc.
Sulphur. The catamenia are too profuse, with pain in
the small of the back; at times the flow ceases, and again
comes on profusely; burning in the vagina, etc.
Ignatia, where the menses are scanty and dark-colored;
the pain amounts almost to spasms; palpitation of the heart,
faintness, etc.
Nux Vomica. Severe pain in the back, constipation,
want of appetite, cramping pains in the abdomen.
56
ΕΑΤΟΝ ΟN DISEASES OF IVOMEN.
CHAPTER VI.
VICARIOUS MENSTRUATION.
By vicarious menstruation is meant the discharge of blood
from some of the mucous surfaces other than the uterine, at
somewhat regular intervals, accompanied with arrest of the
normal catamenial flow. These hemorrhages sometimes take
place from the nose, called epistaxis; from the stomach, called
hematemesis; from the lungs, called hemoptysis; or from the
bowels, either with or without the presence of hemorrhoids.
(Leucorrhoea, diarrhoea, etc., also sometimes seem to be vica-
rious of menstruation.)
These discharges seem to relieve the system, so that the
patient suffers much less than she otherwise would from the
suppression of menstruation. These hemorrhages, of course,
occur at other times and from other causes, and are only con-
sidered vicarious menstruation when occurring in connection
with suppression of the regular flow. When coming on from
other difficulties or diseases, they are ordinarily to be ar-
rested, while in the case troubled with suppression they are
rather to be encouraged (within reasonable limits), and viewed
as conducive to health rather than disease. The patient is
often greatly alarmed at these hemorrhages, until they are
explained to her.
These discharges greatly relieve the hyperemic condition
of the circulation induced by the retention in the system of
the material usually cast off at the menstrual flow; and,
if not relieved in some way, would soon manifest the more
dangerous symptoms of congestion of the brain, lungs, stom-
ach, pelvic organs, or bowels. Frequently, in these cases,
the uterus appears torpid, showing no increase in size, no
VICARIOUS MENSTRUATION.
57
heat or congestion, showing that the fault lies in the normal
periodical nerve excitement in these parts, which invites the
excited circulation of the blood to them. In other cases, the
congestion, heat, and enlargement of the uterus is marked,
showing that there is a normal excitement of the circulation;
but the flow is absent through some abnormal condition of the
endometrium, generally that of thickening, by exudation of a
plastic material on its inner surface, causing the obstruction
of the flow, from its close adhesion to the interior surface
of the uterine mucous membrane. This condition is not of
very infrequent occurrence, as a result of mild inflammatory
action, as shown by the throwing off of stringy, semi-organ-
ized, membranous material, from cases affected with a mild
endo-metritis not always being highly enough organized, or
not adherent enough, to prevent the menstrual flow, but
peeling off and being discharged at the flow and during the
interval. This, of course, might as well be explained under
the head of Amenorrhoea. In some cases an indolent ulcer
on the leg or other part of the body seems to act as a vica-
rious menstruation, so that the patient is relieved from con-
gestive symptoms resulting ordinarily from suppression. Why
it is that in one case the discharge takes place in one patient
from the lungs, in another from the stomach, bowels, or nose,
we can not explain, unless it be that these membranes are, in
the particular patient, in a condition of slight irritation, and
the blood oozes through the minute capillaries more readily,
on this account, in this particular locality.
Vicarious menstruation has been known to take place from
the skin, gums, nipples, etc. (See Edinburgh Med. Journal,
1866; London Lancet, 1872; and Transactions Med. Society
Bombay, 1872.) These instances are, however, of extreme
rarity, and are only worthy of remark on account of their
possible occurrence in the practice of any physician.
Barnes on "Diseases of Women,” p. 182.
58
EATON ON DISEASES OF WOMEN.
Treatment.
As stated before, the discharge of blood vicariously of
menstruation is a relief to the system if within moderation,
still it may be so profuse as to constitute a hemorrhage, and
be dangerous to life if not restrained. Continual
Continual conges-
tions and effusions of blood, occurring in those membranes
not normally so affected, may develop serious ulceration,
and it becomes the physician's duty to carefully diagnosticate
between the discharge which is vicarious, and that which is
pathognomonic of disease in the part or organ from which it
is effused.
In the case of the vicarious discharge it is advisable to
first establish the normal function before doing more than to
restrain the discharge within the bounds of moderation.
This treatment may be found under the head of treatment
of amenorrhoea, and consists of remedies and means to invite
the circulation and nerve force to the generative organs.
This is accomplished with Puls., Canth., Macrotis, etc., the
use of warm foot and hip baths, electricity passed through
the pelvis, or directly through the uterus, by means of the
uterine electrode, exercise on horseback, etc.
But there are cases where menstruation is arrested from
causes somewhat out of the ordinary line, like atresia of the
cervix, the presence of large intra-mural fibroids, pregnancy,
etc. Atresia of the cervix will, of course, be discovered in an
attempt to pass the uterine electrode, which must not be done,
however, if there is a possibility of pregnancy. The condi-
tion of pregnancy sometimes develops vicarious menstruation;
but not often. It is well to be on the alert to recognize this
condition, as active interference would be likely to induce an
abortion. We may, however, seek to equalize the circulation
of the blood by warmth to the extremities, and using some
effort to restrain the hemorrhages by giving Aconite or
Ipecac. I am aware that these cases are not recognized by
VICARIOUS MENSTRUATION.
59
some gynæcologists as vicarious menstruation, on account of
the pregnancy present.
If the flow was from the uterine surface or cervix, and
occurred regularly each month, it would be menstruation,
though pregnancy did exist at the same time, and I see no
impropriety in calling a flow from other mucous surfaces vica-
rious menstruation, if it occurs at regular intervals, although
pregnancy exists. The treatment must be modified, how-
ever, as has been suggested. Some cases of this kind may
be so difficult of diagnosis as to baffle, for a time, the most
skilled physician, owing to the peculiarities in the particular
case; still, the more thoroughly the subject is studied, the less
likely will the physician be to fall into errors in treatment.
Atresia of the cervical canal, of course, demands an oper-
ation; stenosis requires dilatation. These conditions, as well
as those where uterine fibroids are present, must be treated
as will be stated under these special heads.
Remedies indicated in amenorrhoea are usually demanded in
these cases.
(See Chapter III.)
The remedies must act to stimulate strength and activity
in the ovaries and uterus in atonic conditions, and to allay
irritation when these organs are inflamed.
60
EATON ON DISEASES OF WOMEN.
CHAPTER VII.
INFLAMMATION OF FEMALE GENITALIA.
Etiology.
THE female genital organs are probably more subject to
inflammation than other parts of the body. This is owing
to various causes, some of which I will mention. The most
prominent one that suggests itself is cold. The open cloth-
ing so commonly worn by women offers little protection
to the pelvic organs from severe changes of temperature.
Especially is cold injurious at or about the menstrual period.
The ovaries, uterus, and vagina are at this period congested,
so to speak, though the function of menstruation is a physio-
logical one, and one that is necessary to the health of the
female. Still we may speak of the congestion of the parts
occurring at this period, and generally a few days previously.
This congestion especially affects the mucous membrane
lining the uterine cavity. Cold baths, taken by girls and
ladies while menstruating, have often caused inflammation of
the uterine organs. I have seen the inflammation of so high
a grade from these causes as to endanger life. I have seen
it also produce paraplegia, hemiplegia, as well as hysterical
convulsions.
Sexual Intercourse, which is resorted to by the lower
animals solely for the purpose of reproduction, except in one
or two species, is resorted to by man as the most common
indulgence of his nature, and is frequently the cause of
inflammation of the uterus, and, from the irritation and
excitement produced, causes also the effects of cold to be
more severely felt.
The reading of lascivious books, the nature of the asso-
INFLAMMATION OF FEMALE GENITALIA.
61
ciations of many of the amusements of society, constipation
which is due to not attending to the evacuation of the bowels
at proper intervals, tend to produce inflammation of the
uterus. This is particularly the case with teachers and schol-
ars, who delay the calls of nature for a more convenient op-
portunity; and they soon lose the inclination to evacuate the
bowels, and the retention of the fecal matter causes the hard,
constipated stool, requiring straining in its expulsion, produc-
ing hemorrhoids, and general congestion of blood in all the
pelvic viscera. Constant standing, distress of mind, self-
abuse, falls, jolts, heavy lifting, careless management after
abortions, or confinement at term, lacerations of the cervix
uteri, etc., all tend to produce inflammation. It is a fact to
be borne in mind that causes which might produce severe in-
flammation in one, might not affect another; but this is also
true throughout the whole range of physical ailments affecting
mankind. Hence, because one woman, or possibly a class of
women, may not receive injury from a particular cause, it
does not disprove the possibility of others being affected
seriously by it.
There is much in the constitution of women, as well as
men, to withstand or predispose to disease. The girl of ro-
bust parentage, brought up to active exercise suitable for her
years and strength, using suitable food and clothing, till
she is twenty years of age, will ordinarily endure five times
the fatigue that one could endure reared under opposite.
circumstances, and having parentage broken in health and
constitution.
Symptoms.
The term inflammation indicates heat, or burning, in itself,
and the term is used in medicine to indicate a high tempera-
ture, tenderness, generally swelling of a part, tissue, or organ.
This is true of acute inflammation, and is as applicable to in-
flammation of the female genital organs as to any other part
of the body, and no more so.
62
EATON ON DISEASES OF WOMEN.
But we have a sub-acute form of inflammation affecting
these organs more frequently than other parts of the body,
and these sub-acute forms are characterized by a train of
symptoms quite different from those produced by acute in-
flammation. We will, for convenience, make the following
divisions of inflammation as affecting the female genitalia :
1. Acute Inflammation.
2. Sub-acute Inflammation.
3. Chronic Acute Inflammation.
4. Chronic Sub-acute Inflammation.
ACUTE INFLAMMATION.-This sometimes commences with a
distinct rigor or chill; but this is not always well marked,
and in some instances entirely absent. This cold stage varies
in duration from an hour or two to ten or twelve hours, when
reaction comes on, and we have increase of heat, much thirst,
dryness of skin, and general symptoms of fever. So far the
symptoms might be present in any inflammatory attack, pre-
ceded by some congestion, in any part of the body; and even
in the various forms of intermittent fever we have a similar
array of symptoms as we have in the outset of an attack of
acute inflammation of the genital organs in the female. After
the lapse of about twenty-four hours we have additional
symptoms that characterize this disease, which are not pres-
ent in ordinary fevers, or in congestive or inflammatory at-
tacks of other parts of the system. These are pain, heat, and
tenderness of the vagina and uterus, and, in some cases, fre-
quent desire to urinate, accompanied with pain in the urethra
of a burning character. If the ovaries are affected, we will
have tenderness, with some swelling, of these organs. These
urgent, active symptoms are present in cases of acute inflam-
mation of any, or all of the genito-urinary organs, and are
present, I may suggest, also, when the inflammation is caused
by specific poison (i. e., gonorrhoeal); but, in the acute in-
flammation of the gonorrhoeal case, these symptoms may be
three days or more from the time the first intimations are
ACUTE INFLAMMATION.
63
noted till the full development of the inflammation, when we
have also the symptoms of a copious yellowish white dis-
charge from the vagina, with great swelling of the labia
majora and minora. But I will not enter more into detail in
the matter of gonorrhoeal inflammation, as its importance
merits an entire chapter, and I prefer to give a full descrip-
tion of the disease under the proper heading, where it will
be found in connection with the homoeopathic treatment for
cure.
its cure.
In the acute inflammation caused from colds, exposure,
and, I may mention, sometimes the suppression of eruptions.
on the skin, we have active symptoms, as I have described,
and they point to this disease unerringly. There is no chance
to be misled. Soon, in addition to the symptoms of heat,
pain, tenderness, swelling, etc., just enumerated as affecting
the labia, vagina, uterus, ovaries, etc., we have, within two
or three days, a profuse discharge, generally acrid in its
character, light yellow, or milky, and in no way to be recog-
nized by its appearance from the discharge produced from
gonorrhoeal inflammation. There is no way at the present
day, so far as I know, to determine by its appearance whether
or not the vaginal discharge in such cases is gonorrhoeal or
not. We have to note other symptoms than the discharge, to
make up a diagnosis. Of course, gonorrhoeal discharge some-
times follows impure connection, and, did we know of this
exposure, we might be the more ready to call the disease
gonorrhoeal. But let the physician be cautious; much trouble
might result to him and others by giving such an opinion.
The non-specific inflammation comes on, ordinarily, much
more suddenly than the specific; but the symptom of painful
micturition is not very prominent unless the disease affects
the bladder mainly; in which case we have none of the ten-
derness, heat, and pain in the vagina, nor much of the vaginal
discharge just mentioned as occurring when the vagina has
been inflamed for any length of time. Hence, this case would
64
EATON ON DISEASES OF WOMEN.
be diagnosed as cystitis, and not as acute inflammation of the
genito-urinary organs. We will also have nausea present, in
many instances, produced by sympathy with this acute in-
flammation of the pelvic organs in the female.
Treatment.
The treatment of acute inflammation (non-specific) should,
in the first instance, be rest for the entire body, warmth to
the extremities, a warm full bath, or sitz bath, for ten or
fifteen minutes, and when taken from the bath the patient
should be rubbed dry, and well wrapped in warm blankets;
and repeat these baths once a day as long as the urgent,
active symptoms show themselves.
The first remedy to be given, and I may say the last also,
in many cases, is Aconite nap. This remedy alone usually
controls all these symptoms, and will ordinarily carry the case
through to a favorable termination, unaided by other reme-
dies. We will very often find this remedy to cut short every
symptom, and restore to a state of health almost as if by
magic, stopping the disease before any discharge has made its
appearance. If we were so fortunate as to be called in the
first stage, or rather when we had congestion present, cold-
ness, etc., I would prefer Gelseminum or Arsenicum alb., the
Ars. being indicated if nausea and vomiting, with thirst, were
prominent symptoms, otherwise give Gelseminum. When the
second stage is established give Aconite. After the acute
stage is passed and we have not succeeded in curing the
case, and it passes into a chronic, active inflammation, or a
chronic sub-acute form, I would use other remedies, which we
will designate under the treatment for those conditions.
SUB-ACUTE INFLAMMATION.-The term sub-acute inflamma-
tion indicates a grade of inflammatory action that is more
mild in its symptoms than acute inflammation. The sub-
acute form of inflammation may come on so insidiously as
to be scarcely noticed until the disease is thoroughly estab-
SUB-ACUTE INFLAMMATION.
65
lished and the patient is much broken down in health, and
perhaps consults the physician on account of this general
debility, or under the impression that the difficulty is some-
thing entirely different from what is really the matter.
Etiology.
The causes of this disease are somewhat similar to those
which produce active inflammation, but owing to the good
constitution of the patient, or the small amount of exposure,
a very acute inflammation is avoided, and in its stead a
sub-acute form is established. The sub-acute form is often
caused also by the use of cold vaginal injections to prevent
conception, and by acid injections for the same purpose. Fre-
quent child-bearing is also a fruitful cause of this sub-acute
form; neglect of cleanliness, as well as too frequent bathing,
may produce the disease. The wearing of hard vaginal pes-
saries, as well as rough, brutal copulation by the husband, or
promiscuous sexual intercourse, sub-involution of the uterus,
and lacerations of the cervix uteri in confinement, also tend
to cause this disease.
Symptoms.
The symptoms of sub-acute inflammation may not mani-
fest themselves in the parts affected to any great extent,
and in some instances there may be no symptoms that point
directly to the difficulty, unless we are aware of the fact that
the symptoms indicating sub-acute inflammation are generally
in some part of the body somewhat remote from the pelvis,
and are caused by reflex nerve action. True, we may some-
times have slight tenderness of the vagina or os uteri, or
slight tenderness in the ovarian region; but often we have
no tenderness. Sometimes we have a slight vaginal dis-
charge and sometimes none. On making a physical exami-
nation we find the vagina warmer or colder than natural.
The secretion instead of being oily and slippery to the
feel is often tenacious, and the odor of the vaginal secretion
5
66
EATON ON DISEASES OF WOMEN.
is nauseous. The os uteri is found enlarged, the length of
the uterus, as found by introducing the uterine sound, indi-
cates considerable increase of size, sometimes measuring,
from os to fundus, four or four and a half inches. Some
tenderness is found to be present in some cases, and in rare
instances a complete hyperesthesia of the parts is caused
from sub-acute inflammation. Still in these cases of acute
sensibility, we have absent those general symptoms of ex-
treme heat, swelling, and general fever we have in the acute
form. Sometimes we have hot flashes, as the patient de-
scribes them.
The symptoms that we may expect the patient to com-
plain of in sub-acute inflammation of the genital organs in
the female are backache, pain in small of back, sometimes
at the extremity of the coccyx, pain under the left breast,
palpitation of the heart, various dyspeptic symptoms, tym-
panites, etc.; with pain in the occiput, heat in top of head, sci-
atic pains, general lassitude, weakness of the limbs, sometimes
a feeling of weight in the pelvis, sometimes not. It will be
appreciated that these symptoms, though more moderate in
their action, are nevertheless wearing on the patient, and
though the disease might kill slowly, it might kill just as
surely as the more active form of inflammation.
This sub-acute form of inflammation, when affecting the
ovaries or uterus, is one of the most prominent causes of
tumors in these organs. Generally we have sterility as
another symptom of this disease, and it will probably con-
tinue till the disease is cured; and possibly barrenness may
result, and remain after all other evidences of disease have
disappeared.
Treatment.
Aconite, so useful in the acute form of inflammation, is of
little use in the sub-acute; here we need Bry., Bell., Ars.,
Ars. iod., Merc. iod., Rhus, Ignatia, Nux, Puls., Sepia, etc.
These should be selected according to the homoeopathic indi-
CHRONIC ACUTE INFLAMMATION.
67
cations in each particular case. (Consult works on Materia
Medica.)
As to local applications, I will say, my experience justi-
fies the use of some local treatment; but not such as has
heen in use by all gynæcologists of the old school, and, I
blush to say, some of our own. I refer to nitrate of silver,
nitric acid, strong chromic acid, tincture of iodine, leeches,
etc., ad infinitum. We discard all these, in treatment of these
diseases. I sometimes, however, apply the Solution of Iodine
locally to the os externum and internum, and even to the
intra-uterine surface. This solution is to be prepared with
water and the addition of Kali iodatum in the proportion
of three grs. of the latter to one of the former. I usually
use the strength of about three or five grs. to the ounce, ap-
plied with a camel's-hair pencil every three days. Some
cases of sub-acute inflammation of uterus and vagina are
greatly benefited by the ball of cotton (to which is attached a
string for its easy removal), saturated with equal parts of Tr.
Hydrastis and Glycerine, placed in the vagina well up against
the os uteri. It may be noticed that I am not entering into the
description of the special inflammations or their treatment,
this chapter being intended as general in its application to de-
scription and treatment. A more minute description of the
treatment of special inflammations of particular parts may be
found under the chapters on Vaginitis, Metritis, Ovaritis, etc.
Warm Water. The warm water vaginal injection and
warm sitz bath are quite generally useful, and, I believe, can
in no instance do harm in any form of pelvic inflammation,
when used properly.
CHRONIC ACUTE INFLAMMATION.-There are some cases of
inflammation of the pelvic organs that go on actively for a
considerable time, having a tendency to progress to the extent
of the formation of an abscess or ulceration, in spite of the
most active measures we may use to subdue them. The allo-
pathic profession have tried the antiphlogistic treatment, have
68
EATON ON DISEASES OF WOMEN.
bled and leeched, physicked, and given remedies the most
powerful in depressing the activity of the circulation; and still
active inflammation has continued till abscess resulted. The
homoeopathic treatment of active inflammation has not al-
ways been successful, though much more frequently so than
the allopathic. Hence, we have a class of cases to which
it seems to me appropriate to apply the term chronic-acute
inflammation.
Symptoms.
The exact time at which an acute inflammation becomes
chronic, we are not able to specify in hours or days. The
symptoms will be a better guide to the proper nomenclature
to be applied than the expiration of any particular length of
time. I am inclined to draw the line at such time as the
general symptoms of fever, general heat, and extreme rapid-
ity of the pulse subside in part, and, if it be a week or so
after the onset of the active symptoms, and still we have the
tenderness and heat of the pelvic organs remaining, the
vagina tender to the touch, the labia swollen, tenderness of
abdomen in hypogastric or iliac regions, the patient, unrelieved
by proper medication, continuing to present these symptoms
with depressed general strength, pulse weak, though often as
high as 100 to 120 per minute, temperature indicating from
101° to 103°, tongue generally coated light brown or brownish
white, with red tip and edges, papillæ elongated, we denomi-
nate the case chronic-acute inflammation. Following on in the
progress of the disease, we have, in the next stage, those
symptoms that are indicative of the formation of pus; such
as slight rigors, throbbing sensation in the pelvis, some in-
crease of heat, etc. On vaginal examination, we may feel fluc-
tuation, usually in the posterior portion of the vagina, the os
tender and swollen, the heat of vagina much above the natural
temperature, generally accompanied with a copious muco-puru-
lent discharge from the vagina. The patient complains of
great pain at stool; the most careful manipulation causes great
CHRONIC ACUTE INFLAMMATION.
69
suffering. We do not wish to be understood as saying that all
cases of chronic-acute inflammation always result in abscess;
but we say that there is a great tendency to the formation of
abscess. We also have a class of cases which may be consid-
ered chronic in that they are subject to frequent attacks of
active pelvic inflammation, they being really cases of sub-acute
inflammation, that, owing to cold or exposure of some kind,
has caused the acute for a time to supplant the sub-acute,
then under treatment; ordinarily, by the natural restorative
powers of nature, active inflammation subsides, and leaves the
sub-acute form in its stead, there being enough irritation re-
maining to attract towards the parts all the impurity of the
blood, retard and retain all the degenerated blood corpuscles,
thereby aiding in the development of malignant disease, or,
perchance, only hypertrophy or areolar hyperplasia of the
uterus. The most frequent seat of abscess, when it does form
from general pelvic, chronic, acute, or active inflammation, is
in the cellular tissue, generally posterior to the vagina and
uterus. I can only account for this from the fact that the
position of the patient on the back, with the thighs semi-flexed
on the abdomen, which is the position usually voluntarily as-
sumed by the patient in acute pelvic inflammation, allows the
uterus, with weight of bladder and its contents, to press more
heavily against the cellular tissue posterior to these organs,
and tends to retard more fully the circulation there, and, of
course, on this account, gives greater tendency to the forma-
tion of abscess in this locality than in the anterior or lateral
portions of the pelvis. Abscess forming anterior to the uterus,
between it and the bladder, is usually caused from circum-
scribed inflammation in this particular location, induced by
anteversions of the womb, direct injury, peri-metritis, etc.
Treatment.
We must not allow the bowels to become charged with
fecal matter, and thus press upon the inflamed tissues. The
70
EATON ON DISEASES OF WOMEN.
most suitable means to prevent this is the regular daily use
of warm water enemæ, with plenty of soap dissolved in the
water. Never let the solicitations of the patient or friends.
induce you to allow the administration of purgative medicines.
The increased peristaltic action of the bowels that they would
occasion would be more injurious than to allow the bowels to
remain inactive. Still there is no need of their remaining
overloaded, and it is better to insist on their being moved
with enema than to neglect them. Warm vaginal injections
of castile-soap and water, used several times a day, with warm
fomentations with hop-bags applied to the perinæum and over
the hypogastrium, are to be used, with warmth to feet and
sustaining diet of beef-tea, egg-nog, and the like. Milk will
be well borne and easily digested, if to it is added a small
quantity of salt. Let this hint be ever remembered. Milk
often disagrees with the stomach of patients because of too
much acidity there; but if we correct this acidity with a little
lime-water or a little salt added to the milk, we chemically
overcome the acidity, and our diet of milk is very acceptable
and satisfactory. Should all means fail of accomplishing reso-
lution of the inflammation and absorption of the matter, we
may have to evacuate the abscess. This is much better prac-
tice than to allow it to go on to spontaneous evacuation, as it
may form an opening in an inconvenient locality, and, besides,
be much more difficult to heal than when evacuated artificially.
As to methods of operating, we refer the reader to the chapter
on Cellulitis, where he will also find some general directions
as to the after treatment of the abscess.
The remedies most frequently indicated are Bell., Merc.,
Hyos., Bry., China, Sepia, Cimicif., Can. ind., and Hamamelis,
internally and externally.
CHRONIC SUB-ACUTE INFLAMMATION-Description.-We find
in practice that there are cases where there is present a sub-
acute inflammation, not only of the cervix uteri, but also of the
endometrium, the ovaries, bladder, vagina, and cellular tissue
CHRONIC SUB-ACUTE INFLAMMATION.
71
surrounding the pelvic organs as well, often implicating the
peritoneal covering, so that it may be considered, as a whole,
under the name of chronic sub-acute, pelvic inflammation.
The patients in these cases may be able to go about their
usual avocations a considerable part of the time, though suf-
fering much pain. This pain is in the organs themselves,
and also in the back, loins, thighs, occiput, top of the head,
and under the left breast. Digestion is generally impaired,
much flatus in the stomach and bowels is generally pres-
ent; and palpitation of the heart and fainting spells are
frequently symptoms of this difficulty.
Etiology.
The cause is often obscure. These cases generally come
under our care with a history often so long that we need to
make a special appointment of an hour to hear it, and, when
we learn it all, we generally find that the array of treatment,
and the names of different physicians who have from time
time treated the case, will occupy no small part of the
recital; and as several years have generally elapsed since the
patient has been a sufferer, we often find it extremely diffi-
cult to decide what was the cause of her trouble in the first
instance. Sometimes it is clear that a miscarriage, or con-
finement badly managed, was a prime cause, in other cases
that a cold taken and neglected at the menstrual period
seems to have laid the foundation for the long train of suf-
ferings that the patient has endured. Again, injudicious
treatment, especially with pessaries, caustics, frequent cold
baths, the continuous use of cathartics, etc., seem to have
kept up the irritation. Again, unsatisfied
Again, unsatisfied sexual passion,
as in the case of those ladies who have married men many
years their senior (whose sexual vigor was inadequate to
satisfy the wife, though sufficient to excite her); entire
continence, in cases of the unmarried, at ages ranging from
thirty to thirty-five years, has seemed to me to tend to pro-
72
EATON ON DISEASES OF WOMEN.
duce this condition. My experience would lead me to believe
that the two latter classes of ladies are rather more subject
to this difficulty than any other. This condition may be, in
some instances, caused by uterine displacements and the
accompanying ovarian displacements, producing irritation of
the organs themselves and the surrounding parts as well.
Diagnosis.
In these cases it is not hard to see that the patient is
ill, as the constitutional disturbance generally present will
clearly indicate it; and, did we fail to see at a glance that
something was the matter, the patient will not long allow
us to remain in ignorance that she is a great sufferer.
Doubtless these patients have much real suffering, but the
gravity of the prognosis should not be measured by the
extent of the patients' complaints, as we would be led to
believe from them that dissolution was imminent. They do
not always, however, refer their sufferings to the part dis-
eased, but often to the stomach, back, or head, and fre-
quently to the liver, which does become torpid in some in-
stances, it is true, by reason of the depressed nerve strength
of the system, tending to torpidity of the glandular system
in general, thereby producing a condition of imperfect secre-
tion and excretion. This tends to emaciation, and to pro-
duce that swarthy, yellowish color of the skin we so often
see in this class of cases. The long train of symptoms pro-
duced from dyspepsia-the depression of mind, the unrest,
the dissatisfied disposition-will lead us to be on the alert to
investigate the condition of the pelvic organs. The exami-
nation will disclose similar symptoms as in case of sub-acute
inflammation; and these, conjoined with the grave constitu-
tional symptoms just mentioned, together with the great
length of time the patient has been in ill health, will give us
reason to diagnose the ailment, chronic sub-acute inflam-
mation. We will generally find hypertrophy of the uterus in
CHRONIC SUB-ACUTE INFLAMMATION.
73
these cases, though occasionally in the patient of fifty years
of age and upwards-sometimes in those of thirty-five or
forty years of age, who have remained virgins-we have an
atrophied condition of the organ; but in the case of atrophy
we generally have increased sensibility, amounting to great
tenderness. The ovaries are usually enlarged and tender,
sometimes only one is affected; if so, it is generally the left.
There is a sense of weight and bearing down in the pelvis
while in the erect posture. The chronic yellowish leucor-
rhoea, often acrid, is frequently a persistent symptom. Pain in
the small of the back or in the sacro-iliac articulation, sciatic
pains, burning in palms of hands and soles of the feet, heat in
the top of the head, palpitation of the heart (though the rhythm
remains normal, and no abnormal sounds are to be observed
by stethoscopic examination), tenderness in epigastric region,
coated tongue, loss of appetite, restless sleep, bad dreams,
etc., are symptoms we find in most cases. Chronic constipa-
tion is almost always present; spasmodic stricture of oesopha-
gus, and the globus hystericus, are often complained of. Para-
plegia, of almost any part of the body, may result from this
disease. The menstrual function is usually deranged in those
ladies who have not passed the climacteric period. Some-
times we find scanty and sometimes profuse menstruation,
sometimes too frequent and sometimes delayed menstruation.
The sympathetic symptoms are almost endless, and when
we find a lot of obscure symptoms in a patient, who has also
a considerable number of the symptoms just enumerated, we
are generally right in supposing they are caused from this
chronic sub-acute inflammation of the pelvic organs. Mu-
cous polypi, hydatids, and, in fact, all the forms of polypi,
as well as fibroids of the uterus, ovarian fibroids, and
fibro-cysts and vaginal cysts, are caused largely, in my opin-
ion, from this condition of chronic sub-acute inflamma-
tion. Acute inflammation may attack a case previously suf-
74
EATON ON DISEASES OF WOMEN.
fering from chronic sub-acute inflammation, and the sub-
acute is often left after the subsidence of the acute form.
Treatment.
First, I will recommend in these cases, as of the utmost
importance, some form of abdominal supporter, to lift and hold
up the abdominal organs, so that they do not press upon the
irritated pelvic organs. I can not be too emphatic upon this
point. Without the aid of the abdominal supporter, I would
not expect to be successful in curing these cases, and, with
its use, we have trouble enough. I generally use my Improved
London Abdominal Supporter (see plate No. 12), or one made of
silk and elastic; but every physician should use judgment and
ingenuity in adapting the support to each individual case. I
think no set rules need be laid down, except to use a support
that is efficient, and at the same time comfortable to the
patient.
Where we have severe peri-metritis in the case, we may
have to enjoin perfect rest in the recumbent posture, till we get
this condition somewhat relieved by remedies; but very long-
continued decubitus is objectionable, in that it tends to debil-
ity, and seriously interferes with the process of digestion.
It is better, therefore, to hold up the abdominal organs with
suitable support, and not only permit, but enjoin, exercise of
a moderate character.
I am so impressed with the necessity of exercise, and at
the same time keeping the tender parts from suffering irrita-
tion from the superincumbent weight of the abdominal
organs, that I prefer the abdominal supporter to all the reme-
dies that can be given in the treatment of this disease.
Doubtless remedies are beneficial, and do cure, when we have
suitable conditions and accessories. The frequent use of the
tepid, salt water, hip bath is very beneficial. Let the patient
sit in the bath ten or fifteen minutes, twice a day. Sponge
CHRONIC SUB-ACUTE INFLAMMATION.
75
off the hips well with alcohol and water, equal parts, after
each bath. The following preparation of watery Solution of
Iodine may be applied freely over the os every two or three
days, and also to the intra-uterine surface in obstinate cases.
If it becomes necessary to apply it to the endometrium, it
will be generally necessary to dilate the cervical canal with a
sponge tent or two, and then use a soft brush or the uter-
ine applicator to apply it.
R.-Iodine, res., grs. v.
Potass., iodide, grs. xv.
Aqua, 3 1 m.
Et. sig. Solution Iodine.
This solution can be further diluted with water to any
extent desired. We can not do this with the Tr. of Iodine.
When much water is added to the Tr., the solid Iodine is
deposited and becomes a caustic. The dilution of Tr. Iodine
with alcohol is objectionable, in that the alcohol smarts too
much. The use of Tr. Iodine to the os uteri, or applied
to the intra-uterine surface, is not desirable because of its
caustic properties. The usefulness of the solution of Iodine.
as I recommend, is to promote absorption of the serous infil-
tration in the tissues, which is so commonly present, and to
allay the unhealthy action we call by the name of chronic
sub-acute inflammation. The daily use of this remedy is not
beneficial. It would be like the administration of the prop-
erly selected homoeopathic remedy in too low an attenuation.
It might aggravate the difficulty. The introduction of this
solution directly into the substance of the uterus or ovaries,
in cases of enlargement that resist all other measures, is
useful and to be recommended. This is accomplished with a
large syringe with a long, stout tube. (See syringe for inject-
ing uterine fibroids.) This may be repeated once in three or
four days for two weeks, when it is best to wait two or three
weeks and watch results. There is, perhaps, no one remedy
that exerts so beneficial an effect upon this disease as Phy-
76
EATON ON DISEASES OF WOMEN.
X
tolac. dec., in the 1 or 2 attenuation, given every three or
four hours.
China, Ars. iod., Bry., Nux, Sepia, Cimicifuga, Bell., Cal.
carb., Ignatia, Cantharis, Hepar sulph., Cham., etc., are
the remedies to select from in each particular case, as the
totality of the symptoms seem to indicate. If we have uter-
ine hemorrhage, or absence of menstruation, polypi, cysts,
or tumors, we must treat them on the principles laid down
under these diseases, which will be treated of specifically
under their proper heads. Attention to the administration of
suitable diet, that is nourishing and still easy of digestion, is
always to be remembered. Cheerful company, change of
scene and climate, will sometimes aid materially; and, if the
patient has lived in a malarious district, we must recollect
how much this tends to lower the strength of the nervous
system, and produce a condition of chronic congestion, and
apply our remedies accordingly.
METRITIS.
77
CHAPTER VIII.
METRITIS.
THE term metritis signifies inflammation of the uterus as
a whole, including its muscular tissue, serous covering, lining
membrane, and sub-mucous and cellular tissues. In a case of
metritis we have, then, peri-metritis, endo-metritis, and cer-
vicitis combined. There is generally sympathetic inflamma-
tion of the ovaries and broad ligaments in a case of metritis.
The inflammation may extend to all the pelvic and some of
the abdominal viscera, or it may remain confined to the
uterus. When the pelvic cellular tissue is invaded by inflam-
mation, the disease is called cellulitis, which may also com-
plicate a case of metritis.
Generally, we have an active inflammation to contend
with in these cases, which will require skill and firmness in
treatment, though the diagnosis is easy. The disease in its
acute form runs a rapid course, either to destruction of the
patient or ends in restored health within a few weeks, and
sometimes in a few days. When the disease extends to the
abdominal organs, the case is grave. Puerperal metritis I will
not discuss at this time, as a separate chapter is required for
its full explanation. It being best discussed in connection
with puerperal peritonitis, and having so much in it depend-
ent upon the condition of the lying-in state, I prefer to speak
of it separately. I will, however, include in this chapter in-
flammation of the uterus following abortion, which is some-
what allied to puerperal peritonitis, with much less of involu-
tion requisite in the uterus, but, at the same time, perhaps the
more dangerous of the two. The fatality in metritis following
78
EATON ON DISEASES OF WOMEN.
abortion I will explain in this chapter, as it is more like
the cause which produces mortality in ordinary metritis.
Diagnosis.
The diagnosis of metritis, as I mentioned before, is not
difficult. The patient complains of great pain and heat in
the uterus. There is soreness and tenderness of the entire
organ. Generally, the acute attack commences with a chill,
or at least chilly sensations, followed by a fever, often of a
high type; generally some nausea, and, in some instances,
frequent vomiting. The fever continues, or intermits for a
short time, and returns as severely as ever; the pulse is
fine and wiry; tongue generally coated white, sometimes
white or brown coat in center of tongue and red around the
edges; enlarged papilla here and there project through the
coating of the tongue, and are extremely red; considerable
headache and backache is complained of; constipation is
common, though diarrhoea is sometimes present. There is
little or no tenderness of the vagina in the recent uncompli-
cated case, but it feels hot to the touch, and the uterus is
found hot, swollen, and tender. Pressure made just above
the pubis causes much pain. As the disease progresses the
tenderness extends over the lower abdomen, showing peri-
tonæal complication. In this case (peri-metritis) gentle pres-
sure over the hypogastrium produces pain. It is to be dis-
tinguished from enteritis in that we require deep pressure to
produce pain in the latter disease.
There is a profuse discharge of matter, mingled with
streaks of blood, in the severe form of this disease, after it
has lasted a few days. The introduction of the uterine sound,
and sometimes even digital examination, produces a free flow
of pure blood, even if gentleness is used in the examination,
owing to the extremely congested condition of the lining
membrane of the uterus, and also that portion of the vaginal
membrane reflected over the neck in the vagina.
METRITIS.
79
The sub-acute chronic form of metritis I will speak of
as areolar hyperplasia of the uterus. Strictly, any inflamma-
tion of the uterus is metritis; but special names are given to
the disease when only a portion of the uterus is affected.
Some writers divide metritis into two forms, that which
affects the cervix mainly, terming it cervical metritis; and
that which affects the fundus, giving to it the name of me-
tritis. In chronic cervical metritis we have a mild inflamma-
tion of the sub-mucous tissue, which first tends to effusion in
this tissue of a fibro-plastic material, which organizes after a
time, to produce the indurations of the os found in these
cases, if of long duration. To what extent the muscular
tissue is involved in chronic metritis we are unable to say,
but probably very slightly; and we have no evidence, in
most cases, that the peritoneal coat is much affected, except
in cases of the acute form of this disease.
In metritis of an acute character there is usually con-
siderable tympanites; but this does not distinguish it from
inflammation of either of the internal female genital organs,
or of the cellular or peritoneal tissues, as this symptom is
common to all of them, both in their acute and chronic forms.
Acute metritis may result in hypertrophy, softening, or gan-
grene of the organ, but usually, under homoeopathic treatment,
terminates in resolution.
Etiology.
Acute metritis results from cold taken at the menstrual
period, first causing arrest of the flow, secondarily, inflam-
mation; or it may attack a lady who has had some operation
performed upon her for the removal of a uterine polypus
or has had the sponge tent used without having taken suit-
able care of herself; or it may be caused from hard work
and some exposure while very warm; or it may result from
excessive coitus, or cold vaginal injections, or the use of in-
struments to prevent conception or produce abortion; or su-
80
EATON ON DISEASES OF WOMEN.
pervene on a chronic endo-metritis or endo-cervicitis; or it
may follow an abortion, from want of care, and rising too soon,
with exposure to cold; or from a retained placenta, or a part
of one; or a cold taken at this time; or from lacerations of
the cervix uteri in labor.
After a miscarriage or premature labor, women are liable
to be very careless, as they imagine little care is necessary.
This want of care and caution tends to produce the acute
attack of metritis. The retroverted state of the organ pre-
disposes to inflammation, especially the chronic variety; retro-
version or retroflexion sometimes exists in girls, caused from
jumping or a severe lift, and as puberty comes on the uterus
becomes unduly congested, and an inflammatory condition is
set up.
This gives rise to severe suffering at the menstrual
period, and is often a cause of the non-appearance of the
flow, although monthly pains come on with regularity, and
the general health is much affected. Constant standing, as
in case of clerks and teachers, is frequently a cause of the
sub-acute inflammation, which readily becomes acute and act-
ive from taking a cold, as this class of women are likely to
do from exposure in all kinds of weather.
Treatment of Acute Metritis.
The first requisite in treatment is perfect rest in the
recumbent position. If there is any peritoneal complication,
placing the knees and thighs in a semi-flexed position gives
some relief.
The warm sitz bath, warmth to the feet, warm
wet compresses over the hypogastrium, are all beneficial.
Aconite should be given till the pulse is under control, be-
comes soft, and the general fever subsides; after which Bell.,
Bry., Sepia, or Sulph. are frequently indicated. Injections of
Hydrate of Cloral into the vagina are useful in soothing the
irritation, tenderness, and pain. Do not be tempted into
giving allopathic doses of Morphia or Opium; though they
give temporary relief, they derange the action of the stomach
METRITIS.
81
and bowels, arrest healthy secretion, benumb the system, and
prevent the proper action of other remedies.
The same remarks apply with equal force to the hypo-
dermic use of Morphia. Its use has become shamefully
frequent with some practitioners, and should be discounte-
nanced, because we can relieve our patients in a short time
without it; and because it so seriously interferes with the
natural process of digestion and assimilation; and, worst
of all, establishes in many the opium habit. The alarming
increase of the habit of opium-eating in this country should
cause us to be active in suppressing it, and careful not to aid
in its spread. The import duties on opium paid the United
States government for the year ending June 30, 1877,
were $1,778,347. This gives some idea of the great amount
of the drug consumed by opium-eaters in the United States.
Cool lemonade is a means of great relief to the fever,
and is much relished by most patients. Cold water may be
drank with freedom in small quantities, often repeated. The
diet should be very plain, consisting of gruel of corn or oat-
meal, toast, with a little milk. The entire surface of the
body should be frequently sponged with tepid water. Ca-
thartic medicine must be positively forbidden, and tepid
soap and water enemæ used to move the bowels, in case of
want of action in them. I speak of this, not that I expect
any homoeopathic physician will prescribe a cathartic in these
cases, but knowing that we sometimes have patients who
have previously had allopathic treatment, and that they may
take a cathartic without asking the physician's advice.
From the swollen condition of the uterus and its pressure
against the rectum in these cases, as well as some degree of
irritation of the bowel from the spread of the active inflam-
mation in the uterus, the patient feels a constant ineffectual
desire to evacuate the bowels, which tempts her and her
friends to use a cathartic. Hence, I make the suggestion to
the student to forbid them, unless he knows his patient well
6
82
EATON ON DISEASES OF WOMEN.
enough to be sure she will not take them unknown to him.
The enema of water will unload the rectum if any fecal
matter is lodged there; and, besides, it serves to soothe the
irritation in the bowel, while the cathartic increases the irri-
tation, and may change a mild case into one of great severity.
Remedies.
In addition to Aconite, Bryonia, Bell., Sulph., and Sepia,
already mentioned, Verat. alb., Verat. viride, Ignatia, Hyos.,
Puls., China, etc., will be sometimes indicated. (See works
on Materia Medica for indications.)
Treatment of Chronic Metritis.
The student is requested to read the treatment of endo-
metritis, as being largely applicable to cases of chronic
metritis, excepting some complications more likely to arise
in metritis than in endo-metritis. (Also, see Areolar Hyper-
plasia of the Uterus.)
COMPLICATIONS IN METRITIS.-In metritis we are liable to
have some inflammation of the bladder as a complication.
This is due, in some cases, to the pressure of the womb upon.
the bladder, from its increase of size, and sometimes to a par-
tial ante-flexion or retro-version of the organ. In other cases,
a continuation of the inflammation from the peritoneal cov-
ering of the uterus to that covering the bladder, and thence
to the muscular, and even the mucous, lining. This gives
rise to a desire for frequent micturition; in fact, we may
have all the symptoms of cystitis, including a great amount
of mucous discharge, which adheres to the bottom of the
vessel with great tenacity. I know of no better remedies
for this condition than Can. ind., Cantharides, Uva Ursi,
Acon., Bell., or Cubebs.
TENDENCY TO DROPSY.-In some cases we have a tendency
to dropsy; but it is generally manifested as ascites. This
is produced from the peritoneal irritation causing an effu-
COMPLICATIONS IN METRITIS.
83
sion of serum into its cavity in excess of what is normal.
The student will understand that, in the healthy condition
of the peritoneum, a small amount of serum is thrown out in
its interior to lubricate it, and we may readily see how an
irritation of the membrane may cause an excess of this secre-
tion; and this accumulation of fluid in the cavity of the abdo-
men is termed ascites.
Ars., Merc. iod., Digitalis, China, Apocynum, etc., are the
remedies to be studied for this complication.
CELLULITIS AS A COMPLICATION.-General pelvic cellulitis.
may complicate these cases; for the treatment of which see
chapter on Cellulitis.
GENERAL EFFECTS OF CHRONIC METRITIS.-It is readily un-
derstood how the increased weight and size of the uterus
would tend to produce displacements of the organ.
In con-
nection with displacements we would have, not only the
reflex symptoms in ordinary displacements, but they are
likely to be intensified, from the fact of having the irritable
condition of the organ, produced by the sub-acute inflamma-
tion, in addition to the ordinary nervous effect in displace-
ments. Hence, we are more likely to have hysterical spasms,
a greater amount of brain symptoms, more derangement of
digestion, etc., than in ordinary recent displacements without
metritis.
THE EYES are sometimes affected, so as to produce various
forms of amaurosis, and sometimes much inflammation, as a
result of these conditions of the uterus. The oculist needs
to be thoroughly conversant with these facts, as otherwise his
treatment would be calculated to give, at best, only tempo-
rary relief.
STERILITY, ABORTION, ETC.-Sterility is a common result,
though in rare instances, where the irritation is slight in the
endometrium, pregnancy may take place; but as the uterus
enlarges in pregnancy, it is liable to contract (owing to its
irritable condition), and expel the foetus prematurely.
84
EATON ON DISEASES OF WOMEN.
་
COPULATION INJURIOUS.-Copulation should be interdicted
in these cases, as it can hardly be otherwise than harmful by
producing greater irritation, temporarily at least; and as con-
ception is likely to be followed by abortion, it is better it
should not occur till a year or so after the patient appears
well; otherwise we may have a relapse.
TUMORS.-Metritis tends largely to the growth of tumors.
of the uterus, especially fibroids and fibrous polypi. It also
tends to the development of cancer of the organ.
MENSTRUAL DERANGEMENTS.-We also have menstrual de-
rangements in metritis. More frequently than otherwise the
flow is increased in duration, quantity, and frequency. This
drain upon the system, in connection with the excessive leu-
corrhoeal discharge and the pains she has to endure, with the
poor nourishment she gets by reason of the disordered stom-
ach generally present in these cases, tends to seriously exhaust
the patient to an extent which may threaten her life.
The development in the uterine cavity of vegetations of
the endometrium, hydatids, or polypi, or granulations of the
cervix, may cause this hemorrhage; and it may be best to
at once insert the sponge tent, dilate quite fully the cervix,
and ascertain what the trouble is, if possible, in chronic cases,
where uterine hemorrhage is present. The tent will tempo-
rarily arrest the flow, and aid us in finding out what the real
trouble is in the case.
Remedies in Metritis.
Remedies necessarily take a wide range in cases of me-
tritis, on account of the various conditions present and the
various constitutions of women. We have mentioned a few
remedies in connection with the treatment, and will add some
few indications for remedies in a more compact form.
Aconite.-Fever, wiry pulse, dry skin; nausea; great
tenderness of uterus, fear, restlessness, and despondency.
METRITIS.
85
Bell.-Dull, heavy headache; tenderness; pain in fore-
head just over the eyes.
Bry.— Stitches, cutting pain, fever, pulmonary compli
cations.
Cal. Carb.—Light complexion, with profuse leucorrhoea;
general irritation of the mucous membranes; scrofulous pa-
tients, with leuco-phlegmatic temperament, cold feet, vertigo,
fear of impending evil, supra-orbital neuralgia, sour taste in
the mouth, involuntary emissions of urine, bearing-down pain
in the uterus; especially useful with fleshy people.
Ferrum.-Menorrhagia in women with red face; great
weakness; menses stop and return again.
Gelsem.-Hysterical symptoms; hyperesthesia of a part
of the body; tendency to hemiplegia; confusion of the mind;
sleeplessness; hysterical spasm; fever without thirst; the
fever intermits; great nervous exhaustion.
Graphites.—Profuse leucorrhoea, coming in gushes; in
ladies inclined to obesity, affections of the ovaries, severe
bearing-down pain, constipation, the leucorrhoeal discharge is
tenacious, excessive sensitiveness to cold, etc.
Ignatia. Uterine cramps and stitches; chlorosis; much
pain in rectum; excessive flatulency; incontinence of urine;
restlessness; changeable mood; hysterical manifestations;
excessive yawning.
Borax.—White, thick leucorrhoea; menses too profuse
and too frequent.
Cimicif. Rac.-Chorea; great pain in the uterus or ova-
ries; tendency to rheumatism; has hysterical tendencies;
rheumatic or neuralgic pains in the uterus.
Caulophyllum.—Insomnia; paraplegia; atony, and re-
laxed condition of the uterus; hysterical spasms; irregular
menstruation; excessive uterine hemorrhage.
Carbo. Veg.-Great weakness; tympanites; cardialgia:
eructations of glairy mucus; acrid leucorrhoea; heat, redness,
itching of the labia and vulva; voluptuous thoughts.
86
EATON ON DISEASES OF WOMEN.
L
Conium Mac.-Swelling of the breasts; stitches in the
breast, mostly at night; induration of the cervix uteri, with
sharp pain in the part; acrid leucorrhoea; prolapsus uteri.
Colocynthis.-Flatus; rolling pain in the bowels; agon-
izing pain in the bowels; blood flows from anus; urine is
thick, foetid, scant; restlessness, with great anxiety; sci-
atic pains.
Verat. Viride.-Congestive state of the pelvic organs;
tenderness of the uterus; fever; heat; restlessness; palpita-
tion of the heart; local or general hyperesthesia.
Verat. Alb.-Hyppocratic countenance; excessive sexual
passion; tendency to diarrhoea; despair; hysterical or puer-
peral convulsions; fretful disposition; nervous headache.
Patinum.—Depression of spirits; excessive sexual de-
sire; excessive uterine hemorrhage; much bearing down pain
in pelvis; ovarian tenderness; indurations of the uterus;
albuminous leucorrhoea; useful in hysteria.
Rhus Tox.-Numbness of feet and limbs; rheumatic
complications; takes cold easily; white sediment in urine;
uterine hemorrhage.
Secale Cor.-Bearing down pain in uterus; uterine hem-
orrhage; has cold perspiration; flabby condition of the mus-
cles; menses profuse; relaxation of the uterine tissues.
AREOLAR HYPERPLASIA OF THE UTERUS.
87
CHAPTER IX.
AREOLAR HYPERPLASIA OF THE UTERUS; OR, CHRONIC PAREN-
CHYMATOUS METRITIS.
AREOLAR HYPERPLASIA of the uterus has been, until of late,
described as chronic metritis. Professor Thomas, of New
York, has taken great pains to elaborate this disease in his
work on "Diseases of Women," fourth edition. I shall take
the liberty to quote considerably, at length, from him, as his
views regarding this disease are so fully in accord with my
own, I feel that in all respects, save a part of his treatment,
I can fully agree with him; the objectionable points (in my
mind) in his treatment being scarifications and blisters locally
to the cervix uteri, and his drug medication, which is, how-
ever, in accord with the school of medicine to which he
belongs, and is, I believe, as good as any which has been
proposed by any one of that school. I am convinced of the
more satisfactory results of homoeopathic drug medication,
and one of the best wishes I could ask for man, as well as
woman kind, would be that the old school might, in a body,
embrace and practice the principles of homoeopathy. As
I turn to Professor Emmet's new work on "Diseases of
Women" to learn what he says upon this disease, I am sur-
prised to find he has omitted it entirely, and find, on further
search, that he has said but a few words upon hypertrophy
of the uterus, and nothing under the heads of either metritis
or chronic parenchymatous metritis, though his work is so
very elaborate and excellent in many respects. I had pre-
viously noticed that in his index I could find no mention
made of puerperal fever, puerperal phlebitis, mammary ab-
scess, hydatids, hysteralgia, cervicitis, rectocele, sterility, etc.,
88
EATON ON DISEASES OF WOMEN.
still I was unprepared to find that he gave but a page or so
to the consideration of all the forms of inflammation of
the womb.
Inflammation of the uterus, in its various forms, we have
considered of the utmost importance, and we have attempted
to describe and give the treatment of metritis, endo-metritis,
cervicitis, endo-cervicitis, and peri-metritis, and still we could
not feel our work complete, or up with the onward progress of
medical discovery, without giving some time to the consider-
ation of areolar hyperplasia of the uterus. This is rather a
result of disease than a disease per se. The connective or
cellular tissue, situated between the endometrium and mus-
cular tissue, between this muscular tissue and the outer cov-
erings of the uterus, and also connecting the fibers of the
muscular tissue of the organ, is the part affected in this dis-
ease, which results as a consequence of long continued irritation
of some part or the whole of the organ. In the outset the
disease of the uterus may have been endo-metritis, cervicitis,
or even endo-cervicitis only, and still the connective tissue
may have become, after a time, affected so as to produce
hyperplasia of this tissue.
The condition is similar to that found in cases of chronic
cervicitis. There is engorgement of the cellular tissue, from
effusion of serous fluid into its interspaces.
This effusion, resulting from chronic irritation, may some
day be discovered to contain material which is not always so
mild in its effects as serum; and I suspect that herein may
be found, at no distant day, an explanation of the develop-
ment of carcinoma of the uterus.
In hypertrophy of the uterus all the tissues of the organ
In areolar hyper-
are enlarged, especially its muscular tissue.
plasia the muscular tissue may be atrophied instead of en-
larged, although the organ as a whole is enlarged, owing to
the distension of the connective tissue from the effusion
mentioned.
AREOLAR HYPERPLASIA OF THE UTERUS.
89
This effusion in time becomes organized, forming new
areolar tissue, or distending the minute cells of this tissue so
as to appear increased in its substance. Following this con-
dition, further effusion may take place into this tissue of
sero-plastic lymph, or of abnormal cell plasma, which may
cause induration, or cancerous degeneration of the tissues; or
the hyperplasia may remain (for a long period at least) without
resulting in induration or carcinoma. In these cases the uterus
is found enlarged, somewhat patulous, often displaced, espe-
cially downwards, and often retro-verted or flexed. Constipa-
tion is an almost constant symptom in these cases, vesical
irritation, strangury, ischuria, etc., being frequent; pain in the
loins, back, or thighs, pain at the base of the brain, or on
the top of the head, gastric derangements, nervous or hyster-
ical manifestations, etc. This is the train of symptoms point-
ing to this condition, especially when the history of the case
shows that these symptoms have been present for a long time.
Pain in the pelvis is not very frequently complained of in
these cases, and the absence of this pelvic pain is the very
point likely to mislead the physician in diagnosis. The symp-
toms are largely sympathetic, and embrace, at one time or
another, about all the sympathetic effects manifested by any
uterine disease. (See Sympathetic Affections.) Of this dis-
ease Dr. Thomas** says:
"One of the most common pathological combinations which
confront the gynecologist is that which I here endeavor, in
as concise a manner as possible, to picture. A patient calls
upon us for relief of backache; pelvic pains; dragging sen-
sation about the loins; 'bearing down pains;' leucorrhoea;
menstrual disorder, tending chiefly to excessive flow; throb-
bing sensation about the uterus; general feeling of despond-
ency, malaise, and weakness; and irritability about the blad-
der and rectum. All these rational signs pointing to the
uterus as the probably delinquent organ, a physical explora-
*Thomas's "Diseases of Women," p. 274.
90
EATON ON DISEASES OF WOMEN.
tion is made, and furnishes the following results: The uterus
is usually discovered to be in the condition of descent, retro-
version, or ante-version; it is voluminous, tender to the touch,
and evidently engorged with blood; from the cervical canal
a leucorrhoeal matter pours; the probe carried to the fundus
finds it tender, and creates the flow of a little blood; the
cervix is often in a condition of granular or cystic degenera-
tion; and a low grade of vaginitis exists.
"To this pathological combination the more superficial
diagnostician will often apply a name which announces one
only of the existing conditions; as, for example, uterine ca-
tarrh, ulceration of the cervix, or retroversion or prolapse.
The more reflective and intelligent examiner will ordinarily
group the coincident morbid states together under the name
of chronic metritis.'
6
"The latter would be fully sustained in his position by
authority as abundant as it is orthodox, for by systematic
writers, since the days of Récamier, this uterine state has
been described as one of chronic parenchymatous metritis.'
Only within a very recent period have the pathologists of
the German school begun to question the validity of this
conclusion, which, taking its origin in France, was spread
through England and America chiefly by the writings of Dr.
Henry Bennet. According to this view, the following patho-
logical changes were believed to be those resulting in the
condition just described. In the first stage the parenchyma
was regarded as gorged with blood, a state of active conges-
tion existing. This was supposed soon to pass into the sec-
ond stage, consisting in an effusion of lymph, when, unlike a
similar process in other parts, the morbid action ceased, or
rather did not advance, and, unless relieved by treatment,
continued stationary for a length of time. The third stage
of inflammation in other parts, that of suppuration, was ad-
mitted to occur rarely here, or in the parenchyma of the
body, but in time, all inflammatory action ceasing, the cervix
AREOLAR HYPERPLASIA OF THE UTERUS.
91
remained large and indurated without sensitiveness, or the
effused lymph might be absorbed, and great diminution in
size occur with induration. Were this really the case the
condition would constitute one of inflammation, even if we
restricted ourselves in the use of that ambiguous term to the
narrow and precise limits prescribed by Dr. J. Hughes Ben-
nett, when he says: 'It should be applied only to that per-
verted alteration of the vascular tissues which produces an
exudation of the liquor sanguinis; it is this exudation alone
which can be held to unequivocally characterize an in-
flammation.'
"Examined more recently, however, by the more certain
and less theoretical processes of modern science, all this has
come to be looked upon as erroneous. Cases which were
formerly regarded as instances of inflammation-on account of
the existence of enlargement, congestion, and tenderness upon
pressure the microscope now proves to have been instances
of excessive growth of the connective tissue of the uterus,
with congestion, and resulting hyperæsthesia of its nerves.
"It may result from three entirely different pathological
states: first, from interference with retrograde metamorphosis
of the puerperal uterus from any cause; second, from conges-
tion long kept up by mechanical causes, such as displace-
ment; third, from a formative irritation or state of hyper-
nutrition excited by endo-metritis, or the existence of fibrous
tumors. Whatever be the originating pathological condition,
that which results and which we are now considering con-
sists in hyperplasia of connective tissue as its most marked
feature, and of congestion and nervous hyperesthesia as im-
portant accompaniments.
"Every-where throughout the recent and progressive lit-
erature of gynæcology the foreshadowing of the advancing
change in views with regard to this subject will be recog-
nized. The pendulum, swung too far by the hand of Dr.
Henry Bennet, is making its inevitable return. That it may
}
92
EATON ON DISEASES OF WOMEN.
6
"The
stop on safe middle ground must be the hope of all.
determination of blood to a part here noticed, characterized
by dilatation of the arteries, with increased flow of blood
through the capillaries, must be distinguished from the con-
gestion of inflammation, characterized by the accumulation
and stagnation of red and white corpuscles in the vessels,
tending to be abnormally adherent to each other and to the
vessels,' says Dr. H. G. Wright, quoting from Dr. Aitken.
Tested by this standard' (that of Dr. J. Hughes Bennett,
already quoted), says Dr. Graily Hewitt, the uterus is cer-
tainly very little liable to "inflammation;" exudation, and
transformation of such exudations, purulent and otherwise,
similar to what may be witnessed in other organs of the
body, being very rarely witnessed in the parenchyma of the
uterus. The morbid processes with which we are familiar
as affecting the tissues of the uterus are, for the most part,
alterations of growth, irregularities in growth, slight modifi-
cations, in fact, of the processes which follow each other in
due succession in the natural condition of things. The word
"inflammation," used in Dr. J. Hughes Bennett's sense of
the word, certainly fails to convey an adequate idea of the
modifications observed under such circumstances.' 'Diffuse
growth of connective tissue,' says Klob, constitutes the
so-called induration, hitherto considered as a result of par-
For rea-
enchymatous inflammation of the uterus.
6
sons mentioned I would also advise a disuse of the term
"chronic inflammation.' In a discussion || upon chronic
metritis, before the New York Academy of Medicine, Dr.
Noeggerath limited the disease to 'growth of cellular tissue,
both of the body and neck, occurring only during the puer-
peral state.' Dr. Peaslee preferred 'to call the disease under
consideration congestion, rather than inflammation, because
it has none of the events of inflammation;' and Dr. Kam-
"Dis. of Women," p. 363.
"Med. Record," No. 92, p. 475.
"Uterine Disorders," p. 218.
"Op. cit.," p. 129.
AREOLAR HYPERPLASIA OF THE UTERUS.
93
6
merer expressed the view that chronic inflammation of the
substance of the non-puerperal uterus is never met with;
what has been described as such is hypertrophy of connec-
tive tissue, resulting from long continued hyperaemia.'"
"These views, which, among men who are in the advance.
in gynæcology, are rapidly gaining ground, are not sustained
by analogical reasoning, but by anatomical proof. I know
of nothing which will more surely convince the reader of the
necessity for an alteration in our nomenclature concerning
this condition than a perusal of Scanzoni's article upon it.
This author, after heading his chapter Chronic Parenchy-
matous Inflammation of the Womb,' goes on to say: 'The
nature of the disease would then be, in an anatomical point
of view, a hypertrophy of the cellular tissue.' Certainly
the anatomical point of view' is an important one, and it is
supported by what we observe from a clinical stand-point.
6
"So much evil has arisen for pathology and treatment
from the use of the term chronic metritis, and so clear a
demonstration has been made that the condition so called is
not one of true inflammation, that some other appellation
is not only desirable, but has become absolutely essential.
It is incontestable that there is a peculiar condition that
affects the uterus which is characterized by distention of
blood-vessels from vital or mechanical cause, effusion of
the serum of the blood, and hypergenesis of connective tis-
sue. To denote this state, gynecologists have long required
a name, for medical nomenclature is as necessary as it is
faulty. Lisfranc felt this need when he styled it 'engorge-
ment; Hodge, when he entitled it 'irritable uterus;' Bennet,
when he called it 'metritis;' and others have also acknowl
edged the necessity; Klob, for example, in 'habitual hyper-
æmia' and 'diffuse proliferation of connective tissue;' and
Kiwisch, in infarctus.'
"The appellations infarctus, engorgement, and hyperæmia
*"Diseases of Females," Am. ed., p. 181.
94
ΕΑΤΟΝ ON DISEASES OF WOMEN.
only convey a partial idea of the truth; they only announce
one element of the condition-congestion-while that of
irritable uterus ignores all structural change in announcing
another element-nervous hyperæsthesia. At the same time
that the phrase, 'diffuse proliferation of connective tissue,
due to hyperæmia,' which is employed by Klob, clearly de-
fines the pathological condition, it is too long and burdensome
to answer the purpose of a name to be conventionally em-
ployed. If there be a term now in existence which does
really convey the idea truly and completely, it should surely,
in the interests of pathology and treatment, as well as out
of consideration for the overburdened student of medical
nomenclature, be employed in preference to the adoption of
a new one. Enlargement of an organ, due to the formation
of new cells similar to those of the tissue in which they are
developed, has been styled, by Virchow, hyperplasia, in con-
tradistinction to hypertrophy, which consists in increase of
size from distension of cells already existing. As the con-
dition of the uterus now under consideration is one arising
from over-excitation of the vaso-motor and excito-nutritive
nerves, a 'formative irritation,' as Klob styles it, and result-
ing in a numerical hypertrophy, it appears to me that the
term areolar hyperplasia would more correctly designate it
than any other with which I am acquainted. With a sincere
desire to lessen, and not to increase, the labors of the stu-
dent and the perplexities of the gynecologist, I shall, there-
fore, replace the confusing term, chronic metritis, by that of
areolar hyperplasia of the uterus.
"If the disease really consists in a proliferation or hyper-
trophy of the areolar or connective tissue of the uterus, and
not in chronic inflammation, it would certainly be advan-
tageous to apply to it some name which would signify that
fact. 'Areolar hyperplasia" expresses this fact concisely,
*Hypertrophy signifies excessive growth of the elements of a tissue already
existing; hyperplasia signifies the development of new tissue.
AREOLAR HYPERPLASIA OF THE UTERUS.
95
and hence I have employed it. But the only proof of the
appropriateness of a newly applied term is its general adop-
tion. If this be accepted, I shall feel that good has resulted
from my effort; if its approval be not implied by adoption,
I shall admit, with regret, that I have only helped to render
confusion worse confounded.
“PATHOLOGY OF AREOLAR HYPERPLASIA.-The vast majority
of cases are due to interference with that retrograde meta-
morphosis occurring in the puerperal uterus, styled involu-
tion. To comprehend the pathology of cases thus arising, it
will be necessary to consider the physiology of that process
as well as the pathological conditions which may affect it.
"It is only within the last quarter of a century that we
have understood the process by which the uterus, an organ
measuring three inches, in the short space of nine months
enlarges so as to contain a child, or even two or three chil-
dren, and then, within two months after delivery, undergoes
so rapid an absorption as to return to its original size. The
credit of elucidating the subject belongs chiefly to Germany,
for it is to Virchow, Franz Kilian, Heschl, Kölliker, and
Retzius that we are most indebted.
"The important pathological fact, that arrest in a disturb-
ance of this process constitutes a condition of disease, ema-
nated from Sir James Simpson, who, in 1852, published the
first article which drew especial attention to it. His article
was entitled, 'Morbid Deficiency and Morbid Excess in the
Involution of the Uterus after Delivery. Since that time, the
condition which now engages us has become generally recog
nized as a uterine state of great frequency and moment.
"To fully comprehend this part of our subject, it is nec-
essary to bear in mind the component parts of the healthy
uterine parenchyma. It consists of five elements: 1. Fusi-
form fiber cells, or, as they are termed, the smooth muscu-
lar fibers; 2. Round and oval nuclei, which are supposed to
be elementary fusiform fiber cells; 3. Amorphous or homo-
96
EATON ON DISEASES OF WOMEN.
geneous connective tissue, which permeates the parenchyma
and binds together the fiber cells and nuclei; 4. Fibrillated
connective tissue or white fibrous tissue; and, 5. Elastic
fibrous tissue. These elements, together with nerves, blood-
vessels, and lymphatics, make up the tissue of the uterus,
which is covered by a serous membrane externally and a
mucous membrane within.
"No sooner does this structure feel the stimulus of con-
ception than it develops rapidly, partly by growth of already
existing structures, and partly by new formations. The
round or oval nuclei rapidly develop into fusiform cells, and
these as rapidly grow into colossal cells, which grow longer
and more powerful as pregnancy advances. A new forma-
tion of muscular fiber also takes place,'* the connective tissue
elements grow proportionately, and the blood-vessels enlarge.
"Parturition occurs, and almost immediately a retrograde
evolution begins to restore the uterus to its original constit-
uency. The fully developed fibers undergo a fatty degener-
ation; the fat thus formed is absorbed, and the organ rapidly
diminishes in size and weight. This fatty degeneration affects
the organ after the fourth day subsequent to delivery, and,
according to Heschl, the commencement of a new formation
of muscular fibers is recognized in the fourth week after
labor, in the form of nuclei and caudate cells. At the end
of the eighth week the uterus has returned to its nor-
mal state.
"Certain untoward influences may retard or check this
process, and the uterus remain flabby and large, when it is
said to be in a state of sub-involution, or arrested retrograde
evolution.
"Thus far we have been dealing with facts thoroughly
ascertained by histological investigations and fully established
by evidence yielded by the microscope. But from this point
the pathology of sub-involution is not so satisfactorily settled.
* Arthur Farre: "Cyc. Anat. and Phys.," Article Uterus.
AREOLAR HYPERPLASIA OF THE UTERUS.
97
Prof. Simpson declared that the disease was due to the fact
that 'this retrograde metamorphosis of the uterus has not
taken place during the puerperal month, or has taken place
only to such an imperfect degree that the uterus is of the
size we usually see it have at the end of the first week or
so after delivery;' but he entered, if I may judge from the
posthumous volume of his work upon Diseases of Women,
upon no detailed account of the existing pathological defect
in the organ. Since his writing, it appears to have been
agreed upon that this consists of persistence of the muscular
fibers, characterizing pregnancy, in a state of fatty degener-
ation. Thus Dr. Wright* says: 'Pathologically, it closely
corresponds with that state of the heart structure so admir-
ably described by Dr. Richard Quain, and commonly known
as fatty degeneration.' Dr. West† expresses himself thus :
'Though fatty degeneration of the tissues takes place, yet
the removal of the useless material is but imperfectly accom-
plished, while the elements of the new uterus are themselves,
as soon as produced, subjected to the same alteration.' I
search in vain the literature of the pathology of this subject
for a basis for these hypotheses. That literature is scanty in
the extreme as yet, and the subject awaits extended re-
searches before we can speak intelligently of it. The day
has passed, however, when we can let probabilities in pathol-
ogy pass current for facts.
เ
"The best, indeed I may say the only, detailed account
of this condition studied by the microscope, which I have
been able to obtain, is one by Dr. Snow Beck,‡ of London.
The enlargement of the uterus did not depend so much upon
an increase in the size of the contractile fiber-cells as upon an
increased amount of round and oval globules, with amorphous
tissue in the uterine walls.
The essential condition
of the organ consisted in the elements of the different tissues
*"Uterine Disorders," p. 221. "Dis. of Women," 3d Eng. ed., p. 89.
"London Obstetrical Trans.," Vol. XIII, p. 239.
7
98
EATON ON DISEASES OF WOMEN.
retaining a portion of the natural enlargement consequent
upon impregnation. But this enlargement was more due to
the increased size and amount of the soft tissue present in
the walls of the uterus, as well as at the internal surface, than
to the increased size of the contractile fiber-cells." Marked
congestion existed, the blood-vessels being large and forming
a complete and continuous system with the capillary network
on the inner surface of the uterus. No allusion to prepon-
derance of muscular fibers is anywhere made, and no mention
of fatty degeneration occurs.
"The condition of the uterine cavity is important. It is
always enlarged, the glands of the cervix are usually en-
larged, and upon the lining membrane of the cavity fungoid
growths are commonly developed.
"This is all that can with positiveness be said of the
pathology of the early periods of sub-involution in the pres-
ent undeveloped state of the subject.
"The uterus, the study of the tissues of which gave Dr.
Beck's results, measured 3 inches in length, 24 inches across
the fundus, the walls were 13 inches thick, and the uterine
canal was 3 inches deep.
"As time passes the uterine walls diminish in size, their
tissue grows less vascular, the blood-vessels become smaller,
and the uterine cavity assumes smaller dimensions. But the
organ does not assume its original size; it remains large,
dense, firm, and sensitive, for years presenting the character-
istic appearances of the so-called chronic parenchymatous
metritis. Although taking an entirely different view of the
pathology of chronic metritis, Dr. West signalizes almost
the same fact in the following words: It must, however, be
at once apparent that after inflammation has passed away, its
effects may remain in the larger size and altered structure of
the womb, and that the very nature of these changes will be
such as to render the repair of the damaged organ both un-
"Op. cit.," p. 89.
AREOLAR HYPERPLASIA OF THE UTERUS.
99
likely to occur and slow to be accomplished, and must leave
it in a condition peculiarly liable to be aggravated during the
fluctuation of circulation and alternations of activity and re-
pose to which the female sexual system is liable.' This is
just the state to which I allude at the commencement of this
chapter, as one existing years after labor, and which, attended
by congestion, displacement, catarrh, and granular degenera-
tion, is styled chronic metritis. It is, I think, this state which
most frequently furnishes instances of areolar hyperplasia to
the microscope.
"Let any one patiently and faithfully watch a case of sub-
involution for a year or two with reference to this point, as I
have repeatedly done, and I can not doubt that he will have
the same evidence which makes me so strong in my present
belief. Lastly, let it be remembered that, by the French
school, no condition of arrest of development is recognized as
accounting for it; these are cases of post-puerperal metritis,'
metritis, according to M. Gallard, without symptoms, 'chron-
ique d'emblée.'
"Does any one claim that between this condition and
chronic metritis a difference should be made? Let him tell
me by what means he can at the bedside distinguish one from
the other, and I may agree with him. There are no means
for such differentiation. If the uterus be very large and the
patient recently delivered, the case is termed sub-involution
by English writers; if its dimensions have diminished, years
have elapsed since parturition, and the almost universal ac-
companiments of the condition, leucorrhoea, granular degen-
eration, and displacement be present, it is styled chronic
metritis.
"Arrest of involution of the puerperal uterus is an occur-
rence of very great frequency. It constitutes the chief cause
of all chronic uterine disorders, and for this reason its impor-
tance can not be overestimated. Until this subject receives
"Op. cit.," p. 372.
Uor M
100
ΕΑΤΟΝ ON DISEASES OF WOMEN.
the attention which it deserves, the present confusion as to
the causes, pathology, and general features of chronic metritis,
which helps to weaken uterine pathology, must continue.
(
"In the first stage of the disease the hypertrophied
areolar tissue is congested, containing absolutely more blood
than normal, and the whole of the affected part, neck, body,
or entire uterus, is greatly increased in size and weight. As
time passes, the second stage of the disorder supervenes, and
an opposite state of things is set up. Klob describes it in
these words: The parenchyma on section appears white or
of a whitish-red color, deficient in blood-vessels, from com-
pression of the capillaries by the contraction of the newly
formed connective tissue, or from partial destruction or oblit-
eration of vessels during the growth of tissue; the firmness
of the uterine substance is also increased, simulating the
This
hardness of cartilage, and creaking under the knife.'
constitutes a true sclerosis of the uterus.
"Every practitioner must have met with cases in which
a large, red, engorged, and soft uterus, examined after an
interval of several years, has been found, to his surprise, to
have become small, densely hard, white, and anæmic, and its
cavity diminished in size. Such an organ removed from the
body cuts like fibrous tissue, and appears when cut almost as
dense and bloodless.
"COURSE AND TERMINATION.-The length of time which
this condition may last is very uncertain. After the con-
nective tissue once becomes thoroughly affected by the dis-
ease, it rarely returns to its original condition; but so complete
is the relief which may be afforded the patient by removal
of those concomitant conditions that attend upon it and in-
crease the discomforts which are due to it, that she will often,
for years, imagine herself well. Very suddenly, however,
imprudence during menstruation, the act of parturition, over-
The term sclerosis was, I believe, first applied to this condition by Skene,
of Brooklyn. Subsequently Gallard likewise employed it.
AREOLAR HYPERPLASIA OF THE UTERUS.
101
exertion, or some other influence creating congestion, will
produce a relapse which will convince her of her error. It
is astonishing to what an extent enlargement of the cervix
as a result of areolar hyperplasia will go. Sometimes this
part will equal in size a very small orange, and, filling the
vagina, will compress the rectum to such an extent as to
interfere with its functions. Uninterfered with by art, the
disease has no fixed limits. The increase of uterine weight
which it induces usually results in displacement. This
increases already existing congestion, and the patient suffers,
until the menopause at least, from endo-metritis, granular
cervix, and the ordinary symptoms of displacement.
"In some cases contraction of the exuberant tissue oc-
curs, and uterine atrophy, with its accompanying symptoms,
takes place.
"FREQUENCY.-This affection is one of great frequency,
and as it was formerly universally regarded as chronic paren-
chymatous metritis, this is one great reason why inflamma-
tion of the structure of the uterus was thought to be so
common. This fact makes its careful study a matter of great
moment to the gynæcologist. I do not hesitate to declare
that he who fully masters it, and thoroughly appreciates its
frequency and influence, will possess a key to the manage-
ment of numerous cases which would in vain be sought for
elsewhere.
"PREDISPOSING CAUSES.-These may be enumerated as-
"A depreciation of the vital forces from any cause;
"Constitutional tendency to tubercle, scrofula, or spa-
næmia;
"Parturition, especially when repeated often and with
short intervals;
"Prolonged nervous depression;
"A torpid condition of the intestines and liver.
"THE EXCITING CAUSES are the following:
"Overexertion after delivery;
102
EATON ON DISEASES OF WOMEN.
!
"Puerperal pelvic inflammation;
"Laceration of the cervix uteri;
"Displacements;
"Endo-metritis ;
66
Neoplasms;
"Cardiac disease;
"Abdominal tumors pressing on the vena cava;
"Excessive sexual intercourse.
"After delivery many of both these sets of causes are
developed by the pernicious system of management which
nurses frequently adopt. The nerve and blood states of the
woman are depreciated by starvation, impure air, and disturb-
ance of sleep by attention to the wants of the child, while
the enlarged uterus is forced into retroversion, and the con-
gestion which it induces, by a very tight bandage, rendered
still more hurtful by a thick compress over the uterus. The
practitioner who regards delivery of the placenta as the end
of the third stage of labor furnishes a marked predisposing
cause. The third stage of labor consists in complete and per-
manent contraction of the uterus, and may not be accomplished
for hours after the expulsion of the placenta. No obstetrician
has done his duty who leaves his patient before its accom-
plishment.
"Symptoms.
"It is impossible to present the symptoms of this condi-
tion entirely separated from those of complications which
very commonly attend it; such, for example, as displacement,
laceration of the cervix, ovarian congestion, granular cervix,
etc. These states, of course, produce symptoms of their
own, which mingle with those of the main disorder. The
symptoms, then, which are due to areolar hyperplasia, and its
If the
almost inevitable complications, are the following.
cervix alone be affected, there are:
"Pain in back and loins;
"Pressure on bladder or rectum;
AREOLAR HYPERPLASIA OF THE UTERUS.
103
"Disordered menstruation;
"Difficulty of locomotion;
"Nervous disorder;
"Pain on sexual intercourse;
66
Dyspepsia, headache, and languor;
"Leucorrhoea.
"If the affection be general or corporeal, graver symptoms
manifest themselves.* Chief among these are:
"A dull, heavy, dragging pain through the pelvis, much
increased by locomotion;
"Pain on defecation and coition;
66
Dull pain beginning several days before menstruation,
and lasting during that process;
"Pain in the mamma, before and during menstruation
"Darkening of the areolae of the breasts;
"Nausea and vomiting;
"Great nervous disturbance;
1;
"Pressure on the rectum, with tenesmus and hemorrhoids;
"Pressure on the bladder, with vesical tenesmus;
66
Sterility.
"PHYSICAL SIGNS OF CERVICAL HYPERPLASIA.-Vaginal touch
will generally discover that the uterus has descended in the
pelvis so that the cervix will rest upon its floor. The cervix
will be found to be large, swollen, and painful, and the os may
admit the tip of the finger. If the finger be placed under
the cervix, and it be lifted up, pain will be usually complained
of, and if it be introduced into the rectum so as to press upon
the cervix as high as the os internum, it will often reveal a
great degree of sensitiveness. Under these circumstances,
the direction of the uterine axis will generally be found to be
abnormal. The cervix will, in some cases, have moved for-
It must not be supposed that all these symptoms occur in all or even in
the majority of cases. In many cases few, and in some almost none of them,
will be recognized.
104
EATON ON DISEASES OF WOMEN.
wards and the body backwards, or the opposite change of
place may have occurred.
"PHYSICAL SIGNS OF CORPOREAL HYPERPLASIA. If two
fingers be carried into the vagina, and placed in front of the
cervix so as to lift the bladder and press against the uterus,
while the tips of the fingers of the other hand be made to
depress the abdominal walls, the body of the uterus will,
unless the woman be very fat, be distinctly felt, should the
organ be ante-flexed. Should it not be detected, let the two
fingers in the vagina be now carried behind the cervix into
the fornix vagina, and the effort be repeated; if the uterus be
retro-flexed or retro-verted, or even in its normal place, it will
be detected at once. By these means we may not only learn
the size and shape of the organ, but its degree of sensitive-
ness. This may likewise be accomplished, to a certain extent,
by rectal touch. The uterine probe may then be introduced,
the cavity measured, and the sensitiveness of the walls care-
fully ascertained.
"A point which should be settled before the diagnosis
can be considered complete will be whether the cervix alone
is affected, or whether its enlargement is only a part of a
general uterine development. To determine this question,
two means are at command: First, the examiner, introducing
one or two fingers under the body of the uterus, and depress-
ing the abdominal walls by the other hand, so as to clasp
the fundus, ascertains whether it is larger than it should be,
or of normal size, and free from sensitiveness. He then
passes the uterine probe into the cavity of the body, and
measures it. If the uterine cavity be increased in size, the
evidence is in favor of the disease having extended to the
tissue of the body. Should its size be normal, this is prob-
ably not the case. This sign is not, however, to be entirely
relied upon.
"Sometimes, suspicion of scirrhous cancer in an early
period being entertained, it becomes necessary to decide
AREOLAR HYPERPLASIA OF THE UTERUS.
105
between its existence and that of the second stage of areolar
hyperplasia, or sclerosis. Scanzoni doubts the possibility of
deciding, but it appears to me that the investigator will
usually succeed in doing so by the following comparison of
signs and symptoms:
In Cervical Sclerosis.
"The patient shows no cachexia.
"There is tendency to amenorrhoea.
"The history usually points to parturition.
"It has been preceded by symptoms of
uterine enlargement.
"The cervix feels like dense fibrous tissue.
“The body is, perhaps, implicated.
'A sponge-tent softens the tissue.*
In Scirrhous Cancer.
She often does.
There is tendency to hemorrhage.
It does not.
It has not.
It feels almost like cartilage.
It is very rarely so.
It leaves it hard and dense.
"Prognosis.
"The prognosis in hyperplasia of the entire uterus, or of
the body alone, is unfavorable with regard to complete cure,
though highly favorable with reference to great relief of
symptoms and to danger to life. Should the patient be
approaching the menopause, it is possible that, after the
functions of the uterus cease, atrophy may occur, and relief
be obtained. But one can not be sure even of this, for the
monthly discharge may give place to metrorrhagia, or all the
symptoms may continue, in spite of the menstrual cessation.
Under a course of local treatment, combined with one con-
ducted with special reference to the general system, hope may
always be held out that, although restoration of the uterus
to its normal condition may not be effected, the evils result-
ing from the complications of this disease can be so fully
controlled that comfort will be obtained. When the neck of
the uterus alone is affected, a favorable prognosis may always
be made, for here there are fewer grave complications to be
encountered; such, for example, as corporeal endo-metritis,
menorrhagia, etc. The diseased part is likewise more access-
ible to local treatment, and is also a much less sensitive and
This test originated with Spiegelberg.
106
EATON ON DISEASES OF WOMEN.
important part of the organism; I might, indeed, almost say
a less important organ, so distinct are the uterine body and
neck, physiologically and pathologically. As I have else-
where stated, the prognosis will depend, in a great degree,
upon the patient. If she be unwilling to sacrifice her incli-
nations and pleasures, but half fulfill the directions of the
attending physician, and clandestinely expose herself to
prejudicial influences, the treatment will accomplish nothing.
In the case of a reasonable patient, who appreciates what
is at stake, and is anxious to regain her health, it may be
regarded as favorable.
I
"Treatment.
"REST. The patient should be instructed to take much
less exercise than usual, to lie upon her bed or lounge for
an hour every day, about midday, and to be especially quiet
during menstrual periods. It is highly improper to confine
her to bed, for many women become restive under the con-
finement, and suffer both in mind and body, the sanguineous
and nervous systems being impaired by want of fresh air.
If the connective tissue be so much affected that the cervix
is very painful upon pressure, absolute rest upon the back
may become necessary, but my impression is that deprivation
of fresh air and exercise ordinarily does more harm than is
compensated for by the advantages arising from quietude.
Every day she should go, unless deterred by some special
cause, into the open air; and a limited amount of exercise
should be inculcated, as a means of keeping up the general
health.
"The uterus should be placed at rest as much as possible.
Its natural tendency, under these circumstances, is to fall
from its position; consequently, all pressure should be re-
moved from its fundus by the use of a skirt-supporter and
a well-fitting abdominal bandage."
The use of the abdominal supporter I have found of the
AREOLAR HYPERPLASIA OF THE UTERUS.
107
utmost benefit; in fact, we doubt if these chronic cases
can be successfully treated without its use. We would not
dispense with them on any account. They need to be used
with care and judgment, however. They must be made to
fit so as to be really supporters of the abdominal viscera, and
not compressors of the abdomen. (See improved London
Supporter, Plate XII.)
SEXUAL INTERCOURSE.-Sexual intercourse is harmful in
these cases as a rule, and should be prohibited in most cases.
DIET. The diet should be nourishing, but not stimulat-
ing. It should be easily digested and taken in moderation,
and at regular times only.
Remedies.
Ars. iod., Merc. iodid., Phytolac. dec., Ferrum, Merc. cor.,
Kali idro., Nux, Ars. alb., Secale, Ignatia, Iris vers.,
Hyosc., Verat. vir., etc., are indicated remedies in this dis-
ease, and the sympathetic affections dependent upon it.
Special indications for these remedies may be studied best
in works on Materia Medica.
Remedies in HOMOEOPATHIC practice are not given according
to the name of any disease, and must always be selected ac-
cording to the pathogenesis of the drug, and we simply men-
tion here the remedies most likely to be indicated to facili-
tate the selection of the appropriate one, by the study of
each individual case. I have named the remedies in the
order in which they are prominent in regard to the fre-
quency of their being indicated.
Local Treatment.
Some gentle local treatment we have found useful. The
warm vaginal injection of water, using a large quantity,
with a Davidson's syringe once a day, is of service. We
think when there is a displacement of the uterus its reten-
tion in situ is usually the thing to attend to at first. The
108
EATON ON Diseases of WOMEN.
displacement, though it may have been in a measure caused
from this disease, may be a cause of its continuance. The
malposition of the uterus tends to keep up an irritation of
the nerves, and to cause an increase of the circulation in
the parts.
Displacements can not always be relieved at once, on ac-
count of the tenderness of the parts. In such cases, we
must direct the patient to take rest in the recumbent posi-
tion, use warm vaginal injections of water, and take reme-
dies for the relief of the tenderness. These remedies indi-
cated by the tenderness are, Bell., Arnica, Acon., Gelsem., or
Verat. viride. We may also apply a wad of cotton saturated
with glycerine to the cervix uteri. As soon as the uterus is
sufficiently free from tenderness to allow of it, we should
proceed to rectify the displacement. (See Displacements.)
Now, in addition to the use of the homoeopathically indi-
cated remedies given internally, we may use some local treat-
ment. The object to be obtained is, absorption and con-
traction.
The local application to the cervix uteri, externally and
internally, of a solution of Iodine, is the most efficient rem-
edy we have found, using the solution of the strength of
about ten grs. of Iod. res., and Potass. iodid., 3ss. to Aqua
3i; applying this to the cervix with a soft brush, and to
the cervical canal with a small uterine sound wrapped with
cotton. These applications we would not make oftener than
once in three days. During treatment the daily use of the
warm water vaginal injection is advisable.
Scarifications of the cervix, blisters, and caustics we do
not use, and can now say (after ten years of experience with-
out them, and having had more than that number of years
of experience in. their use in hospital and private practice
while in the old school), that we feel sure their use is
harmful. Our experience is decidedly in favor of leaving
them entirely alone.
AREOLAR HYPERPLASIA OF THE UTERUS.
109
SPONGE TENTS.—A sponge tent covered with glycerine,
and placed for about six hours in the cervical canal, is often
very useful. First, it dilates the canal so as to make it
easier to apply the Iodine. It compresses the tissues so as
to temporarily impede the capillary circulation, and the local
application of the glycerine is also of service. In using the
sponge tent caution must be exercised that the patient does
not take cold. It better always be done at the patient's
home, and the sponge should not be allowed to remain more
than six or eight hours in this class of cases.
110
EATON ON DISEASES OF WOMEN.
CHAPTER X.
PERI-METRITIS—PELVIC CELLULITIS–PELVIC ABSCESS.
PERI-METRITIS indicates, strictly, an inflammation of that
portion of the peritonæum attached to and covering the
uterus; but, by common consent, it is applied to the inflam-
mation of the peritonæum situated within the pelvis. It is a
frequent complication of cellulitis, and, when existing inde-
pendently of cellulitis, has many symptoms in common with
it. In a case of pure and primary peri-metritis we have not
the effusion which takes place in cellulitis, and the tender-
ness in the vagina is confined to the upper portion entirely.
After the lapse of several weeks, we may have effusion of
serum into that portion of the peritoneum lining Douglas's
cul-de-sac, and the case then may resemble recto-vaginal hæma-
tocele, though it is much smaller in size and is not so diffuse.
Symptoms.
The symptoms of peri-metritis are much like cellulitis.
There is the stage of congestion, followed by fever and reac-
tion, with the wiry, rapid pulse; acute pain in the pelvis just
posterior to the pubis. Vaginal examination does not reveal
any evidence of inflammation in the cellular tissue. Slight
pressure upon the uterus upwards produces no pain, but hard
pressure causes much suffering; the pain and tenderness
being referred to the lower portion of the abdomen, just
above or posterior to the pubis, about the fundus of the
womb, and in the region of the bladder. There is not, how-
ever, the frequent desire to pass water which we have in
cystitis, as the lining membrane of the bladder is not affected.
PERI-METRITIS.
111
There is some little pain from distension of the bladder, but
the sensation is more often described as an uneasy feeling.
Slight pressure in the lower portion of the hypogastric region
produces pain, while in metritis, endo-metritis, etc., slight
pressure causes no pain, but hard pressure can not be en-
dured. Generally, in a few days, and sometimes in twenty-
four hours, the inflammation extends over the peritoneum,
and we have a case of general peritonitis. In some cases,
however, the disease is arrested at once, and no extension of
inflammation occurs. The disease may exist as a primary
difficulty, or may exist as a complication of, or in connection
with, the inflammation of some of the pelvic organs or vis-
cera. The disease may be acute, chronic, or sub-acute.
The acute form, though more dangerous, is not so likely to
produce effusion as the chronic.
Etiology.
It is probable that most primary cases of peri-metritis
are the result of cold, generally taken at the menstrual
period, or following surgical operations. But peri-metritis
very frequently results from extension of inflammation in
the uterus, ovaries, or cellular tissue, and occasionally the
bladder.
Treatment.
The treatment must be in accordance with the stage of
the disease and the special indications in each particular case.
In the early part of the disease Ars. alb., Acon., Bry., or
Arnica are indicated, while later in the disease Merc. cor.,
Merc. iod., Kali iod., China, Cimicif., Colocynth., or Nux are
the remedies. Rest is necessary. The recumbent posture
should be maintained, and warm applications be made to
the feet and limbs. Cool, acidulated drinks are often grateful
to the patient. The diet should be mild and non-stimulating.
Fomentations of hops, or the hop or warm water compress,
112
ΕΑΤΟΝ ΟN DISEASES OF WOMEN.
may be applied to the hypogastrium, and the warmth main-
tained by coverings of dry flannel.
Great industry should be exercised to arrest the inflam-
matory action, by promoting the action of the skin and secre-
tions generally, in this way establishing an equilibrium in
the circulation, relieving the congestion and inflammation.
Cathartics, anodynes, or the hypodermic syringe, are to be
strictly prohibited. Meddling friends will often be suggesting
these things, as well as turpentine externally; but there is
no way that proves satisfactory but a firm though kind re-
fusal to allow of their use. Teach the people that benumbing
the system is not curing the disease; show them the bene-
ficial effects of homoeopathic treatment by giving a single
dose of Colocynthis (which is very often indicated in this dis-
ease), and let them observe its effect, and then notice the
freedom from nausea, constipation, and loss of appetite, pro-
duced by opiates, to say nothing of the terrible effects of the
opium habit, so often resulting from the administration of the
drug, allopathically, for the relief of pain.
Sequelæ.
The result most to be feared after peri-metritis is effusion
of serum into the peritoneal cavity. If it does occur, Apis
mel., Ars. alb., China, Dig., Can. ind., Merc. iod., etc., are
usually indicated. Sterility may be looked for as another
sequel of peri-metritis, though it is not a certain result. This
is owing to the thickening of the peritoneal covering of the
ovaries from inflammatory action, and the consequent preven-
tion of the escape of the ovum from the ovisac; hence, it
becomes impossible for the ovum to enter the fallopian tube
or the uterus, and become impregnated. The retention of the
ovum may cause the development of ovarian cystoma or
fibroma; hence, we see that peri-metritis may be a cause of
ovarian tumors.
PELVIC CELLULITIS.
113
PELVIC CELLULITIS.
Cellulitis, Para-metritis, Pelvic Abscess, etc.-These terms
indicate inflammation of the cellular tissue surrounding the
The cellular tis-
uterus, vagina, fallopian tubes, ovaries, etc.
sue serves to fill up the interspace between the rectum and
vagina; and, in fact, is a connective tissue which connects,
and still separates, all the pelvic organs, and serves as a bed,
in which are located the blood-vessels and nerves as well.
This tissue is more liable to inflammatory action than is
generally supposed, and many cases of cellulitis are over-
looked and misdiagnosed, being denominated inflammation of
the womb, neuralgia of the womb, irritable uterus, etc.
Too much stress can hardly be put upon the necessity of
more care in the diagnosis of female complaints, and espe-
cially cellulitis. Many a patient suffers greatly and loses her
life from a want of proper attention to the diagnosis and
proper treatment of the diseases of her generative organs;
and perhaps no disease is more frequently unrecognized than
cellulitis. The cellular tissue, being sponge like or honey-
combed in structure, is adapted to the uses for which it was
intended, allowing of the elevation of the uterus in gestation
and its depression in prolapse.
Cellulitis may affect the entire cellular tissue of the pel-
vis, or it may be circumscribed and confined to a small space.
In making a vaginal examination of a patient for the first
time, we should always be careful to note any evidence of
cellulitis, for otherwise we might use treatment which would
be injurious. For instance, if we found a displaced uterus,
and at once proceeded to replace it without any reference to
the cellulitis already present, we would probably find great
increase of pain, and the development of inflammatory symp-
toms which might be severe and alarming. Cellulitis may
develop as a primary affection, or it may result from the
114
EATON ON DISEASES OF WOMEN.
extension of inflammation from some of the pelvic organs or
from the peritoneum. It was formerly claimed by authors
that cellulitis only occurred as a result of displacement of
some of the pelvic organs, or the extension of inflammation
from some of them; but it is now admitted to exist as a pri-
mary affection, although the pathology of the disease is not
as well understood as could be wished, and it is hoped that
more light will be found ere many years have passed, and
we shall soon come to understand more thoroughly the pa-
thology of this important disease.
*
Prof. Emmet claims that "cellulitis most frequently exists
as a primary affection, and that affections of the ovary, uterus,
etc., are due, very often, to some previous lesion in the cell-
ular tissue. He holds that the uterus is entirely dependent
upon the blood which is distributed through the cellular
tissue, and that, as the nerve filaments reach the uterus by
the same route, the connective or cellular tissue is the first
and most exposed to the influences exerted through the blood-
vessels, and, consequently, is more liable to become inflamed,
as he who transports nitro-glycerine is more exposed to dan-
ger than he who is to receive it.”
Women are most liable to this disease during their period
of menstrual activity, though it occurs occasionally after the
cessation of the catamenia (probably about five per cent).
Quite young girls are stated by Prof. Emmet to be liable to
the disease. How he goes to work to make up a diagnosis in
their cases he does not tell us, and I can not imagine. True,
we might diagnose general pelvic inflammation in case of
young girls; but I judge it is impossible for any one to very
satisfactorily differentiate, in their cases, as to the particular
part affected, and I do not think it important, as treatment
should be very similar in their cases, whichever organ or part
in the pelvis is affected.
* Emmet, “Prin, and Prac. of Gynæcology,” p. 260.
PELVIC CELLULITIS.
115
Etiology.
The causes which produce cellulitis in the female are, cold
taken at or about the menstrual period, produced or acci-
dental abortion, constipation, displacements of the uterus, cold
taken after severe physical labor while in a perspiration.
means used to prevent conception, severe and protracted
labor, lacerations of the cervix uteri, the use of pessaries too
long continued, strong vaginal injections, excessive coitus
(especially soon after marriage), allowing of the too great
and protracted distension of the bladder; pelvic, ovarian, or
uterine tumors, etc. The tubercular diathesis, conjoined with
some local irritation, the climacteric period, gonorrhoeal infec-
tion, local phlebitis, etc., may produce this disease. Unsat-
isfied sexual passion in widows of full blood may also cause
this disease; as it may also, in the case of the married, where
the passion is excited but not satisfied, owing to incapacity
on the part of the husband. Fruitful married women are less
liable to cellulitis than the sterile or unmarried.
During the last quarter of a century the almost indiscrim-
inate use of caustics to the os and internal surface of the uterus,
by the allopathic medical profession, has been a fruitful source
of cellulitis, which even their own authors are now willing to
concede. How any body of intelligent, scientific, professional
gentlemen could have adopted such a routine practice as this.
causing such sad results in some cases (as they now freely
acknowledge), and being of so little benefit in most cases, is
truly astonishing. Too great faith in their leaders, and a blind
following of their example, produced this unfortunate result,
just as it did in the use of venesection and antiphlogistic
treatment, so-called, almost universally used for many years
by them, and now entirely, or almost entirely, abandoned for
the tonic or the expectant treatment, which means stimula-
tion, or the use of placeboes-or, as we say, blanks-and wait-
ing for nature to accomplish a cure; the latter of which is cer-
116
EATON ON DISEASES OF WOMEN.
tainly commendable, in that it shows either a great respect
for nature and nature's God; or a distrust of the efficacy of
their established routine, double-distilled, scientific treatment.
Symptoms of Pelvic Cellulitis.
The acute attack of cellulitis is usually ushered in with
a chill, or at least chilly sensations, for a period varying from
a few moments to several hours, when reaction sets in, and
fever rises, with considerable pain in the pelvis. Sometimes
the pain is sharp and piercing, at other times sore and aching—
the sore, aching pain being most prominent in cases arising
from excessive coitus or severe labor, while the darting, lan-
cinating pain accompanies an attack caused from cold, either
general or local.
The general symptoms of an acute attack of cellulitis are
similar to those in acute attacks of vaginitis, ovaritis, metritis,
cystitis, or peritonitis. In cellulitis a vaginal examination
will generally reveal tenderness on all sides of the vagina,
although the vagina itself is but slightly increased in tem-
perature or color. There is an absence of the intense redness
and spasmodic tenesmus, usually present in vaginitis; pres-
sure upon the uterus produces little increase of pain, while
in metritis this pressure could not be endured. The func-
tions of the bladder are little disturbed, micturition being
accomplished with tolerable ease, in great contrast to the
extreme pain in this act accompanying cystitis. It will be
understood I am now speaking of the recent attack of cellu-
litis, for, in some instances, when the disease is not arrested,
the inflammation extends to all the pelvic viscera, and we
have a case of general pelvic inflammation, as well as
cellulitis.
Cellulitis may also be circumscribed. In this case it is
somewhat more difficult of diagnosis. We then have local
tenderness at the inflamed point, in connection with the gen-
eral symptoms enumerated. Defecation is usually painful,
•
PELVIC CELLULITIS.
117
and constipation a prominent symptom. In the early stages
the blood vessels, being full in the cellular tissue, and the
circulation obstructed, a condition of congestion is present,
which not only gives rise to the pain, as well as the tender-
ness on pressure, but soon causes effusion of serum into the
cellular tissue, giving rise to a feeling like the vagina was sur-
rounded with cotton batting, pressing it inwards and decreas-
ing its size. We must be careful not to confound this
narrowing of the vagina with recto-vaginal hæmatocele, as we
may distinguish it by its presence in the posterior part of
the pelvis entirely, and not affecting the anterior portion at
all; besides, in recto-vaginal hæmatocele the size of the effu-
sion (or the apparent tumor caused by the effusion) is much
greater in the same length of time than is present in cellu-
litis. After two or three weeks we may have an abscess
form posterior to the vagina, and greatly resemble in its
physical features a recent hæmatocele; so time must be an
element in making up the diagnosis, as also must the history
of the case. Nausea and vomiting are often symptoms in
these cases, as well as severe headache. Perhaps headache
is the most constant symptom with which we meet in chronic
cellulitis, though backache and a sense of weight in the pelvis
are very common. Hysterical symptoms of almost any form
are liable to be manifested in this disease.
There also exists, in a great many patients, a chronic form
of cellulitis, where the symptoms of the acute attack have never
been experienced, cellulitis being, in these cases, the result of
the extension of inflammation from some of the pelvic organs
or viscera, the symptoms of tenderness and effusion having
been so moderate as to have been overlooked or ascribed to
some other ailment. The pain in these chronic cases is
usually of a burning character. The patient is often tortured
with hot flashes, becomes easily fatigued, is very nervous.
and complains of all manner of absurd and conflicting symp-
toms; is usually peevish, fretful, notional, and whimsical.
118
EATON ON DISEASES OF WOMEN.
Sometimes she is emaciated, but is often of full habit, having
a good appetite and digestion. In these cases a sense of
weight in the pelvis and bearing-down pain is usually com-
plained of, and pain in the back as well, especially after
exercise. A physical examination, however, reveals no pro-
lapse or version of the uterus, although there is a supersensi-
tive condition of the entire pelvic contents, and often the
tenderness is greatest in one or both iliac regions.
In cellulitis the passing of the sound into the uterus, even
to the fundus, would produce no special pain, while in endo-
metritis the pain would be intense from its introduction. This
is an important point in differential diagnosis between endo-
metritis and cellulitis. In the introduction of the sound for the
purpose of diagnosis great care should be exercised that no vio-
lence is done the mucous membrane. In fact, this care is
always necessary in making an explorative examination for
the purpose of differentiating in a case where we find that
pressure upon the os causes pain to be felt higher up, and
pressure above the pubis causes some pain, and there is
apparently some supersensitiveness on the sides and upper
portion of the vagina, with only mild symptoms of inflam-
matory action, without hemorrhage.
The use of the speculum is hardly ever required in making
the diagnosis of an acute attack of cellulitis. By separating
the labia we may see enough of the vaginal mucous membrane
to satisfy us, in connection with the digital examination,
whether the case is one of vaginitis or cellulitis. In either
vaginitis or cellulitis, the speculum causes too much pain in
its use to cause it to be recommended, even in diagnosis of
these cases; for I take it for granted that a digital exam-
ination should always precede a specular examination in all
cases, in making an examination for the purpose of diagnosis;
and we can learn enough by the introduction of the finger to
assure us of heat and tenderness, the location of the tender-
ness and its extent, the amount of effusion and congestion
PELVIC CELLULITIS.
119
of the tissues, the position of the pelvic organs in the main ;
and, in the few cases where we are not satisfied there is not
a flexion of the uterus, with digital examination, we can
gently introduce the sound, and clear up that much of the
diagnosis. I lay it down as a general principle of gynæcolog-
ical practice that we should never attempt to introduce the
speculum when a digital examination gives any considerable
pain. (The tenderness should be first removed by suitable
treatment.)
Prognosis.
The prognosis of cellulitis will be favorable, in most cases,
of acute attacks, if treated promptly and rationally, terminat-
ing generally in resolution, leaving the uterus less movable
than normal, however, owing to adhesions which usually form
at some part of the location of the inflammation. We may
also detect the band-like or corded feel of the folds of
some portion of the vagina, generally its upper part. These
are also caused by adhesions, and may offer considerable
resistance to the advancement of labor, should gestation
occur. In some instances, however, suppuration develops, and
a pelvic abscess is formed, and may point in the vagina or
find exit through the rectum, the opening of the abscess
into the rectum being the more common. Or the abscess
may open into the bladder in rare instances (only one case
of this kind has come under my personal observation);
or we may have blood poisoning from the absorption of the
pus, in which case we have rigors and fever, with great
nervous prostration, and death may result.
In occasional instances the pus has found exit through
the small intestines, owing to adhesions between them and
the sac of the abscess; and the pus may follow down the
psoas muscle, and open in the groin; or it may pass through
either sciatic foramen, and burrow under the glutei muscles,
or it may become sacculated. and remain for years.
causing a diagnosis of fibroid to be made; or it may be
120
EATON ON DISEASES OF WOMEN.
entirely overlooked until, for some reason, some inflammatory
action is set up, and even then it may be mistaken for a
recent attack of cellulitis. Generally the abscess discharges
voluntarily, or is evacuated artificially, at its most depend-
ent portion, and the pus is very thoroughly drained off,
leaving the sides of the sac of the abscess in contact, causing
adhesions and a cure of the whole trouble with little treat-
ment except of a general character. In chronic cellulitis we
may look forward to a protracted, if not an incurable, case;
for generally the ovaries and uterus are more or less involved,
and the nervous irritability is such that the patient suffers
much from prostration. The symptoms being somewhat
obscure, the patients are said to go into a decline, which
simply means they run down, and no one knows what is the
matter with them.
Sterility is a common result of pelvic cellulitis, which
is caused from the organization of the plastic material
thrown out around the ovaries, making it impossible for the
ovum to escape from the ovary; or sterility may, in these
cases, be caused from the adhesion of the fallopian tube in
such a way as to prevent its receiving the egg at all.
Hence, we see that cellulitis may be a prime cause of ovarian
inflammation and tumors, in that it may prevent the escape
of the ovum, and it may prove the nucleus of a cystic or
fibro-cystic growth. Cases which early come under homoeop-
athic treatment are usually relieved without the formation of
pus, and chronic cases are relieved with homoeopathic reme-
dies which have bidden defiance to old-school treatment.
Occasionally, however, chronic pelvic cellulitis may take on
active inflammatory action, and pus may form as in acute
attacks, which go on rapidly to suppuration. One attack of
cellulitis offers no immunity from subsequent attacks, but
rather predisposes to them.
COMPLICATIONS IN PELVIC CELLULITIS.-The extension of
inflammation from the cellular tissue to the peritoneum is
PELVIC CELLULITIS.
121
the most common complication in this disease, although me-
tritis, cystitis, and rectitis are not of infrequent occurrence.
If we do not see the case till several days after the attack,
and fully developed peritonitis has resulted, we will have
only the history of the case to aid us in diagnosing it from
ordinary attacks of peritonitis. We have the tenderness on
slight pressure over the abdomen, the tympanitic condition,
wiry pulse, great prostration, constipation, loss of appetite,
fever, frequently accompanied with profuse perspiration, as in
ordinary attacks of peritonitis; but the history of the case
will show that the pain in the pelvis was manifested one or
more days before it occurred in the abdomen. A vaginal ex-
amination will show the tenderness of the connective tissue, and
will probably indicate some effusion into this cellular tissue,
showing that the origin of the disease was in the cellular
tissue of the pelvis, and consequently the case is one of
cellulitis complicated with peritonitis, and should be so desig
nated. The gravity of this case is much greater than ordi-
nary peritonitis, which is always serious.
The symptoms of rectitis, as a complication, are those
present in dysentery in connection with those in pelvic cel-
lulitis. There is diarrhoea, tenesmus, ineffectual urging to
stool, with no operation, save a little mucus, or blood; while
in peritonitis, as a complication, there is no urging to stool,
not even a desire for stool, although the pain in the abdo-
men may be of great severity. When cystitis complicates a
case of cellulitis, there is the frequent desire to pass water,
accompanied with pain in the effort and a sensation as if
there was more urine to pass, which can not be discharged.
This is owing to the presence of mucus in the bladder,
which is very tenacious, and difficult to dislodge, and its par-
tial entrance into the urethra, as well as the inflammation in
the bladder, causes the feeling of frequent desire to mic-
turate. The presence of the urine in the bladder, even in
small quantities, in its inflamed condition, tends to produce
122
EATON ON DISEASES OF WOMEN.
this feeling also. These symptoms, taken in connection with
those of cellulitis, clearly show cystic complication. The
pain is not so much in these cases at the time of the flow
of the urine through the urethra, as in urethritis, but follows
the flow, as a sort of straining, or tenesmus. Urethritis may,
however, be present, due to extension of the inflammation
from the cellular tissue or otherwise, and in that case we will
have the scalding, burning pain in the urethra while the
water is passing.
Treatment.
In the first stage, or that of chill, Arsenicum is most
prominently indicated, with the warm foot bath, and warmth to
the limbs. The full warm bath, succeeded by a warm pack
in a warm wet sheet, with the administration of large
draughts of moderately cool water, will frequently establish
the equilibrium of the circulation. In this case the disease
is aborted in its first stage, and we can only denominate it as
congestion of the pelvic organs.
It is not often, however, that we are called to a patient
in this stage, and we usually find that reaction is fully es-
tablished in the general system, and fever, with a rapid, wiry
pulse, is present, although there is still evidence of conges-
tion in the pelvic cellular tissue. The remedy indicated in
this case is generally Aconite, although, if the cause is from
excessive coitus or protracted and severe labor, Arnica should
be alternated with the Aconite, and followed in a day or two
with Bry. or Mercurius, if there is a tendency to suppuration.
Bell., Hyos., Plat., Cimicif., etc., are sometimes indicated.
(See their pathogenesis in works on Materia Medica.)
The hygienic measures necessary are, first, perfect rest in
the recumbent posture, with the thighs partially flexed upon
the abdomen. The patient should be enveloped in flannels from
neck to foot. Warm vaginal injections with an elastic syringe.
should be used freely, with the patient recumbent, a bed-pan
being placed under her to receive the water as it passes out
PELVIC CELLULITIS.
123
of the vagina. Warm injections per rectum are also of great
service. The food should be very light and non-stimulating.
Cold water may be drank freely. The vaginal and rectal in-
jections of warm water should be used every three or four
hours for some time, till the evidences of active inflammation
subside. Should pus form, I prefer to evacuate it artificially
in the vagina, if possible, as its opening into the rectum,
colon, small intestines, or bladder, or even into the groin,
makes a more troublesome case, and there is very much more.
danger of fatal results. Some cases result favorably, how-
ever, when the pus escapes through these outlets by ulcer-
ative action.
Some cases of chronic cellulitis, sub-acute in character, as
all cases of chronic cellulitis are (unless, from some exciting
cause, acute inflammation supervenes upon the chronic sub-
acute inflammation), will nearly baffle all the remedial measures
and remedies we can employ. Here it is necessary to look well
over the general system, and ascertain the functional derange-
ment or organic lesion, if any there be, which may so affect
the system as to keep up the disease or prevent its cure.
Sometimes it will be found to be a displacement of the uterus,
sometimes disease in the rectum; at other times we find its
explanation in the tubercular diathesis of the patient, impu-
rity of the blood, or some disease or tumor of the uterus or
ovaries. Sometimes these difficulties can be relieved and
removed, and sometimes not. If possible, we must, of course,
remove the cause of the irritation, which, if we can accom-
plish, will enable us to get relief from the tenderness, back-
ache, weight in the pelvis, etc., by the use of Nux, Rhus, Ars.,
China, Bryonia, or Pulsatilla. When the disease is depend-
ent upon impoverished or impure blood, we find great benefit
from Iod., Ars., Phytolac. dec., China, Merc., Thuja, etc., as
indicated. The application of a Solution of Iodine, ten grs. to
the ounce, to the vaginal mucous membrane, by means of a
brush, used through the speculum once in three days, with the
124
EATON ON DISEASES OF WOMEN.
external application of Colorless or Tr. Iodine above the pubis,
together with attention to the movement of the bowels regu-
larly, will greatly aid in the cure of these cases.
Supporting the abdominal viscera by an abdominal sup-
porter is often a great relief to the patient, and a measure
calculated to be of service in the cure, as it relieves the
tender parts from being pressed upon by the weight of the
abdominal organs when in the erect posture. In the chronic
form of cellulitis attention must be paid to the promotion
of healthy digestion and assimilation, as well as the general
nervous recuperation. Generous, easily digested diet, with
moderate exercise and pure air, as well as medicine, are
necessary. The exercise must be moderate, however; hard
labor, or riding in a hard vehicle, over a rough road, could
not be tolerated. Even sweeping carpets and making beds
must be prohibited. Sexual connection must be forbidden.
The tepid sitz bath, daily, is of much service, as is also a
general sponge bath, followed by active friction to the ex-
tremities and back. Do not be inveigled into the use of
anodynes, either by the stomach or by the use of that con-
temptible little instrument, the hypodermic syringe, which
has done more harm than decades can eradicate, in the
establishment of the opium habit. We, however, withdraw
objection in case of cancerous disease (which is hopeless),
and, perhaps, some other hopeless cases, as mangling from
external violence of such severity as to preclude the hope
of recovery. Listen not to the importunities of patient
or friends; do for the patient what your judgment dictates.
Cheer the patient with all the hope you can honestly give
her, and explain the injurious after-effects of anodynes, and
help her to be brave by your own tranquillity, and have firm
faith in the remedies and means used.
The complications of cellulitis must be treated on the
general plan laid down when they occur as separate diseases,
using remedies singly, however, and not making a mixture
PELVIC ABSCESS.
125
of remedies because you have a complication of diseases.
If two or three remedies seem to be about equally indicated
it is well to give one for a few days, then omit it, and use
another for a time. We then get a better action of the
remedy, and we also learn something for our own, or some
one's, future use.
PELVIC ABSCESS.
Abscess in the pelvis, resulting from pelvic cellulitis, is
not of very infrequent occurrence. We know of its forma-
tion by the occurrence of rigors and the soft, fluctuating feel.
When we are certain that an abscess has formed, it is best
to evacuate it if possible through the vagina with the long
curved trocar.

G. TIEMANN &CO..
ان
FIG. No. 5.-LONG CURVED TROCAR.
Allowing the pus to remain can do no good, and it may
do much harm by its absorption into the circulation, or it
may point and cause ulceration in very inconvenient locali-
ties, as into the bladder, intestines, or peritonæum. Usually
draining the abscess with the trocar allows the sides of the
walls of the sac to come together and adhere, and causes a
cure of the abscess; but if it does not, and more pus forms,
we may evacuate it again in the same way, and follow the
evacuation of the pus with injections into the interior of
the sac of a Solution of Iodine, ten grs. to the ounce. Instead
of the curved trocar, we may evacuate the pus with the Aspi-
rator. (See chapter on Instruments, and Plates IX and X.)
126
EATON ON DISEASES OF WOMEN.
CHAPTER XI.
CHILD-BED FEVER.
PUERPERAL PERITONITIS, PUERPERAL METRITIS, METRO-PHLEBITIS, AND
PERITONITIS.
THIS disease, occurring as it does after parturition, is
treated of in some works on obstetrics, but not in all, and, as
it is one of the diseases peculiar to women, I deem it properly
considered in a treatise upon "Diseases of Women," although
very generally omitted in these special works. Puerperal
fever indicates something more than a fever occurring after
delivery. It consists of an inflammation of the womb, gener-
ally accompanied with peritonitis and following delivery but
a few days. By some, the term has been restricted to the
malignant, epidemic form of the disease. It is essentially an
inflammation, accompanied with a severe fever, and it is
more. It includes a blood poisoning, also. The inflamma-
tion may be seated mostly in the muscular tissue of the
uterus; or it may be in the uterine veins, being then a uterine
phlebitis; or it may mainly affect the peritoneal tissue; or it
may affect all the pelvic organs, and extend to the abdominal
viscera as well. The nervous system does not escape in this
disease, and we have extreme prostration of strength very
much like that which we have in typhus fever.
Unfortunately, the writings of authors of eminence upon
this disease have been so conflicting, not only regarding its
treatment, but also its symptoms and pathology, that the
term "puerperal fever," unexplained and unqualified, conveys
to the mind of the experienced, thorough physician no assur-
ance of the real nature or severity of the complaint, unless
he is aware of the ideas entertained by the speaker upon
PUERPERAL PERITONITIS.
127
this disease. During the last few years those of the profes-
sion who exercise most care in nomenclature and diagnosis
have discarded the use of the term puerperal or child-bed
fever, and use the terms puerperal peritonitis, or puerperal
metritis, instead. This is much the more satisfactory method
of nomenclature.
A few years since it seemed to me to be my duty to
criticise the remarks of a prominent author, made to a large
number of medical gentlemen of the North-west, in the par-
lors of the Grand Pacific Hotel, Chicago, upon puerperal
fever, he including phlebitis of the extremities, milk fever,
pneumonia, and intermittent fever (occurring in the puerperal
state), as well as abscess of the breast, septicemia as well as
pyæmia, under the general head of puerperal fever. He
had the perception and manliness to acknowledge the justice
of the criticism I made, and expressed the hope that
hereafter the profession would be more careful in medical
nomenclature.
On the one hand, it might be considered that partu-
rition, being a physiological process, it should not very
materially tend to disease. On the other hand, when we
consider the large dimensions to which the uterus attains
at full term of natural gestation; the consequent displacement
of the abdominal viscera; the pressure to which the kidneys,
liver, and stomach are subjected; the obstruction offered to
the free action of the bowels; and the consequent derange-
ment of digestion and assimilation, we may wonder that
disease is not a constant effect of this process.
When we consider the violent straining and tension to
which the muscles of the body are subjected in the process
of the expulsion of the child, both in natural and abnormal
deliveries; the depression and exhaustion to the nervous
system, caused by this process, we wonder more and more
that the recoveries from confinement are as favorable as
they are.
128
EATON ON DISEASES OF WOMEN.
Any student, by making a careful study of puerperal
peritonitis or metritis, will, from the history and description
of the disease given by different authors, become convinced
that it sometimes occurs epidemically, sometimes sporadically,
and sometimes as the result of contagion or infection; and
that it sometimes follows the easiest as well as the most
severe labors; that it occurs in the robust as well as the
weak; that there is generally evidence of blood poisoning;
but whether it be from atmospheric conditions, or from the
absorption into the system of poison from the person of
the accoucheur, or the putrid matter within the uterus from
decay of a portion of retained placenta, or from cold and the
arrest of the natural secretions, he will not be prepared to
say. He will feel sure, however, that either of these causes
may develop the disease. He will be convinced that the
accoucheur can not, with safety to the patient, attend cases
of confinement while he has in charge a case of puerperal
peritonitis, and that he can not safely dress suppurating
wounds and then attend cases of confinement. He will also
be convinced that a case of puerperal peritonitis may arise
in the practice of any physician, in spite of the utmost care
and caution on his part.
The nervous system is claimed by some to be the seat of
all the derangements of the system, and especially puerperal
diseases. M. Flourens* says: "The form of the nervous
system determines the form of the entire animal, and the
reason why it is so is plain; it is because, in fact, the ner-
vous system constitutes the entire animal, all the other sys-
tems being added merely to serve and maintain it." Meigst
says: "That the nervous system is the only part or element
upon which medicines, miasms, or contagions can act." (This
theory should make a homoeopathist of him, as in it is found
one explanation of the perceptible action upon the system
* Analyse Raisonnée des Travaux de Georges Cuvier, page 88.
† Meigs's "Obstetrics," page 642.
PUERPERAL PERITONITIS.
129
of the minute dose.) But, however we may theorize, we
may as well, first as last, admit that all cases of puerperal
peritonitis do not result from the same cause; but to one
thing we can adhere, that in every genuine case of puerperal
peritonitis there is blood poisoning and nerve depression, and
that a certain train of symptoms are necessary to indicate
the disease.
Symptoms.
The first symptom which presents itself in an attack of
puerperal peritonitis or metritis is a chill, either affecting the
whole or a part of the body, and varying in severity from
mild, chilly sensations to severe rigors, causing shivering and
chattering of the teeth. This chill comes on generally with-
out premonition, often occurring in those cases which have
for two or three days, and sometimes a week after delivery,
seemed to be doing well. In some cases, however, there is
some premonition of the attack in an increase of the rapidity
of the pulse previous to the chill, with a feeling of exhaus-
tion or excitement.
The occurrence of a chill does not, however, indicate
with certainty the attack of peritonitis, as it may be due to
the secretion of the milk or the commencement of an ordi-
nary intermittent or bilious attack of fever. In the attack
of puerperal peritonitis there is fever following the chill, so
there is also in intermittent and bilious attacks; but in the
attack of peritonitis we have tenderness over a portion or a
whole of the abdomen, generally commencing in its lower
portion and extending upwards; we also have a wiry pulse,
which we do not have in intermittent or bilious fever.
Pain in the abdomen and pelvis is another symptom in-
dicative of this disease. This pain is greatly increased
by pressure, even very gentle pressure often producing
acute pain-sometimes the weight of ordinary clothing
can scarcely be endured. The patient draws up the limbs
9
130
EATON ON DISEASES OF WOMEN.
and flexes the thighs upon the abdomen. Great thirst
is complained of, and the swallowing of cold water often
causes vomiting. In some cases the mind wanders, in others,
the patient insists that she is getting along nicely, seems uncon-
scious of her condition, and does not seem to suffer pain
except when some pressure is made over the abdomen, or
she attempts to move in bed. Tympanites over the entire
abdomen is soon manifested; though percussion is very
painful we may use it enough to satisfy ourselves of the
actual condition present, though it would be very unwise to
subject the patient to frequent examinations by percussion.
The tongue, at first red or furred in the center, with red
edges and tip, becomes dry and fissured. There is inability
to obtain rest in sleep in most cases, though sometimes an
almost constant drowsy, semi-comatose condition is present.
Profuse perspiration is sometimes a constant symptom after
the first few days of the disease, although the pulse remains
frequently up to 130 or 140 beats per minute. It becomes
softer in favorable cases, and gradually diminishes in frequency.
Sometimes the skin remains dry and hot. The temperature
of the body is high, ranging from 103° to 105°. As a gen-
eral rule, the higher the temperature the more grave the case.
Dr. Blundell* has given the term hidrosis, or hidrotid fever,
to this disease, when characterized by very profuse perspira-
tion. He divides these cases into seven varieties, "the ultra
malignant, the malignant, the acute, the lingering, the mutable,
the fugacious, and the remittent" (which is splitting hairs when
we have no use for the hair). It amounts to no practical ad-
vantage, but would tend to make more intricate that which is
poorly enough understood at best when made as plain as pos-
sible. The secretion of milk is generally arrested, and the
child has to be fed artificially. The bowels are usually con-
stipated. This is a more favorable symptom than diarrhoea,
as diarrhoea in this disease indicates that the peritonitis has
"Obstetricy," by Costle, p. 770; Ramsbotham, p. 545.
PUERPERAL PERITONITIS.
131
enteritis as a complication, greatly increasing the gravity of
the case. There is great prostration of strength, with entire
loss of appetite. The breath is offensive. The lochia is gen-
erally arrested, and the odor of the vaginal discharge (if there
is any) is very putrid and nauseating. The eye looks glassy
and inexpressive. The countenance is sallow, dejected, and
ghastly. Sometimes a metastasis of the inflammation takes
place, and the disease suddenly seems to leave the perito-
næum and attack the pleura; but in these cases there are not
all the symptoms of puerperal peritonitis fully developed, and
the case is one which some authors, especially Professors
Ramsbotham and Keating, have denominated false peritonitis.
which is more of a neuralgic than inflammatory condition,
though it manifests many symptoms indicative of genuine
puerperal peritonitis. Sometimes pain in the back is more
complained of than any thing else. Frequently there is
almost an entire arrest of the secretion of urine, and in these
cases the pain in the back is doubtless due to congestion of
the kidneys, causing the arrest of the natural secretion. Cold
hands and feet I may also mention as generally present in
this disease, although the body is unnaturally warm.
ness of the skin, with obstructed respiration, may be some-
times noted.
Blue-
Etiology.
Upon the cause of puerperal peritonitis there is a great
diversity of opinion. From my own experience, and all I
can learn from authors and the experience of my brethren. I
am of the opinion that the causes are various, but producing
a uniform effect upon the nervous system through the agency
of the blood, sometimes by inhalations of poisonous gases.
sometimes by absorption of poisonous gases, or matter in the
uterus, and sometimes from cold. The arrest of the process
of involution of the womb after labor, on account of lacera-
tions of the cervix, makes it requisite that there should be
132
EATON ON DISEASES OF WOMEN.
considerable discharge per vaginam. An irregular contraction
of the womb, so as to cause retention of this effete matter,
may cause the generation of such poisonous gases as might
develop the phenomena we witness in this disease. The re-
tention and putrefaction of a bit of placenta may produce the
same result. The removal of so much pressure as has been
exerted upon the abdominal viscera by the gravid uterus
tends to render the parts liable to congestion and subsequent
inflammation. Doubtless epidemic influences are such, in
some instances, as to merit the term contagion, though it is
clear that contagion is not necessary to the development of
the disease. The coincident occurrence of epidemics of ery-
sipelas and puerperal fever have led some to suppose the dis-
eases were interchangeable; but this manifestation is doubt-
less simply the effect of the atmospheric conditions which
have favored the development of these diseases, the nature
of these conditions of the atmosphere being as yet unknown.
Prognosis.
Sporadic cases will usually terminate favorably under
proper treatment; but in severe epidemics a considerable
number will be lost under the best treatment. The disease,
when terminating favorably, generally results in resolution,
but sometimes leaves an effusion of serum in the peritoneal
cavity, called abdominal ascites. This may be absorbed by
the powers of nature, assisted by remedies, or require artificial
evacuation by tapping.
Complications.
The extension of the inflammation from the uterus and
peritoneum to the cellular tissue, ovaries, etc., is not infre-
quent, and sometimes causes sterility, from the effusion of
plastic lymph around the ovaries, as in pure cellulitis; or pus
may form in the cellular tissue, or between the layers of mus-
cular tissue, in the uterus, or in the peritoneal cavity. In
PUERPERAL PERITONITIS.
133
the latter case it is rapidly fatal. Cystitis, pleuritis, puer-
peral mania, or cerebral meningitis sometimes complicate
the case.
POST-MORTEM APPEARANCES.—These are quite uniform. The
abdomen is large and tense. On opening it, there is an
escape of fetid, nauseous gas. The peritoneum is found
highly vascular, with discolored patches, and some evidence
of pus at these points. The omentum is thickened, and a
considerable quantity of turbid serum is found in the perito-
næal cavity. The womb is sometimes found to be normal in
appearance; at others so soft as to allow of being easily torn
to pieces with the fingers.
Treatment.
If we are so fortunate as to see the patient during the
onset of an attack while there is coldness or rigors, Ars. alb.
is indicated, administered in the 3 trituration, in the dry
state, upon the tongue, every quarter or half hour. Place
the feet in a very warm foot bath. This is best done in
this case by allowing the patient to lie upon her back in
bed, with the limbs drawn up, and the feet placed in the
small foot bath-tub, which can be slipped under the bed-
clothing. The tub should be well warmed before being
used, so as not to chill the patient should she chance to nit
her limbs against its edges.
*
As soon as reaction is established, Aconite in low dilution,
alternated with Sulph. is demanded, and should be continued
until free diaphoresis is established. In place of Sulph, Kali
chlo., 1 trituration, given every two hours, is of great serv-
ice. After the perspiration has continued for several hours,
blanks should be used for a time, to allow us to see the
condition of the patient when not taking medicine; if fever
is found to be mostly gone for a few hours, and the case
shows clearly that the attack was not due to the secretion
of milk (it having been secreted before the chill, or it is
134
EATON ON DISEASES OF WOMEN.
X
too early for the milk to come), we do well to give one gr.
doses of Sulph. Quinia every two hours for a day or so,
especially if we have a white coating upon the tongue, and
aching of the limbs is complained of. If nausea is a promi-
nent symptom, together with general aching, Ars. alb. should
take the preference of the Sulph. of Quinia. In case fever
returns, there is no further use for Quinia. We must use
either Kali chlo., Sulph., Carbol. acid, Iodine, or Ars. iodid.,
with intercurrent remedies, as indicated. They will be
found among the following: Bell., Aconite, Bry., Rhus
tox., Apis mel., Verat. viride, Merc., etc. When convales-
cence is established, China, Nux, Puls., etc., are useful
according to their most prominent homoeopathic indications.
During the greatest activity of the fever, Aconite low has
served me well, generally in alternation with Iodine 6 or
Sulph. 30. Bell. takes preference of Aconite if the dullness
of the sensibilities is the most prominent symptom.
viride, so useful in pleuritis, I have not found satisfactory
in peritonitis, though some have claimed to obtain excellent
results from its use in this disease. Beef tea is the most
satisfactory diet; cool water may be given freely; hot teas
and stimulants are hurtful; warm compresses to the abdomen
are used by many, but, on account of their dampness, are
not very desirable. Where there is extreme tenderness the
compress should be wet with warm hop water, and kept
in situ with a flannel bandage. In most cases the dry flan-
nel bandage, evenly applied, is all the local application nec-
essary. Vaginal injections of tepid water and castile-soap,
followed by an injection of Liq. Soda chlo., one part to six
of water, are of service-using the injection of a tempera-
Intra-uterine
ture high enough not to chill the patient.
Verat.
injections of Solution of Iodine, two to five grs. to the ounce,
are sometimes promptly beneficial in very bad cases, espe-
cially when the evidence is clear of the suppurating condition
in the interior of the womb.
PUERPERAL PERITONITIS.
135
"
Good air is another necessity in the successful treatment
of puerperal peritonitis, or metritis. The old style of keep-
ing the patient in a small room, with every crevice carefully
closed to prevent the ingress or egress of a breath of air
should never be followed; but, on the contrary, see to it
that a free supply of fresh air is admitted to the sick-room,
and abundant means are secured for the passing out of the
impure, poisonous gases, which are always present in great
amount. Do not be satisfied with a small opening for the
ingress of fresh air; but have two openings so the air in the
room may circulate, taking care that the patient is not in a
draft. Let her be well protected with warm coverings, and
let these, as well as her personal clothing, be changed often.
There is no good, but a positive harm, in allowing the bed-
ding and patient's clothing to remain days and weeks with-
out change. Let the patient be bathed often, and wiped or
sponged off frequently, also, using a little soda in the water
when the fever is high, and a little Bay-rum when there is
less fever.
Keep most visitors out of the room, and, if possible,
away from the house. They often are a positive injury by
disturbing needed rest, and exciting alarm by unwise though
well-meant solicitude.
The complications of this disease must be treated accord-
ing to the peculiar conditions present, and the urgency of the
symptoms, taking care not to compound the remedies, using
one for a few hours or a day, singly, and then changing to
another, which the complication seems to demand; the al-
ternation which I have already mentioned being in the giv-
ing of some antiseptic remedy in alternation with the one,
especially indicated in that particular case. I am well aware
that some homoeopathic physicians believe nothing in anti-
septic treatment. So far as I can get at their objections to
it, they are due to the fact that the term has been used by
allopaths. Now, the reason for the faith which is in me is
136
EATON ON DISEASES OF WOMEN.
this: I believe that in the genuine case of puerperal peri-
tonitis we have a blood poisoning which has a tendency
to develop a pyæmic condition of the blood and the conse-
quent depression of nervous strength, which develops the
Diathesis seu Infectio purulenta. Now, if this is not indica-
tion enough for the giving of antiseptic remedies, then there
are no indications for remedies. If we can not give anti-
septics, neither can we use any kind of antidotes to poisons,
and really an antiseptic is an antidote. If it can be ex-
plained in any way which does not show its antidotal quali-
ties, I am mistaken.
I will digress just here to remark that in the treatment
of Scarlatina Maligna, Diphtheria, and Epidemic Cerebro-
Spinal Meningitis, the need for antiseptics is equally great,
and they prove as eminently beneficial. Without their use
I would not take the responsibility of a case of either
disease.
HOMEOPATHIC REMEDIES.
137
}
CHAPTER XII.
HOMEOPATHIC REMEDIES.
DESIRING to condense as much as possible, we make a
few suggestions regarding homoeopathic remedies. We do
this, not to interfere with works upon Materia Medica, or
Therapeutics, but that the reader may understand the opin-
ions we entertain regarding them and their action on the
system. Having used them now over ten years, and having
previously graduated in allopathy, and practiced it for up-
wards of a decade, we may, perhaps, offer some practical
hints, and we say, unhesitatingly, that we consider homoeop-
athic medication the more speedy and certain curative treat-
ment, and we offer our understanding of its modus operandi.
ATTENUATION. This term has been so often confounded
with potency that many have come to use the two terms as
synonymous. This seems to me to be a grave error, and has
led to much hard feeling on the subject of high and low
potencies.
As I understand Hahnemann, in his work on "Chronic
Diseases," Vol. I, when specially teaching the preparation
and nomenclature to be used, and as I find Jahr and Grüner's
"Pharmacopoeia," as edited by Hempel, contains the same
directions verbatim,* I must conclude there was in the early
days of homœopathy no idea that attenuation and potency
were synonymous terms. There, we learn in plain English
that the 1 trituration is to be called the 100th potency;
that the 2 attenuation is to be called the 10,000 potency;
and that the 3 attenuation is to be called the 1,000,000
potency.
h
h
* Jahr and Grüner's Pharmacopoeia, by Chas. J. Hempel, pp. 4, 5, 6, and
7. Also see tables on pp. 32, 33, ibid.
138
EATON ON DISEASES OF WOMEN.
There is no chance to deny that these were the plain
instructions of Hahnemann, and were quoted and appropriated
as authority by Jahr and Grüner and Hempel. If these
were the plain instructions of these fathers of homoeopathy,
why should we not adhere to this nomenclature still? If we
did, we would hear no one speak of the 200th potency, as
there is no intimation in the works quoted that it is possi-
ble to make any attenuation that should be called 200th po-
tency. The 30th potency sometimes mentioned is probably
intended to mean the 30th attenuation.
Trituration, attenuation, or dilution may be used as
synonymous, as regards strength of medicine (trituration is
attenuation with sugar of milk; dilution is attenuation with
alcohol), but potency is quite different, as I have shown
from Hahnemann's own teachings. The 10,000th potency, as I
understand it (and as Hahnemann, Büchner, Grüner, and
Hempel teach), indicates the 2 attenuation on the centesi-
mal scale, and the 4th on the decimal scale.
On account of the confusion of the terms potency and
attenuation, much controversy has arisen in the profession as
to the comparative merits of high and low potencies, which
need not have existed had it been understood as Hahnemann
taught in his work on "Chronic Diseases," just quoted, for
all would have seen that the low trituration or dilution was
the same as the high potency. After having given much
time to the study of this matter I am fully convinced that
Hahnemann never conceived of using remedies carried above
the 30th attenuation. The late lamented Dr. CARROLL DUN-
HAM, of New York, carried up several remedies by dilution to
the 200th attenuation and claimed excellent effects from their
use, as have several other excellent gentlemen.
Drs. Swan and Finkie have claimed to make high dilu-
tions, which they have called potencies, by a process of math-
ematical calculation as to the attenuation produced by means
of a certain amount of running water through a tube, in
HOMEOPATHIC REMEDIES.
139
which had been placed a small amount of medicine. Allowing
the water to flow through the apparatus a certain number of
hours, they have calculated that a certain attenuation was
reached. They call the manufacture of remedies in this way
the fluxion process. They, and many others, have reported
cures with these high dilutions, the height of the potency
of which is beyond human calculation. I will not deny the
efficacy of these preparations, but will say they doubtless
would have astonished Hahnemann had they been invented in
his life-time; and if it is given to disembodied spirits to scan
the acts of those below, what must be the emotion of Hahne-
mann's spirit at the heights of fancy, imagination, and credulity
reached by some of his disciples!
We have found, from our own experience, that from the
2x to the 6 attenuations, or, if you please, from the one hun-
dredth to the one millionth potencies (which is saying the
same thing in different language), is the strength of medicine
we find acts satisfactorily to us. Sometimes mother tinctures
may act better; sometimes it may be best to use potencies
higher than the one millionth. Did we know the strength of
the medicine used in the provings, we might better select the
attenuation in treating cases of disease. The 3 being suited
to overcome symptoms indicated by provings with the first on
the centesimal scale, while the first attenuation will overcome.
those provings, not toxicological, made with mother tinctures;
and mother tinctures are to be used in the treatment of those
toxicological symptoms produced from poisonous doses of the
remedy, when, of course, these symptoms are produced from
disease. To overcome toxicological symptoms while the drug
is still acting, of course, antidotal treatment is to be at once
used. We feel convinced that the minute quantity of a given
remedy produces on the system effects directly opposite to
those produced by that remedy in large quantity. Hence,
we have an explanation of the action of the properly selected
homœopathic remedy in any given disease. The remedy is
140.
EATON ON DISEASES OF WOMEN.
selected because of the similarity of the symptoms we have
in the case to those we know the remedy produces when
given in considerably greater quantities than we use in the
cure, the curative action being that of correcting these symp-
toms, or, in other words, antagonizing them. The giving of a
single remedy should be the rule, avoiding all alternation of
remedies. I have known a physician to give five different
remedies in the same case at the same time. Though he gave
them separately, the intervals were sometimes only ten min-
utes, and the people found it impossible to keep the run of
the remedies, and they changed physicians. Success never
perched on that physician's banners, though he was educated
in Germany, and talked learnedly of symptomatology, and
ignored pathology. Every physician should seek to add
something to the general stock of knowledge possessed by
the profession. To do this it is important, at this age of the
world, that we learn more of individual remedies, given
singly, without alternation.
The affinities which remedies possess for some particular
parts of the body, or some particular organ of the body, can
not be explained. We only can observe that it is so. We
can no more tell why it is so than we can explain the law
of gravitation or cohesion. We may observe the phenomena,
but at last we have to say, God made it so. Why opium
in minute doses is a stimulant, and in large ones is a seda-
tive, can we explain, more than to assert, it is so?
We learn, however, how to apply the remedy from our
knowledge of its action. Homoeopathists use remedies for
their primary action, or the action produced by the minute
dose, while allopathists use remedies for their secondary
action, in a large dose. Hahnemann discovered the law that
the minute dose cured symptoms produced from disease
which were characteristic of the remedy in large doses when
given to the healthy man; hence we have a law to guide us
in the selection of a remedy, while the allopathist has none.
HOMEOPATHIC Remedies.
141
>
Does any allopathist dare say our theories are unphilosophical
or untenable? Does he call a homoeopathic physician a quack
because he has adopted an exclusive dogma, as he says?
Then let him seek light in his own U. S. Dispensatory, where
I found mine. Let him note the action of the small dose, and
compare with the action of the large dose, as there laid down,
and he will find enough to convince him of the universality
of the law just mentioned. Then let him try in practice
the application of this principle, and he will soon be able
to declare that he, too, has found, not only joy in believing,
but joy in practicing as well.
142
EATON ON DISEASES OF WOMEN.
CHAPTER XIII.
INSTRUMENTS.
THE use of instruments has been sadly abused by the
profession in the diagnosis and treatment of the Diseases of
Women, to the extent of causing some thoughtful medical
gentlemen to condemn their use in toto. We do not go this
far, and still we are free to condemn many of the instruments
in frequent use, especially most pessaries, and also the con-
stant use of the speculum, uterine dilators, hysterotomes, etc.
These instruments are occasionally useful; but probably not
one-fourth as often as some have been in the habit of em-
ploying them. We shall present only those instruments in
this work which we can recommend (about eighty in num-
ber), and we devote one chapter exclusively to their con-
sideration, that the student may learn something of the uses
and advantages of them, as well as be cautioned against
their abuse. There is no work on Diseases of Women now
published (1880) which, in our opinion, is fully up with the
times in the matter of gynaecological instruments. This is
strikingly evident in the matter of speculums, Cusco's being
the best bi-valve published, and Sims' original speculum be-
ing the best one presented as a retracting speculum-all ex-
cept Richardson having omitted Dawson's improved Sims'
speculum. (See Plate III.)
This has one of the blades slit in two, and fixed with a
screw so they may be separated, which is a great improve-
ment in enabling us to bring into view the walls of the
vagina or the cervix uteri. If we desire to use the instru-
ment in its original form, we have but to screw the divided
blade together and we have it. This instrument we ordi-
રામ
PLATE III.

G.
TIEMANN=CO.
SIMS' ORIGINAL SPECULUM.

SIMS FOLDING SPECULUM.

M.WOCHCF. & SON CIR.O
DAWSON'S SIMS' IMPROVED SPECULUM.
Um
PLATE IV.

C
G.TIEMANN 8 CO
Komunik
NELSON'S TRI-VALVE SPECULUM.
GEMANN & Co.
FURGUSON'S MIRROR SPECULUM.
NAWEEK
CESON CIN 0.
WOCHER'S BI-VALVE SPECULUM.
.
QUNULOTLA
வர்


INSTRUMENTS.
143
narily only use in operations for the treatment of vaginal fis-
tulæ, uterine polypi, or lacerations of the vagina, or cervix
uteri. Whenever we do need to use a Sims' speculum the
advantage of the divided blade is obvious, as it can be
opened or closed during the operation at our pleasure.
The speculum which we use for ordinary vaginal exami-
nations, when they appear necessary, and for bringing the os
and cervix uteri into view for ordinary treatment, is the
bi-valve made by M. Wocher & Son, of this city. (See
Plate IV.)
This speculum combines the advantages of Cusco's han-
dles, Higbee's screw on the side, and Taylor's blades, with
the wide crest on the upper blade, to keep the flesh and hair
of the labia out of the way. In our experience the advan-
tage of having the upper blade shorter than the lower, as in
Taylor's instrument, is very great. Taylor's speculum has
to be opened with the screw, which is not so convenient as
the handles of Cusco's, but Cusco's blades are of equal
length, and it has not the wide crest on the upper blade.
Wocher seems, in his instrument, to have combined the best
parts of all the others, and left out their objectionable ones.
The instruments are made of three sizes.
Nelson's tri-valve speculum-Plate No. IV—is a very con-
venient instrument, especially in those cases where the vagina
is very large, loose, and flabby, as it distends the anterior
walls of the vagina in a lateral direction. It is very good
in office treatment, but can not be carried in the pocket so
conveniently as Wocher's bi-valve, or Sims' folding speculum.
(See Plate III.)
Furguson's round mirror speculum is convenient to have at
hand, to examine partially a suspected case of gonorrhoea
or syphilis where we do not wish to introduce those we
daily employ. The instrument is cheap, and is universally
known. We also put them to a different use from that of
making vaginal examinations. We employ them as vaginal
144
EATON ON Diseases of wOMEN.
dilators, and to admit the atmospheric air in cases of pro-
lapsus, or a tendency to this displacement, having the patient
recline, with the hips elevated, while it is inserted. (See
chapter on Prolapsus Uteri.)
Sims' vaginal dilator, Plate VI, is all right in cases
of vaginismus, or a contracted vagina, first smearing the
vagina with Belladonna ointment before its introduction; but
in cases where we wish to dilate the vagina to admit
atmospheric pressure direct to the uterus they are useless,
as they are closed at one extremity.
UTERINE SOUNDS.
The uterine probe, or sound, is a useful instrument in
diagnosis of uterine disease and displacement. It should
always be used with skill and care. No considerable force
should ever be used in its introduction, or any manipulations
with it after it is introduced. Used carelessly, it may be a
cause of much evil; but, if used with care, it is not inju-
rious.
Simpson's uterine sound has been much used, but it
is too stiff. The steel sound, which can be easily bent with
the fingers, is to be preferred, as it is often of great advan-
tage to be able to change its curve. The steel sound should
not be larger just at the point (see Plate V), as uterine
sounds are usually made; neither should it be sharp or more
pointed at the end, but should be of uniform size for four
or five inches from its extremity. It is well to have notches
in the sound, at intervals of one-half inch, that we may
note more readily the length of the uterus. Dr. Skene has
invented a very good sound for measuring the length of the
uterine cavity (see Plate V). It has a slide which is drawn
back when the sound is introduced, and, when fully inserted,
the slide is pushed up against the os, and we can determine
by it just how far the sound has entered the womb.
Hard rubber uterine sounds should never be used unless
1
PLATE V.

ว
a
G. TIEMANN¿CO.
Fig.1
SKENE'S SOUND.





A. DIEMAPjaz
WHITE'S HYSTEROTOME.
SIMPSON'S HYSTEROTOME.
Fig. 1.
G. TEMANN CO
00
UTERINE DRESSING FORCEPS.
STEEL SOUND.
GEO TIEMANN&Co.
SIMPSON'S UTERINE SOUND.
FUDRL
6.TIEMANN&CO
PLATE VI.

IMPROVED PEASLEE PERINEUM NEEDLES.
'O'NID NOS 8 BEW
EATON'S WIRE HOLDER AND TWISTER.
TIEMANN ECONY
SIMS' VAGINAL DILATOR.




O
METHOD OF USING WIRE HOLDER AND TWISTER.
O NIO NOS BEHOM W
EATON'S NEEDLE HOLDER
INSTRUMENTS.
145
!
great care is taken to warm them by putting them in warm
water. When cold they are liable to break, even from slight
pressure.
CAUTION.—The physician should always be sure pregnancy
does not exist before he attempts the introduction of the
uterine sound.
CELLULITIS also contra-indicates its employment, even for
purposes of diagnosis. The use of the sound, or even any
considerable manipulation with the finger, in cases of cellu-
litis, is very likely to awaken an increase of the inflammation.
The use of the sound gives us information of the pres-
ence of stenosis of the uterus, tenderness and flexions of
the organ, the size and attachment of fibrous polypi, and
some information regarding intra-mural fibroids, etc., etc.
HYSTEROTOMES.
The hysterotome is an instrument for incising the interior
of the cervical canal. It is occasionally needed in stenosis
of the cervix; Its use must, in these cases, be followed by
the daily introduction of the bougie smeared with vaseline to
prevent the adhesion of the cut surfaces, and the consequent
diminution of the size of the cervical canal. I prefer Simp-
son's or White's. (See Plate V.)
EATON'S NEEDLE HOLDER.
In addition to the straight needle holder already mentioned
for sewing up longitudinal lacerations and fistula of the vagina,
the gynaecologist needs an instrument for placing sutures in
a transverse laceration or fistula. This is accomplished with
my needle holder, as can be readily seen from the cut, Plate
VI. It enables us to insert the needle into the vaginal tis-
sues from above downwards with the same facility with
which we use the straight holder in stitching from side to
side, for which purpose my holder may also be used by
grasping the needle further down on the blades.
10
146
EATON ON DISEASES OF WOMEN.
1
To fasten or twist the wires after the sutures are placed
in a vaginal laceration, or either form of vaginal fistulæ, we
use our wire holder and twister. (See cut of wire holder
and twister, Pate VI.) Pass the ends of the wire through
the two holes in the end of the holder, make traction on the
wires with one hand, and slide the instrument up to the
lacerated tissues with the other this approximates their
edges. We then give the instrument two or three turns, with
the fingers holding it, and the wire is twisted and the suture
secured. We now slip the twister off the wires and cut

g
W.F. FORD
FIG. NO. 6.-LONG CURVED SCISSORS.
them with the long, curved scissors. This instrument makes
the twisting of the wires high up in the vagina a very easy
operation.
We present Palmer's uterine dilator (see Plate VIII),
not to advocate its frequent use, but because rapid dilatation
of the cervical canal of the uterus is sometimes necessary;
and when so, we prefer to use "Palmer's Uterine Dilator."
With it we can make the dilatation as gradual as we please,
and still, with the aid of the screw in the handle, maintain
an even and regular expansion, and increase or diminish it at
will. The blades which are inserted into the os are slender
and slightly curved, and still not too pointed nor too blunt,
as are some others.
Rapid dilatation is most frequently called for in cases
where women have passed a piece of a hard rubber probe
or a stick into the uterus and broken it off; or have passed
in short pieces of whalebone and lost hold of them. I have
been called to remove foreign substances of this character
from the uterus in several instances where dilatation of the
G.TIEMANN & CU.
له
COCK SIE
TENT
1
PLATE VII.

O O
BABCOCK'S SUPPORTER.


2
PLATE VIII.



G TIEMANN & CO.
PALMER'S UTERINE DILATOR.
TEMANA-CO-WY
CIVIALE'S LITHOTRIPTOR.
STRAIGHT LITHOTOMY FORCEPS.
90.00
INSTRUMENTS.
147
os uteri internum, as well as externum, had to be ac-
complished rapidly.
Occasionally its use facilitates the getting at an internal
uterine polypus, where we have but a short time at com-
mand. Very rapid dilatation is in most other cases objec-
tionable, in that it lacerates the tissues, and, in their healing,
causes somewhat of a cicatrix, which interferes with the re-
laxation and dilatation of the os in labor subsequently, and
may cause stenosis, or even atresia of the cervical canal,
and prevent impregnation, arresting the menstrual flow, and
producing hæmatometra.
Hence, whenever rapid dilatation is used, care should be
taken to keep up some degree of expansion till the tissues
are healed. Passing into the cervix every two days a bougie
smeared with Vaseline, is a good way to accomplish this.
PERINEUM NEEDLES.
In operating for lacerated perineum it is most convenient
to use Peaslee's improved perineum needles and holder
shown in Plate VI, whether we wish to use the quill or ordi-
nary interrupted suture. The needles fasten into the han-
dle with a thumb-screw, and the eye of the needle is
near the point as shown in the cut. This is much more
convenient than having the needle screw into the handle.
Having the three needles threaded before commencing the
operation there is no delay in placing the sutures, as one
needle can be taken from the handle and another, all
threaded, inserted almost instantly. (See the old form, Plate
XI.) In an emergency the largest sized surgeon's curved
needles may be used to place interrupted sutures in the lac-
erated perineum; but the regular perineum needle is much
to be preferred, when we can have it, and in placing the
quill sutures this, or a similar needle, is absolutely neces-
sary. (See chapter on Lacerated Perineum.)
148
EATON ON DISEASES OF WOMEN.
Pease's staphylorraphy needle represented by Fig. No. 7,
was invented by G. M. Pease, M. D., of San Francisco.

FIG. No. 8.-PEASE'S NEEDLE.
This needle is described in the proceedings of the Pacific.
Homœopathic Medical Society, 1874-6, and in the proceed-
ings of the American Institute, 1871. The needle is useful
in operations for vaginal fistulæ, as well as cleft palate.
The silver wire is propelled through the needle (which is
conula shaped, with the eye near the point), by means of
the little wheel on the side of the handle.
PESSARIES.
I am well aware that medical gentlemen of high standing
advocate the use of pessaries, even those of hard rubber; but
they have to acknowledge that, unless used with skill and
judgment, they may do much harm, and that the physician
must have experience, as well as a mechanical talent, to ad-
just and select them properly (see Emmet's "Prin. and Prac.
of Gynæcology," one of the most prominent of the old school
books, which acknowledges all this, and still advocates their
use very strongly). Now, how many medical men have skill,
judgment, experience, and mechanical talent?
Can we say
that more than one in ten have all these? If not, then must
we recommend the other nine-tenths to use pessaries indis-
criminately to the injury of their patients?
Simply introducing a pessary into the vagina is not
using it with skill, even if it be so small as to cause no
pain. Besides, the use of them, as has been the custom, and
the theory regarding their beneficial effects, have been en-
INSTRUMENTS.
149
tirely erroneous and founded upon erroneous ideas of the
etiology of displacements, as we will more fully show in the
chapters upon Displacements of the Uterus.
W. F. FORD
While we condemn pessaries from a conviction of the in-
jury they have done and a belief that they may, in nearly all
cases, be discarded, I am aware that, in some few cases,
where we can not manage the patient or obtain her co-oper-
ation, and where a patient is obliged to be con-
tinuously traveling or standing, and in the case
of old women, where we can not hope for a
cure, some form of soft pessary may be ad-
visable. In these exceptional cases we use
the inflatable rubber pessary or the elastic
ring. The abdominal supporter must always
be used in connection with even these pessaries, as otherwise
the uterus is placed between the pressure of the bowels from

C.H. &
FIG. No. 8.-ELASTIC
RING PESSARY.

Co
FIG. NO. 9.-ELASTIC RUBBER PESSARY, WITH TUBE AND STOP-COCK.
above and the pessary from below, and injury readily results
in the way of flexions of the uterus, or inflammation of this
organ, the cellular tissue, or the ovaries.
Before inserting a pessary of any kind, the bladder and
bowels should be evacuated, and the patient should recline
with her hips elevated, with the body low, and the uterus
should be replaced before the pessary is introduced into the
vagina. Then an abdominal supporter should be applied
before the patient rises. The pessary should be removed and
cleansed at least once a week. It should not be worn, in any
case, but a few weeks, as a rule.
The Babcock Supporter holds the womb up in a cup-
150
EATON. ON Diseases of wOMEN.
shaped instrument. (See Plate VII.) It is objectionable in
retaining the secretions and in being too stiff. The cup is sup-
ported by a steel shaft, which is held in position by a belt
around the lower portion of the abdomen. The shaft of steel
may be moulded to the form somewhat. In some old women
suffering with prolapse this instrument

W.F.FORD
is worn with comfort; but ordinarily
it is found that it causes pain and irri-
tation. It will sometimes answer a
good purpose where the atonic condi-
tion of the system is marked, and
where we can not do better. The in-
strument, if used, should be often re-
moved and cleansed. The different
shaped cups make it adapted to varie-
ties in the shape and location of the os uteri. (See Plate
VII.) M'Intosh's Uterine Supporter and Abdominal Sup-
porter Combined is sometimes found useful; but internal sup-
port is to be avoided in all cases where it is possible to do so.
(See Treatment of Prolapsus Uteri.)
FIG. NO. 10.—M'INTOSH'S UTERINE
SupporteR.
SPONGE TENTS.
G. TIEMANN & CO
The uses of sponge tents we mention in connection with the
conditions and diseases for which we recommend them. They
should be solid and smooth, and be
furnished with a strong cord to aid
in their removal; and should have
an opening in their larger end to
insert the end of the sponge holder,
which it is advisable to use in the
introduction of the sponge into the
cervical canal. The best of the
sponge tents now in use are carbolized in their manufacture;
still it is well to dip them into carbolized glycerine just
before we insert them.



FIG. NO. 11-SPONGE TENT.
INSTRUMENTS.
151
Dr. Emmet, of New York, has invented a sponge dilator,
as he calls it, which is advantageous in some instances. The
advantage of this dilator (see Plate IX) is that with it the
sponge does not become imbedded in the tissues of the
cervix as when the sponge is directly applied. Dr. Em-
met describes the instrument and its uses in the following
language :
*
66
Through a disk of hard rubber passes a brass tube, which
is perforated by a number of small holes at the upper portion,
and is open at each extremity. This tube is passed through
the center of a sponge tent of suitable size. The tent is then
covered by a thin India rubber cot or bag, and its mouth
stretched over the edges of the disk. The free edge of the cot,
which has been drawn over the disk, is then secured, com-
pressed between the under side of the disk and the brass plate
A B, on screwing up the latter sufficiently. The brass disk A
B has attached to it on side at B a knob which can be grasped
by a pair of forceps, the limbs of which are closed by sliding
forward the canula E. When the knob B is held by the
forceps, a ball-and-socket joint is formed, which will admit of
any motion within the radius of a sphere. To the bulb at C
is attached a piece of India rubber tubing, a foot or more in
length, through which water is introduced for swelling up the
tent, and at the end of the tube is a stop-cock. To the other
side of the stop-cock a Davidson syringe may be joined, or
what I have found to answer better, a thin India rubber bag,
such as are used for pessaries, with tube and stop-cock. The
dilator is introduced by steadying the cervix with a tenaculum
in one hand; and by holding the forceps and tubing in the other
the proper direction can be given to the instrument. When
it has been introduced within the canal to the proper depth,
a small amount of water is to be thrown in before removing
the forceps. As the tube occupying the center of the sponge
* Emmet's "Principles and Practice of Gynecology," page 32.
152
EATON ON DISEASES OF WOMEN.
is open at its extremity and its sides perforated, the water
will make its exit at the upper portion, and dilatation will
extend from above downward, so that the instrument can not
slip out. Enough of the sponge is dilated in a few moments
for the purpose of retention, so that the forceps may then be
removed by sliding back the canula. I direct the patient to
lie in bed on her back, and to place on the abdomen the air
bag, which has been filled with water, from which a sufficient
supply to fully dilate the sponge is made to flow by occa-
sionally compressing the bag with the hand.
"I generally leave the dilator in place for some twelve
hours, unless there should exist some special reason for more
rapid dilatation. The instrument is easily withdrawn by
placing the patient on her back, removing the bag, and turn-
ing the stop-cock for the escape of water from the sponge.
The forceps can be passed along the index finger into the
vagina and attached to the instrument, when it can be with-
drawn, guarding against displacing the uterus by holding the
finger against the cervix.
"The chief advantage of this dilator is that it greatly
reduces the risk of blood poisoning, and if we could dispense
with the unprotected sponge in the first instance this danger
would be entirely obviated. Fortunately, when this does
occur, it is seldom from the use of a single tent; and, if the
precaution be taken, which I always insist upon, to wash out
the canal thoroughly whenever a tent is removed, we will
greatly lessen the risk. It is also a great advantage gained
from the use of the dilator that the mucous membrane is not
injured, and consequently we have no bleeding from the canal
when it is removed.
"The disadvantages are, that we can seldom dilate to the
same extent as can be done by the tent alone. The resist-
ance offered by the uterine wall will yield to the steady
pressure of the sponge, but the elasticity of the India-rubber
1
O
4
PLATE IX.

3
ல
11
32
ה יויו
ا بالن
!!!
-10
10
3
1
2
G.TIEMANN & CO
1
TIEMANN & CO'S ASPIRATOR.
C
TIEMANN & CO
7

EMMET'S SPONGE DILATOR.
INSTRUMENTS.
153
bag is persistent, and will, to some extent, counteract the
force of the sponge. Consequently, we are obliged to use a
cot much larger than the sponge, which will occupy an
additional space, and, therefore, makes it necessary that the
canal should be partially dilated before the dilator can be
introduced.
"On the other hand, this dilator has the advantage that
the force can not be concentrated at any one point, but
must be exerted throughout, as the sponge gradually dilates.
I have used the instrument several times for rapid dilation,
and it answers the purpose, but, unless there should be a
necessity for doing so, the more gradual process is to be
recommended, as attended with less risk in surgical pro-
cedures; but the contrary is true in obstetrical practice.
For rapid dilatation, however, it has no advantage over any
other instrument of the kind, as at first the water escapes
outside of the sponge when rapidly thrown in, and becomes
the dilating power, but, as soon as the sponge has had time
to expand, it absorbs the water, and the pressure then
becomes uniform."
ASPIRATORS.
Aspirators are now used very extensively. They enable
us to evacuate effusions into the pleura, and even in the
pericardium. In gynaecological practice they are used to
diagnose the nature of an ovarian cyst, and differentiate
it from the cyst of the broad ligament in some cases. With
it we may sometimes evacuate a pelvic abscess. The wound
made by the introduction of the aspirating needle is so
small that little or no irritation in the tissues is left after
its use.
I copy the description of Dieulafoy's instrument, given
by Dr. Jas. L. Little, of New York (see Plate X). Tie-
mann & Co., of New York, make another very good instru-
ment also (see Plate IX). I have had some trouble in
keeping the stopper in the jar of this instrument air-tight.
154
ΕΑΤΟΝ ΟN DISEASES OF IVOMEN.
The Tiemann instrument is so simple that it needs no special
description:
"Dieulafoy's aspirator consists of a strong glass cylinder,
about seven inches in height, two inches in diameter, and
of a capacity of one hundred and forty-five grammes, equal
to nearly four fluid ounces. In front, upon a nickel-plated
German silver casing, which envelops the cylinder in part,
is a graduated scale that reads off in grammes the amount
of fluid contents-the gramme here being not a measure of
weight, but of capacity (each gramme being equal to the
space occupied by a cubic centimeter of water at a tempera-
ture of 39.2° Fahr.). Above, the piston is raised by means
of a rack and pinion motion, worked by the handle, and kept
from slipping by the spring. At the bottom are two stop-
cocks that may be opened or shut as needed. Upon these
are fitted two strong, yet perfectly flexible, rubber tubes.
Upon the one may be seen a perforated aspirator needle,
while the other is dipping into a receiving bowl. In the
tube which holds the needle is inserted a piece of glass
tubing, near the needle extremity (not shown in the cut),
that indicates whether the material to be evacuated is pass-
ing through the tube. The other tube is to allow discharge
of the cylinder's contents.
"The capillary tubes, trocars, or aspirator needles are seen
on Plate X. They are of various lengths, and vary greatly
in their diameters, the smallest being one-third of a milli-
meter (the size of the ordinary hyperdermic needle), while
the largest is about one and one-half millimeters, in diameter.
"It is well to have also two or three small canulas and
trocars on hand, their handles detachable, so that when
introduced, and the trocar withdrawn, they may be attached
to the rubber tubing.
"To use the instrument, attach to the two taps the two
pieces of rubber tubing, and to the one tube attach the
needle to be used. The other tube should be placed in a
G
A
E
PLATE X.

T
B
C
F
H
GTIEMANNE
DIEULAFOY'S ASPIRATOR.

G. TIEMANN = CO.
VULSELLUM FORCEPS.

G.TIEMANN &CO
EXPLORING TROCAR AND CASE.
.
•
I
INSTRUMENTS.
155
basin. Having every thing in readiness, close both stop-
cocks, turn the handle, thus raising the piston to its fullest
extent, and creating a vacuum. Next insert your aspirator
needle with a gentle rotary motion into the cavity to be
aspirated, turn the stop-cock, and the fluid will be seen to
pass through the glass tubing and up into the instrument.
When this is filled, close the stop-cock, and open the oppo-
site one, pull out the spring, and push the piston down.
The fluid is thus driven out through the tube into the bowl
or bottle ready to receive it. If there be more fluid present
turn both stop-cocks, and, again raising the piston, proceed
in the same manner as before.
"In using the instrument attention to the following prac-
tical points is necessary:
"1st. Before using, assure yourself that the instrument
is in perfect working order; that there is neither stoppage,
leakage, or difficulty in manipulating, or stop-cocks hard
to turn.
"2d. The needles or trocars, which should be perfect,
should be oiled before attempting their introduction.
"3d. Slow, steady, even pressure, with rotation, the
needle being held between the thumb and index finger, will
be found to accomplish the result with as little pain and
injury to the tissues as is possible. The skin should be
slightly nicked with a scalpel before inserting the needle.
Local anesthesia may be used if thought desirable.
"4th. In removing the trocar, do so slowly, aspiration
being continued meanwhile, to prevent the escape into the
tissues of any fluid that may be in the trocar. Bear this
in mind, especially in aspirating the peritonæum.
"5th. After using the instrument each time, carefully
wash it out, and its attachments, by drawing carbolized or
chlorinated water several times, with the cylinder, through
the tube attached to taps, forcing the same out through tube
at taps, after the manner of aspiration and discharge of fluid.
156
EATON ON DISEASES OF WOMEN.
"6th. The piston may be kept in good condition by
occasionally unscrewing the head of the cylinder, and pour-
ing in about half an ounce of sweet oil.
"7th. Always keep wires through the needles when not
in use."
LENTIS' MODIFIED INHALER (See Plate XI)-needs no
explanation. It is convenient where we desire to use
anaesthetics.
LITTLE'S ANTISEPTIC SPRAY APPARATUS-Consists of a spirit
lamp placed underneath a copper boiler, as seen in Plate XI.
The antiseptic or disinfectant is placed in the glass jar at
the side, and the steam generated in the boiler forces the
liquid in the jar up through the glass tube inserted into it
by means of the vacuum produced, and a fine spray is made
by the steam coming out through the horizontal tube.
ABDOMINAL SUPPORTERS.
Appliances for holding up the abdominal viscera, from
pressing down unduly upon the pelvic organs, are termed
abdominal supporters. They have been so poorly adjusted,
or have been so poorly made, in some instances, as to be
designated by a contemporary as abominable supporters.
And when improperly used, or constructed improperly, they
are abominable. Must we condemn them in toto because
they are capable of doing injury when improperly used?
Under this ruling, I believe, every surgical, obstetrical,
and gynæcological instrument might be condemned and
called hard names. Fire or water may destroy life when
improperly used; on the contrary, they may preserve it,
when properly made use of. Shall we banish fire, water,
surgical, obstetrical, and gynaecological instruments because,
when improperly used, harm may result? Or shall we use
them properly, and obtain the good results which follow their
intelligent use?
The abdominal band, when applied to compress the ab-
EMANN & CO.
LENTE'S MODIFIED INHALER.
PLATE XI.


BEMANN & CO
LITTLE'S ANTISEPTIC SPRAY
APPARATUS.

ASHTON'S PERINEUM NEEDLE.
-G=TISMATN=&-C 0
PEASLEE'S PERINEUM NEEDLES.
NELATON'S TUMOR FORCEPS.
C


O
PLATE XII.

GEO.TIEMANN &C° N.Y.
SILK ELASTIC ABDOMINAL SUPPORTER.

૨૦TER
THE OLD LONDON ABDOMINAL SUPPORTER.

LONDON
SUPPORTER:
EATON'S IMPROVED LONDON ABDOMINAL SUPPORTER.
INSTRUMENTS.
157
domen around the waist, must be injurious, by pressing the
abdominal viscera down into or towards the pelvis. On the
contrary, if applied to the lowest part of the abdomen tightly
and made less tight above, it lifts and holds up the abdom-
inal viscera, especially when the patient is erect. (In the
reclining posture no abdominal support is ever required.)
Twenty and more years of practical experience in the
use of abdominal supporters gives me stronger faith in their
beneficial effect, than in any previous time of my life; and
I have always been an advocate of their proper use. Their
range of application is in those cases where there is tender-
ness, inflammation, or displacement of the pelvic organs,
cystitis, metritis, ovaritis, versions, flexions, or prolapse of
the uterus, all of which require that the weight of the intes-
tines be kept from pressing down into the pelvis. This can,
of course, be done by maintaining the horizontal position,
but it is usually desirable that our patient take some exer-
cise, which she can not do without injury in these com-
plaints, unless some means are used to maintain the intes-
tines in situ, or even lift them above their natural position
slightly.
I am not particular about any special make of supporter;
we only insist upon the principle being carried out. Some-
times extemporized bands are made by patients themselves,
or their friends, which support the abdomen quite well. Dun-
can Bros., Chicago, have a very good supporter of this kind,
which needs, however, to be improved by inserting strong,
elastic straps. Ordinarily, however, among a well-to-do class,
it is best to buy for them a band made by the regular instru-
ment-maker. The band needs to be a little firm in front and
back, to prevent wrinkling, and must be elastic in part that
it may give somewhat, and not bind the hips, as the lower
part of the band, to be of service, must come below the crest
of the ilium.
The supporter which we commonly use has two elastic.
158
EATON ON DISEASES OF WOMEN.
straps on the side, reaching from the front to the back piece,
one of which I place below, and the other above the crest of the
ilium. Leaving the upper one a little loose, I make the lower
one quite tight, having the front stiffened part bent inwards,
to fit the shape of the abdomen. In cases of small abdomens,
we have to apply a pad underneath the band in front, so as
to get a better upward pressure with the supporter. (See
Plate XII.) This is a modification of the London supporter,
which I have had made by the Messrs. Wocher, of this city.
The London supporter (see Plate XII) is objectionable in
that it is more difficult to obtain the tightness of the band at
its lower part, where it is needed, the straps being too near
together, and the lower one too far above the lower part of
the front piece of the supporter. Sometimes, in case of pen-
dulous abdomens, we have the entire band made of silk elas-
tic to fit the shape of the lower abdomen, and buckled on so
as to be tightest in its lowest part. (See Plate XII.) We
could not get along without the use of some support for the
abdominal viscera.
Fitch's supporter made with springs of steel, which are
placed over the crest of the ilium and rest against two pads
at the back, and in front against a stiff piece well padded, is
made too small, and the steel pieces are too stiff; conse-
quently, it has gone into disuse. It might, however, be made
a useful instrument by correcting the objectionable parts of it,
which I have mentioned.
The woman affected with uterine complaints is more uni-
versally relieved by the use of a properly applied abdominal
supporter than by any one means within our knowledge. The
physician using abdominal supporters intelligently will receive
more thanks and gratitude for them than for any other service
he can render, for the reason that relief is so apparent.
OBJECTIONS.-Objections have been urged to their use that
they do not fulfill the indications. I reply, then they were
carelessly or ignorantly applied.
i
PLATE XIII.

G.TIEMANN & CO.
HALF CURVED SUTURE NEEDLES

6.TIEMANN CO.
BOZEMAN'S TENACULUM.

TIEMANN-CO.
CALLENDER'S DRAINAGE CANULA.

GJIEMANN & CO.

SELF-RETAINING
CATHETER.
FULL CURVED SUTURE NEEDLES.
...
1
CURATA MEBLATIDLAND 37
ADAMI DIDNOND.
B
SIMS' ELEVATOR.
LITTLE'S TROCAR.
AN-00-NNYWEIL'S
G.TIEMANN&CO
ELLIOTT'S UTERINE ELEVATOR.
A
D
PLATE XIV.



INSTRUMENTS.
159
It has been objected to the use of abdominal supporters,
that the patient becomes accustomed to them, and after awhile
can not do without them. We reply, this has not been our
experience. That they have usually to be worn for several
months is true, as regards chronic cases, but is not true in
recent cases requiring their use.
UTERINE ELEVATORS.
Various instruments have been devised to replace flexions
and versions of the womb. Sims' elevator (see Plate XIV)
is a very good instrument in retro-version, but can not be
readily used in retro-flexion, ante-version, or ante-flexion.
Elliott's instrument (see also Plate XIV) is adapted to all
displacements. By means of a screw in the handle the
point of the instrument is moved from side to side, or
extended in a direct line; hence making it easy of introduc-
tion; and, when introduced, we have but to turn the screw
in the handle to bend the other end of the elevator in the
opposite direction, and thereby correct the flexion we wish to
rectify. In versions of the uterus it is equally serviceable.
ELECTRICAL BATTERIES.
There is no end to the various styles of electrical bat-
teries. Electricity is the same in whatever form of battery
we develop it from chemical decomposition. Friction batter-
ies are out of date as therapeutic agents, and we will not
describe or recommend them. The object to be obtained
with the use of electricity is a tonic effect upon the nerves,
and for this purpose must always be used in a mild current
(an exception being made in cases of paralysis, where it may
be used quite strong).
Severe treatment with electricity I think as unwise and
injurious as large doses of drugs, and equally to be avoided.
Immense batteries we do not think necessary, unless the
160
EATON ON DISEASES OF WOMEN.
physician desires to add to the furniture in his office in
this way.
FLEMMING&TALBOT.
PHILADELPHIA,
In the chapter on amenorrhoea, page 38, may be found
a cut of the combination battery, which I think as large as
there is any need of in the treat-
ment of the diseases of women. In
chapter on sub-involution is a cut
of a medium-sized battery, which
is as large as the physician ordi-
narily requires. I prefer the Far-
adic or interrupted current. The
automatic rheotome attached to the
combination battery makes it every
thing that could be desired.
family use the small
instrument shown in

ABLANC
FIG. No. 12.-FARADIC BATTERY.
the annexed cut is
very desirable, and
obviates the neces-
sity for the physician to take his from the
office.
For

FIG. NO. 13.-CASE OF
A very neat case of electrolysis needles ELECTROLYSIS NEEDLES.
is put up by Flemming & Talbot. It contains six needles
and conducting cords.
PEDICLE CLAMPS.
Although we do not believe in the use of pedicle clamps
as a rule, we present cuts of some, that the student may be-
come familiar with them, if he desires to put them in use.
(See Plate XV; also, chapter on "Ovariotomy.")
With it
The Spencer Wells clamp has had many friends.
a very powerful, but quite unnecessary, pressure can be
exerted upon the pedicle by means of the handles, which can
afterwards be removed. For myself I prefer the Dawson
clamp. (See "Ovariotomy.")
PLATE XV.


G.TIEMANN & CO.
G.TIEMANN, & CO
THOMAS' CLAMP.
G.TIEMANN & CO
SPENCER WELLS' NEW CLAMP.
(Detached from the handles.)
G.TIEMANN & CO.

1
#
J
SPENCER WELLS' NEW CLAMP.


FES
SPENCER WELLS' NEW CLAMP.
SPENCER WELLS'
ORIGINAL CLAMP.
ĮTIEMANN & CO
INSTRUMENTS.
161
SPHYGMOGRAPHS.
The sphygmograph is an ingenious instrument with which
to note the varieties of pulse, which is often of importance
in making both the diagnosis and prognosis of disease.
W.F.FORD
FIG. NO. 14.-SPHYGMOGRATH.
་་་་་་་་་་་་W..]
The instrument is so
delicately constructed
that the slightest irregu-
larity of the pulse is
noted by it, and made a
matter of record, as is
seen in the sliding piece
of smoked glass seen in
the top of the cut. By
means of a spring in
the wheel this smoked
piece of glass is pro-
pelled evenly, while an
index needle traces the
throbbing of the pulse
with exactness. With
its use we can discover
an irregularity of the
pulse which we could not

detect by the sense of feeling. This may give us important
information regarding the heart's action, as well as the con-
dition of the blood vessels, and in some instances may throw
light upon the diagnosis of nervous diseases also.
11
162
EATON ON DISEASES OF WOMEN.
CHAPTER XIV.
INDURATION AND HYPERTROPHY OF THE CERVIX UTERI—
VAGINISMUS AND DYSPAREUNIA.
INDURATION of the cervix signifies a hardening of the neck
of the uterus, giving it the feel of gristle, and sometimes
much like bone, while hypertrophy of the cervix signifies an
enlargement or elongation. Hypertrophy may affect the whole
cervix, or be confined to one lip of the os. It may consist
of soft, spongy tissue, or be associated with induration;
hence we may have hypertrophy
and induration in the same case.
Induration exists in all stages,
from the very slight, confined to
even a part of one lip, or affecting
the whole of one lip or the whole
cervix.
Hypertrophy may exist in
small or great degree. It may
have the effect of causing an
enlargement of the cervix lat-
erally, only (see Fig. 15) giving
greatly increased thickness to
the walls of the cervix, and gen-
erally accompanied with a cor-
responding enlargement of the
os uteri. In other cases the hypertrophy produces an elonga-
tion of the cervix, without any considerable increase in its
diameter. On introducing the uterine sound, in some cases we
find the cervical and uterine cavity to measure from four
to six inches. In women who have borne children we

FIG. No. 15.-SUB-INVOLUTION AND HYPER-
TROPHY OF THE CERVIX.
INDURATION AND HYPERTROPHY.
163
should have a measurement of at least four inches in the
cervix and uterus, or we could not denominate the case
one of hypertrophy, however much the cervix projected
downwards, even to the extent of appearing externally. It
would be a case of procidentia and not hypertrophy, unless the
measurement of the uterine canal showed considerable in-
crease above what is normal; and, further, simply an increase
in the length of the uterine cavity, with prolapse, will not
indicate hypertrophy of the cervix positively, for the gravid
womb and a condition of sub-involution would present this
condition of elongation. (Of course, the reader will under-
stand the sound is never to be introduced if there is any
probability of pregnancy.) We must be sure that the elon-
gation is due to increase of length in the cervix. The cer-
vix uteri is firm in structure, and elongation must be due to
development of tissue in this part, or the case is not hyper-
trophy of the cervix.
It is something very common that medical men have
strange ideas, not to say hallucinations and hobbies, on some
particular subject, while very correct on all others. I sup-
pose I, too, have mine, but as we can not see our own, to
some one else must be assigned the duty of pointing mine
out, while I feel it my duty to call attention to a peculiar
idea advanced in Prof. Emmet's excellent work, pages 482-3.
He says:
*
"Among sterile and unmarried women cases occasionally
come under observation which are supposed to be instances
of elongation of the cervix, when the disease is not in the
cervix proper; and, instead of there being an enlargement of
this portion, actual atrophy is the rule. Some change in the
character of the tissues forming the supra-vaginal portion of
the uterus takes place, of the precise character of which I
must confess my ignorance. It is to be hoped that the
pathologist will be able to throw sufficient light upon the
* “Prin. and Prac. Gynæcology."
164
EATON ON DISEASES OF WOMEN.
subject to indicate the proper mode of treatment. In such
a case the uterine body becomes elongated when the woman.
stands, and while the fundus stands stationary, the tissues
below stretch out, as if formed of soft putty, becoming elon-
gated by their own weight.
"In this prolapse the uterine neck is pushed forward in
the vagina, and frequently beyond the outlet, and the supra-
vaginal portion of the uterus appears with a covering of the
vagina presenting the appearance of an elongated cervix.
The probe may be passed in such a case five or six inches,
or a blunt sound may be introduced to the fundus, when, if
the cervix be drawn with a tenaculum along the staff to the
handle, the depth of the canal is shown to be eight or nine
inches. If we next place the patient on the knees and
elbows, for examination, the change brought about will be a
remarkable one. The whole of this elongation will disap-
pear, and the uterus will be found to be but two and one-
half inches in depth. In this position the uterus seems to
shut up, falling together, as would an old worn-out spy-glass,
if held upright.'
Now, I have never seen a case like the one above de-
scribed, nor have I ever before heard or read of such a con-
dition in the married, unmarried, barren, fruitful, or other-
wise. The affection may be peculiar to New York; I can
not say.
Whenever I have drawn down the uterus, I have
found that its interior measured about the same as before. I
would as soon expect to elongate a finger by making traction
upon it, as the uterus by drawing down the cervix.
Dr. Emmet asserts that the fundus remains stationary in
these cases, and that traction upon the cervix with a tenac-
ulum, or even its own weight, stretches the tissues of the
uterus from two and a half to eight or nine inches. This
is a pretty good showing for the strength of the tenaculum,
the firmness of the attachment of the fundus, or the elastic-
ity of the uterine tissues.
INDURATION AND HYPERTROPHY.
165
My opinion is, that such a condition of the uterine
tissue as this will not often be met with, and would show-
well, as Dr. Emmet does not attempt to explain, I will not.
As I freely accord to him the honor of being the discoverer
of this condition, I will leave to him to explain what it in-
dicates. The student (especially in New York), will, how-
ever, be on his guard, and not amputate an apparently elon-
gated cervix till he has taken care to ascertain if it be one
of the spy-glass variety described by Prof. Emmet, as just
quoted. Ordinarily, the student will find that the uterus is
firm, and not elastic; that when he draws down the cervix,
the fundus comes along also, even if pushed up with the
sound, while traction on the cervix is being made.
Etiology and Pathology.
Inflammation is an important agent in the production of
hypertrophy or induration of the cervix, in most cases, if it
is not, in every case, the prime cause.
The causes of the inflammation are various. They may
be cold, excessive coitus, masturbation, or traumatic injury in
confinement, or otherwise. The lateral hypertrophy and in-
duration I have found most common in women who have
borne children-generally, though not always, caused from
lacerations of the cervix in confinement-while the longitu-
dinal hypertrophy is mainly found in the barren or unmarried,
this condition being a probable cause of barrenness, some
cases being congenital.
The process of development of hypertrophy is this:
Owing to some of the causes enumerated, there is an excess-
ive activity in the circulation, for a time, in these parts, fol-
lowed by congestion or stagnation of blood. This causes the
throwing out of serous effusion into the cellular tissue beneath
the mucous membrane. With this serous effusion is mingled
some amount of plastic material. This effusion distends the
tissues, and causes a soft, semi-fluctuating feel to the touch
166
EATON ON DISEASES OF WOMEN.
for a time. After a period, varying from two months to sev-
eral years, this effusion organizes into non-elastic, fibrous
tissue in some cases of induration. This may remain, and
produce no inconvenience to the patient. In other cases it
serves as a nucleus for the development of fibrous tumors or
cancerous disease. In other instances non-striated muscular
tissue is formed, causing hypertrophy without induration. In
still other cases continuous irritation keeps up continuous
effusion, and there is a puffy, though hypertrophied, condition.
Disorders of menstruation are frequently connected with
hypertrophy and induration.
Differential Diagnosis.
The diseases with which hypertrophy and induration of
the cervix are most likely to be confounded are acute inflam-
mation of the uterus, a fibrous uterine polypus, which has
been expelled into the vagina, having so short a pedicle as to
be almost stationary and as large as a hen's egg, cauliflower
excrescence of the cervix, cancer of this part, and the condi-
tion of pregnancy.
From acute inflammation it is to be diagnosed by absence
of heat, tenderness and fever, and from the history of the
case, showing the difficulty to be chronic; from the fibrous
uterine polypus, by discovering the os uteri at the depending
position of the enlargement which could not be found in the
fibrous polypus; and by passing the finger by the side of the
polypus we would feel its neck entering, or attached to, the
side of the os uteri. In cauliflower excrescence, the feel is
extremely uneven, the unevenness being like folds, with the
creases between them branching irregularly, some of the folds
being ear-shaped, and bleeding profusely on slight touch.
From pregnancy, by the history of the case, and the accom-
panying symptoms peculiar to that state (though absence of
menstruation coming on gradually might complicate a case of
induration or hypertrophy); it is more usual, however, that
•
INDURATION AND HYPERTROPHY.
167
the flow is very profuse. Exceptional cases do occur where
it is scanty, and in some it is entirely absent.
Again, we must take into account the length of time these
symptoms have been present. If suppression has existed for
several months, the uterus could be felt in the abdomen, if the
case was one of pregnancy. If it could not be felt there, and
the os was open, we would be justified in ruling pregnancy
out of the question. Besides, when suppression does come
on, in these cases of induration, it is gradual, and not sudden,
as is usual in pregnancy.
In cancer of the cervix we have the induration and
enlargement, and also the sharp lancinating pains, mostly or
entirely felt at night, and the cancerous cachexia is present,
the two latter symptoms not being present in ordinary hyper-
trophy or induration. In cancerous ulceration of the cervix
the odor of the discharge is distinctive, but can not be
described. The physician of experience will, however, read-
ily recognize it. It is to be hoped that every student will
have the privilege of seeing a case in hospital before en-
gaging in private practice. He will then readily recognize
the odor.
Treatment.
The remedies from which we receive the most benefit
are Ars. iodid., Phytolac. dec., Nux, Secale, or Merc. cor.
I can not advise reliance upon internal medication alone
in this disease, though it is of much value in putting the
general glandular system in a healthy condition, and pro-
moting secretion and excretion, digestion, and assimilation,
which is of much importance. By conjoining local treatment.
much may be accomplished. I am well aware that some
homoeopathists claim that local treatment in all diseases is
quite unnecessary, and often injurious. (To the latter asser-
tion I subscribe when it is improperly used, or is of too
severe a character, but to the former I can not agree.)
Quite a prominent author, who maintains that local treat-
168
EATON ON DISEASES OF WOMEN.
ment of the uterus is a snare and delusion, was asked, in a
medical convention, in my hearing, if he had ever treated
a case of endo-metritis. His reply was, No. Now, I can
but suppose that, this being the case, he either had had
little experience in diseases of women or had not been very
thorough in diagnosis. Still this gentleman condemns strongly
those who use local treatment. I must conclude that he
does so from theoretical reasons, and not from his own prac-
tice and experience. However this may be, I am disposed
to write my own opinion, founded upon my own experience
and that of others.
I will say that, in my hands, the local application of
Tr. of Iodine or a Solution of Iodine, in various degrees of
strength (five to fifteen grains to the ounce), has accomplished
much good in softening the indurated cervix, and in causing
diminution of size in cases of hypertrophy. I apply the
remedy, with a soft brush, to the exterior of the cervix,
taking care not to have too much liquid upon the brush, so
that it might flow off on to the mucous membrane of the
vagina. I apply the same remedy to the interior of the
cervix with a director something like a uterine sound, only
not enlarged at the extremity, and wrapped around with
raw cotton, dipping this into the fluid, and passing it into
the cervix, where it should remain for a minute or two.
After making these applications through the speculum, which
should be repeated only once in three or four days, I gen-
erally introduce a wad of cotton (to which is attached a
This serves to protect
twine string), firmly against the os.
the vagina, and retains any superabundant iodine in contact
with the cervix. I direct the patient to remove the cotton,
in about twelve hours, by means of the string. The patient
should lie in a recumbent posture for a half hour or so after
the treatment.
This plan, in connection with internal remedies, will soften
the induration and very often greatly reduce the size of the cer-
INDURATION AND HYPERTROPHY.
169
vix. Much depends upon the length of time the hypertrophy
or induration has existed as to the length of time required for
relief. I would not promise the patient relief in any speci-
fied time, as a period named shorter than the results finally
justify will discourage the patient, while a time long remote
would discourage her in the outset.
I must acknowledge that some cases are not amenable to
medical treatment. They are usually those of many years'
standing, or of congenital origin. In these intractable cases
we may be justified in resorting to surgical treatment. This
consists in amputating the superfluous tissue. It may be
performed with the scissors, or the ecraseur, with but little
trouble and with little fear of hemorrhage. Styptics should,
of course, always be at hand to arrest any free flow of
blood that might occur. The important thing after the op-
eration is to maintain the size of the os uteri, and prevent
its closing. Taking four stitches in the manner shown in
Figs. 16, 17, is an efficient means to accomplish this object.

་་་
1

FIG. No. 16.-STITCHES INSERTED AFTER
AMPUTATION.
FIG. No. 17.-SUTURES TIGHTENED
AFTER AMPUTATION OF CERVIX
UTERI.
These sutures should be of silver wire, and should be
inserted as shown, so as to draw the mucous membrane of
the vagina over the stump, and also serve to draw out to
some extent the mucous membrane of the cervical canal, and
170
EATON ON DISEASES OF WOMEN.
prevent a cicatrix, which might close the os.
This plan,
also, has the advantage of causing healing by first intention
of a large part, if not all, of the stump, which saves much
time from that required for healing by granulation. The
sutures may be cut and removed about the seventh day. A
wad of cotton smeared with vaseline applied twice a day
against the os is a desirable dressing, both before and after
the sutures are removed. It is best to do this without the
aid of the speculum, as its introduction will, in a measure,
bruise the stump, and prevent healing. The sutures may
best be inserted and removed with the aid of Sims' speculum
improved by Dawson. (See Plate III in chapter on In-
struments.)
Amputation of the cervix uteri with the ecraseur does not
positively demand the use of any speculum. The patient ly-
ing upon the side or back with the thighs drawn up is given
an anæsthetic. We then pass the loop of the ecraseur chain
into the vagina, directed by two fingers of the left hand; ad-
just it around the cervix, being careful not to press it up
so high as to amputate above the vaginal juncture; have an
assistant tighten the chain and screw it down as we direct,
till it is firm upon the cervix, when we may remove our
fingers from the vagina, and complete the operation.
We next insert the speculum, seize the stump with a
strong tenaculum, draw it down and insert the sutures as rap-
idly as possible, withdraw the speculum, release the stump,
insert a wad of cotton smeared with vaseline, and the opera-
tion is completed.
AMPUTATION OF CERVIX UTEKI WITH SCISSORS.-Let the
patient be given an anaesthetic, and then placed upon the
operating table on her back or side, with the thighs well
drawn up.
We now draw down the cervix with the vulsel-
lum forceps exterior to the body. Have an assistant hook a
strong tenaculum into the cervix above where we intend to
amputate to prevent the stump from retracting, then with
INDURATION AND HYPERTROPHY.
171
strong scissors sever the tissues. We now apply Ferri Per-
Sulph. to the stump and stitch the vaginal membrane over it,
as previously directed, after amputating with the ecraseur.
To remove the sutures the same plan may be adopted,
or we may insert the scissors into the vagina with the right
hand, directed by two fingers of the left in the vagina, when
we may cut them seriatim, and insert a pair of needles
or polypus forceps, and extract one at a time till all are
removed; or we may remove them with Cutler's suture
forceps and cutter.
VARIOUS OTHER METHODS OF TREATMENT.-Professor Emmet
urges a liability to return, as an argument against amputation,
and adopts the plan of taking out a wedge-shaped piece of
tissue, the apex of which is upwards, and the base to include
most of each lip of the cervix. His operation is much more
difficult, and offers more danger of closure of the os, and I
can not see that it presents any advantages over amputation.
The use of injections of diluted Solu. Iodine into the
substance of the tissues of the cervix has been recommended
as efficacious in promoting absorption and softening of the
induration-for this purpose a syringe, similar to the ordi-
nary hypodermic, is used, larger in size, with tubes about
three inches long. (See Fig. 18.)

50
50
30
FOLSER DE
20

FIG. NO. 18.-SYRINGE FOR INJECTING FIBROIDS.
In my experience this treatment is only applicable to
cases which are extremely free from sensibility, as otherwise
it produces great pain. In cases which have withstood the
172
EATON ON DISEASES OF WOMEN.
use of remedies and local treatment, the injections may be
made at intervals of three days (not using them, however,
very near to the menstrual period), making about three
punctures and injections at each treatment, throwing in
about twenty drops into each puncture, using the following
prescriptions:
R.-Iodine Res., grs. x.
Kali Iod., grs. xxx.
Kali Brom., grs. xxx.
Aqua, 3 i, m.
Dr. John M. Bennett,* of Liverpool, England, I believe
was the first to recommend and use this treatment, which
he highly commends. He advises its use also in cases of
chronic cervicitis, which would indicate that he would not
restrict its use as much as has been, in my experience, advis-
able. The combination of the Kali iod. renders the Iodine
soluble in water, and dispenses with alcohol, and the bromide
tends to prevent as much pain as would otherwise result.
After this treatment the patient should lie perfectly quiet for
three or four hours, and if possible longer.
VAGINISMUS-DYSPAREUNIA.
Vaginismus, as a distinct disease or difficulty, was first rec-
ognized by Dr. Sims in 1857. Dr. Robert Barnes, of London,
has seen fit to coin a new name for this condition, which is
dyspareunia. This term of Dr. Barnes truly enough signifies
painful union in copulation, but is objectionable in that painful
copulation may be due to inflammation and tenderness of the
uterus as well as the vagina, and may exist independently of
any vaginal irritation or spasm; I therefore prefer to adhere
to the term vaginismus, generally understood to mean a
super-sensitive condition of the whole or a part of the vagina,
accompanied with spasmodic closure from very slight contact,
even with the finger, rendering copulation either extremely
*Dublin Jour. Med. Science.
VAGINISMUS—DYSPAREUNIA.
173
painful or impossible, causing much distress to body and
mind, and sometimes sadly disturbing the peace of families-
standing as a barrier against the completion of conjugal
duties, including the rearing of offspring, and making life a
burden instead of a blessing.
Though not immediately dangerous to life, this condition
tends greatly to shorten it by the depression of spirits, and
consequent derangement of the digestive and assimilative
functions.
It is most common in women recently married, and, I
may add, those who have married at an advanced age, being
very unusual among those who have once become mothers.
Hence the difficulty is one of very great embarrassment as
well as pain and annoyance. The patient sometimes imag-
ines (when recently married) that this state of affairs is
common to all women, and she tries to endure it.
The con-
jugal relation is irksome and loathsome to her, and she
becomes fretful, sullen, and despondent. She communicates
to no one the cause of her depression and sorrow, and her
husband is suspicioned by her friends of being unkind to
her. The husband often is unaware of the severity of the
suffering endured by the wife, and is annoyed, if not dis-
gusted, with her fretfulness and depression, as well as want
of pleasure in his company, and accuses her of cold-hearted
indifference. So on it goes, from bad to worse, till a sepa-
ration and disgrace follow, as a more desirable state than
this just described.
All this trouble and sorrow might be avoided if the
physician would suggest to young men about to marry that
they might have some trouble of this kind, and bid them to
be cheerful, under the assurance that it could be remedied,
and was excellent evidence of the chastity and purity of
the wife, and bidding them be very gentle and moderate,
seeking medical aid if things did not soon right themselves.
Dyspareunia, or painful connection, may be also due to
174
EATON ON DISEASES OF WOMEN.
inflammation of the uterus, or ovaries, or displacements of
these organs, inflammation of the vagina, disproportionate
size of the male organ, want of sexual passion, cystitis, etc.
Symptoms.
Usually the physician will be consulted by the husband of
the patient, who will state that the attempt at copulation pro-
duces in his wife extreme pain, or that it is impossible to
perform the act at all, owing, as he thinks, to some malfor-
mation of the wife's genitalia.
If we see the patient at once, and attempt to make an
examination of the parts, we find a cringing on the part
of the patient as soon as the finger is inserted between the
labia, in some instances; and, upon attempting to pass the
finger into the vagina, we feel it to be spasmodically closed.
If, by using some force, we succeed in inserting the finger,
it is grasped by the sphincter vaginæ, and held very firmly.
We will note, usually, an absence of normal moisture, and
the finger should be smeared with some oleaginous substance
before making an attempt at an examination.
Upon placing the patient under the influence of an
anaesthetic, this rigidity is found to relax, and we can pro-
ceed to examine the position and condition of the uterus.
The sound will determine any flexion which may exist, and
there is no call for the introduction of a speculum in these
cases. In attempting to make a digital examination we may
sometimes find it impossible, even with the aid of the anaes-
thetic, and we feel the hymen, as a firm, smooth obstruction,
quite the contrary from the drawn together feel of the spas-
modic contraction. This is, of course, a case of thickening
of the hymen, or an imperforate hymen (in case we can find
no opening at all), and does not come under the head of
vaginismus.
VAGINISMUS DYSPAREUNIA.
175
Etiology.
The cause of vaginismus is sometimes in the general
supersensitive condition of the nervous system, called gen-
eral “hyperæsthesia," and may result from a local hyperæs-
thesia of these parts. This local hyperesthesia may be due
to the inflammation of the vagina, vulva, meatus urinarius,
or urethra, fissures, or hemorrhoids, moderate cellulitis,
flexions or versions of the uterus, irritating discharges from
the uterus, great size of the male organ, brutality and vio-
lence of the husband in the attempt at sexual congress,
etc., etc.
These causes may also develop at a period somewhat re-
mote from the marriage day, owing to excessive coitus, causing
vaginitis, or owing to the development of some of the enu-
merated causes, at any time.
Some authors name hysteria as a cause of vaginismus;
but, to my mind, in this theory the effect is mistaken for
the cause.
Educated women are much more frequent sufferers from
vaginismus than the uneducated. This is doubtless due to the
greater exhaustion of the nervous system, and consequent im-
pairment of glandular and muscular strength. With most of
these women the animal nature is stunted from want of phys-
ical exercise, and exhausted by keeping late hours, and from
hard study, and loss of sleep.
The mental determination to suppress every sexual emo-
tion causes, in time, a loss of virility, not complete, it is true,
in many instances, but very generally a serious impairment.
In these cases contemplation of the sexual act is repulsive;
there is an absence of secretion naturally thrown out by the
sebaceous follicles, in the labia and nymphæ, while in the em-
brace of her husband, and, consequently, there is dryness of
the parts, instead of moisture. This absence of moisture,
with the little or no sexual passion felt, are important agents
176
EATON ON DISEASES OF WOMEN.
in causing pain and spasmodic closure of the vagina when
sexual congress is attempted,-all having the foundation cause
in the atony and atrophy of the female genitalia, induced by
the exhaustion of the entire system from mental labor.
Neftel,* of France, was the first to suggest that moderate
lead poisoning, from using cosmetics containing lead, may oc-
casionally produce vaginismus; and I am quite sure he is
right. I have, in several instances, observed this condition
apparently produced by cosmetics containing lead. In other
cases it produces paraplegia or neuralgia.
Treatment.
The first thing in the treatment is to ascertain what there
is in the particular case in hand which causes the trouble.
Perhaps the best prescription which can be made for cases
ordinarily, if we must prescribe before making a physical ex-
amination, is to give, according to the homoeopathic indica-
tions, either Ignatia, Nux, Aconite, Bell., or Ars., internally, with
Belladonna Ointment, diluted one-half, passed in small quantity
between the labia minora and up into the vagina, by the
patient herself, twice a day, using very warm water vaginal
injections, in large quantity, at least once a day, taking warm
sitz baths at night, before retiring, etc. Should this treatment
fail of giving relief in a week or two, we should insist upon a
physical examination.
We
For this purpose we may have our assistant, or the hus-
band, administer some Ether compound, or Ether alone.
should then proceed to ascertain at once if there is any dis-
placement of the uterus, and if so, proceed to replace it.
If the uterus is inflamed, this condition will be indicated by
heat and swelling, and we can adopt suitable treatment for
this condition subsequently.
We should also, at this time, examine for fissures of the
anus or vagina, and for hemorrhoids, and also as to the condi-
* L'Union Medicale, 1869, No. 19.
1
VAGI
177
VAGINISMUS-DYSPAREUNIA.
tion of the urethra and its meatus externus. If any thing
abnormal can be discovered in these parts, of course, the
indication is clear to treat these conditions till cured, when,
it is most probable, the vaginismus will be relieved as well.
(Copulation while the patient is under the influence of an an-
æsthetic has been practiced, in this country, to induce concep-
tion, that parturition might cure the difficulty.) Dr. Pack-
ard reports a case where conception occurred, although the
penis never entered the vagina. It is to be expected that
the delivery of a child will effectually cure the vaginismus;
hence, it is always desirable, in these cases, that conception
should take place.
*
Some gynæcologists incise the vagina in several places,
cutting deep enough to sever some of the fibers of the con-
strictor muscle, and then insert a dilator, well oiled, retaining
it till the incisions are healed. This operation has most fre-
quently been performed by Dr. Sims, who has also invented
the plan of gradual dilatation with glass or hard rubber cyl-
indrical dilators of various sizes (see Plate VI), commencing
with the smaller, and gradually using larger and larger ones
from day to day. This latter plan is very generally approved,
and has been an efficient means in my hands when conjoined
with the use of diluted belladonna ointment or vaseline, to
smear the dilators before they were introduced.
As a rule, however, we have no need to use even as
severe means as the vaginal dilators. Warm vaginal injec-
tions and the occasional application of Bell. Ointment and
Vaseline, equal parts, with the finger, either by the physician
or patient herself, conjoined with indicated remedies for
this and other symptoms in the case, together with atten-
tion to diet, hygiene, food, mental quiet, and a cessation
of attempts at copulation, are usually successful. When this
plan of treatment fails it is time enough to use the dilators
or make incisions.
* Amer. Jour. Obs., Vol. II, p. 348.
12
178
EATON ON DISEASES OF WOMEN.
It will be judged by the thoughtful student that efforts
at connection would prove injurious and tend to prevent
recovery. This is the case, and it is better to forbid every
effort at sexual congress till the patient is thought to be
recovered.
Indications for Remedies.
Arnica is indicated where the vaginismus has resulted
after copulation, or injury of any kind.
Aconite is indicated where there is present vaginismus,
with heat and tenderness in the vagina, with a wiry pulse,
aching in the limbs, fever, etc.
Bell., where there is drowsiness, with bearing down
pain; pain in the small of the back, a flushed face, etc.
Ignatia, in the case characterized by weakness, nervous-
ness, insomnolence, etc.
Hyosc. is indicated if there is a tendency to hysteria,
frequent weeping, immodesty, etc.
ULCERATION OF THE OS UTERI.
179
:
CHAPTER XV.
ULCERATION OF THE OS UTERI.
I WRITE a chapter on ulceration of the os uteri, not that I
expect any student will soon see a case, unless it be one of a
specific character, but to express the opinion that true ulcera-
tion is very rare in this locality. From the frequency with
which we hear physicians speak of ulcerations of the womb
one would suppose the disease was one that the gynecologist
would see daily; but this is not the case; on the contrary,
they are seldom seen even as small pimples, tending to
ulcerate. If we use the term ulcer, as it is applied to other
tissues, parts, or organs of the body, I may say we seldom see
it, except in syphilis or the phagedenic or cancerous ulcera-
tions, which are not intended when we speak of ulceration in
general terms, and are always designated specifically as such,
when present.
The ulceration spoken of by physicians so often (see chap-
ter on Cervicitis), is simply a sub-acute inflammation of the
vaginal mucous membrane, covering the cervix uteri, the
epithelial layer being absent (which will usually be the case
after one application of caustic, and this is the almost uni-
versal treatment used by the allopathists, whether they see.
fit to diagnose the case ulceration, inflammation, induration,
hypertrophy, chronic endo-metritis, or endo-cervicitis). Muco-
purulent matter is sometimes thrown off from this inflamed
surface of the cervix uteri, but it is not ulcerated as the
term is generally understood. In these cases there is no
depressed center, there is no disposition to slough; on the
contrary, this inflamed surface is usually more elevated than
180
EATON ON DISEASES OF WOMEN.
the adjacent mucous membrane.
The term ulceration ap-
plied to this condition I consider a misnomer.
When the inflammation is of a rather high grade to be
termed chronic sub-acute, almost coming up to an acute
inflammation, we sometimes have small pimples which are
exceedingly red, with a base considerably inflamed. These
pimples seldom attain to a size larger than that of two or
three pin heads, and usually pass away without ulcerating.
Occasionally they have a little matter in them, which is dis-
charged; but even then the disorder is so slight, as regards
the ulceration, as to be unworthy the name. I have never
seen them fail to heal, in a short time, under the mildest
treatment. Under a severe caustic treatment the healing
process might be indefinitely postponed if it was used with
any degree of frequency.
The irritable ulcer mentioned by Professor Ludlam, that
shows no disposition to heal, but rather increases in depth
and size, I think will be found on investigation to be specific
in its character, or the result of direct violence, as incisions,
wearing a hard pessary for a long time, or a laceration in con-
finement in broken down scrofulous subjects, and will seldom be
met with. Still, as we will sometimes see them, we may
well pay some attention to their consideration.
The class resulting from laceration of the os in confine-
ment is more numerous than is generally imagined, from the
fact that they many times exist without being discovered,
owing to careless examination or a failure to comprehend
their nature and appearance.
The ulcers resulting from unhealed lacerations of the os
are in appearance deep fissures, and generally double, i. e.
one situated upon either side of the neck, the outer margins
of which we find covered with mucous membrane, and some-
what increased in color from the natural tint; but on separ-
ating these false lips as it were, we discover pus in the
bottom of the fissure, and, on wiping it away, we see the raw,
ULCERATION OF THE OS UTERI.
181
ulcerated condition of the bottom of the fissure, which, by
the way, is, of course, upwards towards the fundus of the
organ. These fissures or ulcers may exist singly, either
from the fact of one of them having healed, or from the lac-
eration having occurred only at one point.
The pathological condition recognized by some authors as
ulceration is really one of sub-acute inflammation. Notice the
description given by Prof. Byford.* He says:
"After the inflammation has lasted for a time, if its in-
tensity is increasing, the epithelium gives way, more or less
completely. This epithelial denudation is the simplest and
most common form of ulceration met with in practice. Of
course, in this form of ulceration the red portion is not de-
pressed; it retains its level with the adjoining surface, and,
consequently, the term ulceration is not considered applicable
by some writers. After the epithelium is lost for some time,
there is a gradual increase in the size of the papillary structure
of the membrane, covering the neck of the uterus, and if
the membrane is now examined, instead of the smooth red-
ness there is something of a velvety or plushy appearance.
The intensely red surface is covered by, or, rather, seems to
be formed of, an infinite number of extremely minute pro-
jections so closely opposed that there is hardly any space.
between them. The papillary projections do not seem larger
than the minute silk fibers of velvet, as short and as thickly
set. This surface is almost always covered with mucus and
pus in different proportions of admixture. There is always
pus, however, when this complete absence of the epithelium is
observed. Still the evenness of the mucous surface is not dis-
turbed. There is no excavation at least. If there is any
change in this respect, the red patch is slightly elevated
above the surrounding surface. This kind of surface is al-
ways seen upon a greatly enlarged cervix, which is also
very much indurated. It is very obstinate, but will usually
*"Medical and Surgical Treatment of Women," pp. 185-7.
182
EATON ON DISEASES OF WOMEN.
yield to sufficiently energetic and long continued treatment.
The boldness of the use of caustics necessary to the cure of such
cases as these requires strong nerves to institute and thoroughly
execute." (The italics are my own.)
It will be noticed that Dr. Byford states that "this is
the simplest and most common form of ulceration met with in
practice." And, regarding treatment, says: "The boldness
of the use of caustics necessary to the cure of such cases re-
quires strong nerves to institute and execute," but says, “the dis-
ease is very obstinate." Is it any wonder?
The application of caustics to the healthy os uteri will
cause the exfoliation of the epithelial layer of mucous mem-
brane, as described, with all the accompanying symptoms
mentioned, which really are but the efforts of nature to re-
store the loss of tissue produced by the inflammation either
with or without the caustics. It is one of the mysteries of
medicine that intelligent gentlemen should have applied
caustic applications heroically, perseveringly, and eternally,
where the success was so problematical, as they acknowl-
edge, and where reason and philosophy seem to be ignored.
Especially is it strange among those who claim to be so par-
ticularly scientific, as do the old school. It is on a par with
the universal use of blood-letting practiced by this school of
medicine thirty or forty years since, which has fallen entirely
into disuse; and it is to be hoped that very soon caustic
applications to the os uteri may be as seldom used as is
blood-letting at the present day.
In these remarks I intend no disrespect to Prof. Byford;
on the contrary, I selected a quotation from him because I
thought he gave one of the best descriptions of the appearance
of the os in these cases to be found in any work, and as I know
the treatment recommended by him is a true statement of
the actual practice of his school to-day. I cheerfully acknowl-
edge the obligation I am under to him for instruction twenty
years since, and I hope I shall always remember the respect
ULCERATION OF THE OS UTERI.
183
I owe to him and other old school physicians who did so
much for me in my student days, and also in the first years
of my practice. If I now differ with them, it is only
reluctantly, after having found by experience that we have
in homoeopathy a law for the selection of remedies in the
treatment of disease, and that the treatment of disease with
remedies selected by this law is much more satisfactory than
by the old school methods.
This description of ulceration by Prof. Byford is proba-
bly as good a statement of the condition of the os in cases
so frequently called ulceration as can be found or written.
Still, I see no good reason to apply the term ulceration, as
it certainly deceives patients and friends in regard to the
true nature of the difficulty, and gives great distress to some
sensitive ladies, amounting to almost an abhorrence of life
and detestation of themselves. Generally some leucorrhoea
is present in these cases, and the patient imagines that the
interior of her vagina must be perfectly horrid, if it is so
ulcerated as to cause such a discharge. It is natural that
she should feel much discouraged and depressed in mind-
the very condition we wish to avoid, if possible. But, on
the contrary, with the explanation of the physician that the
difficulty is chronic inflammation of the neck of the womb,
and that it looks somewhat red and swollen, and we explain
that the discharge is the result of this inflammation, it causes
much less alarm, and hopefulness takes the place of fear and
despondency.
There is very generally a tendency to despondency in
all forms of uterine ailments, and to avoid this should be a
constant aim of the physician.
Diagnosis.
Here we need the aid of the speculum-in fact, without
it no diagnosis could so well be made. The digital exam-
ination would not reveal any considerable heat or tenderness
184
EATON ON DISEASES OF WOMEN.
ordinarily, unless hard pressure was made (which would
produce some pain in case of the fissured ulceration of lacer-
ation before mentioned, where the lacerations had not healed),
or in case the ulceration had resulted from scarifications or
single incision, where we would have the smaller fissure.
The chancre does not differ, when seated in this locality,
from its appearance when situated on other mucous surfaces.
For differential diagnosis regarding cancerous ulceration, see
"Cancer of the Uterus."
Occasionally we may find a true ulcer of the os, exca-
vated, discharging pus, the margin blanched or white, the
center red, and showing small granulations after we wipe
away the pus. I will suggest that we have always at hand a
dossil of lint or cotton or soft sponge, and a pair of long
dressing forceps, with which to wipe away any secretions
which may cover the os; otherwise we may be sadly misled
in diagnosis.

O
C.H.&.CO
FIG. NO. 19.-UTERINE DRESSING FORCEPS.
The red spot may be only a few drops of blood which has
just passed out of the os, surrounded with some mucus ad-
hering to the neck of the womb, simulating an ulcer some-
what. Still we may not be misled if we recollect that, in the
case of the true ulcer, we would have pus covering this red
center, unless we had previously wiped it away; and again,
in the true ulcer, we have the depressed center, with irregular
white border, which can not be wiped away. Surrounding
this whitish margin we may have the mucous membrane con-
siderably inflamed and quite red. Especially is this so, if it is
caused from the wearing of a hard pessary.
ULCERATION OF THE OS UTERI.
185
Treatment.
True ulceration, I believe, will seldom be found in the
robust patient; and, when we find it, we will have need to
recollect that good nourishment is a desideratum. Remedies
calculated to build up the system by exciting healthy gland-
ular action, healthy secretion, assimilation, and excretion, as
well as general nerve strength, are needed. They may be
found among the following remedies, selected according to the
peculiar symptoms of each case: Merc. pro., Ars., Phytolac.
dec., Nux, Cal. carb., Sepia, Lachesis, Lycopodium, Iodium,
Thuja, etc. As a local application I would use Solution Iodine,
twenty grs. to the ounce, applied with a camel's-hair pencil
daily, applying it only to the center of the ulcer, or, in
case of the fissure, to the bottom of it, first removing the
pus with a bit of cotton. This will cause granulations to fill
up the depressed surface, and, when that is accomplished, the
mucous membrane will form over the ulcer. God only knows
how. He, acting through established law, has made provision
for the restoration of solutions of continuity of tissue. How
this process is accomplished, either in bone or flesh, we are as
ignorant as the new-born babe. Still, to place the system in
a favorable condition, and sometimes aid nature, seems to be
our privilege, though we know not the process of cure more
than we can understand the selective affinity in the animal
or vegetable world, which selects and appropriates food for
the various parts of the animal or plant, from elements, to our
dull sense, apparently as diverse as possible. But so it is,
and probably so it must remain.
186
EATON ON DISEASES OF WOMEN.
CHAPTER XVI.
VAGINITIS—ADHESIONS IN THE VAGINA FROM INFLAMMATION—
DIPHTHERITIC INFLAMMATION OF THE VAGINA- PERI-
VAGINITIS PHLEGMONOSA DISSECANS.
VAGINITIS.
THIS term indicates an inflammation of the lining mem-
brane of the vagina. It is more frequently chronic than
acute. An acute attack, resulting from cold, is denominated
CATARRH OF THE VAGINA.
It may attack girls or women of any age. In acute
attacks the symptoms most complained of are, heat, burning,
and itching of the part. The inflammation generally affects
the mucous membrane of the labia at the same time, and,
consequently, it sometimes becomes very painful in walking,
as the moving of the limbs chafes the labia, already inflamed,
and causes great pain. In two or three days after an acute
attack of vaginitis, which is often ushered in by chilliness of
the whole body, there is pain in the limbs, back, etc., gen-
erally an increase of temperature, and a rapid, wiry pulse,
tongue generally with a white coating, loss of appetite, with
sometimes nausea and vomiting.
Very often these symptoms last mentioned are the only
ones complained of to the physician, and he is liable to
make a diagnosis of int. fever, or bilious fever, or congestion
of the stomach, or stomatitis. After the lapse of a few days,
however, there is a copious flow of mucus and muco-puru-
lent matter from the vagina, which is more likely to cause
the patient to make known to the physician the true state
of affairs. By this time the patient will generally feel
inclined to take to her bed, if she has not done so already.
VAGINITIS.
187
I have here described the more violent form of acute
attacks of vaginitis. The large majority of cases are more
mild in their symptoms. These severe acute attacks are
usually due to cold taken at the menstrual period, when
we are likely to have also some metritis complicating the
vaginitis. Tedious labor, where the head is impacted in
the vagina, is a cause of severe vaginitis occasionally, and
is to be avoided if possible, even if it is necessary to use
instrumental delivery. It is much safer in skillful hands
than the long impaction of the head.
Traumatic lesions from the use of instruments in labor,
craniotomy, or removal of uterine polypi, or uterine fibroids,
or other violence, the use of strong vaginal injections, ex-
cessive copulation (or violence of the act, especially in those
just married) may produce acute inflammation of the vagina
and labia.
The specific inflammation of the gonorrhoeal poison will
be discussed under its proper head. The differential diag-
nosis is sometimes difficult. The character of the patient
and the history of the case will aid us some in distinguish-
ing the specific from the non-specific. Objectively and
subjectively, the symptoms are much alike. Where the
patient is of good character we usually will, of course, have
the non-specific inflammation, while in the case of prostitutes
we may have non-specific inflammation from causes mentioned;
still, they are comparatively rare among these women.
In gonorrhoeal inflammation, generally, painful micturition
is one of the first symptoms, while in the non-specific it
comes on later in the case, if at all. The smarting, even
then, is mostly confined to the interior of the labia, and not
to the tract of the urethra, as in specific inflammation. Bubo,
which often results in the female (though not as often as in
the male) from gonorrhoeal vaginitis, seldom, if ever, accom-
panies non-specific inflammation of the vagina.
This acute inflammation generally causes so much ten-
188
EATON ON DISEASES OF WOMEN.
derness that even a digital examination is extremely painful;
and I would specially warn all young physicians to not
attempt to introduce a speculum in such cases. The swell-
ing and tumefaction of the parts, as well as the tenderness
and vaginismus, lessen the size of the vagina, and make the
attempt to introduce the speculum a cruelty.
We may have in these cases of acute vaginitis various
sympathetic symptoms very much resembling those produced
from uterine disease-pain in the back and limbs, constipa-
tion of the bowels, weakness, etc., etc. This acute inflam-
mation sometimes produces abscess in the labia majora, which
is particularly embarrassing with newly-married ladies, and
it is just this class which is most frequently affected with
abscess of the labia. In these cases it will sometimes be
found that the inflammation first attacked the labia, and
spread to the vagina.
Ascarides sometimes produce this disease in young girls,
and sometimes from want of cleanliness of the parts, in con-
junction with a sudden cold, vaginitis may be developed.
CHRONIC VAGINITIS is more common than the acute. It
exists in a sub-acute form in many women for years, produc-
ing leucorrhoea, sometimes painful vaginismus, which makes
the act of copulation very painful, if not entirely impossible.
In other cases there is little tenderness or heat, but, on the
contrary, a relaxed cool state of the parts; still, upon exam-
ination, the vaginal mucous membrane looks red, and we ob-
serve an inordinate amount of mucus, and sometimes muco-
purulent matter. This discharge is usually so profuse as to
be exceedingly annoying to the patient. Generally there is
little urethral irritation in this chronic form of vaginitis, nor is
there as much disturbance of the general system as in the
acute form.
The causes which tend to produce this chronic sub-acute
vaginitis are colds, resulting in a sort of catarrh, which does
not get entirely well until another is taken, and so on. Fre-
VAGINITIS.
189
quent child-bearing, as well as miscarriages, tend to leave the
parts either irritated or weakened, and consequently more
sensitive to cold. Excessive venery, want of cleanliness, the
wearing of pessaries for a long time-and, for that matter, a
short time will produce vaginitis in some women. The inter-
course with husbands who have, at some previous period,
been afflicted with syphilis is said, by some authors, to pro-
duce a mild vaginitis; but, in my opinion, based on 'expe-
rience, the most frequent cause of chronic vaginitis is dis-
placement of the uterus-displacements of either variety do
tend directly and materially to produce this difficulty. The
use of washes to prevent conception is another fruitful cause
of this disease, as well as the use of strong injections and
the application of caustics to the os uteri.
The excoriating nature of some of the discharges from
the uterus passing over the vaginal membrane tend to inflame
it, and are the cause of the obstinacy of the vaginitis, in
some cases, in spite of all treatment, because the exciting
cause remains undiscovered and unrelieved.
The scrofulous habit may predispose largely to the devel-
opment of the disease, as well as the debility of excessive
fatigue. The presence of tumors in the pelvis of any kind
will, of course, largely tend to produce and keep up inflam-
mation of the vagina.
Treatment.
The acute attack of vaginitis will require Aconite first, last,
and all the time, taken in the second or third attenuation,
every three hours ordinarily. Some cases, showing depres-
sion of strength, hot flashes, with chillings, require Ars. alb.
3, or higher, if you please. Perfect rest should be enjoined.
Evacuate the bowels with enema of soap and water, place the
patient in a warm sitz bath for twenty minutes three times a
day, apply warmth to the feet, inject into the vagina, and
also apply a soft cloth between the labia wet with a wash
made of Tr. Aconite 3 i, Aqua, O. ss. Still maintain rest and
190
EATON ON DISEASES OF WOMEN.
give a non-stimulating diet-cold water may be drank of
moderate temperature, omitting tea and coffee. After a day
or two following this treatment, I usually apply to the vaginal
surface an ointment of Bell. diluted with simple cerate, about
four hundred per cent, applying it with the finger thor-
oughly, which relieves the tenderness rapidly. Another
excellent application is a wash (used with the syringe)
of Hydrate of Chloral 15 grs. to aqua 3 i, injected every
four hours.
As soon as the tenderness disappears sufficiently to admit
of so doing, it is well to make a thorough physical examina-
tion with the speculum and sound, and also see that there
are no tumors in the vagina causing irritation. If uterine
displacements are present, we need not expect any treat-
ment short of placing the organ in situ, and maintaining
it there, will be of any avail in permanently relieving the
vaginitis. Tumors, of course, should be treated according to
the kind and condition. The use of vaseline, introduced into
the vagina on the finger two or three times a day, will be
found very serviceable (the patient may be taught to do this).
Copulation, of course, is to be interdicted. Warm drawers,
stockings, and shoes are to be advised, with moderate exer-
cise during convalescence. In severe cases, especially those
caused from severe labor, it is necessary to insert into the
vagina some solid material, to keep the sides of the vagina
separated and prevent adhesions. These need not be intro-
duced until the active symptoms have, in a measure, subsided.
They may consist of a tampon of cloth, well oiled, or smeared
If the pa-
with vaseline, and left in position twelve hours.
tient is seen often by the physician, he may omit the tampon,
if he introduces the ointment on one or two fingers daily.
TO PREVENT ADHESIONS OF THE LABIA, which might occur,
if neglected, it is well to keep them separated with an oiled
fold of cloth, lint, or cotton. In case we have adhesions al-
ready formed, which will sometimes occur in a short time, we
VAGINITIS.
191
must break up the adhesions. This can be done by separat-
ing the labia, and using a blunt instrument to lacerate the
attachments, if they are few; but if numerous, or there is a
considerable extent of adhesion, the scalpel should be used to
divide the attachments, and the labia must be kept well sepa-
rated with oiled lint or cotton till healed. I often find that,
after removing the cause of the complaint, I have no disease
left to treat. The leucorrhoea, weakness, tenderness, and all,
have vanished.
The remedies most serviceable in chronic vaginitis are
Cal. carb., Sepia, Mercury, Nux, and Puls. (Puls. especially,
if there is amenorrhoea as a complication.) An injection of
simple Chlo. Potass. in solution, of the strength of about five
grs. to the ounce, is excellent, combined with the vaseline ap-
plications mentioned in convalescence from acute vaginitis.
In chronic vaginitis we have little fear of adhesions forming.
Sometimes Can. ind., Canthar., Cubeb., or Bell. may be given
to relieve the urethral irritation; but they are seldom needed,
as the cure of the vaginitis results in the cure of the urethritis
also. Tepid soap and water vaginal injections are desirable,
used daily, to cleanse away the discharge, and allow of the
direct application of the other treatment. Nourishing diet,
good air, freedom from care and worry, are great aids in the
treatment.
In cases of very young girls we must be sure worms are
not the active cause. If they are, they must, of course, be
removed. Injections into the rectum of thin starch water,
with a few drops of Spts. Turpentine, is an efficient remedy
for these little pin-worms, which are sometimes the cause of
vaginitis. Open the vagina gently, and wipe away any that
may be seen, with a soft cloth. Bathe the parts often with
tepid water, and gently apply vaseline, cosmoline, or basilicon
ointment, twice a day. The remedies to be given are the
same as for the adult.
192
EATON ON DISEASES OF WOMEN.
Indications for Remedies in Vaginitis.
Aconite.-Vaginitis, with dizziness; fear of death; rest-
lessness; rapid, wiry pulse; hot, dry skin.
Arsenicum.-Vaginitis, with nausea; aching of the en-
tire body; chilliness, alternating with hot flashes; profuse
yellowish leucorrhoea.
Arnica.-Vaginitis from traumatic lesions; excessive
venery; loss of appetite; bitter taste in the mouth; sensa-
tion of cold on top of the head, with nervous depression.
Belladonna.—Vaginitis, with bearing-down pains; vag-
ina hot and dry; face flushed, with great thirst; urine copi-
ous, pale, and involuntary; pulse full and throbbing, great
disposition to perspire.
Bryonia.-Vaginitis, with dysmenorrhoea; menses too
profuse, complicated with pleuritis or mucous diarrhoea; mouth
-and lips dry, with nervous depression and dry, hacking, tick-
ling cough.
Cannabis Sativa.-Vaginitis, with copious milky leucor-
rhoea; labia swollen and tender; burning in the urethra;
painful micturition; palpitation of the heart and frightful
dreams.
Cal. Carb.-Vaginitis, with leucorrhoea like milk; dark
offensive urine; vertigo when walking; glandular enlarge-
ments in any part of the body; sweating of the palms of the
hands; feet cold and damp. (Cowperthwaite.)
Cantharis.-Vaginitis, with dysuria; dryness of the vag-
ina, with nymphomania.
Cimicifuga.-Vaginitis, with pain in the ovaries; dys-
menorrhoea; complicated with neuralgia or rheumatism; dull,
frontal headache.
China. Vaginitis, after labor; red sediment in urine;
painful micturition; throbbing headache; roaring in the ears.
Cocculus.—Vaginitis, with menorrhagia; dizziness with
nausea.
VAGINITIS.
193
Carb. Veg.-Vaginitis, with an aphthous condition of
the parts; indigestion; offensive flatus; hoarseness; tend-
ency to sleep during the day; can not sleep at night.
Conium Maculatum.-Vaginitis, with severe itching in
the vagina; cutting pains in uterus, ovaries, or breast, with
increased sexual desire.
Digitalis.-Vaginitis, with palpitation of the heart; mem-
branous dysmenorrhoea.
Dulcamara.-Vaginitis, with amenorrhoea and watery
diarrhoea; pain in small of the back.
Ferrum.-Vaginitis, with redness of the face; rush of
blood to the head; amenorrhoea, epistaxis, etc.
Gelseminum.-Vaginitis, with sharp pains in the uterus
and dizziness; pain in the occiput; trembling and weakness.
Graphites.-Vaginitis, with profuse leucorrhoea; itching
of the pudenda, with morning sickness; aversion to animal
food; nausea from the smell of food; despondency and
weakness.
Hamamelis.-Vaginitis, with uterine hemorrhage, bleed-
ing hemorrhoids, etc.
Hyoscyamus.—Vaginitis, with hysterical symptoms; ex-
cessive sexual desire; immodest exposure; pupils dilated;
eyes look wild.
Ignatia.—Vaginitis, with frequent micturition; sighing;
sensation of weakness; restless sleep.
Iodium.-Vaginitis, with induration of the uterus, and
swelling of the ovaries; mammæ small, undeveloped; scrofu-
lous conditions, with dark hair and eyes.
Kreosotum.-Vaginitis, with yellow leucorrhoea; violent
itching of the labia.
Lachesis. Vaginitis, with hot flashes, dimness of vision;
vertigo, with hysterical symptoms, in old women.
Lycopodium.-Vaginitis, with dryness in the vagina;
excessive appetite, with hiccough; weak memory, with con-
stipation.
13
194
EATON ON DISEASES OF WOMEN.
Platinum.—Vaginitis, with nymphomania; bearing down
pain in the abdomen; objects appear small; sad, irritable mood.
Pulsatilla.-Vaginitis, with scanty menstruation, from
taking cold; leucorrhoea thick, like cream.
Sepia.-Vaginitis, with great tenderness; vagina dry and
hot; urine turbid, with reddish sediment; yellow, sallow com-
plexion; prostration of strength.
Sabina.-Vaginitis, with thick, offensive leucorrhoea;
menses too profuse; strangury; dysenteric symptoms; urging
at stool; vertigo when attempting to walk, etc.
Sulph.-Vaginitis, with corrosive leucorrhoea; constipa-
tion; tenderness of the abdomen; troublesome itching of
the labia.
Thuja.—Vaginitis, with mucous leucorrhoea; great itch-
ing of the genitalia; useful in cases where there is a syph-
ilitic taint.
Verat. Viride.-Vaginitis, with congestion of blood in
the brain, especially affecting its base; sense of fullness in
the back of the neck; irritable disposition; dilated pupils;
gastralgia, etc.
Zincum.—Vaginitis, with irresistible sexual desire; leu-
corrhoea thick, bloody, etc.; dizziness, with weak memory;
mouth and lips dry.
DIPHTHERITIC INFLAMMATION OF THE VAGINA.
When we have diphtheria affecting the throat, in severe
cases we may have also a diptheritic exudation in the vagina,
preceded and accompanied by vaginitis; and we may also
have this diphtheritic inflammation in the vagina without the
throat manifestations. Ichorous discharges from the uterus
may produce it in cases of carcinoma of the uterus, or in
cases of ulcerating fibroids or polypi, or in cases of vesico-
vaginal fistula, measles, small pox, typhus, and cholera;
and we sometimes have this complication in the puerperal
patient.
PERI-VAGINITIS PHLEGMONOSA DISSECANS.
195
This diphtheritic inflammation may be confined to a small
part of the mucous surface of the vagina, or may cover it
and the labia entirely.
Diagnosis.
Its symptoms are those of vaginitis, with the additional
one of the formation of diphtheritic false membrane, and we
have the symptoms of general exhaustion more marked and
decided.
Treatment.
Locally, I find the most benefit from Solu. of Iodine, one
or two grains to the ounce, applied with a sort of vaginal
probang, made by attaching a small sponge to a piece of
whalebone, and swabbing out the vagina thoroughly, after
washing it out with tepid soap and water with the small
vaginal syringe, using this treatment every twelve hours.
Iod. of Ars., Kali chlo., Merc. pro., China, or Rhus, etc., are
usually the indicated remedies. The removal of the cause
should, of course, engage our earnest attention. Granulations
are more numerous after the exfoliation of the membrane
than in ordinary vaginitis, and very great care is necessary
to prevent vaginal adhesions. These must be prevented by
the introduction into the vagina of the oiled fold of cotton,
which must be frequently renewed.
PERI-VAGINITIS PHLEGMONOSA DISSECANS.
I have never seen a case of this disease, and I quote
from Ziemssen :*
"Three cases of this affection have been described; its
etiology is unknown; in Marconnett's † two cases there was
suppurative inflammation of the submucous connective tissue,
which caused the separation of the entire vagina, including
the mucous membrane and muscular layer, and the vagina
was expelled in consequence in 'the shape of a perfect tube,
*Ziemssen, Cyclopædia, Vol. X, p. 496.
† Marconnett, Virchow Archiv., b. 34, p. 1-2.
196
EATON ON DISEASES OF WOMEN.
نگار
together with the mucous layer of the vaginal portion of the
cervix. Healing followed, with suppuration.
"The case of Minkiewitsch was of a more malignant
character. In this instance also the vagina was expelled in
toto; but the patient died, and, at the autopsy, the posterior
vesical and anterior pelvic walls were found gangrenous."
*Minkiewitsch, Ibid., b. 41, p. 437.
IMPERFORATE HYMEN.
197
CHAPTER XVII.
IMPERFORATE HYMEN—ATRESIA OF THE HYMEN (CONGENITAL
AND ACQUIRED)—HÆMATOMETRA, ETC.
THE hymen in the adult female has usually an opening
large enough to admit the point of the index finger. In
some women it is smaller than this, and in a few much larger,
so that copulation, and even delivery, have been accomplished
in a few instances without its being ruptured. But occa-
sionally it has no opening, and is then termed an imperforate
hymen, or atresia of the hymen, the former term being
applicable to the case which is congenital, and the latter,
when it has resulted from inflammation.
The congenital imperforate hymen is the only variety I
can find mentioned by any author; but I have had two
cases of acquired atresia of the hymen, so that I know this
condition may exist occasionally independently of congenital
abnormal development. These two cases developing after
menstruation had become established, lead me to suspect
that some other cases, which are, of course, only discovered
at puberty, may have been acquired in girlhood.
The two cases referred to were patients of my own;
one was seen and examined by the late Dr. M. Troyer,
of Peoria, Illinois, who, after the most thorough examination
with the unobstructed eyesight, and the use of a probe, con-
firmed my diagnosis.
The other similar case no physician
examined but myself. Both had menstruated regularly, and
had been troubled with leucorrhoea and soreness. Menstrua-
tion was arrested in both cases, had at first diminished in
quantity and finally ceased. One had not menstruated for
198
EATON ON DISEASES OF WOMEN.
four months, the other for seven; both had serious symptoms
of lung disease, accompanied with poor appetite, bad diges-
tion, and considerable emaciation-one was about eighteen,
the other twenty-three years of age. The hymen in both
cases was exceedingly tough, and about as thick as sole
leather. There was a considerable accumulation of retained
menstrual flow in one case, and but very little in the other. I
operated on both cases with the result of restoring the gen-
eral health and the re-establishment of the catamenia. Both
are still healthy. One has married and has three children;
the other is well, robust, and fleshy, with no evidence of
lung trouble.
I judge from the history of these cases that inflamma-
tion of the vagina and hymen had caused a thickening of the
membrane, and granulations had gradually closed up the
openings, which probably had been small originally, and were
certainly cases of acquired imperforate hymen.
It is usual in cases of congenital imperforate hymen that
after the adult age, the menstrual flow being retained in the
vagina, causes a bulging outwards of the membrane, and
usually produces serious disturbance of the general health.
This retention of blood in the vagina and uterus is called
HÆMATOMETRA.
In these cases the menstrual secretion is discharged into
the vagina, and may, for a time, cause no very serious conse-
quences, though often causing pain in the pelvis, and a sense
of weight and tenderness. Gradually, as month after month
passes, and the flow is increased and still retained, the suffering
is greatly increased, and the general health suffers in a marked
degree. Generally Emenagogue medicines are administered by
physicians, and the mother uses all the domestic remedies
she knows of or can hear of, and the poor girl suffers on
without relief, because the cause of the amenorrhea is not
discovered.
$
HÆMATOMETRA.
199
This is a sad picture, but a true one, as the remedies often
used by the old school for amenorrhoea are powerful.
In homoeopathic practice the effects of the remedies usu-
ally given are less deleterious, but still of no avail in rem-
edying the difficulty when caused by an imperforate hymen.
In cases of this kind, combined with absence of the ova-
ries, where attempts at copulation have been made, the hymen
has been pushed up into the vagina, and has been mistaken
for atresia of the vagina, as there was no menstrual fluid to
press the hymen down.
This class of cases, however, is exceedingly small. The
physician can not suggest making even a digital examination
of girls affected with amenorrhoea, until remedies have been
given and proven inefficient; and not then, unless the age of
the patient and her sufferings point clearly to something ab-
normal in the physical development. There is delicacy, tact,
and judgment to be used in these cases. But the patient
should not be allowed to suffer and die from excessive mod-
esty and backwardness in ascertaining the true nature of the
difficulty.
Treatment.
As has been suggested in the description of this disease,
medicines are of no avail. A resort to an operation is impera-
tively demanded. It consists in making a free incision into
the hymen by first inserting a sharp-pointed bistoury, and
then inserting a grooved director, to aid in slitting the entire
membrane. Through this slit the retained menstrual secre-
tion should be freely evacuated, and the vagina thoroughly
cleansed with soap and water, followed by carbolized water;
then smear the whole of the interior of the vagina with vas-
eline, and insert a vaginal dilator of medium size, and retain
it there with a T bandage. It is usually best to operate
with the patient under an anæsthetic; but it is not always
necessary, as I have found from experience. Still I rather
prefer the patient be insensible to the pain of the operation.
200
EATON ON DISEASES OF WOMEN.
Every day, until the parts heal, it is necessary to remove
the dilator, wash out the vagina, and replace the instrument;
but if we use an open cylindrical speculum for the dilator, it
may be allowed to remain for three or four days, washing out
the vagina with carbolized, lukewarm water, through the spec-
ulum, once or twice daily.
Remedies may now be given with excellent effect, chosen.
in accordance with the totality of the symptoms. Usually
Puls., Cal. carb., Ars., or China are indicated. Nourishing
diet and fresh air are indispensable.
It is true, any number of sympathetic symptoms may
arise in such cases, hysterical and otherwise, which may be
met with indicated remedies; and we can expect that they
all will pass away upon the cure of the difficulty in the hy-
men, causing the retention of menstrual flow, which has poi-
soned the blood, from its reabsorption and decomposition.
Ramsbotham, Simpson, and Le Fort report cases terminat-
ing fatally from small puncture of the imperforate hymen,
which allowed of the admission of, air, decomposition of
the retained blood, and septicemia following. Free incision
and cleansing should be the rule, in order to prevent this
result.
UTERINE HEMORRHAGE.
201
CHAPTER XVIII.
UTERINE HEMORRHAGE.
THE term uterine hemorrhage is applied to an abnormal
and excessive loss of blood from the uterus. This includes,
of course, menorrhagia. It means menorrhagia, and more
than this, also. It may occur during the course of gestation,
or otherwise. It may occur independently of the menstrual
function caused from some irritation within the uterus from
tumors. It may supervene upon delivery. It may be caused
from ulceration. It may induce and be caused by an atonic
or anæmic condition of the system.
Hence, we see that uterine hemorrhage needs to be thor-.
oughly studied; for a clear understanding of the cause of the
hemorrhage is often of the utmost importance in regard to
the treatment of the case.
I have discussed the hemorrhage caused from uterine
tumors under that head, and excessive menstruation under
the head of menorrhagia; still there are many other condi-
tions which may cause hemorrhage from the womb, and to
these conditions I invite attention.
First, the accidental hemorrhage, occurring during gesta-
tion, caused from a partial separation of the placental attach-
ment. Sometimes this flow simulates regular menstruation,
and the patient does not imagine herself pregnant at all.
and often indignantly repels the intimation. I have seen
several cases of this kind. I will relate one case as some-
what typical.
In May, 1863, I was called to see Mrs. D., aged fifty-
three years, who had been flowing, she told me, almost daily
for five months, and that once a month the flow was exces-
202
EATON ON DISEASES OF WOMEN.
sive, accompanied with some uterine pain. This time being
one of her monthly flows, I found her apparently having
some pain in the uterus, though flowing freely. I learned
from her that the menses had about eight months before
ceased for about three months, since which time they had
been as stated. I requested a vaginal examination, which
she at first refused, thinking it quite unnecessary, but she
finally consented, and I found the os uteri open, the size of
a dime or more, and through it I could feel something pre-
senting. I tamponed the vagina and gave Secale cor. This
increased the pain, and in two hours I removed the tampon
and found a foetus half-way through the os. This I ab-
stracted, which greatly astonished the patient and her
friends. She made a rapid recovery. In several instances I
have had a similar experience with women in their first
pregnancies, and at other times.
Etiology.
After confinement, and after a miscarriage, women often
suffer from severe floodings. This may be due to the reten-
tion of a part or the whole of the placenta, or after labor to
a failure of contraction of the uterus, leaving the blood-
vessels dilated where the placenta had been detached. I
have many times been called to see patients who were flow-
ing excessively after an abortion, and their physician either
failed to realize the cause or was unable to use the means
for relief. These cases are very trying, as it is generally
the case that both patient and friends, and sometimes the
physician, insist that "all has come away." They are gen-
erally led into the error by mistaking a large clot for
the placenta.
We may lay it down as a rule that in miscarriage there
is never excessive hemorrhage after the foetus and placenta
are discharged. If active, troublesome hemorrhage super-
venes after abortion, we know something is still retained,
UTERINE HEMORRHAGE.
203
During the first few hours there may be an excessive flow
from relaxation of the muscular tissues of the uterus, and a
condition of sub-involution of the organ, these conditions
leaving the veins open and liable to bleed, as is also the case
in some instances after labor at term.
The only safety from hemorrhage lies in the full, perfect
contraction of the uterus, following the delivery of the child,
or foetus, and the placenta, or membranes. Careful attention
should be given to the complete discharge of the membranes
after abortion, as their retention in the uterus may cause
hemorrhage from the efforts of the uterus to dislodge them,
alternately contracting and relaxing. During the period
of relaxation the blood is effused into the uterus, and ex-
pelled with each contraction, until the membranes are entirely
expelled.
Hemorrhage may result from intra-uterine fibroids, uterine
polypi, granulations of the endometrium and cervix, uterine
hydatids, mucous polypi in the uterus, inflammation of the
cervix, cauliflower excrescence, and cancerous ulceration.
Most of these conditions I have spoken of under distinct
heads, and the reader is referred to them for description,
etiology, and treatment.
In some persons there is a certain predisposition to
hemorrhage, called a hemorrhagic diathesis; and there is in a
few this tendency to hemorrhage, without the outward
manifestations of any peculiarities characteristic of this dia-
thesis.
The hemorrhagic diathesis is marked by the light complex-
ion; thin, rosy skin; the lymphatic temperament; the large,
languid eye; the slow, compressible pulse; the languid man-
ner, etc. These symptoms, more or less, indicate the nerve
weakness, upon which, it is probable, the whole difficulty de-
pends. Want of tonicity or strength in the nerve, giving
rise to relaxation of the veins and capillaries, allows of the
bursting out of the blood from its natural channels by first
204
EATON ON DISEASES OF WOMEN.
allowing of distension, and, there not being power enough
in the coats of the vessels to withstand the pressure, a lacer-
ation of their coats is the result, and a hemorrhage ensues.
An extremely hyperaemic condition of the system may
largely tend to the production of this diathesis in causing
distension and consequent weakening of the blood-vessels,
and causing the nerve depression, to some extent, by the
pressure exerted upon the brain from over-fullness of the
blood-vessels there. This peculiar condition may be acquired,
or may be inherited. It is sometimes manifested through
several successive generations.
When there is in a patient this peculiar predisposition,
of course, she is liable to hemorrhage from causes which
would produce no effect in others. Recognizing this predis-
position; we may use such preventive treatment, many times,
as will prevent the occurrence of hemorrhages, which other-
wise might be severe, or even fatal. (The time will come
when the people will depend as much upon the physician to
prevent diseases as they now do to cure them.)
The causes of uterine hemorrhage, which are general in
their application, consisting of the atonic and hyperæmic con-
dition, conjoined with the lymphatic temperament, which we
have mentioned, are supplemented in uterine hemorrhage in
pregnancy by certain other causes which operate directly to
produce the hemorrhage.
First, the partial separation of the placental attachment
to the uterus is the direct cause of the hemorrhage. This
may result from straining, lifting, or fright, from a fall or
direct violence, or from the contractions of an irritable womb,
independently of these causes.
The attachment of the placenta directly over the neck of
the uterus, called placenta prævia, causes hemorrhage also; for
as the body of the uterus expands it breaks off a portion of
the attachment, and hemorrhage results (often only in small
amount, however), and is discharged per vaginam.
UTERINE HEMORRHAGE.
205
The inertia of the womb causes, in some cases, sub-involu-
tion of the organ, and may result in hemorrhages for months,
generally occurring at the menstrual periods, and properly
termed menorrhagia.
Diagnosis.
Of course, the discharge of blood per vaginam is the usual
symptom of uterine hemorrhage, being at a period uncon-
nected with menstruation, or protracting that event, and being
excessive in quantity at the regular period. If of small amount
only, when not connected with menstruation, it constitutes a
hemorrhage.
A blanched countenance, white lips, coldness of the ex-
tremities, feeble pulse, etc., are symptoms of excessive hem-
orrhage, and may or may not be accompanied with fainting
spells. When fainting comes on, the flow of blood is gen-
erally arrested temporarily.
Sometimes uterine hemorrhage may go on to a considera-
ble extent without blood being discharged per vaginam, being
retained by clots in the vagina or os uteri. This is particu-
larly the case in post partem hemorrhage; the uterus, having
failed to contract, may become distended with blood, and very
little pass from the patient, producing all the alarming symp-
toms enumerated. And occasionally this may occur after the
uterus has contracted, apparently quite well, slight hemor-
rhage at first, forming a clot at the os. As the blood contin-
ues to ooze out, the uterus relaxes, the blood-vessels open,
and the hemorrhage becomes rapid, and the patient manifests
alarming symptoms, first noticed, perhaps, by the occurrence
of a faint, and our attention is then called to the other symp-
tom of hemorrhage, and, on examination of the uterus, it is
felt distended to about the size it was before delivery.
Treatment.
The first thing to be done in uterine hemorrhage is to take
such action as will at once arrest the flow of blood. In post
206
EATON ON DISEASES OF WOMEN.
partem hemorrhage the first thing to do is to turn out the clots
in the vagina, and, if the uterus does not then contract, we
should pass the fingers within the os, and remove all the
clots from it. If this is not effectual, pass the whole hand
within the uterus, and break up the clots, and gently move.
the hand around the sides of the cavity of the womb, apply-
ing the other over the abdomen, and using gentle friction with
the extended palm. It is well at first to administer a half
ounce of brandy, with a half-teaspoonful of Flu. Ext. of Ergot
in a little warm water.
If these remedies and means fail, take a Davidson's syr-
inge, and inject into the cavity of the womb a quart or two
of very warm water, and in a half hour give another dose of
brandy, and follow it with the Secale in fifteen minutes, if
the uterus does not contract. In the most extreme cases we
may apply the Persulphate of Iron directly to the intra-uterine
surface, by means of a sponge attached to a sponge-holder,
and swab it out in that way. An evenly applied bandage
should be tightly applied about the abdomen, to give support
to the abdominal muscles, and aid in the holding of the uterus
in a state of contraction. The application of ice to the abdo-
men, and introducing pieces of it into the uterus, tends to
shock the system too severely, as well as chill the patient, and
induce inflammation. The trusting to a
The trusting to a single dose of Bell.
200*, or Ipecac. 30, which has been claimed by some to be
efficient, I have never tried, and can not recommend from
personal experience.
After the hemorrhage has ceased I have given Ipecac. 3*,
or 6 in some cases to prevent recurrence of the flooding,
apparently with good effect. China, Secale, Nux, or Ars. are
sometimes indicated. Should the hemorrhage precede the
delivery of the child, every effort should be made to deliver
as rapidly as possible. If the os is not dilated, it and the
vagina may be tamponed, which would restrain the flow till
the os is dilated so that artificial delivery can be attempted
UTERINE HEMORRHAGE.
207
and effected, while subsequent to the delivery the tampon is
inadmissible, as restraining the flow externally to the uterus.
would not prevent the hemorrhage going on actively into the
cavity of the organ, as has been before stated. While the
child is still in the uterus its presence would compress
the bleeding vessels from above, while the clot formed from
the use of the tampon below would restrain the flow and
keep it under restraint.
In cases of hemorrhage preceding and threatening abor-
tion (if excessive) we may use the tampon. (The inflatable
rubber bag, with tube and stop-cock, is the most convenient
means.) If the flow is slight I would give Secale 3* every
two hours, and order perfect rest in the recumbent posture.
following the arrest of the hemorrhage with such remedies as
seemed to be most indicated in each case.
If the foetus has been expelled and flowing is going on
severely, we must see to it that the placenta (or membranes)
is removed, whether the case is one of a few days' or five
months' duration. I have removed one where it had been
retained for seven weeks after the delivery of a foetus,
causing almost daily hemorrhages. The patient's physi-
cian (though of the most regular kind, and in excellent
standing) had failed to realize that the placenta was retained;
still at my first visit I removed it, and the patient had no
more hemorrhage and rapidly recovered. So the great length
of time a hemorrhage has continued must not prevent us
from seeking for a retained placenta, if the hemorrhage dates
from the time of the miscarriage.
To remove a placenta retained after a miscarriage. I
pass within the uterus an ordinary uterine sound considerably
curved, and gently sweep it around the cavity of the uterus,
and by this means detach that portion of the placenta which
is adherent-very often uterine contractions are induced by
this procedure. If so, very well; if they are not, I would
give about twenty drops of Flu. Ext. of Ergot in a little warm
208
EATON ON DISEASES OF WOMEN.
brandy and water, every twenty minutes till contractions
ensued, or until three or four doses have been given; some-
times the long, slender placenta forceps, or the uterine polypi
forceps, can be introduced, and greatly aid us in extracting
the placenta.

G. TIEMANN & CO
FIG. No. 20-GREENHALGHS FORCEPS.
In some cases when the blood flows freely from the
vagina, following the expulsion of a foetus, it may be best
to at once tampon the vagina and allow the blood to fill the
uterus, which, being of small size, would not endanger life,
and which, by its presence, may stimulate uterine contractions
of so strong a character as to detach the placenta and force
out both placenta and clots. Warmth is to be applied to the
feet in these cases, and the lower limbs and body should be
kept warm with covers of flannel.
In case there was a fibrous polypus in the uterus of
some size, causing the hemorrhage after abortion (which is
almost an unknown instance, as pregnancy will seldom occur
in a womb occupied with a polypus, nor will the polypus de-
velop very often, if ever, after pregnancy has occurred), we
will be likely to discover it in our exploration with the
sound, used to detect and dislodge the placenta, in which
case it is to be treated by as rapid removal as possible, on
the general plan of treatment mentioned under the head of
uterine polypi.
These cases do not suffer much from pain, and, conse-
quently, we have few pain symptoms to aid us in selecting
remedies. We must look to the pulse, the countenance, the
general system, as well as the hemorrhages themselves, for
UTERINE HEMORRHAGE.
209
1
indications for remedies. Aconite, Bell., Ipecac, Secale, Hydras-
tis, Nux, Plumb., Opi., Merc., Ars., Puls., etc., are to be
studied in these cases, and given, according to the symptoms
homoeopathic to them.
In cancerous ulceration producing hemorrhage, and in
cases of inflammation of the cervix, vegetations of the endo-
metrium, uterine tumors, etc., I refer the reader to these
special diseases.
The hemorrhagic diathesis is to be treated according to
the prominent indications in each case. Nux, Ignatia, Ars..
Bry., Rhus, etc., which act to tone up the general nervous
system, are indicated, sometimes including such remedies as
Phytolac., Cal. carb., Sulph., Can. ind., Iod., Kali iod., etc.,
with reference to the glandular system. These cases are
often troubled with epistaxis, and free hemorrhage results
from very slight wounds. In these cases we may, with
advantage, also study Trillium, Cimicif. rac., and Erigeron,
which have proven highly beneficial in a disposition to
hemorrhage, when otherwise indicated by the accompanying
symptoms.
REST AND POSITION.-The pregnant woman, attacked even
with slight hemorrhage, should at once assume the recumbent
posture, and remain quiet. The mind must not be agi-
tated by care or conversation. If the attack is severe the
patient should lie with the limbs and hips elevated, and the
head resting upon a small pillow. Do not raise up the
patient because she is faint, but lower her head and raise
the body and limbs. In connection with this care as to rest
and position, the patient should take Secale cor., 6 or 12,
every two or three hours. (The value of this remedy in
minute doses, to prevent threatened abortion and premature
labor, is now recognized by the old school also, which is a
recent concession to homoeopathy in them.) After the flow
has been arrested two or three days the patient may be
allowed to sit up a little, and very soon take gentle exer-
14
210
EATON ON Diseases of wOMEN.
cise, but no hard labor or riding over rough streets should
be allowed. Sexual congress must be strictly prohibited in
these cases.
DIET.-The diet must be as nutritious and easily digested
as possible. Stimulants are, as a rule, injurious, except in
cases of excessive floodings, when wine may be given tem-
porarily, but not continued after the urgent symptoms are
relieved. Milk, with a little salt, beef tea, soup, etc., are de-
manded to replenish the blood. The patient should be
allowed to drink cold water freely, but she is better off
without tea and coffee. Giving to the patient candies, cakes,
pies, etc., is injurious.
Let the food be plain, easily
digested, and consisting largely of farinaceous materials.
Much care needs to be exercised by the physician in regard
to diet in all the diseases of women, but it is especially
necessary in hemorrhage, as the system is drained of a large
amount of this vital fluid, and it must have resources from
which to gain a new supply.
AIR AND LIGHT.-Give the patient fresh air to breathe,
and some of God's sunlight to look at. The effect of a dark
room and stagnant air is so depressing that we do well to
avoid both.
CERVICITIS AND ENDO-CERVICITIS.
211
CHAPTER XIX.
CERVICITIS AND ENDO-CERVICITIS, OR CATARRH OF THE
CERVIX.
CERVICITIS indicates inflammation of the neck of the uterus,
affecting its entire substance. Endo-cervicitis indicates in-
flammation simply of the mucous membranes lining the cervix
uteri.
Areolar hyperplasia of the cervix may simulate, and also
be the result of, cervicitis.
Endo-metritis may or may not exist in connection with
cervicitis or endo-cervicitis.
Endo-cervicitis is one of the most frequent diseases of
young women, and in the recent acute attack is often termed
catarrh of the cervix, or catarrh of the uterus.
Virgins are more liable to this disease than any other
affecting the genital organs, and we often find it in old women
after the climacteric period is passed. We would not intimate
that middle-aged women are free from these diseases; far
from it. Endo-metritis is, however, more common with them
after they have born children. Cervicitis, on the contrary,
is seldom found in the virgin or in women after the climacteric
period, but is quite common in the child-bearing woman.
Cervicitis and endo-cervicitis may be either acute or
chronic.
Diagnosis.
The most prominent indication of the existence of these
diseases is a leucorrhoeal discharge from the vagina; and, upon
examination with the speculum, we find that the discharge is
coming from the os uteri. On attempting to introduce the
212
EATON ON DISEASES OF WOMEN.
uterine sound, we find tenderness often to so great an extent
as to forbid the completion of the examination. On intro-
ducing the sound to the fundus of the womb, we find it
normal in size, measuring, in the virgin, about two and a half
inches, and in those who have born children, about three
inches. (If we find enlargement of the size of the uterine
cavity, we may know that we have endo-metritis, intra-uterine
tumors, or a case of sub-involution.) This discharge from the
cavity of the uterus varies greatly in appearance and quan-
tity. Sometimes it is white and milky, sometimes yellow,
sometimes green, and sometimes mixed with blood. Press-
ure over the hypogastric region produces little or no pain
in cases of endo-cervicitis, uncomplicated with metritis or
other troubles. The constitutional disturbance is, however,
well marked, but is not distinctive of this disease, but consists
of those symptoms peculiar to almost any disease of the
genitourinary organs. If any thing, restlessness is more
marked than other symptoms. The patient is never satisfied
to be still, is fretful about she knows not what. This is prob-
ably occasioned by a sense of irritation, she knows not where;
but feels sure either the world, the people, or something is
all wrong.
Very often this disease is mistaken for vaginal irritation
by the physician (on account of these symptoms, and not
having made a physical examination), and, consequently, the
treatment has failed, and this is an additional cause for the
patient to feel annoyed at the continuation of the leucorrhoeal
discharge, which, it seems to her, should be at once cured
with one prescription. She will, therefore, go from one phy-
sician to another, with about the same success.
Barrenness, if she be married, is another result, which
often causes much dissatisfaction, and it is little likely that
conception will occur in a case of endo-cervicitis. Hence, if
we have barrenness with leucorrhoea, we may mistrust at
once a case of endo-cervicitis. Partial amenorrhoea, dys-
CERVICITIS AND ENDO-CERVICITIS.
213
menorrhcea, or menorrhagia may also lead us to suspect this
disease.
But the positive diagnosis rests in the specular examina-
tion, revealing the lips of the os of a bright red color inter-
nally, and the leucorrhoeal discharge coming from the os, with
the tenderness on introducing the sound, as well as the flow
of blood often produced by its introduction, however gently
it may be done.
In cervicitis there is present all these symptoms, indicat-
ing endo-cervicitis, and, in addition, enlargement and tender-
ness of the cervix, usually accompanied with some fever.
sense of weight in the pelvis, often constipation and painful
micturition. In these cases the gentle touch of the finger
causes pain if the disease be acute, and she tells us copula-
tion is extremely painful or impossible.
Etiology.
The causes of these diseases are various, and sometimes
unexplainable. Cold at the menstrual period is probably the
most frequent in the unmarried, producing a catarrhal condi-
tion of both vagina and uterus; or, in some instances, first
affecting the vaginal mucous membrane, and extending to
the uterine; in other cases, attacking the uterine cavity first.
The cold taken when the vessels of the uterus are engorged
with blood, and the mucous membrane is in a state of con-
gestion, produces, usually, an arrest of the catamenia; and
the retention of the menstrual fluid tends to produce irrita-
tion. The first condition produced is that of dryness, fol-
lowed by exudation of the serum of the blood, which, after
a time, gives place to the thick, mucous discharge. Again.
perhaps a cold is taken, the case is neglected, and we have
a fully developed case of endo-cervicitis almost immediately.
In other cases, the cause seems to be in the debilitated con-
dition of the system, aided by a very slight cold.
After miscarriage we have endo-cervicitis, resulting some-
214
EATON ON DISEASES OF WOMEN.
times from an imperfect separation of the placenta; and we
have cervicitis resulting from imperfect involution of the
uterus after confinement. Again, the careless use of the
sound; or the introduction into the cervix of instruments to
produce abortion; or the injections of irritating fluids into
the uterine cavity, either accidentally or designedly; also,
the use of cold washes into the vagina, immediately after
copulation, to prevent conception, all tend to cause endo-
cervicitis. The presence of uterine polypi, fibroids, hyda-
tids, etc., by their presence, tend to produce this disease;
but it is with special reference to the uncomplicated form
of endo-cervicitis and cervicitis that I am now speaking.
Lacerations of the cervix uteri, in confinement or other-
wise, tend directly to cause these diseases. These fissures
do not always heal readily, and cause much irritation to the
surrounding tissues. When these lacerations heal kindly,
there is left somewhat of a cicatrix, which must cause (more
or less) a tendency to irritation of the cervix, producing
cervicitis, endo-cervicitis, or areolar hyperplasia of the cervix.
Treatment.
Generally, we are not consulted in these cases till they
become chronic; or, if we are consulted in the acute attack,
we prescribe on general principles without making a vaginal
examination; hence, we may often cure acute attacks of
endo-cervicitis without being able (without examination) to
specifically diagnose the case, more than to call it inflamma-
tion of the womb, or vagina; or to call it cold, catarrh, or
something of the kind, as no lady expects to have a vaginal
examination made in ordinary acute attacks, especially if the
symptoms are not severe, which they are not, usually, in this
disease, unless the inflammation extends to the muscular
tissue, lining membrane, or peritoneal coats of the womb
also, when, of course, technically, the case should be called
metritis, endo-metritis, or peri-metritis, with endo-cervicitis.
CERVICITIS AND ENDO-CERVICITIS.
215
If we are so fortunate as to see the case in its inception,
the warm sitz bath, with warm foot bath, should at once be
prescribed, with Aconite every one, two, or three hours, ac-
cording to the urgency of the symptoms.
In the chronic form of the complaint, the remedies most
useful are Cal. carb., Sepia, Phytolac., Sulph., Merc., Kali
iod., etc.
But we find that some local treatment is sometimes nec-
essary. The introduction, daily, into the cervix of tents of
cotton, saturated with Bell. and Glycerine, equal parts, or
Hydrastis and Glycerine, or Glycerine alone, or Glycerine and
Iodine, or Solu. Iodine, using the two latter prescriptions in
cases where there was little tenderness, but much discharge.
The sea-tangle tent or even slippery-elm tent may do good
service; or we may fully dilate the cervix, so as to admit
the finger to the fundus, and then apply Solu. Iodine, five
grs. to the ounce (see Fig. No. 11, on page 150), or we may
use Hydrastis tr. and Glycerine instead. This plan has
proven efficient in my hands for years, and I propose to
write in this work mainly my own experience in treatment.
Caustic applications I must warn the reader against.
Never use them. They are unnecessary, and often very inju-
rious, producing peri-metritis, sloughing, and, in some cases,
atrophy of the uterus, as well as atresia of the cervix uteri.
The use of carbolized ointment with the sound, or Sup-
positories of Hydrastis, Bell., or other remedies, are often
highly beneficial, allowing them to remain in the cervix till
they dissolve.
The application may be made directly to the neck of
the uterus, either of Glycerine or Glycerine and Hydrastis,
equal parts, or of a solution of Iodine 1*; or we may use the
1* attenuation of Comp. tr. Iodine with camel hair pencil; or a
dossil of lint, moistened with a little of the medicine, may be
gently pressed against the os through a speculum, always
216
EATON ON DISEASES OF WOMEN.
attaching a string to the cotton to facilitate its removal.
These applications may be made daily or once in two or
three days in some instances.
The tents by their pressure seem to act beneficially in
repressing the capillary circulation in the mucous membrane
of the cervix. In case of tumors, of course, all treatment
will be simply palliative until the exciting cause is removed.
In this, as in other affections, a careful avoidance of the
exciting cause is to be strictly enjoined.
Intra-uterine injections I do not recommend, as the meth-
ods I have suggested are efficient and less hazardous. Some
physicians use them, however, satisfactorily. If any one
should desire to try them, I warn them to be extremely care-
ful of the temperature of the fluid used, as uterine cramps
are a common result of the use of intra-uterine injections of
low temperature. Caution is also necessary to use but a
small amount, and to use it with the intra-uterine syringe,
with a bulb on the tube about one and a quarter inches from
the end to prevent its entering the uterus too far, and with an
elastic air bag at the other extremity. The method of its
use is as follows: Compress the air-bag to expel all the air,
then insert the tube into the fluid we intend to inject; open
the hand and allow the bag to expand, which will, by atinos-
pheric pressure, cause the fluid to rise into the bag; then hold
the tube upwards to let any air escape that may be in the
bag; gently press the bag while the tube is elevated till the
fluid begins to be expelled from the tube; then, while still
holding the bag in the same state of compression, insert the
tube into the os up to the bulb before mentioned, when we
may compress the rubber bag gently till some of the fluid is
pressed into the uterine cavity; then open the hand and allow
the bag to expand, which will draw back a considerable
amount of the fluid into the syringe again, when it may be
withdrawn.
CERVICITIS AND ENDO-CERVICITIS.
217
RESULTS. Granulations of the cervix and in the uterine
cavity, as well as uterine polypi and sterility, are likely to
result from endo-cervicitis. The inflammation may extend to
the muscular or even peritoneal coat of the uterus. caus-
ing what is termed peri-metritis. In rare cases pregnancy
takes place, but miscarriage is likely to result.
Indications for Remedies.
Aconite is indicated in acute attacks of endo-cervicitis,
where there is present fever, with a rapid, wiry pulse, fear
of death, thirst, etc.
Ars. Alb.-Restlessness; congestion; nausea; chilliness,
alternating with heat, weakness, diarrhoea, etc.
Bell.-When the face is flushed, the patient complains
of bearing down pains, painful straining in micturition, dull
headache, etc.
Bryonia.-Worse, towards evening; sharp pains in the
pelvis, or other parts of the body; worse on motion.
Bovista.-Ill-humor; drowsiness; thick, slimy leucor-
rhoea, etc.
Cal. Carb.-Great prostration in chronic cases; leucor-
rhoea like milk; feet cold and damp.
Merc. cor.-Worse at night; prostration and dryness of
the mouth, with thirst; leucorrhoea greenish.
Phytolac. dec.-In chronic cases where there is gland-
ular enlargement in scrofulous patients.
Sepia.-Profuse milky leucorrhoea, with irritation of the
mucous membranes generally.
Sulph. The discharge from the vagina is offensive.
218
EATON ON DISEASES OF WOMEN.
CHAPTER XX.
ENDO-METRITIS.
ENDO-METRITIS indicates an inflammation of the lining
membrane of the entire uterus, and in conjunction with it
inflammation of the sub-mucous tissue of the organ gen-
erally. Endo-metritis may be acute or chronic.
It produces
a more profound impression upon the general system than
endo-cervicitis.
ENDO-METRITIS, with some metritis, is perhaps the most
common disease of women to-day. I may safely say they
come under the care of the general practitioner almost daily.
I will not say they are always recognized; on the contrary,
chronic endo-metritis is very often overlooked. It produces
so many sympathetic affections, that they are very often
mistaken for the disease, and the real ailment is lost sight of.
The inflammation may be confined to the neck of the uterus,
when it is termed endo-cervicitis, cervical metritis, or cervical
endo-metritis, to distinguish it from endo-metritis, which indi-
cates the affection of the fundus as well.
It may be impossible to diagnose a slight irritation of the
peritoneal covering, but if the irritation of this membrane is
considerable, it will extend so as to be easily diagnosed as
peri-metritis. Inflammation probably most frequently com-
mences in the mucous membrane, and extends to the sub-
mucous cellular tissue, and then to the muscular, but this is
hard to demonstrate. It may commence in the fibrous or
peritoneal tissue.
The body of the uterus is most frequently the seat of the
disease, causing engorgement of the vessels and consequent
enlargement of the entire organ. In some instances the
ENDO-METRITIS.
219
neck seems to be primarily affected, and the inflammation
then extends to the body, and, in some instances, the lining
of the fundus of the uterus is alone affected.
Diagnosis.
Very many times we have vaginitis in connection with
endo-metritis; hence, when we find vaginitis present, we
must not rest satisfied till we are sure we have not endo-
metritis, causing the vaginitis, from the irritating qualities of
the discharge from the cervix. On making a digital examina-
tion we find the os enlarged, tender, patulous, with the mu-
cous membrane covering the neck of a somewhat brighter
color than natural. Tenderness is present on attempting to
introduce the uterine sound. The sound will reveal to us
some increase in size of the uterine cavity. Sometimes this
increase of size is considerable; in other cases, slight.
HYPERTROPHY.—The hypertrophy may be general, affecting
the entire organ, or the cervix may be enlarged and the body
remain normal in size. With this enlargement of the cervix
we may have induration, the neck generally uneven, though
sometimes smooth. Rarely we have induration with an atro-
phied condition of the uterus. The term hypertrophy is not
applicable in some cases, especially where we have effusion
of fibrinous material into the submucous tissue, giving rise to
the soft, patulous feel, and which organizes after a time to
produce the hardness mentioned as induration. (See Areolar
Hyperplasia of the Uterus.)
In hypertrophy we have an enlargement of all the tissues
of the organ, similar to the condition in sub-involution. Hy-
pertrophy and induration are to be considered as results of
chronic metritis, with endo-metritis.
Though we may have enlargement, in cases of acute or
chronic metritis, the extreme tenderness of the organ, the
suddenness of the attack and the accompanying fever, wiry
pulse, etc., will clearly indicate the acute form. The sub-
220
EATON ON DISEASES OF WOMEN.
acute or chronic endo-metritis, with metritis, presents some
tenderness of the organ, but not as severe as in the acute
variety. The history of the case will also throw some light
on the diagnosis.
By introducing the index finger of one hand into the
vagina till it touches the os uteri, and then pressing the other
down on to the uterus from above in the lower hypogastric
region, we may determine the amount of tenderness in the
organ. The amount of the leucorrhoeal discharge is not an
index to the severity of the disease, as in cases which show
the most tenderness we may have little discharge, and vice
versa.
COLOR OF THE DISCHARGE.-The thick, yellow discharge.
indicates some exfoliation of the cervical mucous membrane,
unless it be in cases following after a miscarriage or labor,
indicating a suppuration or sloughing of some small portion
of retained placenta, or that the endometrium has been left
raw and suppurating; or we may have decay of a polypus,
causing this yellowish white suppuration. The thin, slimy,
mucous discharge only indicates an excess of natural secretion
of the mucous membrane, and will indicate very little trouble
in the endometrium or cervix. In the healthy condition of
the parts there should be no discharge from the vagina, except
the menstrual fluid, or, in case of excitation of the sexual
passion, when there is an increase of the vaginal mucus,
which may flow away in considerable quantities during the
continuation of the excitement.
UTERINE TENESMUS-BEARING DOWN.-The patient suffering
with endo-metritis will almost always suffer from a sense of
weight and bearing down in the pelvis, and sometimes the
pain is so intense as to simulate labor. In such cases of se-
vere pain we have reason to suspect that there is some foreign
growth in the uterus, either fibroid or polypoid, especially if
the pains are intermittent. But the sense of weight and
pressure is a common symptom of endo-metritis, in all cases.
ENDO-METRITIS.
221
This symptom is the more prominent if the patient stands
much on the feet. Standing will produce more pain, ordi-
narily, than walking, as in standing the weight of the abdom-
inal viscera rests more directly upon the uterus, and aids in
In
depressing it as well as to produce the sense of soreness.
walking, the body is thrown from side to side alternately, so
that the weight of the bowels rests more on the brim of the
pelvis, and, consequently, produces less suffering than stand-
ing. It is often the case that even a small amount of walk-
ing can not be endured; but the patient has to lie in the
recumbent posture, with the hips elevated.
It must not be thought that these cases require ordinary
treatment for prolapse or other displacements. Generally we
will detect little prolapse while the patient is in the recum-
bent position; still, while she is standing, the uterus will be
usually lower than normal in the pelvis; but this will be rec-
tified as the inflammation subsides and the engorgement and
weight are removed. The amount of pain complained of is
owing as much, or more, to tenderness as to displacement.
The pain produced in some cases seems out of all proportion
to the severity of the case as revealed by physical examina-
tion, and is to be explained in the more highly sensitive ner-
vous organizations of some women than others.
PAIN IN THE LOINS.-Pain in the loins is also a distress-
ing symptom in some cases. This is caused by the weight
of the uterus and its consequent displacement, dragging down
the ovaries, straining the broad ligaments, or from sympathetic
or continuous inflammation of the ovaries.
PAIN IN THE SACRAL OR LUMBAR REGION.-Pain in the
sacral or lumbar regions, or at the extremity of the coccyx,
is another very constant symptom of endo-metritis. The pain
is sometimes at the upper extremity of the sacrum, some-
times in the locality of its articulation with the coccyx. It
sometimes causes great discomfort in sitting. There is, in
some instances, tenderness in these regions, as well as pain,
222
EATON ON DISEASES OF WOMEN.
but in other cases great pain is complained of, with no ten-
derness on pressure.
We must remember that hemorrhoids, prolapse, or inflam-
mation of the rectum may produce pains similar to those
just described. Some writers assert that the rectal difficul-
ties usually produce more pain on the left side of the sacrum,
as well as the left natis and hip. I have not taken notice
of this being so; still, it is well to bear in mind that this
has been noted by others.
PAIN DURING MENSTRUATION.-In cases of acute endo-
metritis we will usually have pain during menstruation ;
at least, at its commencement; while in chronic endo-metritis
we usually have little severe pain, though the patient com-
plains of more soreness than usual, and the sympathetic
pains in the back, loins, and other parts of the body are
increased. In cases of endo-metritis in women who have
never born children we very often have severe dysmenor-
rhoea, owing to the formation of a false membrane, which
requires strong uterine contractions to discharge, in some
cases; in others, owing to the narrowing of the internal os
from the inflammation.
I think I may safely say there is some degree of endo-
metritis in most cases of dysmenorrhoea; so that dysmenor-
rhoea is one symptom of endo-metritis, especially in those
who have not been pregnant. These pains are of a crampy
character, and simulate colic-in fact, are often termed uter-
ine colic.
MENORRHAGIA OR HEMORRHAGE.-Increase of the menstrual
flow is common in endo-metritis in women who have been
mothers. It may be that the flow lasts too long, or comes
on between the regular periods, so as to completely confuse
the patient in her reckoning as to the regular menstrual
period. This is particularly the case when the neck of the
uterus is the seat of most of the inflammation. Sometimes
partial or complete amenorrhoea results from endo-metritis,
ENDO-METRITIS.
223
arising from the general debility induced, as well as the
induration of the endometrium from chronic inflammation.
AMENORRHEA Sometimes results from chronic endo-metritis,
I fear, from the nature of the treatment used-I mean the
use of caustics and strong intra-uterine injections. A sort
of cicatrix of the mucous membrane is produced over a
whole or a part of the intra-uterine surface, through which
the menstrual fluid can not pass, and we have amenorrhoea
as a result.
EFFECTS ON CONCEPTION.-While sterility is as likely to re-
sult from endo-metritis as it is from endo-cervicitis, pregnancy
will sometimes occur in mild cases of the disease, and, in
rare instances, progress to full term of gestation.
During the growth of the foetus, and the consequent
enlargement of the uterus to contain and nourish it, we will
have, very often, much complaint of soreness, tenderness,
and often threatened miscarriage from the irritable condition
of the uterus, producing a tendency to contract and expel
its contents; and very often premature labor results, in spite
of every precaution we may use. But, in the great majority
of cases, barrenness is a condition in these cases; but they
may occasionally become fertile after the endo-metritis is
cured.
Generally, after a miscarriage or labor, there is a great
tendency to acute inflammation; therefore, the physician
should be particularly careful to have the patient remain in
bed longer than usual, and see to it that complete involution
takes place if possible.
Mental derangements, loss of appetite, indigestion, palpi-
tation of the heart, headache, gastralgia, heartburn, etc., may
result from, and be symptomatic of, endo-metritis, as well as
other uterine diseases; but as they are not peculiar to any
special difficulty or disease of the uterus, the totality of the
symptoms must decide the diagnosis. Differential diagnosis,
as well as special, must depend upon the physical examina-
224
EATON ON DISEASES OF WOMEN.
tion mostly, in conjunction with the history of the case and
the general symptoms.
Etiology.
The causes which led to the establishment of endo-
metritis are similar to those producing endo-cervicitis. Cold
taken at the menstrual period is probably the most frequent
cause in the unmarried. Masturbation, also, is a cause of
this disease by producing an excited circulation in the parts,
by arousing the sexual passion frequently. Sub-involution.
of the uterus, in conjunction with cold, develops the disease.
An imperfectly detached placenta, abortion, means to pre-
vent pregnancy, overwork, displacements of the uterus, and
uterine tumors, all tend to cause endo-metritis. Excessive
sexual intercourse and fissures of the cervix from lacerations
may be also mentioned as causing this disease.
Prognosis.
The prognosis of endo-metritis should be guarded. The
length of time it will take to cure a given case no man can
tell. One case may progress to recovery rapidly, while
another will seem so obstinate as to discourage both patient
and physician.
Very much depends upon the attention the patient will
give to the case, and how persistent she will be in the treat-
ment; and also very much depends upon the possibility of
preventing the continuous action of any exciting cause of the
disease. Many times a few weeks of treatment suffices to
cure very bad cases, while again, it takes several months;
and in other cases we are doomed to failure. Still, I
have had a fortunate and happy experience in the cure of
this disease, which I attribute to having carefully studied
each case in respect to diagnosing it and its cause, in each
instance, together with some patience in pursuing treatment.
The physician who hurries through with his patients either
ENDO-METRITIS.
225
because he is very busy or because he desires to appear so,
need not expect to be very successful in this disease.
The engorgement of the vessels of the uterus, in this
disease, it will take time to remove, and, in case of actual
hypertrophy of the organ, we must expect to have some
enlargement remaining, after treatment; though we may get
rid of the symptoms complained of, a physical examination
will reveal in some cases that we have still some en-
largement.
In the sterile patient we can not positively promise a
cure, as so much depends on other conditions besides the
healthy condition of the uterus in securing conception. We
must remember that granulations in the cervix, vegetations
of the endometrium, fibroid tumors of the uterus, polypi,
hydatids, etc., may result from this condition, and the case
may get worse under treatment, or, rather, in spite of treat-
ment, in some few cases, which should guard us in prognosis.
I am of the opinion that the gravity of the disease is
not appreciated by the people or the profession. Patients
with this disease are often sadly neglected by the physician
and friends. A cause of this is doubtless to be found in the
fact that they are able to go about, and often do so when
enduring extreme suffering, rather than complain, partly
from a sense of modesty, and partly from pride (as most
women prefer that it should not be known that they have
any disease or weakness of the generative organs). They
accordingly suffer on, hoping that they will come all right in
time, or using such domestic remedies as they have heard
mentioned as useful. Or they call a physician, and enumer-
ate some of their symptoms, but decline to have a thorough
examination of their cases made, and they, consequently,
get poor, very poor treatment. Or they submit to examina-
tion and treatment by some of those of the Bennett faith,
who use caustics as heroically as even Dr. Byford could de-
sire, "having that nerve" which he mentions as necessary
15
226
EATON ON DISEASES OF WOMEN.
to do so "persistently and thoroughly;" and, as they find their
time, money, and patience exhausted without receiving bene-
fit, they get very much discouraged. Can we blame them?
Cases which have passed through such an experience we
can safely decline to treat; or, at least, we will do well to be
careful to promise little. But with those who have not been.
subjected to the heroic, though mistaken treatment, we may
expect rapid improvement in the majority of cases, if we use
proper treatment, and have the patience to study each case
carefully, and give it the attention it demands; and we can,
at the same time, have the co-operation of the patient.
Very much depends on her co-operation. Most patients,
with this disease, will call at the physician's office, and very
much depends upon their attention to the matter sufficiently
to accomplish a cure. They will often cease treatment when
the symptoms somewhat subside, concluding that they will
soon be well any way. Such cases will not generally recover,
but will soon be as bad as ever, if not worse; and, filled with
disgust at the failure of finding herself cured, she either neg-
lects herself till she gets very bad, or consults another doctor,
or goes off to some water cure, or goes to taking electrical
baths under the direction of some dishonest traveling mounte-
bank who advertises largely.
This, though true, is somewhat of a sad picture in the
matter of prognosis. These trials we all have, or shall meet,
and we can not well know in the commencement of the treat-
ment of any case whether it will give us much trouble or
not. I do not think these cases have a very great tendency
to recover when left to themselves. The tendency is to
increase of the difficulty instead of recovery.
Treatment.
In treatment the physician should consider that he has an
inflammation to treat; not only that, but that the inflamma-
tion is in an important organ of the body, and that this
ENDO-METRITIS.
227
organ produces, when diseased, an immense amount of sym-
pathetic irritation in various other parts of the body. He
should also bear in mind that the physician's duty is to be
cautious that in trying to cure he does not harm.
This feeling has arisen so high in some, that they depend
entirely upon remedies administered by the stomach to cure
this disease, as well as all others. Now, while the physician
should be cautious to do no harm, he is not guiltless who
leaves undone those things which he should do, and thereby
allows his patient to suffer, and perhaps die, on account of
his prejudice against means used by some, because they have
abused them. We must be brave enough to not be extrem-
ists, to use judgment in the adaptation of remedial meas-
ures, and decided and constant in their uses.
Some practitioners of both schools are in the habit of
applying Arg. nit. in solid form to the mucous surface of the
cervix and neck of the uterus, and of introducing into the
cervix and even to the fundus of the cavity of the uterus
fuming Nitric acid for the cure of this disease. They may
speak of the case as one of ulceration all they please.
condition is one of inflammation with the exfoliation of the
mucous membrane, and is, in its entirety, the disease now
under consideration.
The
With this class I can agree no better than with those
who would use no local treatment; and while I deprecate
and warn you against caustic treatment, I am in favor
of and use successfully mild, soothing treatment, as a rule,
by local application, and in some very chronic cases gentle
stimulating treatment; still great reliance is to be placed on
remedies properly selected in conjunction with this treatment
in chronic cases, and in acute cases remedies may be all that
are required.
Treatment of Acute Endo-metritis.
In case of an acute attack of endo-metritis a warm sitz
bath, together with a warm foot bath, or the full bath, may be at
228
EATON ON DISEASES OF WOMEN.
take off from
After the free
once prescribed, following the bath by free, brisk, dry rubbing
of the entire surface. Place the patient in bed, with plenty
of cover, and administer Aconite. Give it every half hour or
hour till a reasonable amount of diaphoresis is induced, then
only once in three or four hours; direct the patient to be
rubbed with a dry cloth every hour or two, to
the skin the perspiration which is thrown off.
perspiration is established, if there is much bearing down
pain, give Bell. If there is alternating heat and cold, hot
flashes, etc., without the bearing down pain, give Ars. Let
the patient drink often of moderately cold water; no tea,
coffee, or opiates. Some homoeopathic physicians seem to
lose their sense in these acute cases, and give morphia like an
allopath or an eclectic. It is not necessary. It is not scien-
tific. It is not good for the patient. Neither can we give
hypodermic injections of morphia with any more reason.
While I would prefer to simply state the treatment I
recommend and practice, I fear silence in this matter might
lead some young practitioner to the use of objectionable.
methods and means, as too much sanction has been given
these things in old school books and among some practition-
ers calling themselves homoeopathic.
The diet should be gruel or other bland, unstimulat-
ing food.
The recumbent posture should be maintained.
Following this plan, we will seldom fail, in a few days, to
entirely cure the case, unless it be one of acute inflammation,
supervening upon a chronic one, in which case we may have
remaining some chronic inflammation, which will require
a somewhat different treatment.
Treatment of Chronic Endo-metritis.
The treatment of chronic endo-metritis tests the capacity,
tact, patience, and perseverance of the physician to the ut-
The patient is usually about the house, and able to
ride or walk some, but suffers considerable pain in this exer-
most.
ENDO-METRITIS.
229
}
cise. When we get such cases a little relieved they are
very apt, by want of care or too much exercise, to cause
a relapse, or they take cold, and a severe inflammation is
aroused, and the patient feels much discouraged.
Now, with a full appreciation of the obstacles he may
expect to encounter the student will be prepared to act
decisively. He will not feel like promising a cure in two
or three weeks. It is better not to promise what we are
doubtful of performing. We thereby lose reputation in the
estimation of our patients. It is best in the commencement
of the treatment of these cases to tell the patient it will
take considerable time to cure her; but assure her that, if
she has perseverance and patience, and will try to follow
your directions, she may expect to get well. Explain to
her that the inflammation has to be subdued and the enlarge-
ment decreased before she can consider herself well. no
matter how well she may feel. If it was a chronic enlarge-
ment of the knee or thyroid gland she would expect that
it would take time to cure it. Don't deceive yourself and
the patient by asserting she is very much better or almost
Such en-
well about the second or third time you see her.
couragement is bound to end in bitter disappointment.
The first application I would ordinarily make to a case
of chronic endo-metritis is Bell. ointment, applied to the
vaginal portion of the neck of the uterus with the finger,
and, with the uterine applicator, to the internal surface of
the uterus if there was not great tenderness. If there was
much tenderness I would only pass a little of the ointment
into the cervix; or, we may use the medicated suppository.
made with Bell., afterwards using Hydrastis; or, we may
sometimes obtain great benefit from the introduction into
the uterine cavity of rolls of cotton, made in the shape of a
sponge tent, with a piece of wire to stiffen it, to which is
attached a string for its removal, having it saturated with
Glycerine, or Glycerine and Solu. Iodine, or Glycerine and Tr.
230
EATON ON DISEASES OF WOMEN.
Hydrastis, allowing them to remain twenty-four hours, and
then applying a fresh one. Generally it is best to introduce
into the vagina a ball of cotton to press against this uterine
tent and prevent its slipping. It is well to have them pre-
pared of different sizes, and to use as large a one as it is
possible to introduce, so as to make some pressure upon the
capillary circulation.
Much good is accomplished with the ordinary sponge
tent, moistened partially with Glycerine. In fact, they may
be, in some instances, more efficient than cotton, but, as they
are more expensive, and sometimes dilate the cervix more
than necessary, and press the fibers of the sponge so firmly
into the tissues of the uterus as to cause some laceration in
removing them, I do not recommend them in all cases, but
only in those where the neck is small, or in cases which are
very obstinate.
Sometimes the sea-tangle tent does very well. I would
place some Belladonna ointment on the end of the tent before
introducing it, so as to aid dilation, and tend to prevent
inflammation. In using the sponge tents, I prefer to remove
them in ten or twelve hours.
An additional advantage of the tent is that it gives us
access to the body of the uterus, and it is often for lack of
getting remedies up to the fundus that we fail. Hence the
advantage in this direction in using the sponge tent in obsti-
nate cases, as well as the double advantage I spoke of before
of compression of the capillaries of the cervix, and the ad-
vantageous application of the remedies with the uterine ap-
plicator. (See Fig. No. 68, page 715.)
In connection with this plan of treatment we may paint
the neck of the uterus with Solu. Iodine (five grs. Iod. to
the ounce of water, combined with fifteen grs. Potass. iodid.),
using a camel's-hair pencil, first wiping away all mucous secre-
tion from the cervix before making the application; or we
may apply a wad of cotton saturated with Glycerine and
ENDO-METRITIS.
231
Iodine, 1 3 of the former to 1 3 of Solu. Iod., made as before
mentioned. Vaseline should be freely applied to the vagina,
daily, in these cases, to protect the parts from acrid discharges
from the uterus, and also to keep the vagina in condition that
we may use the treatment desired for the uterus.
The patient should use, daily, vaginal injections of tepid.
water and castile-soap, to cleanse the parts and to wash out
all secretions.
At about the menstrual periods all treatment should cease
till it is over several days.
Warm, wet compresses, constantly worn over the hypo-
gastric region, are of much service if care is exercised to
cover them with dry flannel (using cotton for the compress),
and binding all tightly with a bandage to hold it on and to
maintain its warmth; for if it is allowed to be loose it will
get cold and be injurious. But, with care in its application, I
consider the water compress of great value.
Another means of great value, as I believe, is the abdom-
inal supporter, to lift the weight of the intestines off from the
uterus, and keep them from irritating it when in the erect
posture. If we could keep these patients in bed we would
have no need of the abdominal supporter; but we can not do
this; and to accomplish the holding up of the abdomen with
proper support calls for ingenuity and patience sometimes.
The support must be at the lower part of the abdomen. Any
tightness about the center of the abdomen tends to press
downwards as much as upwards, and does more harm than
good. I have recently had Messrs. Wocher & Sons, of Cin-
cinnati, make for me an improved London supporter (see
Plate XII), which answers the purpose admirably. With it
we get the lower elastic strap, lower over the hip, and get
tightness across the extreme lower portion of the abdomen.
Leaving the upper strap a little loose, we hold up the abdo-
men like the hands were applied there, trying to lift up the
bowels. By this means we often get prompt relief to many
232
EATON ON DISEASES OF WOMEN.
of the sympathetic symptoms, and we take from the womb a
source of irritation. This band should only be worn when in
the erect posture. When lying down, remove it. The silk
elastic band or supporter (see Plate XII) does well in case of
very pendulous abdomens. Without the use of some kind
of abdominal support we will be greatly hindered in our
treatment. I would not attempt to cure some of these cases
without it.
DIET. It is important to have a generous diet given these
patients that which is nourishing, but not stimulating. Beef-
tea, soft-boiled eggs, milk, soup, etc., should be used. Tea,
coffec, beer, and wine should be avoided, as well as spices and
all highly seasoned food. As a sensitive stomach and bad
digestion are some of the sympathetic affections of this dis-
ease, we need to exercise much prudence in matters of diet,
as upon the proper nourishment of the body much depends.
It is of vast importance that food be taken that can be assim-
ilated. Food difficult of digestion is worse than useless, ex-
cept in some exceptional cases, where the peculiar idiosyn-
crasies of the patient may tolerate it.
BATHING.-Some ladies bathe too much, others not enough.
Some moderation in bathing is as good as in other things.
The full bath daily, in Winter, I consider too much, though in
the heat of Summer, where one perspires very much, it may
be allowed. The bath should be tepid, not warm. After a
few moments in the bath the patient should be enveloped in a
dry sheet, and briskly rubbed by assistants till a full glow of
the surface is established. Such a bath in cool weather once
a week I consider ample. The sitz bath might be taken daily
in some cases of more than usual severity.
ATTENTION TO THE BOWELS.-The bowels should not be
allowed to remain constipated. Use enema of tepid water
and soap, and if no evacuation of fecal matter is produced,
follow the evacuation of this enema with cold water and soap
immediately, and we will produce alvine discharges with
I
ENDO-METRITIS.
233
much certainty. Attend to this each morning, with regular-
ity. The patient should have explicit directions on this point.
The regular habit is to be encouraged. It is well to
throw into the bowel a small amount of water, and let it
remain after the evacuation. Water allowed to remain in the
rectum tends to allay irritation, and the feverish condition
usually present in this class of cases.
CLOTHING.-Clothing should be worn suspended from the
shoulders, and be sufficiently loose about the waist to be
comfortable. It should be sufficient to maintain a healthy
temperature of the body. The feet and limbs should be kept
especially warm with warm clothing. Do not neglect to keep
the feet dry and warm.
SEXUAL CONGRESS.-Sexual congress better be entirely
prohibited. Failure to give these directions often may cause
the failure of treatment. Where there is any great disposi-
tion on the part of the patient to indulge in this way reme-
dies to subdue the passion better be given. This, however,
will seldom be necessary, as in most cases the act causes
pain, and is avoided if possible; but on the partial return of
health the prohibition may be necessary. I think it well for
the physician to fully explain the case to the husband at
first, and thereby obtain some aid from him in carrying out
proper treatment, as well as sanitary regulations.
MEDICATED VAGINAL INJECTIONS.-In endo-metritis I most
emphatically say, let them alone. Pure water or soap and
water to cleanse the vagina is all that is needed in the way
of a wash. A vaginal douche of warm water may sometimes
be a comfort and be proper after a walk, or extra fatigue,
causing some pain. The patient should sit over a chamber,
and sitting with the bowl of water before her, gently throw
in the warm water in as steady a stream as possible. It
will of course pass away at once into the chamber. The
steady pumping in of warm water for ten or fifteen minutes,
234
EATON ON DISEASES OF WOMEN.
sometimes allays the irritation, temporarily, at least, to a
very great extent.
CAUSTICS.—I must speak of caustics to enter my protest
against their use-I hope no student of mine will ever be
inclined to use them, more than he would venesection. Both
are recommended in some old-school books. One is as good
as the other both are, in my opinion, injurious. Blood-
letting has gone out of date, but caustics are in their glory.
Let us hope the end of their use draws nigh. I used them
over ten years, and I know whereof I speak. Many cases of
sterility, of partial and complete atresia of the cervix, atrophy
of the organ, as well as innumerable chronic cases and thou-
sands of untimely deaths, may be traced to their use, either
directly or indirectly.
I am aware I am speaking strongly, but I speak as I feel.
Those who use them are justified by abundant high authority;
but, nevertheless, I raise my humble protest.
IODINE USED WITH THE HYPODERMIC SYRINGE. In chronic
enlargement of the uterus in these cases it is sometimes
efficacious to inject into the tissues of the cervix a solu-
tion of Iodine, from two to five grains to the ounce, by
means of a syringe; some like the ordinary hypodermic. (See
Fig. No. 18, page 171.)
The speculum is an aid in its use, and the tubes are long
enough to make its use convenient. Inject at three places at
one operation; repeat in five or six days-three operations
are sufficient in some cases to produce rapid decrease in the
size of organ. Dr. J. M. Bennett,* of Liverpool, reports many
cures with this treatment after all other means had failed.
Remedies.
Perhaps no remedy is so frequently indicated as Nux.
Arsenicum, Sepia, Puls., Bell., Bry., Ars. iodid., Merc. iodid.,
* Dublin Journal of Medical Sciences.
ENDO-METRITIS.
235
Ignat., Cubebs, Canthar., China, and Sulph., are of service.
according to their special adaptability in each particular case.
Those patients of broken down constitution, with weak
nerves, require Nux, Ars., China.
If there is a tendency to glandular swellings or eruptions
of the skin, Rhus, Phytolac. dec., Ars., or Merc. cor., are
most indicated.
Where cerebral symptoms are prominent, characterized by
severe attacks of headache, Ignatia or Iris vers.
If the headache is complicated with nausea, Ars., Ipecac,
or Puls.
Where the head feels sore like a boil inside, or where we
have much tendency to stupor, Bell. or Opi.
If the pain in the head is sharp, darting, lancinating,
Ac. or Bry.
For renal complications with mucus in the urine, Can.
ind., Cal. carb., Canthar., or Cubebs.
For indurations and enlargement, Merc. iodid., Phytolac.,
Bell.
་
For leucorrhoea, Puls., Sepia, Sulph., China.
For palpitation, Dig., Ignat., Verat. viride.
Secale, Nux, or Ars., in case of debility with diarrhoea, and
a tendency to anasarca.
We should look out for displacements in these cases. Not
only the partial prolapse, but retro-flexion or ante-flexion
especially. I take it for granted that no practitioner would
overlook a case of retro-version or ante-version, as they are
readily recognized; but some cases of flexions are rather
hard to detect; in fact, I may say, impossible, except with the
aid of the uterine sound.
We will not meet with much success in the treatment of
any form of inflammation of the uterus or appendages if
flexions exist, unless we first rectify the flexion; hence, it is
well to lose no time in determining whether or not there is a
flexion in the case.
236
EATON ON DISEASES OF WOMEN.
A failure to do this is a very frequent cause of the want
of success in the treatment of these cases. I feel positive I
might relate numerous cases in illustration which have readily
yielded to treatment after the flexion was rectified, which
had been under good treatment otherwise for years by emi-
nent physicians who had overlooked the flexion.
PESSARIES.-Pessaries must be avoided in these cases, if
possible, though I would use them if I failed to rectify the
flexion or version without them. It is very seldom of late
years that I have any occasion to use a pessary in any case;
and I especially avoid them in any inflammation of the uterus.
The taking off of the weight of the bowels by means of a
suitable abdominal supporter, as before mentioned, and occa-
sionally introducing a medicated ball of cotton into the
vagina after I have placed the womb in situ, I almost always
find sufficient to obtain a permanent relief from the flexion
or version.
It is astonishing, in some instances, how quickly the
inflammation subsides and the discharge ceases when the
version or flexion is rectified. I will relate a case or two in
exemplification, though, if time permitted, I might relate
cases for days somewhat similar.
In October, 1877, Mrs. B., aged about thirty-three years,
came to me from one hundred and thirty miles in the interior
of the State. Native of Ohio; married twelve years; about
nine years since was delivered of a seven-months still-born
child; no pregnancy since. For most of the time since her
confinement, she has had a leucorrhoeal discharge, which for
three or four years has, been extremely bad smelling. Great
tenderness and soreness had been suffered for seven or eight
years, so much so as to make it almost impossible to endure
copulation; bowels constipated, some cough, general emacia-
tion, no appetite, bad digestion, some nausea, catamenia very
profuse and painful, lasting about ten days, and returning in
ten or twelve days. Life was almost a burden to her; she
ENDO-METRITIS.
237
could not perform any labor, and suffered extreme backache.
and headache.
She had been treated by five or six different physicians
of good ability with no relief, they having finally diagnosed
the case to be cancerous. On attempting to make an exam-
ination I found the vagina so tender I desisted, and applied
Bell. ointment to it three times a day for two days, when I
found I could proceed to make an examination of the uterus
without causing much pain. On introducing the finger I
found the os in its normal position, except somewhat lower
in the pelvis than is natural, hard, and enlarged to three
times the normal size. The sound revealed a retro-flexion, and
showed the uterus to measure four inches in length. I ap-
plied my abdominal supporter (see Plate XII), and con-
tinued the Bell. ointment in vagina, and prescribed Nux 3x
every three hours.
On the third day following I replaced the
uterus with Elliott's uterine elevator (see Plate XIV), patient
on knees, with hips elevated more than the shoulders. Let
her lie upon her side twenty-four hours, and allowed her to
get up and go about, still wearing the abdominal supporter
when up. Applied Solu. iodine with brush and applicator to
the cervix uteri twice a week, and continued Bell. ointment
and prescription of Nux 3, directed the vagina to be cleansed
with soap and tepid water, morning and evening, with good
nourishing diet.
Within four weeks all the discharge had ceased; very
slight tenderness remained in the fundus, none in the vagina
or neck of the uterus; copulation not painful; flesh increasing
rapidly; only very slight pain in back or head; menstruation
less profuse, and lasted but five days. Continued treatment
to reduce size of uterus for two months longer, and dis-
charged the case, she says, in perfect health. Eight months
later reported still well.
CASE SECOND.-Mrs. L., of Cincinnati, native of New
York, aged thirty-seven years, of slight build, light com-
238
EATON ON DISEASES OF WOMEN.
plexion, nervous temperament, consulted me, July 6, 1878.
Found retro-flexion of uterus, with endo-metritis. She com-
plained of partial loss of eyesight in both eyes. (She had
consulted Prof. Wilson, a celebrated oculist of this city, now
of Ann Arbor, Michigan, who had diagnosed the cause of her
trouble to be reflex nerve irritation from uterine disease, and
had sent her to me for treatment.) She stated that the eyes
had been troubling her for over three years, being unable to
read or sew. The eye looked well, except weak, with a sort
of stare.
Her history was a sad one of having been treated almost
constantly for twelve years, during three of which she had
had the constant care of Prof. Sims, of New York City, whom
she considered the most eminent gynaecologist in America.
He had used tents, scarification, etc.; others had used caustics
ad infinitum. Still she got no better. Her menstruation had
never been free, pain in her back and head was constant, dys-
pepsia her constant trouble. She had tried hygienic and
water-cure treatment, was troubled much with leucorrhoea and
constipation, great aversion to sexual connection, which was
very painful, her husband informed me.
I commenced the treatment of this case with much dis-
trust of my ability to relieve her. Her long illness, inca-
pacitating her for any exercise without severe pain, taken in
connection with the eminent skill she had employed, was
certainly unpromising; but I concluded to make an attempt.
I at once applied my abdominal supporter (London), and
replaced the retroflexed uterus, gave Sepia, Nux, and China
singly, a few days each, then only Can. ind. till she was well
(six months from commencement of treatment).
I never had to replace the uterus again. It remained all
right. The leucorrhoea ceased, the tenderness left, her diges-
tion became good, her bowels regular, her menses more pro-
fuse, lasting three days; her eyesight became stronger, so
that in November she worked a beautiful pair of slippers, and
ENDO-METRITIS.
239
gave me, besides paying me a good fee in cash. Now, about
two years since I commenced treatment, she is still well,
reads, sews, and walks as far as any lady. I have not treated
her any for about eighteen months. She is rosy-looking and
gaining flesh; her menstruation comes with regularity and
quite freely. She has sent me many patients the past six
months, including two from New York City, who have just
arrived (old friends of hers in New York).
I relate these cases from my note-book informally, to im-
press the student with the importance of correct diagnosis as
to the cause of the disease as well as its nomenclature. It is
much better to make a mistake in naming a disease than in
discovering its pathology and etiology. These ladies, who are
now in health, might doubtless have been more easily restored
years before, and saved years of suffering, had their ailment
been correctly diagnosed. In both cases their sympathetic
symptoms had been mistaken for the real disease by several
physicians.
240
EATON ON DISseases of womEN.
瑞
​CHAPTER XXI.
LEUCORRHEA WHITES.
THIS term signifies an unnatural discharge other than
blood from the female genital organs.
It is not a disease in
itself, but really a symptom only of inflammatory action in
the vagina, or uterus. In the healthy woman there is a
mucous secretion in the vagina, for the lubrication of the
parts, which is oily in its nature; but in disease we have
various discharges, differing in appearance and consistency,
which are termed leucorrhoeal. Patients complain of a
leucorrhoeal discharge, and the physician may often prescribe
for it, without explanation of its true nature.
The term "whites" is sometimes used to designate this
complaint. It may affect girls or women of any age; even
infants are sometimes affected with it. It is sometimes easily
cured, and again it is very obstinate, owing to the various
causes upon which it is dependent.
The discharge may be thin or thick, and white or yellow.
The yellow discharge indicates the uterine origin of the dif-
ficulty. The white and watery discharge comes from the
vaginal mucous membrane. It may be catarrhal in its nature,
and affect at once the lining membrane of the vagina, cervix
and endometrium simultaneously, in which case we have a
varied appearance of the discharge, sometimes thick, some-
times thin, again some yellow matter mixed with the thin
white discharge, and so on.
Diagnosis.
It is not difficult to diagnose that we have or have not
leucorrhoea, but it is not always so easy to make out its
1
LEUCORRHEA-WHITES.
241
cause.
It is true, it must be from the irritation in the vagina
or uterus; but the cause of this irritation is the thing to
find out.
Ordinarily we will take the patient's description of the
discharge and her symptoms to guide us in the selection of
remedies; but in case we are not soon successful in curing
it, we will do well to investigate carefully for ourselves as
to the cause of the ailment. These causes need not be
enumerated here, as the student may turn to the chapters
on endo-cervicitis, endo-metritis, vaginitis, and metritis, and
read the causes there enumerated. Hence diagnosis and eti-
ology go hand in hand in this difficulty. The patient says
she has whites or leucorrhoea. Your next thought should
be, What causes it?
The success in treatment will largely be dependent upon
close discrimination as to its nature and etiology. It must
be borne in mind that the inflammation may be chronic, or
sub-acute. It may be so mild as to be scarcely recognized
as an inflammation at all-being confined mostly to the glan-
dular structure of the vagina, which may pour out an abundant
discharge, though there may be no tenderness or heat observ-
able in the parts. In these cases the vagina will be found
loose and flabby.
The yellow leucorrhoea indicates exfoliation of the epith-
elial layer of mucous membrane, from some preceding active
inflammation, and that pus is being secreted on this denuded
surface; and this condition may be expected to be found
either upon the cervix or in the interior of the uterus. The
white albuminous discharge from the os is simply an excess
of natural secretion in the uterus, showing some undue con-
gestion of the endometrium, but may pass away without
treatment in a very short time. The discharge of a large
amount of pus at one gush, of course, will indicate the for-
mation and rupture of an abscess.
16
242
EATON ON DISEASES OF WOMEN.
Treatment.
Some recent catarrhal cases will be speedily cured with
Aconite, followed in three or four days with Sepia; and if this
is not sufficient give Cal. carb., frequently bathe the parts
with castile-soap and water. Hip-baths are also of service.
As the discharge tends to debility, a good nourishing diet is
necessary. If the patient is very much prostrated from
chronic leucorrhoea, China, Ars., Merc., Nux, or Puls. may be
indicated. After the vagina and labia are well cleansed, it is
well to smear the parts with Vaseline, and, in case of children
and infants, place a soft cotton cloth, smeared with Vaseline,
between the labia, to prevent adhesions, and, in some in-
stances, it is well to gently press a small bit of the cloth, so
oiled, up into the vagina, to prevent occlusion.
Astringent washes are not needed. Sometimes the local
application of a little Glycerine and Hydrastis is, however,
beneficial. In the form I mentioned as being characterized
by the relaxed, flabby condition of the vagina, the stimulating
effect of dilute Citrine ointment, applied to the vagina once a
day, may aid us in making a rapid cure. Try to remove the
exciting cause of the difficulty. Never rest satisfied without
doing this, if you can ascertain what it is.
There is in some cases of suppression of the catamenia a
leucorrhoeal discharge which seems to take the place of the
regular menses, lasting about as long, or a little longer, than
the menses usually did. This form of discharge is not really
leucorrhoeal, but a conservator of health. It is really a per-
verted or incomplete menstruation, and calls for Puls., Macro-
tis, Cocculus, etc., not to suppress it, but to cause the more
free flow, which would probably be healthy menstrual fluid.
So we are constantly reminded of the need of taking into
account the whole of any given case, and not let one symptom
obscure our vision in regard to others, or the conditions pro-
ducing them.
LEUCORRHOEA-WHITES.
243
Remedies in Leucorrhoea, with Special Indications for their Use.
In addition to Aconite, Sepia, Cal. carb., China, Ars., Merc..
Nux, Puls., etc., which I have named, the following remedies
are of service in some cases of leucorrhoea, given when indi-
cated by the totality of the symptoms, which should be care-
fully studied in works on therapeutics. The leucorrhoea may
be kept up by reason of diseases somewhat remote from the
vagina, and, consequently, there may be indications for reme-
dies ordinarily only demanded in other diseases. These rem-
edies are Bovista, Graphites, Kreosotum, Conium, Muriat. acid,
Nit. ac., Platina, Macrotin, Podophyllum, Lyc., Sulph., Carbo
veg., Phos., Zinc, Canthar., Bryonia, Sabina, Sil., Senega, Stann.,
Ferrum, Can. ind., Thuja, Hepar, etc.
*
Dr. Leadamn gives, in ACUTE LEUCORRHOEA, Acon., Amm. c.,
Borax, Cal. c., Carb. v., Con., Kali c., Phos., Puls., Plat., Sab.,
Sep., Sulph. ac.
IN CHRONIC LEUCORRHOEA.- Alum, Amm. c., Ars., Carb. a..
Carb. v., Caust., Canth., China, Cham., Con., Ign., Kali e..
Kreos., Lach., Lyc., Merc., Mez., Mag. c., Nat. m., Nit. ac.,
Phos., Puls., Ruta, Sil., Sulph., Sulph. ac.. Stan., Zinc.
WHEN THE DISCHARGE IS FETID.-China, Kreos., Nat. m.,
Nit. ac., Nux v., Sabina, Sep.
FOR YELLOW LEUCORRHOEA.- Aconite, Alum.. Ars., Bov..
Carb. an., Carb. v., Cham., Kali, Kreos., Lac., Natr. m., Nux
v., Phos. ac., Subina, Sep., Sulph.
FOR BROWN LEUCORRHOEA.Ammon. mur., Nit. ac.
FOR GREEN LEUCORRHOEA.-Bov., Carb. v., Merc., Puls., Sep.
FOR WATERY LEUCORRHEA.-Amm., Ant. eru., Ant. tart..
Carb. an., Carb. v., Cham., Chin., Graph., Kreos., Mag., Merc.,
Mez., Nitr. ac., Puls., Sep., Sil., Sulph.
FOR THICK LEUCORRHOEA.-Ambr., Ars., Carb. veg., Magn.
m., Natr. m., Puls., Sabina, Sepia, Zinc.
FOR MILKY LEUCORRHEA.-Amm., Calc., Carb. veg., Can.,
* "Diseases of Women," pp. 46, 47.
244
EATON ON DISEASES OF WOMEN.
'
Ferrum, Graph., Kreos., Lyc., Nat. mur., Phos., Puls., Sabina,
Sep., Sil., Sulph., Sulph. ac.
FOR BLOODY LEUCORRHEA.-Alum., Ars., Canth., Carb. veg.,
China, Cocc., Con., Lyc., Sep., Sil., Sulph. ac.
FOR MUCOUS LEUCORRHEA.-Alum., Ambr., Amm. m., Ars.,
Bell., Bor., Bov., Bry., Calc., Canth., Carb. an., Carb. v., Cocc.,
Con., Ferr., Graph., Guiac., Kreos., Magn., Merc., Mezer., Natr.
m., Nitr., Nitr. ac., N. vom., Petr., Phos., Plumb., Puls., Sabina,
Sass., Seneg., Sep., Stann., Sulph., Sulph. ac., Thuja, Zinc.
FOR LEUCORRHOEA WITH BURNING.-Amm., Ars., Bor., Calc.,
Canth., Carb. an., Con., Kali, Kreos., Puls., Sulph. ac.
FOR LEUCORRHOEA WITH ITCHING.-Alum., Anac., Ars., Calc.,
Chin., Ferr., Kali, Kreos., Merc., Phos. ac., Sabina, Sep.
FOR CORROSIVE LEUCORRHEA.-Alum., Amm., Ant. c., Ars.,
Bov., Calc., Cann., Canth., Curb. an., Carb. v., Cham., China,
Con., Ferr. Hep., Ign., Iod., Kali, Kreos., Lyc., Magn., Magn.
m., Merc., Mez., Natr. m., Nitr. ac., Phosph., Ph. ac., Puls.,
Ranun. bulb., Ruta, Sep., Sil., Sulph., Sulph. ac., Thuja.
Aconite is indicated when leucorrhoea is complicated with
great timidity, especially after a fright; fear of approaching
death; inconsolable anxiety; predicts the day of death;
excessive restlessness; vertigo, with nausea and vanishing of
sight; burning headache, as if the brain were agitated by
boiling water; scalp sensitive to the touch.
Ars. Alb.—“The leading feature of this remedy is the
nervous restlessness, with rapid emaciation and thirst;" is
sad and tearful; head confused, dizzy, stupefied; face has a
cachectic look; sunken; covered with cold sweat; is expres-
sive of great mental agony; drinks often, but little at a time:
loathing of food; leucorrhoea profuse, yellow, thick, corroding
Cal. Carb.-Rush of blood to the head; leucorrhoea like
milk; ravenous hunger or complete loss of appetite; feet feel
cold and damp; great weariness; not able to walk; profuse
sweat on slightest exertion; sweating of the palms of the
hands.
LEUCORRHOEA-WHITES.
245
China. The key-note symptoms of this remedy are pros-
tration, with neither thirst nor hunger; ringing in the ears ;
taste flat, insipid, slimy, and bitter; leucorrhoea, instead of or
before menses, with spasmodic uterine contractions, is very
sensitive to pain and to draughts of air.
Mercurius.—The chief characteristics of this remedy are
an aggravation of all the symptoms at night, and from the
warmth of the bed; weakness of memory; answers ques-
tions slowly; intolerance of sunlight; aphthæ in the mouth;
painful dryness of the throat, with mouth full of saliva; ex-
tremely violent thirst; leucorrhoea greenish, with smarting,
itching, burning after scratching.
Nux Vom.-Can not think correctly; stupefaction; ver-
tigo after dinner; taste sour; vomiting of sour mucus; hun-
ger, with aversion to food, especially bread; constipation, with
frequent and ineffectual desire for stool and sensation of con-
striction in rectum.
Pulsatilla.-Mild, gentle, timid, yielding disposition, with
inclination to weep; out of sorts with every thing; fretful; ver-
tigo, must lie down; paleness of the face; accumulation of
sweet saliva in the mouth; absence of thirst; leucorrhoea
thick like cream, with swollen vulva; dry cough at night;.
shortness of breath; anxiety and palpitation when lying on
the left side.
Sepia.-Great apathy; indifference to every thing, even
to one's own family; indolent mood; face pale; yellow leu-
corrhoea, excoriating, like pus.
Bovista.-Leucorrhoea, after menstruation, while walking,
thick, slimy, tenacious, like white of egg; with drowsiness;
with anxious dreams; ill-humored.
Graphites.-Leucorrhoea comes in gushes, is very pro-
fuse, and sometimes excoriating; appears day or night; taste
like rotten eggs in the morning; painful, sore nipples.
Bryonia.—The symptoms are worse towards night,
after waking, after a meal, from motion and contact ;
246
EATON ON DISEASES OF WOMEN.
better during rest; with anxiety, discouragement; with leu-
corrhoea.
Conium.-Violent leucorrhoea, with hoarseness, cough,
and expectoration; weakness and pain in small of back, with
labor-like pains from both sides of abdomen; symptoms worse
during rest.
Cantharides.-Violent itching in the vagina; pressing
towards the genital organs; pale face, with wretched, sickly
appearance; stinging over the whole body; painful mictu-
rition.
Cannabis Ind.-Leucorrhoea, complicated with frequent
micturition; mucus in urine when cool; threatened abortion ;
dizziness of vision; excessive sexual passion, etc.
Carbo Veg.-Leucorrhoea, with great weakness; flatus in
the abdomen; slimy diarrhoea, with hemorrhoids; itching of
the vulva.
Macrotin.-Leucorrhoea, with neuralgic or rheumatic
dysmenorrhoea; insomnia, with nausea; pain in the eye-ball
and top of head, pressing upwards and outwards.
Ferrum.-Leucorrhoea, with menorrhagia; flushed face;
anæmia, with pale face; palpitation, etc.; vomiting at mid-
night; great weakness; leucorrhoea corrodes the parts; itch-
ing in the vulva.
Hepar Sulph.-Leucorrhoea in scrofulous patients; fall-
ing out of the hair; useful after the abuse of Mercury.
Lycopodium Clavatum.-Leucorrhoea, with constipa-
tion; red sand in the urine; terrific pain in the back; pains
in the pelvis from the right to the left side, worse at four
P. M.; sharp pains in the labia; one foot cold, the other hot;
sallow color of the skin.
Kreosotum.-Leucorrhoea, putrid, acrid, or corrosive in
character; very offensive odor; cancer of uterus; burning in
the vagina; menses too profuse; deafness during menstrua-
tion; oedema of the feet, with constipation.
Muriat. Ac.-Leucorrhoea, with uterine ulceration; great
LEUCORRHŒA—WHITES.
247
weakness; dryness of the mouth; watery diarrhoea, with
hemorrhoids.
Nitric Acid. —Leucorrhoea, with secondary syphilitic
affections; applicable to cases where too much Mercury has
been used; torpid action of the liver; cases complicated with
prolapsus ani, with smarting, burning pain in the rectum;
urine has a very offensive odor; especially adapted to patients
with dark complexion, black hair and eyes.
Phosphorus.-Leucorrhoea in patients with fair skin,
sanguine temperament; sensation of weakness in the abdo-
men; profuse menstruation; leucorrhoea is acrid.
Platina.-Leucorrhoea, with uterine hemorrhage; bearing-
down pain in pelvis; leucorrhoea occurs only in the daytime;
induration of the cervix uteri; burning pain in the ovaries;
hysterical symptoms, or spasms; feeling of numbness over
the whole body; palpitation of heart, etc.
Podophyllum.-Leucorrhoea, with nausea and giddiness;
bitter taste in the mouth; dark urine.
Sabina.—Leucorrhoea, with profuse painful menstruation ;
strangury; the leucorrhoea is thin, and has an offensive odor;
tendency to abort about the third month; bloody urine; irri-
table temper, etc.
Silicea.-Leucorrhoea, with constipation; colorless men-
strual flow, complicated with induration of the lymphatic
glands in any part of the body; has bad dreams; adapted to
scrofulous constitutions; dizziness, with disposition to fall
forwards.
Stannum.-Leucorrhoea, with great weakness of the
limbs; insatiable hunger; great weakness is the key-note
symptom of this remedy.
Senega. Leucorrhoea, complicated with chronic bron-
chitis.
Sulphur.- Leucorrhoea, with voluptuous itching; the
discharge is offensive and corrosive.
Thuja. Leucorrhoea, with syphilitic contamination; con-
248
EATON ON DISEASES OF WOMEN.
dylomata on the genital organs; burning in the urethra;
headache on left side; can not sleep at night; burning pain
in left ovary.
Verat. Alb.-Leucorrhoea, with violent, copious diarrhoea,
nausea, etc.
Verat. Vir.-Leucorrhoea, with congestive conditions;
pupils dilated; mouth and lips dry; cases complicated with
pneumonitis.
Zinc.-Leucorrhoea, with excessive sexual desire; pain in
left ovary; patient walks in her sleep; constipation, etc.
BARRENNESS AND STERILITY.
249
CHAPTER XXII.
BARRENNESS AND STERILITY.
THE term "barren" should be applied to those cases
which are unfruitful (do not bear children) on account of
some abnormal and incurable development of the female gen-
erative organs, or through the action of disease that is present,
causing a condition which makes it impossible for conception
ever to take place; while the term "sterile" should be ap-
plied to those cases which are unfruitful on account of some
functional derangement of normally developed organs, or on
account of some deformity or displacement which can be
remedied, or on account of some want of sexual affinity with
the husband.
These distinctions are, however, not usually made by the
profession, and the terms "barren" and "sterile" are commonly
used as synonymous. I think it wise, however, to make a
distinction in the terms, for the reason that, when used in a
limited sense, either term conveys to the mind the condi-
tion present, to some extent, as understood by the writer
or speaker. When using the term "barren" he would
convey the idea that the patient was hopelessly unfruitful,
while if he used the term "sterile" he would indicate that
although childless, he considered the patient physically
capable of bearing children, after being subjected to proper
treatment.
It is often of vast importance that sterility should be
cured, so that barrenness does not result. This is the case
in families where property is entailed, as well as for the hap-
piness of those who desire offspring.
The physician is often consulted regarding patients who
250
EATON ON DISEASES OF WOMEN.
have thus far been childless, or have become sterile after
having conceived once or twice. It becomes us, therefore, to
give no hasty opinion, or treat the case as of little moment, for
the possibility or impossibility of being able to bear children
may be, to our patient, of the greatest importance.
Before pronouncing a patient barren, it is our duty to
thoroughly investigate the case, and ascertain if there be any
functional derangement, or abnormal development, which we
might be able to rectify by remedies or operation. In order
to be able to make a correct diagnosis, the physiology, as
well as the anatomy, of the female genitalia must be well
understood. The process of healthy ovulation-the normal
condition of the fallopian tubes, uterus, and vagina-must be
comprehended, and the influence of the mind and nervous
system upon copulation and conception must be noted, or we
may fail to correctly diagnose and treat the case, thereby
leaving the patient hopelessly barren, who might be only
sterile had we properly understood the case and used proper
treatment.
The student should thoroughly study the female organs of
generation in the dissecting room, as well as from works on
anatomy and physiology. Greater facility of diagnosis must
come from the frequent examination of women in active
practice.
I do not deem it necessary here to enter into detail
regarding the anatomy and physiology of the ovaries, uterus,
and vagina. They may be learned from the means and
books referred to. (It is to be understood that we are pre-
suming that the patient is married, and that healthy sperma-
tozoa in healthy semen is properly deposited in the vagina by
the male.)
Sterility or barrenness may be congenital, or acquired.
A woman may bear a child, and from the development of
disease subsequently may become sterile, or even hopelessly
barren.
BARRENNESS AND STERILITY.
251
Etiology.
First, the causes which produce barrenness are absence of
or incurable abnormal development of the ovaries, fallopian
tubes, uterus or vagina; false membrane covering the ovaries, as
a result of cellulitis, ovaritis, or peritonitis; the presence of
double ovarian tumors, very large intra-mural fibroids of the
uterus, and cancerous or tubercular disease of the ovaries or
uterus. These conditions must necessarily entail barrenness
or hopeless and incurable unfruitfulness. When the patient.
is found suffering from either of these conditions or ailments,
we can decide the case barren. She may prove to be barren
when at first she presents only the symptoms indicating ster-
ility. If she prove incurable of those ailments ordinarily
producing sterility she then, of course, is "barren."
Sterility may result from atresia of the vagina or cervix
uteri, imperforate hymen, flexions of the uterus, extreme ver-
sions (posterior, anterior, or lateral), elongation of the cervix
uteri, endo-cervicitis, endo-metritis, inversion of the uterus or
complete procidentia, vaginitis, vaginismus, excessive alka-
linity of the uterine secretions, excessive acidity of the
vaginal mucus, uterine hemorrhage or polypi, imperfect nutri-
tion of the uterine organs, causing atrophy or arrest of func-
tion. This latter condition is most frequently found in those
who have married late in life, or have exhausted their nerve.
strength by hard and excessive study or labor, with want of
proper physical exercise and suitable food. The laceration
of the perineum in labor, or from other accidents, may render
the women sterile or barren, even if there is a failure to
restore it by operation. Incompatibility between husband
and wife may be a cause of sterility, but not of barrenness,
for the impossibility of impregnation would disappear if the
patient should marry to a congenial companion.
It is self-evident that the causes which I have enumer
ated as producing barrenness are incurable, and hence the
252
EATON ON DISEASES OF WOMEN.
woman so affected is permanently unfruitful, and may be
termed "barren."
Regarding those causes which produce sterility, I may
remark, somewhat in detail, that so far as possible the stu-
dent may comprehend why it is that these causes produce
sterility. It is evident that in the case of imperforate hy-
men, atresia of the vagina, or uterus, the semen can not be
introduced into the cavity of the uterus; consequently, no
impregnation can result, unless by surgical interference these
deformities are remedied, after which impregnation and ges-
tation may go on normally.
Flexions of the uterus are often the cause of sterility by
narrowing the canal of the cervix at the point of greatest
flexure; besides, in the patient affected with flexion of the
uterus the retention of the menstrual secretion caused by the
flexion produces a diseased condition of the lining membrane
of the uterus, and may affect it to the extent of making
conception impossible, even after the flexion has been cured.
The abrupt flexure of the organ, either in its cervical portion
or at the juncture of the cervix and body, is almost certain
to cause sterility, while the moderate curvature of the organ
may not do so.
The proportion of married women who have flexions and
are sterile, according to Emmett, is 54.76 per cent; the un-
married were 25.80 per cent-making a total of 80.56 per
cent of all women afflicted with flexures in any part of the
uterus, who were either unmarried or sterile, leaving only
19.44 per cent who were fruitful at all. He does not say
whether any became fruitful after the flexure was treated,
or whether the flexure had taken place after gestation.
These statistics he gives from three hundred and forty-five
cases coming under observation. This, I think, accords with
my own experience, and, so far as I can learn from books and
otherwise, is about the experience of others.
* Emmet's "Prin. and Prac. of Gynecology."
BARRENNESS AND STERILITY.
253
Of the whole number of fruitful women who had flexions
10.44 had flexions of the cervix, and 89.56 per cent of the
body of the uterus; forty-three of the three hundred and
forty-five cases were lateral flexions, out of which number
twelve were fruitful (six were unmarried.) Of married
women affected with flexions of the cervix 94.16 were sterile.
Dr. Emmet thinks that in the very few instances where this
class of women were supposed to have become impregnated,
that there was a mistake in diagnosis, and that future obser-
vations will demonstrate that flexions of the cervix are a
sure prevention to conception, and are to be accepted as
proof that impregnation had never taken place. (He does
not, however, claim that conception is impossible after the
flexion is cured.)
The conclusion to which we must come, from all sources.
of information, is, that all forms of flexion of the uterus are
liable to cause sterility, that flexions in the body of the uterus
cause sterility much less frequently than flexions of the cervix.
Versions of the uterus tend to cause sterility by causing
the os uteri to ascend and lie transversely in the pelvis, and,
consequently, the os is obstructed by the vaginal membrane
on the side to which it is inclined.
About 57 per cent of those women who have ante-version
and about 87 per cent of those with retro-version are sterile.
Lateral versions, not usually being so complete as retro-version,
cause sterility in only 50 per cent of those affected with the
displacement.
Elongation of the cervix causes sterility, by making it
difficult for the spermatozoa to enter the os, on account of
the distance it projects into the vagina, and the depth of the
vaginal cul-de-sac around it. The per cent of those sterile
who have this deformity is not less than 90.
Endo-cervicitis and endo-metritis cause sterility in several
ways First, by the irritable condition they induce, prevent-
ing the entrance of the spermatozoa or the attachment of the
254
EATON ON DISEASES OF WOMEN.
impregnated ovum. They also may cause sterility from the
hemorrhage they produce and the unhealthy secretions they
develop.
Vaginitis may cause sterility, from the intense acidity of
the vaginal secretions and the tendency which there is in
these cases to expel the semen suddenly from the vagina
before it can enter the os uteri. Vaginitis also causes dyspa-
reunia, which prevents the development of the sexual orgasm
so favorable to conception.
Vaginismus causes sterility, by either preventing copula-
tion in toto or stopping the sexual orgasm.
Excessive alkalinity of the uterine secretions, or excessive
acidity of the vaginal mucus, may destroy the vitality of
the spermatozoa, and hence cause sterility.
Uterine hemorrhage, from whatever cause, is likely to cause
sterility, by preventing the entrance of the spermatozoa into
the uterus, or washing it away, if it gain admittance.
Uterine polypi, or hydatids, vegetations of the endometrium,
etc., cause sterility, by blocking up the cavity of the uterine
canal, and by causing hemorrhage, which, as well as unhealthy
secretions, prevent the fructification of the ovum.
Deficient nutrition of the ovaries may cause a failure of
maturity of the ovum, and hence cause sterility.
That incompatibility between the wife and the husband
may cause sterility is probable by instances which I have
observed, and heard of, where parties have not had children,
and where both parties became parents after being divorced
and married to other companions. This proof is, however,
not positive, as the lady may have been suffering from some
disease while married to the first man, and might have become
healthy afterwards; or she might have used preventive meas-
ures with the first, and not with the second husband; or the
husband might have been at fault by reason of disease, of
which he might have become afterwards cured. The proof is
presumptive, however, as it is probable that, in those cases
BARRENNESS AND STERILITY.
255
where there is an aversion to each other, there will be little
sexual passion felt or manifested, and there is, consequently,
a great tendency to unfruitfulness.
The atony and atrophy in those educated and refined
ladies who marry late in life prove a cause of sterility, not
only from loss of sexual passion, but from loss of nutrition
of the parts. There are, however, exceptions in this class of
women; but it is usual that, with women of large mental
development, the physical strength declines, not only sex-
ually, but otherwise as well, especially when they live a life
of celibacy till thirty years of age. This, at least, is my
observation.
Excessive venery is also a cause of sterility, by inducing
inflammation of the ovaries, uterus, and vagina. Some sterile
women are excessively passionate, and it is sometimes pre-
sumable that excessive amativeness may be a cause of sterility;
or it is possible that the irritation of the ovaries causes the
excessive passion and the sterility, so that they both have
similar causes, instead of the one being produced by the
other. Hemorrhage from the bowels, hemorrhoids, and rectal
fissure may be indirect causes of sterility.
Diagnosis.
The diagnosis in cases of those who are unfruitful is for
the purpose of determining the cause of the failure of impreg-
nation. The fact of unfruitfulness is patent to every one.
The diagnosis of the cause which produces the unfruitful-
ness is of importance to determine whether or not measures
and remedies are advisable, or whether the case is hopelessly
barren. Upon the correct diagnosis of the cause of the
sterility much depends.
The diagnosis of flexions and versions of the uterus, vag-
inismus, vaginitis, endo-metritis, endo-cervicitis, uterine hemor-
rhage, polypi, etc., may be read under their proper heads.
The unhealthy secretions are usually caused from inflamma-
256
EATON ON DISEASES OF WOMEN.
tion in some part; but they may serve as an index to the
treatment required. Ordinary test paper may be used to
determine the excessive acidity of the vaginal secretions,
which will be indicated by the turning of the blue paper to a
bright red when placed in the vagina. If only a
If only a slight pink-
ish tint is given to the blue paper, it is indicative of a normal
condition. The uterine secretion may be received upon the
lower blade of a bivalve speculum, and the test applied.
it change red test paper to a blue, this indicates that the
secretion of the uterus is excessively alkaline. If the effect
is simply to blanch the red paper, the secretion is not excess-
ively alkaline.
If
It will be found in practice that flexions or versions are
the most frequent cause of sterility; but in case there is no
flexion or version found, the cause must be looked for in
other conditions I have mentioned. And I may further
remark that an abnormally small os uteri, or narrow cervical
canal, may be a cause of sterility, and, of course, is to be
diagnosed by the effort to introduce the uterine sound and
finding it impossible. Scanzoni denies that the very small
os uteri may be a cause of sterility, as he has seen concep-
tion take place when the os was no larger than a millet seed,
and so have others; but these are exceptional cases, and as
a rule those patients are sterile, and will become fruitful
when the os and cervix are dilated. I think the contracted
os is in many cases found after impregnation, when it nat-
urally contracts, and may have been much larger before
impregnation took place. If, in attempting to diagnose the
causes which produce sterility in a given case, we find the
os very small, we shall not go far astray by deciding this to
be at least one cause of the unfruitfulness.
Some authors mention leucorrhoea and obstructive dys-
menorrhoea as causes of sterility, but they are only symp-
toms of the inflammation and displacements I have men-
tioned.
BARRENNESS AND STERILITY.
257
Treatment.
In looking over the great number of causes which may
produce sterility, we must be impressed with the great variety
of treatment required in different cases to afford relief. The
treatment must be adapted to the removal of causes present
in the particular case before us; and unless we find incurable
deformity or disease, we should proceed upon the assumption
that treatment will be successful, and adopt those measures
which offer the most encouragement for giving relief.
course, when the deformity or disease is such as to cause a
hopeless case of unfruitfulness (termed barrenness), nothing
can be done with any benefit. In case, however, the disease
or deformity is one which can be cured, or removed, it
should be treated and relieved, whether the difficulty be con-
genital or acquired.
Of
It is unnecessary in this connection to go over a descrip-
tion of the treatment required in imperforate hymen, atresia
of the vagina or cervix, contraction or elongation of the cervix,
uterine polypi or tumors, and vegetations of the endometrium.
endo-metritis or cervicitis, vaginitis or vaginismus, as they may
be studied in other parts of this work under their proper
heads. I will, however, say a few words regarding flexions,
conjoined with contraction of the cervix. These require
treatment either with sponge tents or bougies. The treatment
requires some skill and patience.
Usually in these cases of contraction of the cervix, either
with or without flexion, there is present some degree of cer-
vicitis, and attempts to dilate the cervical canal may produce
very much pain and irritation. This may at times be so
great as to affect the whole system, and produce such pro-
found effects as even to endanger life.
It is advisable, then, when we find a case in which there
is considerable pain produced by even an attempt to make out
a diagnosis, that we institute treatment for the relief of the
17
258
EATON ON DISEASES OF WOMEN.
tenderness (at least till it is mostly removed), before we
proceed to any attempt at dilation of the constriction. This
can be accomplished by the daily use of very warm vaginal
injections of water, with the application to the cervix of
wads of cotton saturated with Glycerine, or smearing the
cervix with dilute Belladonna ointment occasionally, and giv-
ing internally Bell. or Aconite, according to the most promi-
nent symptoms manifested by the patient, which are homoeʊ-
pathic to these remedies.
After getting the tenderness mostly or entirely removed,
we proceed to introduce the smallest sized sponge tent, well
smeared with Carbolized glycerine, as far up into the cervical
canal as possible by means of the sponge tent holder (see
chapter on instruments). I generally do this without the
use of a speculum, using the middle finger of the left hand
in the vagina to direct the tent into the os uteri, grasping
the tent holder with the right hand, of course.
The specu-
lum can be used by those who prefer it. But I have found
that its use gives usually more pain in these cases, as they
have commonly a very narrow vagina, and the use of the
speculum gives more pain than it does in women who
have had children. The use of tents and bougies is to be
carried out the same as in the treatment of dysmenorrhoea
caused from flexions and narrowing of the cervical canal.
I will again in this connection warn the student against
the use of the tent at his office, and allowing the patient to
go home with it inserted, although no serious results have
happened in the few instances in which I have done it.
Others have not been so fortunate, and the death of the
patient has resulted from this cause.
Where dilation is well made, so as to include the inter-
nal portion of the cervical canal, and the contraction again
comes on, incising the cervix with the hysterotome (see
chapter on Instruments), and following its use with the
sponge tent for a day or two, and then substituting a tent
BARRENNESS AND STERILITY.
259
made of linen cloth, tapering and of suitable size, is the
proper treatment. These tents should be saturated with
Carbolized glycerine, and a string should be fastened to them
before they are introduced, to facilitate their removal.
After the dilation is accomplished we may treat any
endo-metritis which may be present, causing a leucorrhoea or
the excessive alkalinity of the vaginal discharges with which
some are affected, which destroys the spermatozoa, and which
in part may cause the sterility. (See chap. on Leucorrhoea
and Vaginitis.)
In cases where the cause seems clearly to be atony or
atrophy of the uterus or ovaries, remedies are of great
benefit. Cantharides, Nux, Secale, Puls., etc., are often ben-
eficial. A generous diet and out-door exercise may be rec-
ommended. Prescribe oysters as a part of the regular diet.
Pass a gentle current of electricity through the uterus and
ovaries every two or three days. See that the bowels act
properly and regularly. If they do not, prescribe warm ene-
mas of soap and water, followed by a small injection of tepid
water (after the bowels have moved), which may be allowed
to remain in the bowel, and give the homoeopathically indi-
cated remedy. Let all mental labor be abandoned for recrea-
tion and gentle physical exercise.
Want of compatability is usually best remedied by the
courts. Still the judicious, honest, honorable physician may
sometimes bring harmony out of discord by timely, wise
advice.
Excessive sexual passion may require Kali bro., Pieric ac.
or Camph. to restrain it, and these remedies are often useful
in dyspareunia, vaginismus, etc., as well as excessive amative-
ness. In these latter cases a plain diet, mostly consisting of
vegetables and fruit, is advisable, allowing no stimulants or
pastry, tea or coffee.
We must bear in mind that the husband may not generate
healthy semen; hence, before deciding a lady barren (after
260
EATON ON DISEASES OF WOMEN.
feeling sure that her genital organs are healthy so far as we
can learn, and we feel disposed to blame the ovaries or fallo-
pian tubes for the sterility, and hence make out the case
hopeless), we should ascertain if there may not be some fault
in the husband's health or development which may explain
the want of fecundation. Curling's work on diseases of the
"Testis" may be studied with profit in this connection.
When hemorrhoids or fissures of the rectum exist, they
should be treated in the hope that their cure may not only
bring comfort, but be a relief to sterility as well. These dis-
eases probably cause sterility by making sexual congress
painful, and hence preventing the sexual orgasm on the
part of the female, as well as producing an irritable vagina,
from which the semen is quickly expelled. Dr. Comstock,*
of St. Louis, reports a case of sterility, aged thirty-one years,
married ten years, in which he discovered a fissure situated
half an inch within the anus. The patient suffered greatly in
defecation or attempts at copulation; upon curing the fissure
painful coitus ceased and she became pregnant six months
afterwards. I have had a similar case, with a similar result,
the past year.
The cure of hemorrhage from the bowels may usually
be accomplished with the use of Ars., Hamamelis, Ferr. per-
sulph., Ipecac., or Aconite, according to their indications,
and may cure the sterility in the case by restoring the sys-
tem to greater vigor by stopping the loss of blood, so that the
proper nutrition of the ovaries may take place, and the want
of healthy ovulation be cured, hence relieving the sterility.
Of course, in complete procidentia of the uterus and
inversion of the organ sterility must be present; still by
restoring the organ to normal position the patient may be-
come fruitful.
I have mentioned a case under the chapter
on "Inversion," where conception took place after I had
replaced the inverted organ. I have repeatedly seen it follow
* Hale on Sterility, page 155.
BARRENNESS AND STERILITY.
261
the cure of prolapse. For the treatment of these displace-
ments see treatment of inversion and prolapse.
The characteristic symptoms of the remedies which have
been found of use in sterility are all I shall attempt to give.
These are mainly useful in correcting the diseased conditions
to which I have referred. These I take largely from Pro-
fessor Hale's excellent work on "Sterility," to which the
reader is referred in case he wishes an exhaustive treatise
on this subject.
Indications for Remedies.
Aurum. This remedy is secondarily indicated in amen-
orrhoea, dependent on torpor of the ovaries, in scanty men-
struation with chronic metritis; in sterility dependent on
these states, or due to "coldness" or female impotency with
suicidal depression. (Dose, a few grs. of the 2 or 3 trit.)
Gold is primarily indicated for symptoms similar to Plati-
num, namely: Profuse and frequent menses, congestion of the
uterus, increased sexual desire and mental or emotional
irritability. (Dose, the 12 to 30 Trit.) I prefer the Au-
rum mur., or the muriate of Gold and Sodium.
Agnus Castus.-A complete loss of sexual power and
desire; amenorrhoea; melancholy, etc.
Aletris. General debility; sterility after abortion; ina-
bility of the uterus to retain the impregnated ovum.
Apis Mel. Ovaritis, chronic or acute, with stinging
pains in the ovaries; stinging pains in any part of the pelvis
or abdomen.
Borax. Chronic acrid leucorrhoea. (Hahnemann's
"Chronic Diseases," Part II.) Membranous dysmenorrhoea;
erosions of the os uteri; aphthous affections of the vagina.
Baryta Carb.-Loss of sexual desire and power; scanty
menses; takes cold easily.
Cantharides.—Sterility, with great sexual excitement
(with loss of sexual passion, used in low dilution).
262
EATON ON DISEASES OF WOMEN.
Capsicum.-Fat sterile women complaining of feeling
chilly; amaurosis, with scanty menstruation.
Calcarea Carb.-Sterility, in fleshy women, with leucor-
rhoea; very profuse or too frequent menses.
Caladium. Sterility, with melancholy; fetid urine;
asthma; loss of sexual power; cold sweat of the sexual
organs.
Cannabis Ind.-Sterility, with great sexual excitement;
with urinal troubles, inflammation of the bladder, etc.
Chimaphila.—Atrophy of the ovaries and mamma;
urine full of mucus; scaly eruptions of the skin.
Conium.-One of the best remedies in sterility; acrid
leucorrhoea; scant menses; pain and swelling of the breasts.
(Tr. Conium should be made from the unripe seeds." Hale.")
Cimicifuga.—Sterility, with spinal irritation; want of
vitality in the ovaries; pain in the ovarian region. (I have
known many cases of sterility cured with Cimicifuga when
all other means failed.-"Hale.")
Caulophyllum.-Sterility, with spasmodic dysmenor-
rhoea; patient subject to rheumatism.
Eupatorium Purp.-Sterility in women who suffer from
nervous exhaustion; loss of sexual desire; frequent abortions.
Gossypium.-Sterility, with atony of the uterus; gen-
eral debility; a flabby state of the uterine tissues.
Helonias.-Sterility, with chlorosis; debility; diabetes;
prolapsus uteri; anæmia.
Iodine. An excellent remedy; sterility, with weakness;
general debility; atrophy of the mamma; goitre. Iodine
increases the sexual appetite. Valetudinarian women, who
have been married a number of years without children not
infrequently become gravid after a thorough course of Iodine.
(Tully.) The "Encyclopædia of Mat. Med.," Vol. V, says
that "a case is said to have occurred where the female be-
came sterile soon after commencing the use of Iodine. Before
she commenced the use of the Iodine she gave birth to a
BARRENNESS AND STERILITY.
263
child annually; but from the time of commencing its use to
the present-a period of eight years-she has never become
pregnant." (Hale, p. 189.)
Bromine has a similar effect to Iodine.
Iodide of Lead.—Sterility, with atrophy of the ovaries.
Iodide of Potassium (Kali hydriodicum).—Similar to
Iodine.
Kali Carb. produces sterility (Hahnemann's "Chronic
Diseases"); therefore, it should cure those cases, if leucor-
rhoea appears to be a prominent symptom, with debility.
Bromides. All the Bromides benumb the sexual desire,
and cause a partial paralysis of the reproductive organs. In
high attenuation they are indicated in sterility caused from
sexual inactivity. Give low in cases of excessive sexual
passion, to relieve sterility.
Phosphorus.—The greatest remedy we have in cure of
sterility. (See Hale on "Sterility," p. 193.) It closely re-
sembles Cantharides in its action on the female genitalia.
Phos. Acid.-Similar to Phos.
Platinum.-Sterility, with melancholy; changeable mood
from day to day; hysteria, with onanism; excessive sexual
passion.
Pulsatilla. Sterility, with delayed or scanty menstru-
ation; entire suppression of the catamenia for years, with
sterility. (I have known Puls., two doses of the 3, in sev-
eral cases, at once cause the flow to appear, and conception
to take place within a few weeks, where the suppression had
been of years' standing.)
Ruta. Grav.-Sterility, following abortion, with leucor-
rhoea.
Sabina. Sterility, with profuse menstrual flow; conges-
tion or ulceration of the uterus. Compare with Erigeron,
Trillium, Crocus, and Calcarea.
Secale Cor.-Sterility, with irritable uterus; frequent
miscarriages; uterine hemorrhages (use 6 to 12x attenuation).
264
EATON ON DISEASES OF WOMEN.
Sepia. Sterility, with acrid leucorrhoea.
Stillingia.-Sterility, from syphilis or abuse of mercury.
Compare with Kali iodatum, Phytolac. dec., Aurum, etc.
Ustilago.-(Similar in its action to Secale, Caulophyllum,
and Cimicif.)
In cases of vaginismus, conception may follow copula-
tion, used under the influence of an anesthetic. This should
be, however, a last resort, and can only be advised when
the parents are exceedingly anxious to have offspring. The
student will find occasionally a case where every thing seems
favorable to conception, and still the patient will remain
sterile. In such cases attention to the husband is advisable.
The treatment of his case does not, however, come properly
under discussion here.
DISEASES OF THE OVARIES.
265
CHAPTER XXIII.
DISEASES OF THE OVARIES.
TUMORS of the ovaries and inflammation of these organs are
discussed under special heads in this book. Effusion of blood
as a result of the bursting of the Graafian follicle is treated
of under the head of recto-vaginal hæmatocele.
MALFORMATION OF OVARIES.-The ovaries may be rudi-
When absent the woman or person is
mentary or absent.
sexless; when one exists in a normal condition, all other
parts being normal, the woman may conceive. Usually, in
cases of absence of the uterus, the ovaries are also absent.
Two cases are mentioned in Ziemssen's Cyclopædia, vol-
ume X, where there was a supernumerary ovary.
The
OVARITIS.-Inflammation of the ovaries is of quite com-
mon occurrence. They may both be inflamed at the same
time, but it is most common that only one is affected.
left ovary is most frequently affected by inflammation. This
may be due to its nearness to the colon and rectum, as it
may be pressed upon from a large distension of this part of
the bowel. This affection is a very painful one. The ovaries
are seen to be liable to inflammatory action when we notice
the monthly ovulation which takes place in them. Professor
Ludlam has spoken of this ovulation as a traumatic lesion;
but we can hardly consider the irritation in the system by
this process of ovulation as a case of surgical fever, though
in the escape of the ovum there is some laceration of the
tissues of the ovary in the rupture of the Graafian vesicle at
each menstrual epoch; and, although there is a considerable
increase in the activity of the circulation, we can not term
this, when only normal, as any thing more than a physiolog-
266
EATON ON DISEASES OF WOMEN.
ical condition, though, without doubt, it predisposes to dis-
eased action. The ovary is more susceptible to the action of
cold at the menstrual period than at other times.
The inflammation in the ovary may be acute or sub-acute.
The sub-acute variety may exist for a long time, and be the
cause of painful menstruation; or, at least, produce pain
mainly at the menstrual period; but in these cases the disease
is generally connected with uterine irritation. The acute
form of ovaritis may supervene on the sub-acute, owing to
some unusual excitement, fatigue, or from cold and exposure.
Ovaritis seldom exists independently of other pelvic com-
plications, such as peri-metritis, endo-metritis, or general
pelvic cellulitis.
The acute inflammation in the ovary may exist as a pri-
mary affection, and the inflammation commonly connected
with it in the peritoneum, fallopian tubes, or pelvic veins
may be secondary to it.
The ovary consists of a nucleated, tough, fibrous connec-
tive tissue, with considerable fusiform muscular tissue, form-
ing the stroma-in this stroma are embedded the ovules of
Dr. Graaf. Their number, as seen with the naked eye, varies
from five to twenty; but, with the microscope, hundreds
are seen of very minute size; in various stages of develop-
ment. Hence, we may understand the ovary to be a mass
of eggs in various stages of development, imbedded in this
stromous tissue, surrounded as a whole by two tunics or cov-
erings, the outer one consisting of peritoneum, the inner one
of fibrous tissue. These vesicles, of which the ovary is com-
posed so largely, vary greatly in size, the most fully devel-
oped being nearest the surface. Throughout the structure
of the ovaries permeate an intricate network of blood vessels
and nerves. The absorbent glands are few. The ovaries
are supplied with blood by the ovarian branches from the
aorta, and the nerves are from the spermatic plexus. The
absorbents empty into those of the kidney.
DISEASES OF THE OVARIES.
267
The ovum in its escape from the ovary, at the monthly
period, or otherwise (the rupture of the Graafian vesicle may
take place, with some women, at any time, especially during
great sexual excitement), bursts through the fibrous and per-
itoneal coats of the ovary. Now, in cases of inflammation
and thickening, and consequent toughening, of these coats,
from chronic, or rather sub-acute, inflammation of these parts,
the matured egg may fail to escape. This failure to escape
of the matured ovum may cause, by its retention and pres-
ence, an increase of irritation, and form the nucleus of an
ovarian cyst or abscess, through inflammation in the cyst.
This may develop largely, and other ova may also be retained
from the same cause, and develop other cysts. Or we may
have impregnation of this retained ovum in the ovary, pro-
ducing ovarian pregnancy, which, however, results in an
abortive attempt to develop a foetus, and we have, as a re-
sult, a fibro-cystic growth, containing bones, teeth, hair, etc.,
termed dermoid tumors. Or we may have a retention of these
ova, and the production of no special development of a dis-
eased nature. In this instance, if both ovaries were affected,
we would simply have sterility as a result.
We may have acute inflammation in the parenchyma of
the ovary. It may affect one only, or both at the same
time. This active inflammation may result in resolution, ab-
scess, hypertrophy, induration, softening, or melanosis, or
leave a sub-acute inflammation behind it, which may lay the
foundation for the development of scirrhous, encephaloid, or
simple fibrous tumors, though fibro-cystic growths in the
ovary are more common than fibrous.
The engorgement of blood in cases of acute inflammation
is enormous. If not speedily relieved, pus is formed, and
finds an exit, by ulcerative inflammatory action, into the vag-
ina or rectum, urinary bladder or pelvic cavity, or works its
way along the course of the round ligament, and finds exit
at the inguinal ring; or it may be discharged into the peri-
268
EATON ON DISEASES OF WOMEN.
toneal cavity, in which case the fatal result can be delayed
but a few days. I have seen it point and be discharged in
the iliac region, and the patient recover.
Gangrene of the ovary may result from acute ovaritis,
according to some authors; but I have never seen a case.
Etiology.
Suppression of catamenia from cold is the most frequent
cause of ovaritis, causing first congestion, and then inflam-
mation. Remedies to cause abortion may sometimes prove
active agents to produce inflammation in these organs. Fre-
quent and excessive coitus, self-abuse, or nymphomania, or a
severe cold taken just after or during menstruation, may
conduce to the development of active inflammation in the
ovaries. Or the inflammation may be the result of its exten-
sion from neighboring viscera, or organs, which have been
primarily affected.
Sometimes acute ovaritis may supervene upon difficult
labor, in which case it is probably due to bruising the ovaries
against the bony pelvis in the severe throes of labor, in cases
where the head of the child is very large. It may result
from acute gonorrhoeal inflammation, by continuity of inflam-
mation through the uterus and fallopian tubes; or gonorrhoea
may cause ovaritis by sympathetic or glandular action. In
this case it corresponds to the gonorrhoeal orchitis in men.
Diagnosis.
The diagnosis is not always plain, although, with the ex-
We are
ercise of some care, we may usually be correct.
most likely to confound the disease with pelvic cellulitis and
colitis.
Chronic Ovaritis may be overlooked by most physicians
who have not given diseases of women special study; but as
the results of sub-acute chronic ovaritis are so disastrous, it is
well to be on the alert to discover and remedy it, if possible.
DISEASES OF THE OVARIES.
269
The deep seated burning pain in the pelvis or in the iliac
regions, should lead us to suspect this difficulty, especially
when the pain is aggravated by pressure, motion, or the erect
posture. Some cases suffer only moderately, except at the
monthly periods, when the pain becomes excessive. By
introducing the finger high into the rectum, and making
strong downward pressure with the other hand just above
the pubis, we may generally feel the enlarged and tender
Ovary. We must be careful not to mistake the uterus for
the ovary, and conclude that as pressing the finger against it
does not produce pain, consequently we have no ovaritis.
But the uterus and ovaries must be carefully distinguished.
In cellulitis the enlargement will be felt more extended in
most cases, and will appear immovable, while the inflamed
ovary is movable. If the tenderness is so great that we
can not well make a physical examination, we had better give
an anæsthetic and proceed. Though this excess of tender-
ness is indicative of cellulitis it may mean very active ovar-
itis, either alone or in conjunction with cellulitis; differentially
we should examine through the vagina, when we will find, if
cellulitis be present, a hard enlargement in the upper and
posterior portion of the vagina, which will appear firm and
immovable, as if attached to the bony pelvis. This we do
not find in an uncomplicated case of ovaritis. We find some
tenderness on pressure in the iliac region, and, if the inflam-
mation is active, we soon have an extension of the inflam-
mation and tenderness over the most of the entire abdomen,
causing the patient to semi-flex the thighs and limbs and lie
square upon the back, or the side well turned on the face.
With active inflammation we have rigors, high fever, the
wiry pulse, rapid respiration, great prostration of strength,
nausea, etc.
Treatment.
In acute ovaritis the most efficient remedies I have found
are Aconite, till the pulse is softened, then Secale, Macrotis,
270
EATON ON DISEASES OF WOMEN.
Ars., Bell., Bry., or Puls. If the disease goes on to suppura-
tion, Merc., Lachesis, China, Ars., Hepar sulph. may be indi-
cated. Warm hip baths, and warm water vaginal injections,
with warm foot-baths, are of service in the acute form. Rest
in the recumbent posture, and keeping the bowels moved
with enemæ, is imperatively necessary. In case pus forms,
which it is likely to do in twelve or fifteen days, unless the
disease is moderated by treatment, it is known to have
formed by the occurrence of rigors and chills. If matter
can be detected, we may evacuate it, if possible, through
the posterior walls of the vagina, by means of a long, aspi-
rating needle, or the curved trocar, retaining the canula in
the abscess for a few days, to secure the thorough drainage
of the abscess, and prevent its discharging the pus into the
cellular tissue between the vagina and rectum, which would
awaken a cellulitis, and probably produce pelvic abscess.
Where there is distinct pointing of the abscess in other
localities, it may be evacuated with the trocar or aspirator
artificially, either in the iliac region, or in the linea alba; in
some instances, sometimes, the escape of the matter is spon-
taneous, through some of the natural outlets of the pelvis
(the vagina, rectum, or urethra). In some cases it may be
necessary to use a stimulating injection into the abscess to
cause adhesions of its walls. For this purpose the Comp.
tr. iodine, twenty drops to the ounce of water, is, perhaps,
the best remedy known. This may be repeated every day
for a week or two; and if adhesive inflammation does not
result, we may increase the strength of the injection till it
it is efficient.
Nourishing diet is to be given. Sometimes egg-nog,
beef tea, and the like, are demanded by the prostration.
When only one ovary is affected, conception has been
known to take place. In chronic ovaritis, the treatment
should in the first instance be directed to removal of the
cause, if possible, whether it be onanism, excessive venery,
DISEASES OF THE OVARIES.
271
1
or amenorrhoea. If we are successful in removing the cause
we may expect a speedy subsidence of the irritation, unless
it has progressed to softening or induration, in which case
we can not look for rapid relief, and we are likely to have
sterility remaining at best.
In the sub-acute form it is of the utmost importance that
the disease be early diagnosed, and relieved before serious
consequences have resulted, prevention being better than
cure.
The treatment of ovarian dropsy and tumors, etc., which
may arise from ovaritis will require separate chapters for
their discussion. I will say, however, that there are cases
of hypertrophy of the ovary, resulting from ovaritis, which
may be greatly diminished in size, and sometimes cured, by
the external and internal use of Iodine. Just the condition
of the ovary in some cases of enlargement where death does
not ensue, it is impossible to always know. But that en-
largement of the ovary to a considerable extent may dimin-
ish in size, and sometimes disappear entirely, I assert.
The history of two or three cases I will give in illustration.
Mrs. H., aged about thirty-five years, native of Illinois,
married, mother of three children, youngest aged four years,
consulted me April 10, 1874, in regard to a "tumor in her
side." She stated that it had been observed for over a year,
and was gradually increasing in size. On making a phys-
ical examination I found the tumor to consist of an enlarged
movable ovary. It occupied the entire left iliac region, and
rose one-half the way up into the left lumbar region. It
impinged somewhat upon the hypogastric region as well; but
occupied the left iliac completely. The uterus I found
healthy, though somewhat higher in the pelvis than natural.
The sound indicated no enlargement or tenderness of the
uterus. The tumor was only slightly tender to the touch.
Menstruation had been normal and regular.
She had become alarmed at the prospect of having to
272
EATON ON DISEASES OF WOMEN.
1
She seemed
desired that
undergo the operation of ovariotomy, which had been told her
was necessary by other physicians who had examined her.
She had been sent to me, as her family physician afterwards
told me, to have the operation performed. General health of
patient was good, though from loss of sleep and from de-
spondency she had some little gastric irritation.
almost crazed by the idea of an operation, and
every other means be used to relieve her. (I had the
year before treated a somewhat similar case, with a diminu-
tion of at least one-half in the size of the tumor in two
months, when the lady left the city and I lost sight of her,
and I have not yet learned the result.) I accordingly told her
I would try what remedies would do for her, thinking at least
I would do her no harm, and as time was not important in
her case, I would see if she could be benefited, though I
could arrive at no very definite cause of the disease.
The menses had been somewhat painful for about eighteen
months, at the commencement of which time she had been
troubled with an attack of inflammation of the womb, caused
from a cold, as she supposed from what her physican had
told her. I accordingly put her upon Merc. protiodide 3* for
about a week, giving a powder every three hours; then upon
Iodine 6x at same intervals. I sometimes for a few days gave
Iod. Merc. or Ars.; but mainly Iodine in some form or combi-
nation, and externally over the entire surface of the abdomen,
distended by the tumor, I had painted once or twice a day
Tr. Iodine. Sometimes, owing to the tenderness of the skin,
I would omit the Tr. and apply Tod. and Glycerine for a few
days, and return again to the Tr. alone. Sometimes, for a
few days at a time, I had warm, wet compresses applied over
the tumor, covered with dry flannel and held in place with a
bandage.
I pursued this treatment thoroughly, and had the satisfac-
tion of seeing the tumor diminishing in size after about six
weeks' treatment; after that the diminution was quite con-
DISEASES OF THE OVARIES.
273
stant, though slow, for about nine months, till it finally could
be felt no more.
After three or four months' treatment it
required a little pressure to feel it. It was then about the
size of two fists; it went down smaller and smaller till it dis-
appeared, as I said before. Now, June, 1880, I know the
lady to be still free from any trouble, and there has been
no return of the enlargement of the ovary, now over five
years since I treated her. Her gratitude and joy is, of
course, unbounded.
ANOTHER CASE.-Mrs. N., aged about sixty years, widow,
mother of six children, youngest about eighteen years of age,
consulted me by the advice of friends on account of a tumor
in the side of her abdomen, which, from its weight, gave her
much trouble, she being obliged, from its size and weight, to
stoop very much in walking. She stated that she had first
noticed the tumor of small size in the left iliac region, about
twenty-six years before; that it was tender for some years,
and increased very slowly in size till after the birth of her
last child, when it increased quite rapidly. After she had
noticed the tumor she had borne two children. Her general
health had usually been quite good, though at times she suf-
fered much from constipation and somewhat from indigestion
and flatulency, and the tumor had always felt hard.
She stated that in former years she had consulted several
physicians, who had all agreed that it was an ovarian tumor,
and advised its removal by operation. This she had refused
to submit to, and had thought that for fifteen years it had
remained about the same size. It seemed, of late, to incon-
venience her more from its weight, or she seemed to suffer
more from it with some cystic irritation, causing frequent
desire to micturate.
I had little or no hope of effecting a diminution of the
growth, but made a careful examination; found the tumor
clearly ovarian, extremely hard almost like stone, rising and
enlarging from the left of the pubis, upwards to a little above
18
274
EATON ON DISEASES OF WOMEN.
the umbilicus, occupying the left side of the abdomen and
distending it. The uterus was normal though rather small,
as is usual with women of this age.
I had her under my personal care for about three months,
when the tumor had decreased considerably and softened
very materially. She returned home, and her physicians.
continued treatment, which was similar to that used in the
preceding case all through. I saw her about a year after-
wards, when she could and did walk quite erect; the tumor
had diminished fully two-thirds, and gave no inconvenience;
since which time she has discontinued treatment, and I hear
from friends that she remains quite well still, with the tumor
about the same as when I last saw it.
Many other cases, not quite so striking as these, where
the enlargement had been of shorter duration, or less in size,
I have entirely cured with this plan of treatment.
In some
cases I have failed, the tumor going on to greater and greater
development. Possibly some of them have not been thor-
ough in the treatment, as I have had the personal care of
only three or four of the cases of failure.
The conclusion to which I come is this, that there are
cases of induration and hypertrophy of the ovary which are
not urgent, where we may well make the trial to promote
absorption. If we fail, nothing is lost; if we succeed, much is
gained. Some may claim that these cases reported were
"fibroids of the uterus." If they were, the result was satis-
factory. It is impossible to prove either that they were or
The evidences
were not pedunculated fibroids of the uterus.
seemed clear to me, and the other physicians who saw the
cases, that they were ovarian hypertrophy and induration.
Fibro-cystic tumors of the ovary can not be cured this way.
(See Ovarian Tumors.)
OVARIAN TUMORS.
275
CHAPTER XXIV.
OVARIAN TUMORS.
In a work on "Diseases of Women" we can not go as
fully into the discussion of this subject as has been done
by Prof. Peaslee, who has given us a work of five hundred
and fifty pages upon this topic alone. To Profs. Peaslee,
Ludlam, Gross, Byford, Danforth, Scanzoni, Kiwisch, Beck-
with, Hunt, and others I am under obligation for useful
suggestions.
I will endeavor to present practical points for the guid-
ance of the student in diagnosis, etiology, and treatment,
with as little as possible of speculative theories, developing,
as well as I am able, the homoeopathic treatment.
CLASSIFICATION OF OVARIAN TUMORS.—Ovarian tumors may
be considered in three classes-the solid, cystic, and com-
pound; the solid consisting of solid material; the cystic
being fluid within a sac, or cyst; the compound being com-
posed in part of solid and part of fluid material.
The solid ovarian tumors are:
1. Fibroma;
2. Enchondroma;
3. Osteoma;
4. Carcinoma;
5. Papilloma.
The cystic ovarian tumors are:
1. Hydrops Folliculorum;
Struma;
2. Cystoma Ovarii Oligocysts;
Polycists;
3. Dermoid Cysts.
276
EATON ON DISEASES OF WOMEN.
羹
​Etiology.
The causes of ovarian tumors are not well understood.
Peaslee says: "Nothing is positively known of the cause
of ovarian tumors." Scanzoni maintains that hyperemia of
the ovary causes the disease. Dr. T. S. Lee admits marriage
to be a frequent cause; while Dr. Chas. Clay asserts that
the number of ovarian cysts in the married and unmarried
is about equal. Drs. Rose and Lever support the hereditary
nature of the disease; while others maintain that sterility
is a frequent cause of ovarian tumors.
Now, we think all are right in part, and that sterility,
marriage, hyperæmia, parturition, etc., may sometimes tend
to the production of the disease; but, if we state that sub-
acute chronic ovaritis is the cause of ovarian tumors, we
think we would be expressing, in most cases, the true cause
in few words. This sub-acute chronic ovaritis may be caused
by unsatisfied sexual passion, as well as excessive venery, by
severe labor, by inflammation extending from the uterus in
cases of metritis, or from the peritoneum in case of peri-
tonitis, or from pelvic cellulitis, resulting from cold, abortion,
or puerperal peritonitis. Either of these conditions, as well
as onanism, may produce the condition of chronic sub-acute
ovaritis; and the scrofulous diathesis may predispose the
patient to the development of the disease.
I do not intend to say that we will be able, in all cases,
to make out, from the history of the case, positive evidence
of the chronic sub-acute ovaritis, for the reason that the symp-
toms in these cases, being often somewhat obscure, may not
have been noted, and, as we are not likely to see the case
in its entire development, we may not be always able to
trace the disease satisfactorily from its incipiency. Prof.
He says:
Byford, I notice, leans to this view of the case.
"Inflammation of a low grade and somewhat chronic dura-
tion might cause induration or thickening of the indusium,
OVARIAN TUMORS.
277
so that it would not yield to the upheaving pressure of the
ovisac." Prof. Gross attempts no explanation of the cause of
the development of ovarian tumors. So far as I can learn,
those who claim sterility, marriage, or maternity as causes of
ovarian tumors offer no explanation of the modus operandi.
We are of the opinion that any thing which acts to
produce a chronic irritation in the ovaries may be considered
a prime cause of the disease. In some instances the cause
is so obscured as to be undiscoverable. That the married
state may tend to develop the disease, by causing chronic
sub-acute inflammation of the ovary, by reason of excessive
sexual congress, or too long continued and incomplete excite-
ment, or resulting from abortions, or poor recovery from
confinement, I do not deny; and they may become subject
to ovarian Dermoid cysts as a result of extra-uterine con-
ception (ovarian), according to Cruveilhier, and as We
believe.
The idea of ovarian cysts being formed from the ovisac
has been adopted by Scanzoni, Velpeau, Cruveilhier, Negrier,
Hertz, Hodkin, Paget, Farre, Huguier, and others. Roki-
tansky considers them to result from an elementary granule,
which grows by intussusception into a nucleus, and then into
a structureless vesicle. Dr. Peaslee says: "The oligocyst
commences as a dropsy of the ovisac, and may practically
be considered simply as a larger development of the hydrops
folliculi, and the polycist as a colloid degeneration of the ova-
rian stroma.” Rokitansky has demonstrated the possibility
of a cyst to form from a ruptured Graafian follicle; or, in
other words, from a corpus luteum, and Prof. Emmett has
seen one such case. After the closure of the opening, where
the Graafian vesicle ruptured, the corpus luteum developed
into a cyst; but this method of development must be very
rare, and even the authors quoted do not make the matter as
܀
* Allg. Wiener Med., Z. 1859, No. 34, Lehrb. 3, Aufl. p. 48.
† Page 760, Emmett's "Prin. and Prac. of Gynecology."
278
EATON ON DISEASES OF WOMEN.
)
plain to my mind as I could desire. Still they may be cor-
rect, that the possibility exists for the development of cyst-
oma in this way.
These cases, however, are exceptional to a degree which
makes them unworthy of more than a passing notice. But to
a failure to rupture of the Graafian vesicle owing to the thick-
ened condition of the indusium caused from slow inflamma-
tory action, producing exudation of organizable plastic material
over the surface of the ovary, is probably due the large ma-
jority of cases of cystoma. Rindfleisch has detected ova
in the primary cyst. The cause of dermoid cysts being at-
tributed to ovarian conception seems plausible enough. Still
we must remember that dermoid cysts have been found in the
testicle, and, in a few instances, in the kidney, bladder, scro-
tum, brain, stomach, and behind the peritoneum, on the pos-
terior walls of the abdomen.
In view of these facts, we must conclude there is some
other method of formation of the dermoid cysts besides im-
pregnation. The congenital development of these cysts has
been offered, by Boinet, as an explanation, considering that
two ova were impregnated at the same time in the uterus of
the mother, and that, by some means, the one was partially
developed within the other. How the one ovum got within
the other he does not explain. I will suggest as a possible
explanation that the ovum which became impregnated con-
tained another ovum, owing to abnormal development of the
parent ovum (so to speak) within the ovary-this impregna-
tion resulting in the development of a perfect foetus, with
the exception of this blighted second ovum within the first,
which was sufficiently impregnated to produce parts of a
physical frame, as skin, bone, teeth, hair, etc., these being
contained within a sac, and being located, accidentally, in any
part of the living foetus. If this theory is correct, we read-
ily see why it is that these dermoid cysts are more frequently
Peaslee, p. 44.
OVARIAN TUMORS.
279
found in the ovary or testicle than in other localities within
the body, which observation has shown to be the case.
Fibrous, cartilaginous, and osseous tumors of the ovary
are as clearly due to sub-acute, inflammatory action as are the
purely cystic; this inflammatory action causing an effusion
of plastic material, which takes on organized growth through
a mysterious action in nature (though, perhaps, it is no more
mysterious than the deposit of plastic material between the
ends of a fractured bone, finally developing into an osseous
formation firmly connecting the fragments). Acute inflam-
mation of the ovaries may leave a sub-acute ovaritis, which
may tend to produce ovarian tumors, and in this way the acute
inflammation may be a cause of ovarian growths.
I would not say that sterility caused ovarian tumors, but
that the same cause that tends to produce sterility in some
cases also tends to produce ovarian growths. We have ova-
rian tumors affecting only one side, and the patient conceives,
the ovum coming from the healthy ovary, and pregnancy goes
on in some of these cases to full term, and a healthy child is
delivered, though usually, if the ovarian tumor is of consider-
able size during gestation, the child is weakly, owing to the
unusual pressure to which it has been subjected within the
abdomen, because of the presence of the tumor there at the
same time.
Derangements of menstruation, which some authors have
stated to be a cause of ovarian tumors, I think may be con-
sidered as accompaniments, or caused from the same or
similar conditions, rather than as causes. In cases of men-
orrhagia preceding the discovery of an ovarian growth, I
find that the excessive flow is due to sub-acute endo-metritis,
and in conjunction with this affection we have the chronic
sub-acute ovaritis, either from extension of the inflammation
from the uterus to the ovary or vice versa. But I can not
see how derangements of menstruation can more than indi-
rectly tend to the production of the pathological condition
280
EATON ON DISEASES OF WOMEN.
Cases do occur, 't is
which would develop ovarian tumors.
true, where derangements of the menstrual function (the
menses are sometimes scanty or absent, and sometimes ex-
cessive) precede the discovery of ovarian disease; and we
sometimes have an unusual amount of pain at the menstrual
period in these cases; but I would refer the pain to the
sub-acute ovaritis, as I would the development of the ovarian
growth, and not to the excessive or diminished flow. In so
far as sudden suppression of the menses from cold may affect
the ovary to produce congestion, however, it may indirectly
tend to the production of a condition of induration or inflam-
mation of the organs, so that, in the course of time, an
ovarian tumor might result.
MARRIAGE. From all I can gather, statistical or other-
wise, I conclude marriage has little effect in the development
of ovarian cystoma. Dr. Churchill believes that those who
have borne children are more liable to cystoma; while Dr.
I. B. Brown finds that the larger number of married patients
with ovarian tumors have not had children. Dr. Peaslee's
experience is the same; while my own is that the number of
married ladies afflicted with ovarian cystoma have been about
equally divided between those who have borne children and
those who have not.
•
T. Stafford Lee concludes that disappointed affection is
the most active predisposing cause. With this I can not agree.
AGE.-Cystoma is most frequently developed between the
ages of twenty-five and forty years, showing that the period
of the greatest ovarian activity is the period most favorable
to the development of ovarian tumors, though exceptionally
they have been known to occur in the very young and in
the old.
The disease is sometimes congenital, or develops in
infancy, though very rarely so. Dr. T. G. Thomas reports
to the New York Obstetrical Society a case occurring in
* Amer. Jour. of Obstetrics, 1880, p. 118.
OVARIAN TUMORS.
281
New Jersey in the practice of a physician, whom he does
not name, but who sent the tumor to him, with the following
report of the case: "The child was delivered by him at
full term, and nothing abnormal was discovered at the time.
About one month after birth a tumor was discovered in the
iliac fossa. The child was well developed at birth, but soon
showed signs of impaired nutrition, became emaciated, grew
slowly, and languished till three years and five months old,
and died. Autopsy revealed the existence of an ordinary
ovarian cyst, filling the abdomen. The remains of the fallo-
pian tube and ovary were upon one side of the tumor."
This case seems to have been of congenital origin, although
the development of the tumor occurred subsequent to birth.
PRESSURE FROM THE RECTUM.-It has been thought by some
that the left ovary was the most frequently affected, owing
to its near relation to the rectum in the pelvis; but statistics
do not prove this to be true, but that the right and left ovary
are about equally affected. In fact, the preponderance of ev
idence is rather in favor of the right ovary being most fre-
quently affected; as Dr. Charles Clay reports, that, of eight
hundred and fifty cases examined, two-thirds were of the
right side and one third on the left. In four hundred and
fifteen cases observed by Drs. Scanzoni, Lee, West, and Che-
veau, the right ovary was affected alone in two hundred and
one instances, the left alone in one hundred and forty-eight,
and both in sixty-six cases. This seems certainly to disprove
that the left is most frequently affected.
Symptoms.
It is sometimes the case that in the first stage of devel-
opment of ovarian tumors the patient experiences no peculiar
symptoms, and the growth is first observed as a tumor of
considerable size in the right or left iliac region, and even
then giving no discomfort. In other cases the patient expe-
riences those symptoms considered as indicative of general
282
EATON ON DISEASES OF WOMEN.
pelvic inflammation, or of inflammation of some one of the
pelvic organs.
A sense of weight in the pelvis is experi-
enced, with a feeling of uneasiness; defecation is difficult
and painful; indigestion, nausea, and flatulency are complained
of; and, in fact, all the general symptoms of uterine disease
are sometimes present; and it may be observed that we have
in some patients a complication of uterine inflammation, cell-
ulitis, etc., in the case, and these general symptoms are due,
in large part, to these complications.
The peculiar symptoms of ovarian inflammation are most
likely to be present, and, in some instances, displacements of
the uterus in the form of retro-version or prolapse are present,
having resulted by the weight of the enlarged ovary; and
the difficult defecation is due to the pressure of the enlarged
ovary against the rectum. The pressure of the distended
rectum and the straining at defecation tend to produce down-
ward displacement of the ovary, and, with it, retro-version,
retro-flexion, or prolapse of the uterus. In some cases the
breasts enlarge, and there is a secretion of milk in them.
The menstrual flow is sometimes greatly diminished, some-
times excessive, and sometimes normal. Diarrhoea is some-
times caused by the extension of irritation from the ovary to
the rectum. Tenesmus is usually very annoying, in these
cases troubled with diarrhoea.
On vaginal examination a tense, though somewhat fluctu-
ating, mass may be felt in the posterior cul-de-sac; the uterus,
being crowded anteriorly in the pelvis, often produces irrita-
tion of the urethra, and a frequent desire to micturate, which
is accomplished with considerable pain of a smarting or burn-
ing character.
RECTAL EXAMINATION.-By a rectal examination we may
more clearly ascertain the nature of the difficulty. The ova-
rian cyst is almost always round and uniform in shape, and
the feeling of fluctuation, as of a fluid within a sac, is to be
noticed. There are several conditions liable to be mistaken
OVARIAN TUMORS.
283
for the ovarian cyst in its first stage; viz., extra-uterine
pregnancy, tubal dropsy, or cyst of the broad ligament; but
of these I will speak under the head of Differential Diagnosis.
SECOND STAGE OF DEVELOPMENT.-When the sac enlarges
sufficiently to rise above the pubis, it is called its second
stage of development. The uterus will now usually be found
lower than normal in the pelvis, although, when the tumor
reaches a size sufficiently large to rest upon the brim of the
pelvis, the uterus may be drawn up higher than natural. The
rectal examination, conjoined with the vaginal, will reveal the
absence of the fluctuation discovered in the first stage, al-
ready mentioned as located in the posterior part of the vag-
ina, or, in some cases, laterally. The tenesmus and dysury
are relieved entirely, or in a great measure. We find the
tumor occupying one of the iliac regions, and impinging upon
the hypogastric region. The tumor is fluctuating, though it
requires some dexterity of touch to discover the fluctuation,
owing to the resistance of the abdominal walls. As the
tumor increases in growth, the bladder is pressed upon and
displaced downwards, and we again have the desire for fre-
quent micturition.
The commencement of the third stage is marked by the
tumor reaching to the umbilicus. The small intestines are
crowded behind and above the tumor, so that we now have
dullness on percussion over it. The fluctuation is now more
distinct.
The fourth stage is simply a continuation and increase of
the third, and is characterized by the pressure of the tumor
upon the abdominal viscera to the extent that we have a
diminished action of the kidneys, indigestion, loss of appe-
tite, nausea, sometimes diarrhoea or constipation. The press-
ure is often so great as to interfere with the full action of
the lungs and heart, and the patient is unable to lie down.
The countenance indicates distress and anxiety. It is char-
acterized by Mr. Wells as the "Facies Ovariana." The lips
284
ΕΑΤΟΝ ON DISEASES OF WOMEN.
are thin, eyes sunken, tissues of the face seem atrophied,
skin of face wrinkled. Emaciation of the neck and shoulders
is also marked. Edema of the extremities frequently com-
plicates the case in this stage, and we sometimes have uræmia,
resulting from the pressure of the tumor on the renal vessels.
Differential Diagnosis.
Ovarian tumors are liable to be incorrectly diagnosed
from the fact of various ailments simulating them. It is
common for the physician who has not a large experience
in the examination of women to get embarrassed in making
any examination of the female generative organs; but he is
especially liable to error of diagnosis in relation to the
various tumors which affect these organs; and this is not
to be commented on too severely, as errors of diagnosis in
this regard have been made by the most noted gynæcologists.
But the fact of errors of diagnosis having been made should
stimulate investigation to that extent which may enable the
future generation of physicians to become more expert than
we are, or have been those who preceded us.
The condition of pregnancy is one which sometimes com-
plicates ovarian cystoma, and from which it is sometimes
a little difficult to diagnose. Especially is this the case in
the entire absence of menstruation, or its appearance in small
amount at each monthly period. In the early months of the
development of cystoma it is comparatively unimportant to
make a clear, positive diagnosis, though it is more satisfac-
tory to both physician and patient if we are able to do so.
One of the most positive diagnostic points in pregnancy is
the closure of the os uteri. If we find it closed, the os
seeming as if cemented or glued shut, we may feel sure,
in the absence of menstruation for three or four months.
in connection with the enlargement of the uterus (apparently
corresponding to the time of the suppression of the menstru-
ation), that we have pregnancy in the case, and that the
OVARIAN TUMORS.
285
symptoms of pressure upon the rectum are due to a retro-
verted or retroflexed condition of the uterus. We find, on
examination by the rectum, that the tumor feels dense, and
that palpitation gives no evidence of fluctuation; and, upon
pressing upwards on the tumor, we find the neck of the
womb is moved downwards; while, if the tumor be ovarian,
it might be moved without moving the uterus. The uterine
sound should not be used unless we are positive that the
patient is not pregnant.
The gravid uterus, in the later months of gestation, is
most frequently mistaken for ovarian tumor. I have had
a case-a Mrs. S., of Peoria, Illinois-whose history showed
a gradual development of the abdomen for over two years.
She said the enlargement had commenced in the left iliac
region, and steadily increased. She had the peculiar facies
ovariana (mentioned by Wells), emaciation of shoulders, etc.
Menstruation had been irregular, especially so for about
seven months, being absent sometimes over two months, and
scanty when it appeared. I diagnosed pregnancy, compli-
cated with ovarian cystoma, contrary to seven or eight other
physicians of excellent standing, who diagnosed ovarian cys-
toma alone. The distension of the abdomen was enormous,
and, the patient being very weak at the time I saw her, I
did not feel it advisable to use anesthesia to aid in the
diagnosis; but I could distinguish the pulsation of the foetal
heart, as I thought, though I could not detect motion of the
child. I could feel a hard, irregular mass, occupying a part
of the abdomen. The result proved the correctness of the
diagnosis, as she was subsequently delivered of a dead
foetus. After confinement, the distension of the abdomen
remained, as well as the fluctuation, nearly the same as
before delivery; and, after about two months, the patient
died. I assisted in the necropsy, and found the uterus nor-
mal. There was a large dermoid cyst of the left ovary,
containing about twelve quarts of thick, opaque liquid, with
-286
EATON ON DISEASES OF WOMEN.
· ,
a large quantity of hair. There were also several small
cysts. The right ovary also had some small cysts developed
in it. The case was one calculated to mislead any one, and
it was fortunate that no operative procedure was undertaken.
THE PLACENTAL BRUIT.-The placental bruit, which is heard
in pregnancy, may be present in fibroids of the uterus, or a
sound which can not be distinguished from the placental
bruit may be heard (I should say). Drs. Scanzoni and
Churchill assert they have heard this sound in ovarian
tumors; hence, it is not distinctive, and can not be relied
upon in differential diagnosis.
THE BEATING OF THE FETAL HEART.-In using ausculta-
tion over a suspected ovarian tumor, we should bear in mind
that it is necessary, in order to avoid error, that we compare
the rapidity of the supposed heart of the foetus with the
pulse of the mother. For although the pulsations as heard
in the abdomen may number 120 or 130 per minute, they
may correspond with the pulse of the mother, and be simply
the circulation of the blood in a fibrous tumor of the uterus.
TIME. The time which has elapsed since the develop-
ment of the first appearance of the tumor will give some
aid in diagnosing it from pregnancy, as the ovarian tumor
will, as a rule, develop more slowly than the gravid uterus,
with an occasional exception. It will usually take a year
and a half or more to develop an ovarian cystoma to the
size of the gravid uterus of seven months.
EXTRA-UTERINE PREGNANCY.-Some cases of extra-uterine
pregnancy may be very hard to diagnose differentially from
ovarian cystoma, as the uterus in both instances is about
normal, and we may have menstruation continuing in both
classes of cases.
It is general that ovarian cystoma develops more slowly
than extra-uterine pregnancy. In the extra-uterine preg-
nancy, if it be tubal, there will generally be a rupture of
the tube at about the third month, when a necropsy will
OVARIAN TUMORS.
287
probably be possible, and make the diagnosis clear. In
ovarian and abdominal pregnancy, gestation may go on
longer, and be more difficult of diagnosis, and we have a
condition which simulates fibro-cystic growth of the uterus
more clearly than ovarian cyst. Still, these cases bear
some resemblance to ovarian cystoma. Generally, if the
patient be placed under the influence of an anaesthetic we
are able to make out the outline of the foetus within the
cyst. There is generally more disturbance of the general
health in extra-uterine gestation than in ovarian cystoma
during the first months of its existence.
Of course, the physician will, in these cases, never omit
to listen for the pulsations of the foetal heart, which, if found,
would materially clear up the diagnosis; but if they are ab-
sent, the case may still be one of extra-uterine gestation
with a dead foetus.
ENLARGED LIVER AND HYPERTROPHY OF THE SPLEEN.-Car-
cinoma of the liver or a collection of hydatids of the liver
may be mistaken for ovarian tumor; also the enlarged spleen.
But if we bear in mind these enlargements commence and
are attached in the upper portion, instead of the lower part
of the abdomen, together with the harder feel, in connection
with the general health of the patient, and the history of
the case, we will not be led into this error.
RETRO-UTERINE HEMATOCELE.-Retro-uterine hæmatocele
may simulate ovarian cystoma of small size; but it usually
presses down between the vagina and rectum, much lower than
cystoma, and is more diffused; and, besides, the suddenness
of the attack, occurring, as it usually does, at the menstrual
period, taken in connection with the collapse, and shock to
the nervous system occurring in haematocele, will be sufficient
to differentiate it from cystoma, which comes on insidiously,
without any serious disturbance of the general system at
this stage.
FECAL TUMORS.-A retention of fecal matter in the rectum.
288
EATON ON DISEASES OF WOMEN.
may in some measure simulate ovarian cystoma. Clearing the
bowel with an enema of warm soap and water, followed by cool
injections, will generally produce the desired effect, unless
the impaction is situated above a retroverted uterus; in which
case, if an effort be made to reinstate the uterus by means
of the fingers or an instrument introduced into the rectum,
the nature of the difficulty will become apparent. Constipa-
tion would not be conclusive evidence of fecal tumor, though
it be in connection with an enlargement in the posterior part
of the vagina, as we have very usually constipation in ovarian
cystoma, retro-version, and recto-vaginal hæmatocele.
In some instances the tumor presses so much upon the
nerves and blood vessels as to produce lameness and oedema
of the lower extremities. Sometimes, though rarely, adhe-
sions form in Douglas's cul-de-sac, which give the tumor the
firm, immovable feel, very much like that which is felt in
pelvic cellulitis, and we are to distinguish ovarian cystoma or
fibroma, in these instances, from pelvic cellulitis, in that we
have in pelvic cellulitis extreme tenderness on pressure, while
in ovarian cystoma or fibroma the tenderness is only slight,
even under considerable pressure.
In the second stage of development, the urgent symp-
toms, which sometimes characterize the first stage, are very
much alleviated, as the tumor rises above the brim of the
pelvis, the case is often looked upon and mentioned by the
physician and people as a recovery from inflammation of the
womb the term "inflammation of the womb" being intended
to cover all conditions of inflammation in or about the female
pelvic organs, excepting sometimes the bladder and rectum;
just as the term "inflammation of the bowels" covers (in
their careless way of expressing themselves), peritonitis, en-
But the
tritis, peri-metritis, gastritis, hepatitis, etc., etc.
error of the diagnosis is after a time apparent to one who
understands the development of cystoma, for he knows that
ovarian cystoma does not spring into existence in a day or
OVARIAN TUMORS.
289
week, and develop into a tumor reaching near or quite to the
umbilicus, which is about the period when the patient takes
notice that she has a tumor, or perhaps she considers herself
getting stout, or imagines that she is pregnant, although men-
struation may continue, and be more than usually free. The
patient is liable to believe the flow is an effort to miscarry
or something abnormal, which does happen to some women
while pregnant. They are sometimes so far misled as to
imagine that they feel the motion of the foetus in utero,
and the patient goes on till finally (as labor does not come
on at the time she imagines it should) she becomes alarmed,
and seeks medical advice, when it becomes necessary for the
physician to decide the diagnosis of the case, and make out
whether it is a case of pregnancy going over its usual time
before delivery (which does quite often occur), or whether
it is a case of cystoma or fibroma of the ovary, a fibroid of
the uterus, a tumor of the broad ligament, abdominal ascites or
a fibro-cystic tumor of the uterus.
All of the following conditions have been mistaken for
ovarian tumor, according to Prof Peaslee :
Ascites.
Pregnancy.
Normal.
Extra-uterine.
Molar and Hydatidi-
form.
Spurious.
With ovarian cyst.
Encysted dropsy of peritonæum.
Tumor of broad ligament.
Tumor of mesentery.
Excessive obesity.
Physometra.
Hæmatometra.
Hæmatocele.
Tympanites.
Renal tumor.
Floating kidney.
Splenic cyst.
Hepatic cyst.
Fecal tumor.
Pelvic abscess.
Uterine fibroid, or fibro-cyst.
Distended bladder.
Retained menses.
Retro-flexion.
First, let us ascertain if there is evidence of a fluid within
the abdominal walls, and if we are satisfied that there is, we
* Peaslee on "Ovarian Tumors," p. 122.
19
290
EATON ON DISEASES OF WOMEN.
must proceed to find out whether the fluid is in the perito-
næum as a diffused liquid, or is contained within a sac.
An excellent rule to act upon, in these cases, is to put the
patient under the influence of an anaesthetic during the ex-
amination. By this means the tension of the abdominal mus-
cles is relaxed, and we have a much better opportunity to
discover the nature of the disease, if any be present; for it
is not always that there is any tumor, even when it is sus-
pected, and even when it has been so diagnosed by physicians
of good ability, and even of renown. Dr. Simpson* quotes
six cases, and Boinet + one case, where the abdomen was
actually opened for the removal of an ovarian tumor, when it
was found that tympanitis was the cause of the enlargement
of the abdomen. Of course, some little care in percussing
the abdomen would have caused the avoidance of such a mor-
tification to the physician and danger to the patient. As the
large ovarian tumor displaces the small intestines backwards
and upwards, we find resonance only in the locality of the
colon, or in the epigastric or hypochondriac regions, while there
is dullness over the center of the abdomen.
FROM ABDOMINAL ASCITES.-In abdominal ascites, the fluid,
being contained within the peritoneum, will gravitate to its
lowest portion. Hence, when the patient is placed in the
sitting position the fluid will gravitate to the lower part of
the abdomen, and we will have greater fullness there than
when the patient is reclining, more dullness on percussion
over the lower part, and more resonance in the upper portion.
of the abdomen. Place the patient in the reclining position,
on the back, and the abdomen flattens somewhat in abdominal
ascites, while in ovarian cysts, or fibroma, or fibro-cystoma, preg-
nancy, cysts of the broad ligament, and fibroids of the uterus,
the fullness and hardness of the center of the abdomen is main-
tained about the same as when the patient is erect.
In abdominal ascites there is some degree of resonance all
† Boinet, p. 200.
* Fehr, p. 51.
OVARIAN TUMORS.
291
over the abdomen, while in cystoma there is dullness over the
center. In abdominal ascites we feel the fluctuation of the
fluid more distinctly than in cystoma, where the fluid distends
the sac, and gives to the tumor more the feel of a tense, hard
substance. In abdominal ascites, if we place one extended
palm on one side of the abdomen, and the other upon the
other side, and give a sudden impulse with one hand, we feel
the impulse in waves of motion, and not as a direct jar; and,
by placing the ear to the abdomen, or near it, we may gener-
ally hear the slush of the fluid within the peritoneal cavity,
when it is of considerable amount.
Some inquiry into the history of the development of the
enlargement will aid much in the diagnosis. In abdominal
ascites the enlargement is noticed in the lower portion of the
abdomen, evenly distending it, while in single ovarian cystoma
we learn that the enlargement was first noticed more to one
side. If the patient has been troubled for a considerable time
with renal, hepatic, or cardiac difficulties, we may be quite
sure of having abdominal ascites in the case rather than ova-
rian cystoma; while, on the other hand, if the history of the
patient shows attacks of inflammation in the pelvis, disor-
dered menstruation, with the discovery of the tumor first in
the iliac region, we may conclude, with considerable certainty,
that the case is one of ovarian cystoma.
FIBRO-CYSTIC TUMOR OF THE UTERUS.-The fibro-cystic
tumor of the uterus develops more prominently in the hypo-
gastric region at first, and simulates the impregnated uterus
in its size and location much more than it does ovarian
cystoma.
HYDATIDS OF THE OMENTUM.-Hydatids of the omentum,
though of extremely rare occurrence, are liable to be mis-
taken for ovarian cystoma, when fully developed. It may
be impossible to positively diagnose the difference between
these diseases in some cases. If we bear in mind that hy-
datids of the omentum commence well up in the abdomen
292
EATON ON DISEASES OF WOMEN.
(and they are usually discovered there), and enlarge down-
ward, while in ovarian tumors they commence in the lower
part, and increase upwards, we have a good point in differ-
ential diagnosis. In some instances, where no adhesions
have taken place, we are able to push the mass upwards,
and determine that the attachments are not below and not
adherent to the ovary or uterus.
FROM UTERINE FIBROIDS.-Uterine fibroids have been fre-
quently mistaken for ovarian cystoma. It is quite impor-
tant that this error does not occur, as an operation which
might be advisable in ovarian cystoma might be very im-
prudent in uterine fibroids. The fibroid tumor of the uterus
is more dense, solid, rough, and nodulated, while the ovarian
cyst is smooth. In ovarian cystoma the uterus is little
affected, while in uterine fibroma we find it enlarged; hence,
the uterine sound is an important aid in the differential diag-
nosis of ovarian cystoma from uterine fibroids. In the case
of the intra-mural fibrous tumor of the uterus the uterine
sound may be passed seven or eight inches within the os.
When we can do this we may be quite sure we have a case
of an intra-uterine growth, and not ovarian disease.
CARCINOMA OF THE FUNDUS UTERI.-In Carcinoma of the
fundus uteri we have the constitutional symptoms of cancer,
with emaciation and fetid discharges, and the tumor does not
reach great size before destroying life, so we are in no great
danger of confounding it with ovarian tumors.
DIAGNOSIS FROM FLOATING KIDNEY.-Boinet* mentions four
cases where floating kidneys have been mistaken for ovarian
cystomæ. The following facts are of importance:
1. It is a very rare condition; much more so than is
sometimes assumed, as we may infer from the fact that it is
so seldom found after death.
2. The assertion by writers that it occurs much more.
frequently in women than in men probably rests on the
Peaslee, p. 129. Boinet, p. 205.
OVARIAN TUMORS.
293
fact that a small ovarian tumor is frequently mistaken for
it, and the diagnosis is not confirmed by post-mortem exam-
inations.
3. It is doubtless congenital. It is tender on pressure,
and sometimes nausea is thus produced. It is movable, and
has the peculiar shape of the kidney easily made out unless,
as sometimes occurs, the hilum looks backwards. It can
easily be lifted up out of the pelvis, is permanently the size
of the kidney, and produces no symptoms. It may, how-
ever, undergo cystic degeneration, when the diagnosis is more
difficult.
DROPSY OF THE CAVITY OF THE UTERUS.-Dropsy of the
uterus resulting from a cancroid tumor of the fundus some-
times occurs, and simulates ovarian cystoma. Dr. Simpson*
reports a case of this kind. If the tumor has existed too
long to suspect pregnancy, we should pass the uterine sound
(for in the event of its being pregnancy with a cessation of
its development from partial separation of the placenta it is
unimportant to have the product remain), when we will dis-
cover that there is a fluid within a sac within the uterine
cavity. It may be punctured with a canula and the fluid
evacuated, and such further treatment used as the case
demands.
DROPSY OF THE AMNION. This results, in some cases, from
causes which we are at present unable to explain. The dis-
tension in these cases is sometimes enormous, and may be
mistaken for ovarian tumor. There is usually complete sup-
pression of menstruation for several months, and we feel
distinct fluctuation in the tumor. The patient, though im-
mensely large, has felt no movements of a foetus, and we can
detect no fœtus, or only a small one in the abdomen. Labor
pains come on at the completion of the full term of gestation.
however, when the nature of the difficulty is proven. In all
doubtful cases of suspected ovarian cystoma, it is best to wait
* Simpson on Diseases of Women," p. 431.
294
EATON ON DISEASES OF WOMEN.
until nine or ten months have elapsed before being too sure
of the diagnosis, especially when the menstruation is arrested.
RETENTION OF THE MENSTRUAL FLUID WITHIN THE UTERINE
CAVITY. Cases of this kind, caused from occlusion of the
neck of the womb or the external os, sometimes occur. They
closely resemble in their history and symptoms dropsy of the
amnion, and as we would not use the uterine sound unless
fully convinced of the impossibility of pregnancy, we might
be obliged to wait till the element of time helped to decide
the case, unless the general health of the patient made some
action on our part imperative. These enlargements of the
uterus from dropsical conditions and retention of menstrual
fluid may cause many of the ordinary symptoms of preg-
nancy. There may be the morning sickness, enlargement of
the breasts, disgust at the smell of food, etc., so that we have
to be careful regarding these symptoms.
SINGLE CYST OF THE UTERUS.-I have seen in three in-
stances a large single cyst in the uterus. These cases do not
vary so much as to be important from large hydatid masses
which are formed in some women. (Ten thousand of these
small cysts have been delivered from a single patient.) In
the case of a single cyst of the uterus we have the enlarge-
ment of the uterus, as in pregnancy, with the ordinary symp-
toms of polypi of the uterus; still such a case might be mis-
taken for ovarian cystoma. There is, however, no excuse for
the error to continue to the extent of adopting operative pro-
ceedings for the removal of ovarian tumor; for if we wait
several months we will be convinced whether it is, or is not
pregnancy, and if not, we may proceed to examine with the
uterine sound, when we will ascertain the nature of the dif
ficulty, for very likely we will rupture the sac in making the
exploration, as happened to me in one case which had been
developing for over two years. I dilated the os with sponge
tents, and freely cauterized the interior of the cavity of the
body of the uterus with Arg. nit. The membranes of the
OVARIAN TUMORS.
295
sac were expelled, but no fibrous, foetal, or placental forma-
tion. All these patients have remained without relapse, one
now going on seventeen years, the others four and six years,
respectively.
DISTENDED BLADDER.-The physician who is very careless
will be the only one likely to mistake this condition for ova-
rian cystoma, and this mistake is most likely to be made by
one wishing to be especially expert and show off his wisdom
for the benefit of spectators. We generally find these cases
will inform the physician that they are troubled with inconti-
nence of urine, that it constantly dribbles away. Now this
symptom, to the experienced physician, will at once cause
him to suspect retention of urine, and he will at once use the
catheter, which will clear up the diagnosis as if by magic.
The length of time, also, which has elapsed since the disten-
sion of the abdomen has existed will, in case of distension
of the bladder, be found to be generally but a few days.
while in ovarian cystoma it has been observed for months
or years.
PELVIC ABSCESS.-In pelvic abscess the history of the case.
will show a preceding stage of active inflammation; while
we have in cystoma no such stage. In pelvic abscess the
duration of the difficulty is much shorter; for, if an abscess
forms in the pelvis, the pent up matter seeks an outlet, and
there will be observed tenderness at the point where the
abscess is tending to find exit. In physometra, which con-
sists of a collection of air or gas within the uterine cavity,
sometimes of sufficient amount to cause quite a tumor above
the pubis, we may discover its nature through percussion
over the tumor, which will be so resonant as to indicate
its nature. If we are in any doubt, pass a male gum cath-
eter into the uterus, and make some pressure on the fundus
of the uterus, and expel the air, when the tumor will dis-
appear, and show that there can be no ovarian tumor in the
case.
296
EATON ON DISEASES OF WOMEN.
COMPARATIVE DIFFERENTIAL DIAGNOSIS OF OVARIAN CYSTS FROM UTER-
INE FIBROID IN THIRD STAGE.
Ovarian Cyst.
Uterine Fibroid.
1. More rapid growth.
2. Expression of countenance dis-
tinctive.
3. Abdomen symmetrical.
4. Abdominal veins enlarged.
5. Kidneys inactive.
6. General health impaired.
7. Countenance pale.
8. Frequently amenorrhoea.
9. Fluctuation distinct.
10. Uterus normal.
11. No tenderness.
1. Slow growth.
2.
Natural expression of counte-
nance.
3. Not so much so.
4. Not enlarged.
5. Kidneys active.
6. Not impaired.
7. Dark.
8. Menorrhagia.
9. Rather elastic than fluctuating.
10. Uterus elongated.
11. Somewhat tender.
COMPARATIVE DIFFERENTIAL DIAGNOSIS OF OVARIAN CYSTS FROM UTER-
INE FIBRO-CYSTS IN THIRD STAGE.
Ovarian Cysts.
1. Emaciation.
2. Umbilicus prominent.
3. Abdominal veins enlarged.
4. Expression characteristic.
5. Cyst wall very vascular.
Uterine Fibro-cysts.
1. No emaciation.
2. Umbilicus not prominent.
3. Abdominal veins not enlarged.
4. Expression normal.
5. Cyst wall not very vascular-
light color.
6. Tumor moved independent of 6. Uterus moves with tumor.
uterus.
7. Fluid light in cysts which have 7. Fluid yellow or dark brown-
not been tapped-albuminous.
coagulates.
gated.
8. Uterine cavity not generally 8. Uterine cavity generally elon-
elongated.
9. Not tender on pressure.
9. Tender on pressure.
Diagnosis of Adhesions.
The question whether or not the ovarian or uterine tumor
has formed extensive adhesions is often of much importance;
for, if we feel sure no very extensive adhesions are present,
we may advise operative procedure, when we might not if
we were sure they existed; for the more extensive the
adhesions the more danger there is in the operation for the
OVARIAN TUMORS.
297
removal of an ovarian tumor, other things being equal. Dr.
Peaslee, in his work on ovarian tumors, has given us some
excellent suggestions on this point, which I will take the
liberty to reproduce, although these hints apply to the
adhesions in the anterior part of the abdomen, and at present
we have no way of determining whether or not there are
adhesions in the posterior part. If pregnancy be present as
a complication we have more reason to expect adhesions than
otherwise. The existence of adhesions may be inferred from
the following conditions:
"1. If the relations of the upper extremity of the tumors
are not changed by deep inspiration.
"2. If it is absolutely immovable.
"3. If the abdominal walls can not be moved independ-
ently of it.
"4. If its position be not changed by tapping; sometimes,
after tapping, adhesions may be felt.
"5. If the tumor be a polycyst, and ascites do not co-exist.
"6. If signs of inflammation have existed.
"7. If the fluid obtained by the first tapping is brownish,
or of a darker color.
"8. If the lower extremity of the tumor remains low in
the pelvis, while the uterus is, at the same time, elevated.
"9. If pregnancy has existed since the commencement of
the growth of the cyst. (Dr. Keith.)
66
10. If the uterus is in front of the cyst in the third
stage, even if the cyst is not felt per vaginam in the pelvis.'
SYMPTOMS WHICH INDICATE NO ADHESIONS OF THE CYST, OR ONLY
SLIGHT, IF ANY.
">
"1. If the tumor falls an inch or more during a full in-
spiration, or if the muscles are seen gliding over it.
2. If it can be moved freely up and down.
3. If the abdominal wall can be gathered up over the
tumor, and made to glide from side to side freely.
298
ΕΑΤΟΝ ΟN DISEASES OF WOMEN.
"4. If the cyst falls down in a mass towards the pelvis.
after tapping.
"5. If ascites co-exist with the tumor.
"6. Oligocysts and Monocysts are less liable to adhesions,
but a large Monocyst generally has some adhesions to the
omentum.
66
"7. If the tumor has grown very rapidly, and is not
polycystic.
66
"8. If the tumor is a dermoid cyst.
"9. If no symptoms of inflammation have been observed."
HYDROPS FOLLICULORUM OR VESICULORUM.-This is the sim-
plest form of ovarian cysts, and is comparatively unimpor-
tant, as they seldom attain to any considerable size. They
consist of vesicles attached to the ovary, and are seldom
discovered before death.
CYSTOMA OVARII are divided into the monocysts, poly-
cysts, oligocysts, and struma. The struma is a cysto-colloid
degeneration of both ovaries, sometimes reaching the size
of a man's fist, or larger, in their entirety; made up of
numberless cysts, from the size of a millet-seed to that of a
chestnut. The outer sac, or general capsule, is smooth.
They are extremely rare, and are of little importance, as
they never attain to any considerable size, and the only
effect produced is to cause sterility, or produce some symp-
toms of weight in the pelvis, which are hardly explainable;
and, on rectal examination, and sometimes without, are dis-
covered to be caused from an enlargement of the ovary, and
this is supposed to be simple hypertrophy of these organs,
till death results from some other cause, and a post mortem
reveals the real difficulty.
OLIGOCYSTS, OR MONOCYSTS.-These terms signify the single
large cyst. It may contain compartments or division walls
apparently showing the cyst to be composed of several smaller
cysts; but, upon opening one, it is found that the fluid in the
others is also evacuated, showing a free communication be-
OVARIAN TUMORS.
299
tween them. These division walls are caused from a collasping
of the walls of the cyst after tapping, and, from some adhe-
sive, inflammatory action; becoming adherent in patches, so
as to give somewhat the appearance of a polycystic tumor.
The polycyst does not become a monocyst, as might appear pos-
sible; but this occurs from the oligocyst developing within it
papillary vegetations, which are thrown out like a cauliflower,
which finally adhere to each other, and make division walls in
this way. The unilocular cyst, monocyst, or oligocyst, occurs
only about one-fourth as often as the polycyst, while the dermoid
cyst is found in only one case in about fifty of ovarian growths.
OVARIAN POLYCYSTS. The polycystic ovarian tumor is the
most common form of cystoma with which we have to con-
tend. It is made up of several distinct cysts, of considerable
size. They may number but two or twenty or more. If
more than one they take the name polycystic. The fluid con-
tained within the different cysts varies often. The opening
of one cyst by tapping will often apparently produce little
effect upon the size of the abdomen, though several quarts of
fluid flow away, and the abdomen may feel about as tense as
before. This is convincing proof of the polycystic nature of
the tumor.
Differential Diagnosis of the Three Forms of Cystoma Ovariana.
MONOCYST, OR OLIGOCYST.
1. Slower growth.
2. Uncommon.
POLYCIST.
1. Rapid growth.
2. Common.
3. Health fails late in the 3. Health fails early.
disease.
4. Tumor disappears after 4. Does not disappear.
tapping.
5. Adhesions uncommon.
6. Fluctuations distinct.
7. Contains epithelial
scales.
5. Adhesions the rule.
6. Less distinct and cir-
cumscribed.
DERMOID CYST.
1. Slow growth.
2. Rare.
3. Very late.
4. Disappears only par-
tially.
5. Common.
6. Less distinct.
7. Contains blood pig- 7. Hairs pathognomonic.
ment.
ASCITES, WITH OVARIAN CYST.-The coexistence of ascites
with ovarian tumor was formerly thought to indicate carci-
noma of the ovary; but that idea is not now entertained.
300
EATON ON DISEASES OF WOMEN.
Disease of the heart, liver, or kidney may tend to produce
ascites, and especially is this likely to be the case where the
tumor is of large size, and, from its pressure, interferes with
the normal circulation in the blood-vessels of these organs.
Sometimes the rupture of one of the cysts of a polycystic
tumor may produce peritonitis; or peritonitis may result from
other causes, and effusion of serous fluid into the peritoneal
cavity may complicate a case of ovarian cystoma. It, of
course, increases the gravity of the case.
THE PEDICLE.It is sometimes important to be able to
determine the length of the pedicle of an ovarian tumor, as
we may feel more free to operate in case of a long pedicle
than a short one. The long pedicle is indicated if the index.
finger in the vagina can detect no part of the tumor, and if
the uterus is freely movable independent of the tumor. The
opposite symptoms will indicate the short pedicle.
FIBROUS TUMORS OF THE OVARY.-These are very rare.
Kiwisch notes but two cases; Peaslee only two; Klob one.
case; Scanzoni four. They are really hypertrophies of the
ovarian stroma. They are usually of a size varying from an
orange to a cocoa-nut. They can seldom require treatment.
ENCHONDROMA AND OSTEOMA. Of these varieties of solid
ovarian tumors we will simply say, they are very rare, only
two cases of enchondroma being on record, reported by
Kiwisch, and are both doubtful. Osteoma consists of a deposit
of bone in a fibroid.
CARCINOMA OF THE OVARIES.-This disease spares no period
of life except childhood. Cancer usually affects both ovaries,
and most frequently commences in the uterus, and affects
the ovaries secondarily. As a primary affection of the ovary
it is very rare. It sometimes attains to considerable size.
Lebert gives a case where the the carcinoma weighed eleven
pounds, and Dr. Brown, of New York, had a case in which
the diseased mass weighed nineteen pounds. We have in
connection with cancer of the ovaries the usual cancerous
OVARIAN TUMORS.
301
cachexia, as when it affects other parts or organs. The dis-
ease may be hereditary or acquired. It will not call for
ovariotomy, but may be removed in connection with extirpa-
tion of the uterus entire. (See extirpation of uterus.)
PAPILLOMA OF THE OVARY are also very rare and unimpor-
tant. They arise from the corpus luteum, and consist of
small vascular, vilous, or sometimes fibrous bodies of the size
of a pea, pedunculated.
CYST OF THE BROAD LIGAMENT.-Cyst of the broad liga-
ment is of slow development, is most usual in young women,
and is likely to be confounded with ovarian cystoma. A
single cyst has been known to contain forty pounds of fluid.
Boinet speaks of their development from 1. The areolar tissue
of the broad ligament; 2. The parovarium; 3. The vessels
of the pampiniform plexus. The cyst of the broad ligament
occupies a position lower in the pelvis than ovarian cysts,
and is more readily felt in making a vaginal examination.
Tapping causes complete collapse of the tumor.
HYDROSALPINX, OR DROPSY OF THE FALLOPIAN TUBE.-Cases of
enormous distension of the fallopian tube have been reported.
Such cases, though very rare, are well calculated to be mis-
taken for ovarian cyst. Peaslee reports cases where the tube
contained 130 and 150 pounds of fluid respectively. De
Haen reports a case where there were 32 pounds of fluid in
the tube. The color of the fluid in these cases is very clear
and limpid. Although I have not seen a case of hydrosalpinx,
I fear some error in diagnosis has been allowed to be reported,
for I do not see how the tube can be so enormously distended
without causing rupture. I believe that in tubal pregnancy
the development of the foetus never exceeds four months
before producing rupture of the tube. I am inclined to the
belief that these cases called dropsy of the fallopian tube
are cysts developed exterior to the tube proper, but under
the peritoneal covering of the tube. Dr. Farre also doubts
* Page 36.
302
ΕΑΤΟΝ ΟΝ DISEASES OF WOMEN.
*
the capacity of the tube to undergo such extreme distension.
De Haen states that the tube itself, in his case, weighed
seven pounds. I doubt that the "seven pounds of tube" was
really the hypertrophied tube; but I am inclined to think
it was like Dr. Peaslee's case which he considers dropsy of
the fallopian tube. He says of the autopsy, "There was no
pedicle, and no trace of the left fallopian tube or left ovary."
Now, has he not as good reason to say the tumor was ovar-
ian as tubal? There was a cyst, and a fibrous mass, which
included the ovary and fallopian tube. Doubtless the case
was fungoid, complicated with ovarian cystoma.
FIBRO-CYST OF THE UTERUS.-This disease has only re-
cently been recognized. Only fourteen cases had been re-
ported up to 1869. Their development is much slower than
ovarian cysts. They may be interstitial, or sub-peritoneal.
Fibro-cysts of the uterus occur only about one-fiftieth as often
as ovarian cystoma. They may develop as cysts within, or
attached to a uterine fibroid, or as cysts attached directly to
the uterus. They may be single or multiple. The fluid in
these cysts is spontaneously coagulable.
CYSTS OF THE MESENTERIC GLANDS.-Serous cysts of the
mesentery sometimes form, and are likely to be mistaken
for fibro-cysts of the uterus or ovarian cysts. Their attach-
ment will indicate their nature.
UTERINE FIBROMA (Fibrous Tumors of the Uterus.)
These tumors grow from the surface of the uterus or within
its substance, and are fibrous in their structure. They vary
in size from an inch in diameter to one weighing one hun-
dred pounds. They occur most frequently in the aged.
Their structure is dense, dark, or grayish, and within the
fibrous structure are often contained small cavities filled with
earthy matter, pus, or blood. They are frequently peduncu-
lated. One or more may exist in the same case.
Intra-mural fibrous growths of the uterus and fibrous polypi,
· Peaslee on "Ovarian Tumors," p. 105.
OVARIAN TUMORS.
303
requiring different treatment, will be spoken of separately. They
have been mistaken for ovarian cystoma. They are more
dense and solid, however. In some instances it may be im-
possible to diagnose them from fibro-cystic tumor of the
ovary. They never reach enormous size.
Prognosis.
The probable result of ovarian tumors, if left without
treatment, is dubious as regards ovarian cystoma, for nearly
all prove fatal in from one to four years-generally in about
two years. As regards the solid tumors of the ovary (with
the exception of cancer), they have a favorable prognosis.
without treatment, even if of considerable size. There is
occasionally an exceptional case where the patient continues
for many years to live and carry about an ovarian cyst (sup-
posed to be), and finally dies of some other disease; but these
cases are so rare
rare as to be almost unworthy of mention.
Medical treatment has, in a few instances, been reported as
curing the disease. Boinet reports one and Professor J. D.
Miller, of Chicago, three cases cured after prolonged treat-
ment with Bromide and Iodide of Potassium.
All agree,
however, that medical treatment is in most cases useless.
Dermoid cysts continue for a longer period without caus-
ing death than the other forms of ovarian tumors. After
suitable treatment a large per cent of all forms of ovarian
tumors recover.
Treatment.
Remedies have generally been considered about useless,
although my own experience has shown (see cases reported
under treatment of ovaritis) that enlargements of the ovary do
diminish, and sometimes disappear, from the use of remedies.
It has been held, also, that ovariotomy was the only
relief, and this idea is entertained by many prominent mem-
bers of the profession to-day. Ovariotomy, 'tis true, has
been very successful in skillful hands, but it is a serious
304
EATON ON DISEASES OF WOMEN.
operation at best, and we are glad to be able to show that in
very many cases it is not needed, and that Iodine injections
have cured ninety-three per cent of well selected cases, and about
sixty-three per cent of cases taken at random, polycysts included.
Harm seems to have resulted in but six instances, though
I have collected three hundred and eleven cases operated on
by different gynaecologists in this country, Germany, France,
and England. M. Boinet has done more than any other
man to demonstrate the great advantage of this treatment.
Out of these three hundred and eleven cases collected I find
reported cures in one hundred and ninety-seven cases, or
about sixty-three per cent, including favorable and unfavor-
able cases.
*
It strikes me this is good enough to justify a strong
sentiment in favor of this method of treatment of ovarian
cystoma; besides, it is shown, from the reports of these
cases, that, in the event that this treatment is unsuccessful,
the patient is in nearly as good a condition for ovariotomy
as without it. Peaslee asserts they are in as good condition.
I can not say as much. I will say, however, that I think
that the injury produced by tapping and injecting Iodine is
not so great as to deter us from attempting a cure in this
way in all cases which are clearly monocystic. The punc-
ture or punctures made in tapping may, and often do, cause
adhesions, at these points, between the peritoneum and sac
(not always, however); and, in so much as they do produce.
adhesions, they in so far complicate ovariotomy, in case of
failure of the injection to cure the case and ovariotomy
becoming necessary.
We should also bear in mind that the operation of tap-
ping and injecting the sac is not free from danger, although
Boinet had no unpleasant result in a single instance, out of
ninety-one selected cases, producing sixty-one cures; and
I am sure I have had no unpleasant results following tapping
* Peaslee, p. 209.
OVARIAN TUMORS.
305
and injection with Iodine in a single instance, although I
have treated but seventeen cases in this way, with recoveries
in twelve out of the seventeen. Two died without ovariot-
omy, one with it performed; two recovered after ovariotomy.
Of the twelve cases recovered, three were diagnosed poly-
cystic by myself and others; the other nine were either
monocystic or cyst of broad ligament. (I do not claim it is
always that we can positively diagnose the difference. The
weight of evidence, however, was that they were ovarian.)
The polycysts required from seven to fifteen injections each,
while the others required only one injection in four cases,
and from three to five in the others. On the other hand,
some physicians have had a sad experience in tapping ova-
rian cysts.
cent.
In Germany and England, out of two hundred and twenty-
five first tappings, forty-eight died, or about twenty-two per
Dr. Meigs, of Philadelphia, states that nearly one-half
of the first tappings of ovarian tumors which he had wit-
nessed had proved fatal. Dr. Peaslee* says that "I learn from
several of the most experienced ovariotomists of this and
other countries that they do not consider tapping an ovarian
cyst a dangerous operation."
Here is a conflict of testimony. Can we ascertain why
it is so harmless with one and so destructive with another?
Without casting any reflections upon those who have been
unfortunate in their cases (for misfortune comes to us all in
some shape), let us inquire from what causes a patient is
likely to die in case of tapping of the sac, in case of ovarian
cystoma. 1st. She might die from peritonitis; 2d. From
hemorrhage; 3d. From shock. Knowing the danger of peri-
tonitis, the operator should use every means possible to avoid
accidental cold after the operation, and see to it that the
system is in as good condition as possible before the oper-
ation.
*Peaslee, p. 197.
+
20
306
EATON ON DISEASES OF WOMEN.
$
The danger from hemorrhage is greater in polycysts than
in monocysts, as the walls of the cysts are more vascular;
and there is more danger from this source, in operating per
vaginam, than through the abdominal walls. The operation
should not be attempted through the vagina unless the tumor
can be clearly felt fluctuating there.
As to danger from shock, it is to be avoided by attention
to the maintenance of pressure, as I will mention presently
in describing the operation.
I can not rid myself of the idea that, possibly, want of
attention to some of these points may have caused some
of these fatal cases, though I must acknowledge that bad
results may sometimes follow ordinarily simple operations,
even when the greatest care is exercised, not only in tapping,
but in any operation in surgery.
STRENGTH OF IODINE SOLUTION TO BE USED.-A Solution of
Iodine made with Di of Iodine res. and 5i Potass. iodide to the
3i of water, is the most desirable form and strength to be
used, although in some instances this solution, diluted with
water one-half, is sufficiently strong. The use of ordinary
Tr. Iodine is, to my mind, open to some serious objection. If
the sac has not been completely emptied before the injection
is used, the fluid in the sac might so much dilute the Tr. as
to allow of the deposit of the solid Iodine on the walls of the
sac, which might irritate them too much at the points where
the Iodine is deposited, and cause active inflammation. Dr.
Byford's suggestion to use twenty grs. of Iodine with forty grs.
Iod. potass. to the ounce of water is open to the same objec-
tion, as it requires three grs. of Iodide of Potassium to hold
one gr. of Iodine in solution. The Tr. Iodine compositus I
much prefer to the ordinary Tr. The temperature of the
injection should be not too low nor too high, from 80° to 85°
being the best.
In making the puncture, care must be exercised to insert
the trocar at a point where the tumor presses directly against
OVARIAN TUMORS.
307
the abdominal walls, and, if there be adhesion between the
sac and abdominal walls, all the better. Percussion should
always be made over the point we desire to puncture. If res-
onant, avoid that point, as resonance will indicate that some
part of the intestines intervene between the tumor and the
abdominal wall. A point midway between the umbilicus and
pubis, in the median line, is usually the most desirable place
for puncture, although other points may be selected in some
instances. I prefer not to make an incision in the skin before
inserting the trocar, as without it we get a better closure of
the skin over the puncture.
The patient may sit in a semi-inclined position, or lie upon
the side. There should be a free circulation of pure air in
the room; and the abdomen must be compressed steadily.
This is best accomplished with a piece of muslin two and a
half yards long and about eighteen inches in width, torn down
at both ends into strips about four inches wide, like a many-
tailed bandage, leaving about two feet of the center untorn.
This should be passed around the body, and the strips inter-
locked, and gentle tension should be made by an assistant on
either side of the patient. This keeps up the pressure upon
the abdominal organs, and prevents the collapse which might
otherwise follow the sudden withdrawal of a large amount of
fluid from the abdomen.
In case the cyst can be reached per vaginam, and is felt as
a fluctuating tumor there, it is better to puncture and inject
in this locality.
It has been suggested that the sac be washed out with
warm water. This I do not consider necessary; and, as it
prolongs the operation, it is, in that much at least, objec-
tionable.
The quantity of fluid injected should be at least eight
ounces, that it may come in contact with the entire internal
surface of the sac. This should be aided, also, by turning
the patient from side to side, while all the Iodine is in the
308
EATON ON DISEASES OF WOMEN.
cyst and the compression is still maintained. After allowing
the injection to remain about five minutes, we may permit it
to flow away; and, if the puncture is made in the vagina, the
canula may remain and be held in position by the introduction
of a good-sized sponge into the vagina, so as to press upon
the canula. This should be removed, cleansed, and re-
placed, or a new one substituted, every twelve hours for two
or three days, when the canula should be removed.
In punc-
turing through the abdominal walls I would not allow the
canula to remain, but remove it at once. The instant the in-
jection ceased to flow away, place a piece of adhesive plaster
over the puncture, and pin a bandage tightly about the abdo-
men to maintain pressure.
USE OF THE GUM-ELASTIC TUBE. It is recommended, by
Boinet and Simpson, that a gum-elastic tube be passed through
the canula, when a considerable part of the fluid had been
evacuated, the canula withdrawn, and that the injection be
made through the tube. I object to this on the ground that
the elastic tube must be smaller than the canula in order that
it can be inserted, and, consequently, the puncture into the
sac will be larger than the tube, and will allow of the escape
of the fluid or injection into the peritoneal cavity, especially
if the puncture is made through the abdominal walls. In case
we puncture through the vagina, there is not the same objec-
tion, as it is the most dependent portion of the sac; but even
here we get along better with the canula alone, as it is firmly
grasped by the tissues through which it passes, and is retained
more easily than a smaller tube could be.
REPEATED INJECTIONS.-In case the cyst should refill, and
we feel sure that the tumor is monocystic, we should repeat
the operation as before, using a stronger injection the sec-
ond time.
WINE AS AN INJECTION.-Wine has been used as an injec-
tion into ovarian cysts; with such poor results, however, as
to justify its rejection for this purpose.
OVARIAN TUMORS.
309
MODUS OPERANDI OF IODINE INJECTIONS.-Iodine seems to
possess the property of causing adhesive inflammation, and not
producing suppuration, unless it is used in such a way as to
be escharotic. By adhesive inflammation we mean that when
the Iodine is injected into the ovarian cyst it produces such
an irritation as to cause enlargement of the mucous follicles
of the sac, which spring up like granulations upon an inflamed
conjunctiva, and if these are brought into co-aptation, adhe-
sion results, and a consequent obliteration of the sac is in-
duced, as in hydrocele when Iodine is injected in that disease.
IODINE INJECTIONS INTO OVARIAN CYSTS NOT PAINFUL.-
There is no call for placing the patient under an anæsthetic
for the operation of tapping and injecting a Solu. of Iodine.
Boinet, with the skill which his large experience has given,
says "no pain is experienced when the injection is thrown
into an ovarian sac" (he has performed the operation over one
thousand times); but if it escapes into the peritoneal cavity
it produces great pain and severe peritonitis.
ELECTROLYSIS.—Electricity has proven a curative agent in
the hand of Fieber,* and he reports a striking case of cure
of ovarian cyst by this treatment, and his report is corrobo-
rated by C. Braun and reported by Schroeder. Here is a
wide and inviting field open for investigation and experiment.
At present we can say nothing against the treatment, and
only this much for it.
FORMATION OF A PERMANENT OPENING INTO THE CYST.-In
1836 Ledran made an incision into an ovarian cyst, and kept
it open with pledgets of lint and a canula of sheet-lead for
five months, and the patient recovered. Another case treated
the same way continued to discharge from the artificial open-
ing thus made for upwards of two years; but finally recovered.
In 1824 Récamier proposed to cause adhesion of the cyst
to the abdominal wall by the application of Caustic potassa, and
*Wien Med. Pr. 1871. No. 15.
†Ziemssen's Cyclopædia, Vol. X, page 404.
310
EATON ON DISEASES OF WOMEN.
then make the incision, as Ledran had done. Mr. Bryant, of
St. Thomas's Hospital, reports two cases treated successfully
in this manner. This method has, at the present day, no ad-
herents, that I am aware of.
The tapping of the cyst in the usual manner, leaving the
canula or gum-elastic tube in the puncture (by which means
the fluid in the sac is allowed to be discharged), and using
injections of a Solution of Iodine, to excite adhesive inflam-
mation, is the plan now in favor. Dr. E. Noeggerath,* of
New York, tabulates fifty-three cases of operations of this
kind, viz:

CURED.
DIED.
DISEASE RETURNED.
UNDECIDED.
34
14
4
1
Dr. Noeggerath also recommends the evacuation of the cyst
by means of a free incision through the vaginal wall posterior
to the os uteri, and stitching the incised vaginal and cystic
tissues back so as to cause a permanent opening, and wash-
ing out the sac daily with antiseptic injections. This opera-
tion he terms "ovariocentesis vaginalis." He reports five out
of six cases successful, five of which were polycysts.
SPONTANEOUS RUPTURE OF THE CYST.-Dr. Simpson has suc-
ceeded, in one case, in curing his patient by rupturing the
cyst, and allowing the fluid to pass into the cavity of the
abdomen. He was encouraged to do this from the fact of
some patients recovering after spontaneous or accidental rup-
ture of the cyst (probably most of them were cyst of the
broad ligament). Dr. Tilt has collated seventy cases of
spontaneous rupture of the cyst, with forty recoveries, or
over fifty-seven per cent. Before proceeding to rupture
a cyst, it would be better to aspirate a part of it at least, and
see if the fluid is clear, bland, and transparent in character.
If so, we may have little fear of its producing peritonitis.
Peaslee, p. 220.
OVARIAN TUMORS.
311
If, on the contrary, it is a dark, thick fluid, we may expect
its escape into the peritoneum will produce serious, and
probably fatal, results; and, of course, the operation should
not be attempted in this class of cases. I will frankly state
that I do not see the advantage of this treatment over tap-
ping and injecting a Solution of Iodine; for it strikes me that
it is better to evacuate the cyst by aspirating it than to
allow it to drain off into the abdominal cavity. I think there
can be little dispute on this point; hence, we can not recom-
mend rupturing the cyst in any instance.
<
312
EATON ON DISEASES OF WOMEN.
CHAPTER XXV.
OVARIOTOMY.
THE removal of the diseased ovary or ovaries by surgical
operation is termed ovariotomy. The diseased mass may be
removed through the abdominal walls or the vagina. This
diseased mass, arising from, or connected with, the ovary,
is found to be cystic, or fibro-cystic, in ninety-five per cent of
all cases of ovarian tumors.
HISTORY OF OVARIOTOMY.
To Dr. Ephraim M'Dowell, late of Danville, Kentucky,
belongs the honor of having performed the first operation for
ovariotomy. This he did in October, 1809. His first three
cases were published in 1816. Two years after Dr. Chrys-
mar, of Würtemburg, performed the operation-the first
which had been performed in Europe. His first was unsuc-
cessful; the second, performed a year later, was successful.
Dr. E. M'Dowell shared the responsibility of his first opera-
tion with Dr. Jas. M'Dowell, his nephew, he making the first
incision, though the balance of the operation was performed
by Dr. E. M'Dowell, assisted by Dr. Jas. M'Dowell. The
report of this first case was published in the Eclectic Reper-
tory and Analytical Review for October, 1816. The opera-
tion was performed upon a Mrs. Crawford in 1809, who lived
till 1841.
The second successful ovariotomist in this country was
Dr. Nathan Smith, of New Haven, who performed the oper-
ation in Vermont, July 5, 1821, he not being aware of Dr.
M'Dowell's operation at that time. His operation was also
successful.
OVARIOTOMY.
313
Now, over one thousand operations for ovariotomy have
been performed in the United States, with a record of recov-
eries amounting to about seventy per cent.
In France, the first operation for ovariotomy was per-
formed by Dr. Woyerkowsky, in April, 1844.
This case
was also successful. In Russia, Sweden, Germany, France,
Australia, Italy, and England, the operation is practiced as
a standard operation; while in Ireland, it is seldom performed.
In Belgium, Iodine injections are most extensively used.
The operation has met with violent opposition in this coun-
try and Europe, and it has been only within the last quarter
of a century that the operation has been countenanced gener-
ally. Of late years, the sentiment in its favor has been
very strong in this country and Europe, with the exception
of Belgium and Ireland. Skilled operators have reached
an average of success in about seventy-eight per cent of
their cases, while, if we include in our figures all the opera-
tions recorded, the average per cent of recoveries drops to
about fifty. At the present time there have been probably
over five thousand ovariotomies performed in the world.
As to precedence in the operation, there has been some
dispute, some having claimed that Dr. M'Dowell was not
the first to perform the operation, Dr. Robert Houstoun, of
Glasgow, having in 1701 made an incision into an ovarian
cyst, and evacuated its contents; but he did not remove the
cyst, and his operation could only be called "ovarian sec-
tion." In 1782 Laumonier* operated on a case which has
been claimed as one of ovariotomy. Koeberlé and Boinet,
however, assert that Laumonier's operation was not one of
ovariotomy, but a case of dropsy of the fallopian tube, com-
plicated with ovaritis. The ovary was as large as an egg.
The ovaries were removed, however, in a healthy state
hundreds of years before Dr. M'Dowell's operation. We are
*“Histoire de la Société Royale de Médecine," 1782, tome v.
314
EATON ON DISEASES OF WOMEN.
told by De Graaf* that a Hungarian sow gelder removed
the ovaries from his daughter (being disgusted with her
lewdness) more than two hundred years since; and it is a
matter of history that certain kings of Lydia had the ovaries.
of women extirpated for their service or pleasure, using
them instead of eunuchs as servants. Gyges hoped thereby
to establish their perpetual youth. We have no record of
the per cent of the success of the operation, and it could
not be considered ovariotomy as now accepted, but rather
spaying.
OBJECTIONS TO OVARIOTOMY.
It has been urged against ovariotomy that it was too
dangerous an operation, that the statistics in its favor are
unreliable, that palliative treatment by medicine or tapping
might prolong life indefinitely, that even if the operation is
successful in removing one ovary the other may become
affected. To-day, these objections have little weight; the
danger of the operation is yearly becoming less, owing to
more skillful management. In fact, when we note the rough-
ness of the operation, as detailed by Dr. M'Dowell, in his
first cases, we are filled with wonder that either recovered.
The delay of the operation till the disease was too far ad-
vanced, and till the pressure upon the abdominal organs had
too much disturbed the general health, has doubtless been
the cause of some fatality. But now, that the operation is
sanctioned by the best authority, it is not delayed as for-
merly, and the care exercised to prevent peritonitis and
secondary hemorrhage is such as to add largely to the suc-
cess of the operation.
The statistics, doubtless, are as correct in regard to this
operation as any other. As to relief from medicines I believe
but thirteen cases are on record where a cure is claimed from
*De Mul "Organ Generat. tract. Nov. Cap. xiii."
OVARIOTOMY.
315
internal medication, and doubtless some of these cases were
erroneously diagnosed. Not over five per cent of cases of tap-
ping have proven curative. Tapping, with injections of Iodine,
have proven very successful, it is true. According to sta-
tistics laid before the French Academy of Medicine,* about
three-fifths of the cases were cured by Iodine injections.
Boinet had sixty-two cures and twenty-two failures, and six-
teen deaths out of his first one hundred cases. He does not,
however, attribute any death to the operation, for he says
"the operation did not produce any unpleasant result in a
single instance." Simple tapping seems to be very unpromis-
ing of good results; but the injection of Iodine in connection
with tapping offers a treatment full of promise, especially in
monocysts. The operation of ovariotomy is, then, to be con-
fined mainly to the removal of poly-cystic and dermoid cysts;
fibrous, and fibro-cystic tumors of the ovary.
WHEN SHOULD THE OPERATION BE PERFORMED?
Dr. Clay, Dr. Bryant, Drs. Black and I. B. Brown prefer
to operate as early as possible, about as soon as the diag
nosis is made out; while Drs. Atlee, Bradford, Keith, Smith,
and T. S. Wells, as well as Dr. E. R. Peaslee, speak in favor
of waiting till the disease is well advanced, though not to the
extent of very severe impairment of the general health.
It is best to wait till we see evidences of serious danger to
the patient if the tumor longer remains, for occasionally a
case occurs where many years pass (sometimes two or more)
without deranging the general health to any great extent,
and it is not advisable to jeopardize the patient's life by
an operation which, if left unperformed, might possibly
have permitted the patient to live in the enjoyment of com-
parative health for some time to come, while the operation
might cut her life short at once.
*Peaslee, page 267.
316
EATON ON DISEASES OF WOMEN.
CAUSES OF DEATH AFTER OVARIOTOMY.
The result of one hundred and fifty cases of ovariotomy,
collected by Dr. Peaslee, showed ninety-nine successful opera-
tions and fifty-one deaths. The direct cause of death in
these fifty-one cases he tabulates as follows:
Peritonitis...
Septicæmia.
Shock..
12 or 23.53 per cent.
9 or 17.65
Exhaustion
7 or 13.72
7 or 13.72
(6
Shock and Septicemia
1 or
1.96
66
Hemorrhage
1 or
1.96
CC
Strangulation of intestines in womb...... 1 or
1.96
66
Diarrhoea
1 or
1.96
(6
Erysipelas.
1 or
1.96
Tetanus.
1 or 1.96
Ulceration through bladder...
Unknown........
1 or
1.96 ((
9 or 17.64
51
These figures would be modified very much if we take in
a larger scope. Thus, in two hundred and thirty-four cases
of death from ovariotomy, occurring in Great Britain, Ger-
many, France, and the United States,-
96 were from peritonitis;
33 from hemorrhage;
15 from collapse;
90 from all other causes.
Total, 234 cases.
AFTER OPENING THE ABDOMEN, WHEN SHOULD THE OPERATION BE
ABANDONED?
Before commencing an operation, it is always well to be
prepared for all the emergencies that may arise, as well as
the complications with which we may meet. Surgeons of
large experience have been mistaken in their diagnosis of
ovarian tumors, as has been mentioned while speaking of dif
ferential diagnosis. In case the abdomen is opened, and it is
then found that we have a solid tumor of the spleen, liver,
mesentery, or kidney, it is best to close the incision imme-
OVARIOTOMY.
317
diately, and suspend the operation. If it be a cyst of the
kidney, spleen, liver, or a uterine fibro-cyst, non-pedunculated,
we may tap the cyst, inject a Solution of Iodine, and close the
wound. In case of the uterine tumor having a moderately-
sized pedicle, we may proceed to remove it, if there are not
very extensive adhesions. If the tumor prove to be cyst of
the broad ligament, simple tapping is all that is required. It
is but seldom necessary to abandon an operation on account
of adhesions; for if the operation be abandoned the patient is
liable to die from the result of the incision (about thirty per
cent dying under these circumstances) very soon after the
operation, while those who live, or rather recover from the
operation, are left to die before long from the tumor. Hence,
it is generally as well to proceed with the operation, even
if the adhesions require ligature, although 70 per cent die if
adhesions are so strong as to require ligature.
PREPARATORY TREATMENT.
Operators differ greatly upon this point. Some undertake
the operation with little or no regard to the condition of the
patient, while others attach much importance to the necessity
for some preparatory treatment. We may lay down the gen-
eral rule, however, that it is better that the digestive and
assimilative process should be in as healthy a condition ás
possible at the time of the operation; that the bowels be
freely evacuated with soap-and-water enemæ, and, in obstinate
cases, with some saline waters; that nourishing, easily di
gested food should be given for some time before the operation.
Subnitrate of bismuth, given in three gr. doses every three
hours, for twenty-four hours before the operation, is advisable
in case there is much tympanites in any portion of the abdo-
men. It is of considerable importance to secure free action
of the skin. The operation should not be attempted while
the skin is hot and dry. In this condition it is better to give
Aconite 3 every three hours, till some slight perspiration is
318
EATON ON DISEASES OF WOMEN.
established. The giving of Acon. for three or four days pre-
vious to the operation, in most cases, is a good practice, giving
it at intervals of four to six hours. It has a great tendency
to prevent inflammatory action. Dr. T. G. Thomas gives
opium, in one gr. doses, for four days previous to the opera-
tion, at intervals of six hours. This treatment has the objec-
tion that the opium has a constipating effect upon the bowels
just at a time when we desire their free evacuation.
WHEN THE OPERATION IS IMPROPER.
1. While the patient is in the enjoyment of good general
health no operation should be advised.
2. Not till tapping and injections of Solution of Iodine have
demonstrated that these means are inadequate.
3. When there is organic disease of the lungs, heart,
liver, kidneys, or bowels, cancer of the breast, stomach, or
other parts of the body.
4. The operation should not be performed during the pre-
valence of an epidemic of any kind in the immediate vicinity.
5. When the tumor is evidently malignant.
6. When the patient is so weak from any cause as to
make it very doubtful whether or not she is able to with-
stand the shock of the operation.
PREPARATION NEEDFUL TO BE ATTENDED TO ON THE PART OF THE
OPERATOR AND FRIENDS.
1. THE TIME OF THE YEAR. Both the hottest and coldest
temperature should be avoided. The clear, moderately cool
atmosphere is the best.
2. PLACE. The healthful suburb of a city is, perhaps, the
most desirable, as the patient is then within easy calling dis-
tance of the surgeon, while, if we operate in the country, we
must trust the care of these cases to some assistant. Avoid
operating in a large hospital, as the air can hardly be as pure
here as in the small hospital or private house.
OVARIOTOMY.
319
3. TEMPERATURE OF THE ROOM.-While the operation is
progressing the temperature of the apartment should be main-
tained at 78° or 80°; but as soon as the incision is closed and
dressings applied, the temperature should be lowered to 68° or
70°. The apartment should be quiet, large, and capable of
the best of ventilation. The spray apparatus (see Plate XI)
is recommended, which throws a spray into the room, impreg-
nated generally with a small amount of carbolic acid. This
does well; but, in case we have not the apparatus, a cup of
water may be placed upon the stove, if the weather be cool
and needing fire, and a tea spoonful of Comp. tr. Iodine or Car-
bol ac. added to it, that the vapor of Iodine or Acid may per-
meate the air of the room.
SUITABLE DRESS.-The patient should be warmly dressed.
in flannel, with woolen stockings on the feet.

STOHLMANN: PFARRE & Co
FIG. NO. 21.-OPERATING TABLE.
OPERATING TABLE, INSTRUMENTS, Erc.-A suitable operating
table is convenient. It should be high enough, so that the
operator will have to bend over the patient very little,
or none at all. It should be six feet long and about two
320
EATON ON DISEASES OF WOMEN.
feet wide. It is a great convenience to have a little room
on the table not fully occupied by the patient. The table
should be covered with India-rubber cloth, placed over a folded
quilt or pair of blankets, with hair pillow for the head. It is
well to have the India-rubber cloth covered with a flannel
blanket, so folded as to wrap around the lower limbs and keep
them warm.
i
The surgeon, before commencing the operation, will ob-
serve that he is provided with eight or ten assorted sponges,
well cleansed, and examined that they contain no small bits
of shell or rough points. It is well that they be moistened
with a weak solution of carbolic acid two days before they are
needed. Three or four basins of water, both warm and cold,
should be at hand; and it is better that we use cistern-water,
filtered, for this purpose, that by no means there may be sand
or small, rough particles in the water, which might prove irri-
tating. A small tub and bucket, with a dozen or more tow-
els, two old sheets, some extra pieces of flannel and several
pairs of flannel blankets, should be at hand. The bed upon
which the patient is to remain should also be in the room,
standing convenient to the operating table (though it may be
brought in afterwards, if the room is small).
The instruments needed should be selected in an adjoining
room (so as not to disturb the patient), and placed on a tray
and covered with a towel before they are taken into the pres-
GLTIEMANЯ-CO.
FIG. NO. 22.—SPENCER WELLS' TROCAR.
ence of the patient.
They should consist
of three or four dif
ferent sized scalpels,
dressing, dissecting,
artery, and hooked
forceps, one grooved

director, straight and curved scissors, two or three tenacu-
lums, two trocars (one being long and curved), chain ecraseur,
one steel male sound, three or four strong retractors, one uter-
OVARIOTOMY.
321
1
ine sound, female catheter, eight or ten needles threaded with

carbolized silk thread,
and three ΟΙ four
threaded with silver
wire; also several
pieces of saddler's silk
for ligatures (waxed),
some cat-gut string for
I
B
D
E
G.TIEMANN-CO.
FIG. NO. 23.—DAWSON'S CLAMP MODIFIED.
the pedicle, and a clamp, in case it
seemed best to use it. (See also Plate XV.)
Extra pieces of rubber cloth, adhesive plaster, artificial
serum, bottle of solution of Persulphate of Iron, and Chloro-
form, or Sulph. Ether should also be in readiness. A little
wine, brandy, or whisky should be at hand, as well as am-
monia, a can or bag of oxygen gas, and a bottle of Nit. Amyle.
THE METHOD OF PERFORMING OVARIOTOMY.
The patient is now placed upon the operating table with
only a small pillow under the head. (Some authors have
recommended a large pillow, or even two or three pillows,
placing the patient in a semi-recumbent position, which is
very objectionable on account of the anaesthetic, it being
much more unsafe to use any anaesthetic while the patient is
semi-recumbent than in the recumbent position.) Four assist-
ants should be at hand, three of whom should be skilled
surgeons, the other may be a student or nurse, who will be
found useful to hand what is required, regulate the tempera-
ture of the room, etc.
The administration of the anaesthetic should be entrusted
to none but a skilled and experienced surgeon, as very much
depends upon its proper administration, and the operator and
two assistants should feel that they are obliged to have no
care about the anaesthetic. The physician giving the anæs-
thetic should know when complete anaesthesia is required,
and when it will do to allow it to be partial; when to use
Ammonia or Oxygen to revive her, etc.
21
322
EATON ON DISEASES OF WOMEN.
The patient is now brought fully under the influence of
the anaesthetic, and every thing being in readiness the first
incision should be made through the skin in the direct line
of the linea alba, commencing a little below and a half inch
to one side of the umbilicus, and extending downwards to
within an inch of the pubis, in case we perform gastronomy,
which is the usual operation, and is the necessary one, if
the tumor is of any considerable size.
After making the first incision with the scalpel, which
may penetrate somewhat into the adipose tissue (if there is
any), we pass the grooved director under successive layers
of fascia and muscular tissue, and incise with the edge of the
scalpel, away from the patient, till the peritoneum is reached,
when it should be seized with the hook forceps and an incis-
ion made in it with a sharp pointed, straight scissors after
the arrest of any hemorrhage. Into this cut made with the
scissors I prefer to insert the index finger of the left hand,
and explore for adhesions in the line I desire to incise the
peritonæum; and if I find adhesions make the incision to one
side of them, if possible, using the finger so inserted as a
director, making the incision through the peritoneum in
length to correspond to the external cut. We now bring the
tumor into view by separating the lips of the incision.
The next step is to explore for adhesions, and make out
a clearer diagnosis of the tumor; then tap the cyst (if it

EG TIEMANN & CO
FIG. NO. 24.-SPENCER WELLS' ARTERY FORCEPS.
be one) with Spencer Wells' trocar; detach adhesions;
ligate the pedicle; remove the tumor; arrest the hemorrhage,
OVARIOTOMY.
323
by torsion or ligation of the bleeding vessels; examine the
other ovary, and remove it if required; cleanse the periton-
æal cavity; close the incision; apply proper dressing; see the
patient placed properly in bed, and returned to conscious-
ness. It is sometimes best to tap the cyst, or cysts, if there
be more than one of any size, before exploring much for adhe-
sions, as it often is of so large a size as to be very difficult
of examination before tapping.
Before inserting the trocar place a small elastic band over
the instrument, and have it strong enough to clasp it firmly;
then sieze the sac with a pair of hook forceps, draw it out

TIEMANN & CO.
FIG. No. 25.-DOUBLE TENACULUM FORCEPS.
a little, and, after turning the patient well on the side,
plunge in the trocar, and, as soon as some portion of the
fluid has passed out, draw the sac up around the canula,
sieze it with the hooks, draw it back, and slip over it the
elastic band, so as to grasp the walls of the sac, and hold the
canula firmly. In this manner no fluid from the sac need
escape into the abdominal cavity.
We now sieze the sac, and ascertain if our incision is
large enough to easily extract the mass after evacuating the
cysts. If not, then we may extend it upwards as high as
necessary, using two fingers passed up between the tumor
and the peritoneum, and making the cut through all the
tissues at once.
We now arrest any hemorrhage caused by this second
incision, and proceed to find and divide any adhesions
324
EATON ON DISEASES OF WOMEN,
between the tumor and the surrounding parts, breaking off the
adhesions with the fingers, if it can be done without using
very great force. If not, a small silk ligature may be ap-
plied firmly, cut short, and left in the abdomen (or left long
if near the incision). This is very generally necessary in
case of the adhesion of the omentum; or we may cut out a
piece of the sac, and leave it attached in the abdomen.
If, on tapping the sac, we find its contents too thick to
run out through the canula, we may, after enlarging the
incision in the abdominal walls (to the greatest possible
extent), turn the patient on the side, as for tapping the sac,
and, lifting the tumor out of the abdominal cavity as much
as possible, proceed to make a free incision into it, and turn
out its contents.
If it is of sufficient size so as to seriously interfere with
getting at and tying the pedicle, after emptying one cyst in
this manner, by free incision, and finding the tumor to be
multilocular, it is best to divide the walls of the other cysts,
so as to allow of the discharge of these other cysts, also,
through this first one incised.
The recommendation of some authors to immediately
sponge out any fluid or blood which escapes into the abdom-
inal cavity is a poor practice. It irritates the peritoneum
much more to keep wiping it out than it does to allow the
fluid to remain till the tumor is separated from the pedicle,
and have the whole cleansing performed at once; besides, the
practice of frequent sponging delays the operation very
materially, and is objectionable in this respect as well as on
account of the irritation it is calculated to produce. Of
course, in case we tear a blood-vessel, and torsion does not
at once arrest the hemorrhage, we must stop and apply
a fine silk ligature to the bleeding vessel, cutting it short,
as before mentioned.
In case we find, after opening the abdomen, that we have
a case of a considerable fibrous mass in connection with the
OVARIOTOMY.
325
cyst, we find advantage in passing the male sound all around
the tumor to discover at what point and to what extent we
have adhesions to contend with. If they are so extensive
as to make it impossible to separate them and remove the
mass, we may proceed to evacuate the cysts in the manner
described; and, if the tumor, or rather the cyst wall, is not
very vascular, we may ligate some parts of it, and cut it
away, sponging out the remaining portion of the cysts with
Comp. Tr. Iodine or Solution of Iodine. Carefully sponge out
the cavity of the abdomen with warm water or warm artificial
serum, to which a few drops of Carbolic acid has been added,
and then close the incision as rapidly as possible.
In case we find that the adhesions can be broken up, or
are not very numerous which require ligation, we proceed
to carefully divide all the attachments and lift the tumor out
of the abdomen.
We now examine the pedicle. If it is not larger than a
man's finger, it may be ligated as a whole; while, if of
greater size, a double ligature should be used, placing the
ligature in either instance about an inch from the bulk of
the tumor. This ligature for the pedicle must be strong cat-
gut, whip cord, or extremely strong silk ligature (I prefer
the catgut), tie it tightly in three knots so as to avoid the
possibility of its slipping. (These ligatures, as well as all
those used in the operation, should have a previous prepara-
tion by being wet with a weak solution of carbolic acid.) The
ends of the ligature may now be seized by an assistant, and
the chain ecraseur thrown around the pedicle close to the
tumor, so as to allow about an inch of pedicle beyond the
ligature; screw down the ecraseur, and thereby divide the
tumor from the pedicle. We should next sponge the end of
the pedicle with warm, carbolized water, holding it out of
the cavity of the abdomen if it can be done without using
too much traction (which is to be avoided).
After we see that the ligature is firm and that there is
326
EATON ON DISEASES OF WOMEN.
no oozing of fluids, we proceed to examine the other ovary,
and, if found diseased, it should be at once removed by ligat-
ing its attachment and removing it with the ecraseur as before.
If not diseased, of course it should remain, as it may per-
form its function well, and the patient by its aid may bear
fruit thereafter, which would be impossible if both ovaries
were removed.
We now sponge carefully all the secretions from the ab-
dominal cavity, cleansing the sponges in carbolized warm
water or artificial serum of a temperature as high as 96°
or 98°.

STIEMANN==PICO
FIG. No. 26.-SIMS' SPONGE HOLDER.
When we are sure we have cleansed the peritoneal cav-
ity of all blood or other foreign substances as carefully and
with as much gentleness and dexterity as possible, and we
ascertain there is no small twig of a blood-vessel lacerated,
bleeding, and overlooked, we proceed to cut off the ligatures
surrounding the pedicle within about an inch of the knot
and drop the ligated pedicle gently into the abdomen and
proceed to close the incision with interrupted suture of
silver wire of good size, or tolerably stout silk thread (I
much prefer the silver wire), have the needles threaded with
long enough wire so that we have plenty of it, so as not to he
inconvenienced on account of its shortness. The open-eyed
needle is most convenient.
The assistants should hold

A
G. TIEMANN & CO
B
FIG. NO. 27.—OPEN-Eyed Needle.
the parts in apposition as
well as possible; the stitches
should be set back about one-half inch from the cut, and
should dip down to, and include, the peritoneum (this was
not formerly done; but it is now the more general practice).
The stitches should be placed at intervals of about three-
fourths of an inch. The silver wire should be well twisted,
OVARIOTOMY.
327
cut off rather short, and bent down smoothly upon the ab-
domen.
After the sutures are adjusted, the intervals between the
sutures should be covered with long strips of adhesive
plaster reaching at least one-half around the body. Then
apply other strips upon these, which need only be four or
five inches long, and let them cover the sutures, so that the
entire incision is hidden from view; and, of course, atmos-
pheric air is perfectly excluded if the adhesive plasters are
properly adjusted (during the application of the plaster the
anaesthetic should be entirely suspended). When we desire
to examine the wound we have only to raise one end of
some of the short pieces of plaster, and when we desire to
remove the sutures one of the short pieces of adhesive
plaster may be raised, the suture cut and removed, and the
adhesive plasters immediately replaced, one by one, till all
are removed. The long pieces of plaster should remain for
a week or more, and when removed should be replaced by
others at once one by one.
After applying the adhesive plaster in the manner de-
scribed, a compress of flannel (about four thicknesses) should
be applied over the abdomen, and a cotton roller or bandage
applied around the body to support the abdomen and hold
the compress evenly and tightly.
The patient should be now placed in bed, and, on the
return of consciousness, a powder of the 3 of Nux may be
given. Unless full reaction sets in, it should be repeated
every hour till it is established. Avoid stimulants and
opiates. Then Aconite, given every three or four hours,
should be administered, and, if pain is complained of, give
Arnica in alternation. The thighs should be flexed to re-
move tension from the abdominal muscles, and the limbs
should be supported with pillows, and a rubber bag, filled
with warm water, placed against the soles of the feet.
Soups, porridge, thickened milk, custard, bread and milk,
328
EATON ON DISEASES OF WOMEN,
oat-meal gruel, etc., should constitute the diet for a week or
more. No solid food should be allowed, and no applications
should be made to the abdomen except those already men-
tioned. Wetting the compress with water or Arnica is not
necessary, and is calculated to loosen the adhesive plaster,
and makes the patient more liable to take cold, and had
better be avoided.
DIFFERENT METHODS OF OPERATING.
The incision which is now almost, if not quite, universally
made near the median line in the linea alba, was formerly
made obliquely at the side of the abdomen. This was the
place of the incision made by Dr. M'Dowell on his first
operation, following a line in the direction of the fibers of
the external oblique muscle.
Treatment of the Pedicle.
The various means used by operators to secure the pedicle
are more diverse than is any other part of the operation.
The pedicle is tied by some, and one or both ends of the
ligature are brought out of the incision at its lower portion,
leaving the pedicle in the abdomen. This practice has proven
successful, but as it takes several weeks for the ligature to
become separated, and in the mean time causes a fistulous
opening between the peritoneal cavity and the external
atmosphere, giving rise to more or less of suppuration around
the ligature, I prefer to cut the ligature short, and allow it
to remain within the abdomen, and close the peritoneal cavity
permanently and at once.
Dr. Nathan Smith ligated each artery of the pedicle,
separately cut the ligatures short, and returned the pedicle.
Dr. Atlee crushed off the pedicle with an ecraseur, and
returned the pedicle after cauterizing the end of the stump.
Dr. I. B. Brown applies the actual cautery with red hot
iron to the end of the pedicle, and replaces it in the abdomen.
OVARIOTOMY.
329
Twisting off the pedicle, using a clamp to hold it before
it is severed with the scalpel, leaving a portion beyond the
clamp an inch or more in length, then applying another
clamp to this free portion, and while holding the lower clamp
firmly twisting the other around like wringing a chicken's neck,
till the pedicle is twisted off-this method has been practiced
by Dr. G. H. B. M'Leod, of Glasgow.
Torsion of the separate vessels of the pedicle has been
successfully used by the late lamented Dr. G. D. Beebe, of
Chicago-eight out of ten cases treated in this manner hav-
ing recovered. No hemorrhage occurred in either case.
sion of the whole pedicle has succeeded in the hands of
Mr. Jessup.+
Tor-
The clamp has been more generally used than any other
means to secure the pedicle. It is placed upon the pedicle
and screwed tightly, and the end of the pedicle is retained
outside the abdomen by this means, placing the clamp trans-
verse the incision. With the use of the clamp no ligation
of the pedicle is required. Its advantage is that it is easy
of application. Its disadvantages are, that in case the ped-
icle is not very long it produces too much traction. It pre-
vents the perfect closure of the incision, and the weight of
the clamp resting upon the sensitive abdomen, is a source of
irritation and sometimes causes much trouble. It requires
much attention after the operation. It does not always pre-
vent hemorrhage. Strangulation of the intestines has oc-
curred with its use.
OBJECTIONS TO THE LIGATURE.-Theoretically it is urged
that the presence of the ligature and the sloughing of the
stump of the pedicle produce peritonitis and septicemia.
This is not proven by experience (see Peaslee, page 445),
but the contrary is abundantly demonstrated by Peaslee,
Spiegelberg, Waldeyer, Veit, Simon, I. B. Brown, and others.
† Lancet, 1871, page 654.
* Transactions Amer. Inst., 1871.
Peaslee, page 453.
330
EATON ON DISEASES OF WOMEN.
Bringing the pedicle out through the incision, and trans-
fixing it there by means of long needles, which are arranged
with points which may be removed, is another method. These
needles are passed through the skin, cellular and muscular
tissue, and peritoneum, the same as we pass the needle to
insert a suture, except that it is made to transfix the pedicle
at about the point where the ligature is applied. While they
are being inserted the assistants hold the abdominal walls in
apposition, and steady the pedicle in the proper position.
After about three needles are inserted, at intervals of about
an inch, the ends of the ligature are twisted over the needles
like the operation for hare-lip. The points of the needles
are now removed, and the other sutures necessary to close
the abdomen are inserted, and adhesive plaster is applied, as
I have before mentioned.
In 1846 Mr. Handyside carried the ligature attached to
the pedicle through the recto-vaginal cul-de-sac into the vag-
ina (instead of cutting it short, as I recommend, and leaving
it in the abdomen). Other surgeons have occasionally per-
formed the operation in this manner. This establishes a com-
munication with the atmosphere and the peritoneum, and is
more objectionable than cutting the ligature short and leaving
it in the abdomen, especially when the catgut ligature is
used, as it produces very little or no irritation.
Transfixing the pedicle is open to nearly the same objec-
tions as the clamp. The pedicle must necessarily be very
long, to allow of the adoption of this plan.
Professor Peaslee uses a method of his own, but I do not
know that others have adopted it. He gives cuts and full ex-
planation in his work on "Ovarian Tumors," page 469. As
the arrangement is quite complicated, I will not occupy the
space to fully explain it, but simply say that the ligature is
passed through a tube, which is left in the incision, supported
by a cross-bar.
"Gross.," Vol. II, p. 871.
OVARIOTOMY.
331
It seems to me the plan is open to very serious objections
on account of its allowing the admission of the atmosphere
into the peritoneal cavity, and I can not see its advantages
to be superior to other methods.
Some authors have recommended leaving a tent in the
most dependent portion of the incision. I can not approve
this practice.
After Treatment.
Some patients require no after treatment, except rest, mild
diet, and the removal of the sutures in about five days. These
should be removed scriatim, being careful to straighten out
the end of the wire we intend to draw out, so that it does.
not lacerate the tissues. As each suture is removed, adhe-
sive plaster should be applied at once, and allowed to remain
a week or more.
In case of severe peritonitis supervening upon the operation
of ovariotomy, we can hope for only moderate success from
treatment. Why it is, I leave others to explain; but such is
the fact, which we may as well acknowledge. The symptoms.
as they arise in various cases are to be met by homoeopathic
remedies applicable in other cases, only bearing in mind that
Arnica internally is of the greatest value. Arnica, Aconite,
Bell., Bry., China, Ars. alb., Nux, etc., will occasionally be
indicated. Stimulants and opiates are to be avoided.
I will again mention, as it has been so common to give
opiates before and after this operation, I must be emphatic
enough to be understood as objecting seriously to their use.
Then, I say, unless the case is hopeless, and sure to die,
give no opium in any form; but, for the relief of pain which
nothing else will relieve, in hopeless cases, give morphia for
humanity's sake.
HEMORRHAGE AFTER OVARIOTOMY.
Hemorrhage may take place from the surfaces from which
adhesions have been detached, or from the pedicle. It gen-
332
EATON ON DISEASES OF WOMEN.
erally takes place in from twelve to twenty-four hours after
the operation, if at all, though in Koeberle's fourth case it
occurred on the fourteenth day. In one of Dr. Clay's cases
hemorrhage occurred on the second day.
In case of hemorrhage, the physician in whose care the
patient is left should have the assurance and nerve, as well
as knowledge, to at once remove the sutures and other dress-
ings, seize the pedicle, and ascertain if it bleeds, and, if so,
place another ligature upon it at once; and he should always
have a suitable ligature at hand. If it is found that the ped-
icle does not bleed, search must be made for the vessel which
has been lacerated in the operation, which has broken loose,
and when found it must be at once secured and ligated. The
blood and clots should be removed as gently and expeditiously
as possible, and the abdomen carefully sponged out. The in-
cision should now be closed and dressed as before, and some
egg-nog or wine whey may be given
SEPTICEMIA OR PYEMIA AFTER OVARIOTOMY.
Symptoms.
In septicemia the symptoms are usually those character-
izing the typhoid condition, and occurring after a serious
operation as a result of the absorption of poisonous gases
into the circulation; while pyæmia consists of the absorption
of pus into the blood.
The symptoms, as shown in general, are much alike, and
as nothing but a microscopic examination of the blood would
positively differentiate between these conditions, and as the
treatment necessary is the same, we will not take time to
discuss these conditions separately. We have the rapid,
weak pulse; the dry, coated, red or brown tongue; dry, hot
skin; and a haggard, exhausted countenance; and generally
drowsiness. Sometimes rigors are present in alternation with
flashes of heat, and are pathognomonic of the formation
OVARIOTOMY.
333
of pus in a case which has shown evidence of inflammatory
action for some time.
Prognosis.
Rather doubtful. although recoveries have taken place
after severe attacks of septicemia. (See Amer. Jour. Med.
Sciences for January, 1856; also, ibid., April, 1863, and
July, 1874.)
Treatment.
When symptoms of septicemia arise an examination per
vaginam should at once be made while the patient is semi-
recumbent, in order to ascertain, if possible, the presence
of a fluid in Douglas' cul-de-sac. If found, it should be
tapped with a canula, through the posterior wall of the vag-
ina, injected with Solution of Iodine, two or three grains to
the ounce (with ten or fifteen grains of Potass. iodide added),
and the drainage tube inserted and retained in the puncture.
(See also Plate XIII.) The injections may be repeated

G.TIEMANN &CO.
FIG. No. 28.—DRAINAGE Tube.
daily, and if pus is discharged we will find benefit in mak-
ing the injection twice as strong. The remedies indicated
are Iod., Ars. iod., China, Rhus, Ferrum, etc.; sometimes
Baptisia or Merc. In some instances the Liq. Soda Chlo-
rinatæ, diluted with water, has been found useful as an
injection into the pelvis, and given internally 3 dilution,
a teaspoonful every four hours.
TEMPERATURE OF INJECTION.-The temperature of the injec-
tion should be about 98°. Care is necessary in this par-
ticular.
VOMITING.
Vomiting may be caused by the anaesthetic used, or it
may be a symptom of incipient peritonitis, too high temper-
334
EATON ON DISEASES OF WOMEN.
It
ature of the apartment, improper food, or other causes.
is a serious symptom after ovariotomy. It is liable to produce
hemorrhage; or it may produce serious traction upon the ped-
icle, in case it has been secured by clamp or transfixed with
needles. It may also detach a ligature which has been a little.
too loosely tied.
Treatment.
The surgeon who has not administered opium to his pa-
tient will avoid many cases of vomiting following this opera-
tion which he would otherwise have. So we may recollect a
part of the treatment is preventive, in not giving opiates, as
I have warned you before. In this, as other difficulties, it is
best to try to remove the cause, if possible. See to it that
the temperature of the room is not too high. If there is
much tympanites of the stomach, give 1 Trit. Potass. chlo.
every half hour. If there are rigors, alternating with flashes
of heat, give Ars. alb. For heat, accompanied with dizziness,
rapid pulse, etc., with the vomiting, give Aconite. For passive
vomiting, with no other special symptoms, I would depend
upon Ipecac. Place a very large compress over the epigastrie
region, and bind it tightly with a band around the body.
X
FAILURE OF THE ABDOMINAL PARIETES TO ADHERE.
This occurred in Mr. Wale's fourth case and in Mr. Wells'
twenty-second case. Of late years I find no account of such
an occurrence. It results from either an improper adjustment
of the tissues in applying the sutures, or as a result of too
loose bandaging, so as to allow of too much movement, or not
including the muscular and peritoneal structures in the
sutures (simply stitching the skin together might readily
result this way); or it may depend upon the bad condition
of the patient, she having a low assimilative and recuperative
power, causing a want of plasticity of the blood.
OVARIOTOMY.
335
Treatment.
First give supporting diet; then the edges of the wound
may be pared, the hemorrhage arrested, abdomen cleansed,
and the sutures properly applied with the adhesive strips, as
in first dressing; or the edges of the incision may be touched
with strong nitric acid (using great care not to drop it into
the cavity of the abdomen), and the parts placed in apposi-
tion as after paring the sides of the incision.
ABSCESS.
Sometimes an abscess forms in the line of the incision
(most likely to do so from the irritation of the clamp).
Treatment.
As soon as discovered it should be freely evacuated, and
treated as if occurring in another locality. Vaseline is, per-
haps, the best dressing for it.
VAGINAL OVARIOTOMY.
The removal of a small ovarian tumor through the vagina
is possible, as has been demonstrated by Professor T. G.
Thomas, of New York. The operation is only possible in
small tumors without adhesions, and it is a question, whether
their removal should ever be attempted when small. Dr. T.
reports his case as follows:
"Drs. Peaslee, Noeggerath, and myself met in consulta-
tion, and carefully investigated the case..
In discussing
the subject of treatment, three plans were proposed: 1. That
the cyst should be allowed to develop so that ovariotomy
might be resorted to after some years of life had been passed
in comparative comfort; 2. That the cyst should be tapped
per vaginam; and, 3. That the operation of ovariotomy should
be performed through the fornix vaginæ, in the same manner
* Amer. Jour. Med. Sciences, April, 1870.
336
EATON ON DISEASES OF WOMEN.
that it is ordinarily accomplished through the abdominal
walls. This last proposal was made by myself and urged
upon these grounds:
"1. I felt satisfied that the cyst being movable (as
proved by the fact that the knee-elbow position would at
once cause it to roll out of the pelvis), sufficient space could
be obtained through the fornix vagina to withdraw the
emptied sac.
"2. I preferred this procedure to simple tapping, because
drainage is very apt to follow paracentesis when practiced
through the vagina, which might exhaust the patient and
prevent a resort to vaginal ovariotomy at a later period. Fur-
thermore, I did not regard the increase of danger attendant
upon vaginal section as very great, even if removal of the
cyst proved impossible; for, in case of such an occurrence,
I proposed simply to tap the exposed cyst, and close the
vaginal opening by silver sutures.
"3. I urged the adoption of the vaginal operation, rather
than waiting for the full development of the cyst, because of
the peculiarly anxious nature of the patient. After being
informed of the nature of the disease she thought and spoke
of almost nothing else; lost appetite, slept badly, and evidently
depreciated in strength. From all that I could learn from her
husband, who is a practitioner of medicine; from Dr. J. L.
Brown, who had attended her, and from my own observation,
I thought that she would prove a most unfavorable case for
ovariotomy, at the time of full development of the tumor;
and, to repeat a consideration just given in connection with
paracentesis, I regarded the tentative process as not attended
by great risk, since it involved incision only into the depend-
ent portion of the peritonæum.
"On February 6, 1870, at three P. M., I proceeded to
operate, in the presence of Drs. Penslee, Brown, Walker,
Purdy, J. C. Smith, and Sproat. Dr. Purdy having anæs-
thetized her with ether, she was placed in the knee-elbow
OVARIOTOMY.
337
position, and secured upon the apparatus of Dr. Bozeman.
This apparatus not only completely secures the patient in
this position by straps and braces, but makes the position
perfectly comfortable for any length of time, and also favors
the administration of an anesthetic. To prevent all possi-
bility of the rectum falling into the line of incision, a rectal
bougie was inserted for about five inches. Sims' speculum
being now introduced, and the perineum and posterior vaginal
wall lifted, I caught the fornix vaginæ midway between the
cervix and rectum with a tenaculum, drew it well down, and
with a pair of long-handled scissors, one limb of which was
placed against the rectum and the other against the cervix,
cut into the peritoneum at one stroke.
"The first step of the operation being now accomplished,
I proceeded to the second. The patient's position was
changed to the dorsal decubitus, and, passing my finger
through the vaginal incision, I distinctly touched the tumor,
which had now fallen again into the pelvis, and fastened a
tenaculum in its wall. With a small trocar I then punc-
tured, one after the other, three cysts, which gave vent to
about six or eight ounces of fluid, which looked precisely
like vomited bile. Drawing upon the cyst it now passed
without difficulty into the vagina.
"For the third step of the operation the position of the
patient was again changed. She was now placed in Sims'
position on the left side, and his speculum introduced. Pass-
ing through the pedicle, at its point of exit from the vaginal
roof, a needle armed with a strong, double-silk ligature, I
tied each half of the penetrated tissue and cut off the cyst
and ligature. The cul-de-sac of Douglas was then sponged,
the pedicle returned to the abdominal cavity, the incision in
the vagina closed by one silver suture, and the patient put to
bed. The entire operation occupied thirty-five minutes, and
presented no difficulties other than those slight ones inci-
dental to ligature of a pedicle at some distance up the vagina.
22
338
EATON ON DISEASES OF WOMEN.
16
Subsequent to the operation the patient was kept quiet
and free from pain by opium, sustained by fluid food, and
strictly confined to the supine posture. Her only discomfort
arose from sleeplessness and nausea which followed the use
of the anaesthetic, and for ten days she progressed without
any unfavorable symptom. At this time, being allowed to
leave the bed and lie upon the lounge, she exerted herself
unduly, and an attack of peri-uterine cellulitis invaded the
right broad ligament. The pulse became rapid, the skin hot
and dry, and a phlegmonous mass, as large as the fist, hard
and painful to the touch, could be distinctly felt. This soon
began to diminish, and now, at the end of the thirtieth day,
has ceased to prove a source of any annoyance, while the
general condition of the patient assures me that she is entirely
out of danger."
The case recovered.
The operation is certainly more difficult than the operation
by gastrotomy or abdominal section. It is more difficult to
ligate the pedicle, and is not less dangerous than the ordinary
operation. I have never thought this operation advisable.
BED SWING.
After ovariotomy and other serious operations, as well as
in some painful diseases, it is convenient to have some means
of moving the patient without causing her pain. The fol-
lowing cut represents a very cheap and convenient arrange-
ment, and I copy the description of it given by Dr. D.
Milliken, in the Cincinnati Lancet and Clinic for September
20, 1879. He says:
"Some months ago a puerperal patient of mine suffered
from an exquisitely painful attack of pseudo-rheumatism in
the hips and one shoulder during the course of a septic
fever. For about thirty days it was necessary to catheterize
her, and, as if to complete her wretchedness, she lost con-
trol of all the muscles of the rectum, expulsive and retain-
OVARIOTOMY.
339
ing, so that she could neither expel her fæces completely
nor retain them perfectly. Her vitality was as low as it
could be, and I was in constant dread of bed sores.
"When her case had assumed this aspect, it became
perfectly evident that she would die merely from the pain
inflicted by so much rolling and lifting as was necessary for
cleanliness; and it was equally plain that she would die
from sloughing if not kept scrupulously clean.
"In this dilemma I took her husband to my office, and
showed him pictures of the more approved fracture-beds
and swings, and directed him to make some sort of apparatus
to swing her from the bed. He had been trained in the best
of all schools of invention-a farm-and was at the head of
a manufacturing establishment, where his training was made
more complete. I knew that his ingenuity, stimulated by
the desperate necessities of the case, would devise some
useful apparatus, but I was

as much surprised as de-
lighted to find, after a few
hours, the admirable contri-
vance which I have shown
in the rude cut.
"The inventor and builder
had carried home some hick-
Of
E
G
D
H
A
ory stuff from a factory
where buggy-felloes are
steamed and bent.
straight pieces he selected
four, slightly knotty, and,
therefore, unfit for bending.
He took home, also, four
felloes-two large ones and two small ones—which were un-
salable on account of a slight tendency to splinter. The
lumber, as specified, cost fifteen cents. He laid two of the
FIG. No 29.-BED SWING.
B
340
EATON ON DISEASES OF WOMEN.
straight pieces, A, B, on the bed, near and parallel to its
edges.
At the head and foot of the bed he set up the larger
felloes, A, C, A and B, D, B, and bolted them to the side-
pieces at A, A, B, B, as shown. Then he laid two other
straight pieces, E, F, on the bed parallel to the first pair,
but closer to the patient's sides, and these he bolted to the
ends of the two smaller felloes, E, G, E and F, H, F. On
the highest point of the arch formed by each large felloe he
bolted blocks, C and D, perforated for a long windlass, C, D,
two inches in diameter. Ropes were attached to this wind-
lass, and connected to the straight pieces lying close to the
patient. The carpentry being thus finished, some strips of
strong muslin were doubled and slipped under the patient-
one under her head, one under her shoulders, another under
her hips, and a wide one under her legs and thighs. When
these strips had been stitched to the side-rails, the windlass
was turned, and the patient was raised from the bed with-
out pain.
"She was not only lifted for all purposes of sponging,
syringing, vaginal irrigation, and defecation, but she often
asked to be raised merely for a change, and, as she said, 'to
cool her back.' A number of little pads and cushions were
provided, and, by rearranging these on the bed, points of
pressure were shifted almost hourly, and all danger of bed
sores was obviated.
"You will observe that I am not reporting a case, but
am praising one form of swing:
"1. Because it is cheap. The lumber can not always be
procured from a factory for fifteen cents, but can always
be bought or borrowed at a carriage-shop for a trifling sum.
The iron crank, the carriage-bolts, and the clothes-line cost
very little.
"2. Because, resting on the bed, it takes up no space on
the floor of the sick-room.
OVARIOTOMY.
341
"3. Because it is staunch. The patient does not swing
from tottering upright posts, but from the summits of arches
based on the bed.
"4. Because it can be built in an hour or two without
noise.
The windlass and
"I have drawn the apparatus as it was built. Like
every thing else, it is capable of improvement.
For a
heavy patient another felloe, and perhaps another rope,
would be needed at the middle of the swing, where the
weight of the hips tends to make it sag.
ropes ought to be so arranged that they could be quickly
detached and laid away. We improved our apparatus by
substituting a single piece of canvas for the four strips of
muslin which originally supported the patient. This is a
doubtful improvement."
I will suggest an improvement, however, which is to cut
out from the canvas under the hips a piece, so that the evac-
uation of the bowels may be accomplished without trouble,
having this opening covered, when it is not needed, with a piece
of canvas fastened to one side of the swing, and buckled to the
other side, so that when the bowels were about to move we
could unbuckle the one side, and slip the piece of canvas out,
raise the bed, place the vessel under the opening to receive
the feces, and afterwards remove it, let down the bed, and
slip the piece of canvas under the patient, and fasten it with
the buckles.
342
EATON ON DISEASES OF WOMEN.
CHAPTER XXVI.
UTERINE FIBROMA—MYOMA-FIBROUS TUMORS OF THE UTERUS.
FIBROID tumors of the uterus are much more common than
is generally supposed by the profession, as in many cases
they are of small size, and are not discovered till after death.
Klob estimates that over forty per cent of women who die
over the age of fifty years are affected with uterine fibroma,
while Boyle declares that 20 per cent of those who die over
thirty-five years of age are so affected. They have not been
found before the age of puberty. They are more frequent
relatively among negresses and mulatto women than among
the whites.
Etiology.
Undoubtedly some local irritation at the point where the
tumor originates causes its development. This irritation
might arise from external violence, little noticed at the time,
and soon forgotten; or from the retention of a small bit of
placenta; or from the use of instruments to produce abortion.
Some authors have claimed sterility as a cause; but it is
rather a result than a cause. About forty-five per cent of
patients who have been discovered to be affected with uterine
fibroma have been sterile.
Pathological Anatomy.
The fibroid tumor, when examined with the microscope,
consists of unstriated muscular fiber and connective tissue.
The connective tissue is firm, white, and almost cartilaginous.
The arrangement of fibers is concentric. The tumor is scant-
ily supplied with blood-vessels, and almost or quite destitute
of nerves. The tumor may undergo changes, among which
!
UTERINE FIBROMA.
343
are softening, fatty degeneration, oedema, induration, calca-
reous degeneration, etc.
Klob mentions one case of primary carcinomatous degen-
eration, which is the only one on record. Extension of car-
cinoma from neighboring parts is more common. Sarcomatous
degeneration is still more frequent.
VARIETIES OF FIBROIDS.-We have the subserous, the sub-
mucous, the intra-mural or interstitial varieties. The first two
may be pedunculated; the submucous projecting into the
uterine cavity, and, when attached to the uterine tissue by a
pedicle, called a fibrous polypus (which, owing to its peculiar-
ity, will be discussed separately); the subserous projecting
into the abdominal cavity. It may either be pedunculated or
non-pedunculated. The intra-mural variety develops in the
muscular tissue, either of the body or cervix, its more com-
mon seat being in the body. I will insert a few cuts to rep-
resent the different varieties of uterine fibroma.



FIG. No. 32.
FIBROMA
FIG. No. 30.-SUBSEROUS FI-
BROID OF THE UTERUS.
FIG. No. 31.—SUBMUCOUS FI-
BROID OF THE UTERUS.
.OF THE NECK OF
THE UTERUS.
Symptoms.
Subserous fibroids, when small, produce little disturbance
in the system, and give rise to few symptoms. They tend to
produce displacements of the uterus, however, from their
weight, as, when situated in the anterior portion of the body
of the uterus, they tend to antivert or antiflex the organ, and
344
EATON ON DISEASES OF WOMEN.
when in the posterior part they produce retro-version or retro-
flexion, or a lateral flexion when entirely to one side. With
these flexions there is some tendency to prolapse as well. In
the large development of subserous-fibrous or fibro-cystic
tumors of the uterus, we have similar symptoms to those we
have in ovarian cystoma (more especially the dermoid vari-
ety), together with some enlargement of the uterus. If the
tumor is pedunculated, there is less enlargement of the length
of the cavity of the uterus than in the intra-mural form.
In the submucous variety (where the tumor projects into
the cavity of the uterus) we have also an enlargement of
the size of the cavity of the uterus, but the space is occu-
pied largely by the tumor, and the sound may pass six or
eight inches up by the side of the tumor, and, if pedun-
culated, may sweep nearly all around it; while, if non-
pedunculated, we can only pass the sound up on one side.
In the submucous form of uterine fibroids we have great
disturbance of the general health early in the disease (while
the tumor is small), accompanied by excessive floodings, in
many cases, although I have seen exceptional instances
where, owing to the tolerance of the uterus, little hemor-
rhage or general disturbance was manifested, the tumor be-
ing discovered by examination with the sound, while seek-
ing to discover displacement, which we suspected from long
continued pain in the knee, in one instance; in another,
chronic pain in the back, with some gastric derangement.
I have now a patient, who has flowed very little for over a
year, who has a large intra-mural, submucous fibroid. She
formerly flowed excessively, but was treated by Dr.
of this city, with daily injections into the tumor of Ergotine,
causing great inflammation, which has caused adhesion of
the tumor to the entire intra-uterine surface. The lady
(widow of a deceased prominent allopathic physician of Cin-
cinnati) is now in the enjoyment of quite good health, since
I succeeded in subduing the inflammation, and the injections
UTERINE FIBROMA.
345
of Ergotine seem to have accomplished the arrest of the
hemorrhage most efficiently, although the tumor remains as
large as ever.
Diagnosis of Uterine Fibroids from Pregnancy.
In pregnancy we usually have a cessation of menstrua-
tion, while in subserous uterine fibroma it is normal, or in
excess, and in submucous uterine fibroids it is almost uni-
formly in excess. The fibrous tumor develops more slowly
than pregnancy. The neck of the uterus is obliterated in
case of submucous uterine tumors when the tumor has ad-
vanced to the size of the uterus at about four or five months
of gestation, whereas in pregnancy it is not obliterated till
three or four months later.
Diagnosis from Atresia of external Os with Hæmatometra.
In atresia of the external os with hæmatometra we also
have obliteration of the cervix early in the disease, but
there being no flow in atresia and a free flow in fibroid
tumors of the uterus, we need not be misled in diagnosis.
In making a digital examination of a suspected fibroid of
the uterus it is well to select the menstrual period, as then
the os is more open, and will, in case of tumors of the
uterus, often admit the index finger, and we are able to feel
the tumor, and more clearly make out its size, shape, and
attachment. When we can not do this, insert sponge tents
till we dilate the os sufficiently to make the examination
thoroughly.
Prognosis.
The prognosis depends much upon the variety, size, and
attachment of the tumor, as well as upon the treatment
used. The polypoid variety of the submucous tumor usually
requires an operation for its removal, and we may expect
success if the patient is in a favorable condition. (I have lost
but one case out of over one hundred operations of this
346
EATON ON DISEASES OF WOMEN.
kind I have performed, and that was a lady from College
Hill, Ohio-a patient of Dr. Vance-who died from cancer
of the breast about a year after I removed the fibroid from
the uterus, and I think life was prolonged in this case even,
as it arrested the hemorrhage from the uterus-from which
she had suffered for over two years-and for several months
after I operated her health was improved). The small sub-
serous fibroids give no trouble, unless they enlarge and take
on, also, a cystic formation. Larcher* reports a case of
rupture of the uterus from a uterine fibroid.
Treatment.
In large fibro-cystic tumors of the uterus, which are, of
course, of the subserous variety, and are pedunculated (which
can not always be positively ascertained, however, till the ab-
domen is opened and the pedicle is explored), the operation
required is very similar to ovariotomy.
The pedicle may be ligated singly if small, or it may, if
large, be divided into two or three parts in the ligation by
passing a needle armed with a double ligature (catgut is pref
erable). Tie the ligatures tightly with three knots each. Have
W
FIG. NO. 33.
the ligatures interlock in this manner (Fig.
33), otherwise they might tear apart the dif-
ferent portions of the pedicle separately lig-
ated, causing hemorrhage. Cut them short,
and leave them in the abdomen. The opera-
tion will have to be abandoned in some cases,
or else extirpate the uterus by ligating it
above the vaginal juncture, and then removing the uterus
with the tumor. (See Extirpation of the Uterus.) When
it is found that the attachments are so very extensive as to
be too large to ligate, unless extirpation of the entire uterus
is performed, it may be attempted in desperate cases, as the
result of recent operations seems to justify the operation,
*Barnes's "Diseases of Women," p. 327.

UTERINE FIBROMA.
347
which I will discuss under the head of "Extirpation of the
Uterus."
The removal of submucous tumors of the uterus which
are pedunculated (termed polypi) I will speak of under the
head of Uterine Polypi.
The non-penunculated, submucous, fibrous tumor of the
uterus may be removed in the following manner by what is
called enucleation: First of all, the os uteri must be as fully
dilated as possible; or, it may be incised after the patient
is placed under an anesthetic, and we can then pass the hand,
or at least two fingers, high up into the uterus, having its
fundus pressed upon by assistants through the abdominal
wall. We next pass up between the fingers we have intro-
duced a long-handled bistoury, and make an incision into the
tumor as long as convenient. We now withdraw the instru-
ment, and peel back the coverings of the tumor as well as
we can, and if we can entirely detach the tumor from its
inclosed sheath in this way, aided by the use of Sims'
enucleators, it is best; but if it can only be partially de-

G.TIEMANN &CO.
G. TIEMANN & CO

G.TIEMANN & CO
FIG. NO. 34.-SIMS' ENUCLEATORS.
tached we should seize the detached portion with the vul-
sellum forceps (see Plate X), or Nélaton's forceps (see Plate
XI), and as we make traction with them continue to attempt
to make further separation with the fingers or enucleators.
If the tumor can not be extracted entire, it may be torn
348
EATON ON DISEASES OF WOMEN.
off piecemeal, scraping the interior of the sac with the circu-
lar sharp enucleators or curettes (using care not to injure the
uterus), thus removing all of the tumor, as I did in a case
of this kind in a lady from Kentucky last year (and made
a success of the operation). The tumor's vitality in this
case seemed to have been lost by the use of sponge-tents,
used in dilating the os. and it became quite soft, although
on the first attempt at dilatation, six weeks before, the tumor
was solid and firm.
In case we can draw down the enucleated tumor to the
mouth of the vagina, or into the vagina even, we may sever
its connection with the ecraseur; simply incising the tumor
and allowing the contractions of the uterus to enucleate it,
sometimes succeeds. Again, inserting tents into the sub-
stance of the tumor and inducing suppuration is recom-
mended; but is more hazardous than enucleation.
Byford reports two successful operations of this kind.
Professor
Mr. I. B. Brown reports sixteen cases treated by incis-
ing the os uteri freely, causing an entire arrest of hemor-
rhage in ten cases; in six of these cases the tumor materially
diminished in size or entirely disappeared. When this pro-
cedure is insufficient, Mr. Brown cuts into the tumor, and by
twisting the knife around similar to coring an apple, removes a
part of its central portion, then plugs the vagina to arrest
hemorrhage.
In performing either of these operations the patient
should lie upon the side with the thighs flexed upon the
abdomen, and the vagina should be dilated with Sims' im-
proved slit speculum held by an assistant. (See Plate No. III.)
Professor Danforth, of Milwaukee, has preserved a submucous
fibroid of the uterus which he removed several years since
by enucleation. The tumor weighed, when removed, eight
pounds, and the patient recovered.
INJECTING THE TUMOR WITH ERGOTINE.-For some years
the profession was elated over the expected successful treat-
UTERINE FIBROMA.
349
ment of fibrous tumors of the uterus with injections of
Ergotine; but experience has not confirmed the good effect
of this treatment to a sufficient extent to make it worthy of
much confidence. The operation produces great pain, usually
for several hours, and severe inflammation sometimes results.
Electricity has been used to produce absorption of these
tumors, with but very little success.
TREATMENT BY SPONGE TENTS.-My attention was directed
of New
some years since to a case related by Dr. Sims,
York, who accidentally left a sponge tent in the uterus for
seven days which he had inserted to examine a fibrous polypus,
and upon its removal found the polypus quite destroyed; and
I have taken the idea that pressure is good treatment in uter-
ine polypi, and I believe it to be very serviceable in submu-
cous fibroids. I have attempted this plan with twelve cases
of polypi successfully, but in only one case of submucous
intra-mural fibroid. In this case the effect was all that could
be expected. The hemorrhage, which had been almost fatal
for over five years, was cured, and I removed the tumor
piecemeal with the vulsellum forceps by enucleation, finding
it easily torn to pieces, and I was troubled with little hemor-
rhage. In these case I would provide myself with about four
sizes of sponge tents, the largest at least an inch in diameter
when compressed, in length about four inches. The smallest
size I introduce and allow to remain about eighteen hours,
then another and another, and allow to remain about the
same length of time. In this way we keep up constant press-
ure, and they do not become very offensive in eighteen hours.
PALLIATIVE TREATMENT in Cases which, for some Reason, it
is not Desirable to adopt Operative Measures.-In displace-
ments caused by the weight of small intra-mural fibroids, we
should rectify the displacement, and retain the uterus in situ,
even if we have to use the vaginal pessary in some form; it
being better to do this than to allow the patient to suffer from
*Sims' Uterine Surgery, page 64.
350
EATON ON DISEASES OF WOMEN.
of
the sympathetic pains and derangement of general health con-
sequent upon displacement of the uterus.
Hemorrhage, which is so excessive in some instances, may
be arrested with the tampon in the vagina, or the sponge tent
and tampon combined. Ferruginous and astringent remedies
used by the old-school have little effect, and I can say but
little more in favor of Ipecac, Aconite, or other remedies used
by homoeopaths (in this class of cases, though efficient in
many other forms of hemorrhage).
Tamponing the vagina or uterus is a necessity in many
cases; and the most convenient and efficient vaginal tampon
known is the French elastic rubber bag, with a tube and stop-
cock. This a patient can introduce, and the nurse can inflate.
The sponge tent arrests the hemorrhage, and prepares the
womb for examination or operation, and if continued, and
properly watched, will, I fully believe, in many cases, cause a
destruction of the vitality of the tumor, arrest of its devel-
opment, and, in some instances, its absorption and disappear-
ance. We know it will do so in pedunculated fibroids, and
I believe that it will exert a salutary effect upon submucous
fibroids as well. I do not claim that one case demonstrates a
principle; but it is better than no trial.
Of course the anæmia and general weakness caused by
great loss of blood are to be remedied all we possibly can by
nutritious diet and such remedies as China, Ars., Chi. ar's.,
Merc., Nux, Rhus tox., etc., as homoeopathically indicated;
but it is best, in these cases of excessive hemorrhage, depres-
sion, and exhaustion, to operate for the removal of the tumor,
or at least try to arrest its growth and destroy its vitality, if
possible; but it may be first necessary to place the patient
in a condition to bear operative measures.
Liquid Persulphate of iron, as an intra-uterine injection in
these cases, I most heartily condemn, as calculated to produce
great irritation, with nothing more than temporary relief.
POSITION MAY AFFORD RELIEF.-In some cases the tumor
Uterine FIBROMA.
351
i
just fills the pelvis, and produces strangury by pressing upon
the urethra. In such a case lifting the tumor above the brim
of the pelvis may afford very great relief, the distressing
symptoms entirely disappearing; and the patient goes on for
years without trouble, if the tumor be subserous or intra-
mural. In case it is submucous, of course, the demand for
operative procedure would still remain, as the hemorrhage
would continue, although the other symptoms might be
relieved.
Where hemorrhage is active from a submucous, intra-mural
fibroma of the uterus, and circumstances or the condition of
the patient forbid its attempted removal, the ovaries may be
removed, to stop the hemorrhage. Both ovaries may be re-
moved through one opening in the abdominal cavity, as would
be made for the removal of a small ovarian tumor; the open-
ing may be made to either side of, or directly in, the median
line. If the incision is made to one side of the median line,
it should be made about four inches in length obliquely in a
line from the anterior superior spinous process of the ilium to
the symphysis pubis. The base, or pedicle, of the ovary
should be ligated with catgut ligature, and replaced in the
abdomen, closing the incision tightly with silver sutures and
adhesive plaster.
This operation has so far proven successful in every case.
The first one to perform this operation for this purpose was
Dr. Trenholme, of Canada, who operated in 1876, since
which time Prof. Hegar, of Freiburg, Prof. Nusbaum, of
Muncie, and Dr. Wm. Goodell, of Philadelphia, have per-
formed the operation successfully, as regards the recovery,
and also in arresting the hemorrhage from the tumors, and
the tumors have diminished in size as well.
352
EATON ON DISEASES OF WOMEN.
CHAPTER XXVII.
UTERINE POLYPI.
VEGETATIONS OF THE ENDOMETRIUM
UTERINE HYDATIDS · VASCULAR
POLYPI― PLACENTAL AND GRANULAR POLYPI, ETC.
THE uterine polypus usually consists of a fibrous, pear-
shaped tumor, attached to some portion of the internal sur-
face of the uterus, by a pedicle or stem. The size of the
FIG. No. 35. FIBROUS
POLYPUS, WITH SHORT
PEDICLE.
pedicle varies somewhat with the size of
the polypus; although occasionally quite
large polypi are attached by small pedicles,
and, in other occasional instances, the small
polypus has a pedicle about as thick as its
own diameter. The fibrous uterine polypus
usually exists singly, al-
though I have known one
instance where there was
one quite large fibrous pol-
ypus in connection with
several small fibrous growths at the same
time in the same uterus. The small mul-
tiple fibrous growths of the body and cer-
vix are termed vegetations of the endome-
trium. The small and semi-organized
growths are termed mucous polypi.
Hydatids of the uterus consist of numer-
ous small cystic tumors generally attached
to each other like a bunch of grapes. The
enlarged mucous polypi are shown in the


FIG. NO. 36.-Mucous POL-
YPI AND CONSTRICTED
VAGINA.
annexed cut, representing the growths as they existed in a
patient whom I treated about two years since. These
UTERINE POLYPI.
353
growths, about two inches in length, looked much like a
leech as used by our old-school brethren, and consisted of
semi-organized fibrous tissue covered with mucous membrane.
These growths came away by the contractions of the uterus
seeming to break them loose. They caused excessive hem-
orrhage, and much pain was experienced previous to their
discharge, which usually occurred every few weeks, with no
regularity, from two to twelve being discharged at a time.
The patient was about thirty-five years of age, married ten
years, barren and exceedingly reduced in strength from loss
of blood, pain, and sympathetic gastric derangement. Her
trouble had existed some seven years.
The vegetations of the endometrium or enlargement of the
follicles of the cervix sometimes exist in great numbers.
They are sometimes termed granulations of the cervical
canal or granular tumors of the womb. Large mucous
polypi, with large supply of blood vessels, are termed vas-
cular polypi.
The fibrous uterine polypus seldom reaches a greater size
than that of a child's head, and they more frequently are
expelled naturally or extracted artificially when of much
smaller size.
The single cystic growth of the cavity of the uterus sel-
dom attains a large size, usually not as large as a child's head.
Hydatids of the uterus sometimes attain to very great
dimensions in their totality, though singly they are small.
Their size often distends the uterus about the same as gesta-
tion at term, and their presence has been mistaken for preg-
nancy. They frequently occur in connection with pregnancy,
and from their presence interrupt the regular course of ges-
tation, and cause either a miscarriage or a premature delivery.
Granulations of the cervix or vegetations of the endometrium
do not cause any considerable enlargement of the uterus.
Neither do mucous polypi of the uterus produce any great
enlargement of the organ.
23
354
EATON ON DISEASES OF WOMEN.
Hydatid developments are not confined to the uterus, but
have been found in the liver, lungs, testicles, mamma, and even
in bone.
The granular polypi are quite uncommon in the uterus; but
the vascular polypi are occasionally met with in this organ.
Polypi of the uterus are most common in the middle-aged
and older women. They sometimes are developed in young
women even in the virgin state.
Polypi of the uterus may be attached to the interior of
the body or cervix, and sometimes just at
the margin of the os, and hang suspended
in the vagina. When attached at the mar-
gin of the os they produce no hemorrhage
or other disturbance, as a rule, and are dis-
covered in this situation accidentally, the
patient not having thought of the existence
of any thing of the kind. Polypi attached
in this locality are usually not larger than a
hickory-nut.

FIG. NO. 37.
FIBROUS POLYPUS WITH
LONG PEDICLE.
Placental polypus may develop from a
partially retained placenta, or rather from the retention of a
part of the placenta, on account of inflammatory action hav-
ing caused abnormal adhesions between the placenta and
uterus. They are a source of active hemorrhage. C. Braun
(Dublin "Med. Jour.," 1851) describes this variety of
polypus of the uterus. Braun relates five cases; but, from
the description, I think it would be as well to designate
these cases as partially retained placenta, and not classify
When removed they
them under the head of polypi at all.
certainly have no disposition to return.
Etiology and Morbid Anatomy.
Doubtless, the origin of the fibrous polypi vegetations of
the endometrium and mucous polypi may be found in an
inflammatory condition. The reason why some cases of in-
UTERINE POLYPI.
355
flammation, and injury causing inflammation, develop tumors
in the uterus of various forms and qualities in some instances
and not in others, is hard to explain; in fact, I may say,
explanation is impossible in the present state of our knowl-
edge. From all that I can learn I believe that the fibrous
polypus originates in the fibrous tissue of the uterus, like an
intra-mural, submucous, or subserous fibroma of the uterus,
from inflammation at this particular point in the organ.
Around this point of inflammatory action (which may have.
been caused by a bruise accidentally received during gestation,
in labor, or otherwise), there is exuded a plastic material,
which organizes into a hard mass, usually largely consisting
of white fibrous tissue, especially if the injury is upon the
internal surface of the uterine muscular tissue beneath the
mucous surface. The muscular contractions of the uterus
press this hard mass into its cavity, and it gradually becomes
pedunculated through these contractions of the uterine mus-
cular tissue. The polypi of the uterus seldom contain any
muscular tissue or nerves of any size. Why this is so, and
why they consist of white fibrous, and some yellow elastic
tissue, I can not explain. They sometimes contain sinuses
filled with serous liquid. Generally a
Generally a single blood vessel is
all the means they have of nourishment. Their growth is
consequently slow. Arising beneath the mucous membrane
they push it before them, and it is this which constitutes
their covering as they develop. It is not unlikely that the
use of instruments to produce abortion, or rude efforts in
performing versions, in labor, or the imperfect detachment of
the placenta may be a cause of the development of the irri-
tation which tends to the development of these tumors.
Vegetations of the endometrium are enlarged granulations
which have been thrown out to repair injuries received by
the interior of the cervix. They are not ordinarily covered
with mucous membrane, and bleed on the slightest touch.
They may resemble enlarged mucous follicles; but the mucous
356
ΕΑΤΟΝ ΟN DISEASES OF WOMEN.
The enlarged
follicle is covered with mucous membrane.
mucous follicle in time becomes the mucous polypus. This en-
largement is probably due to closure of the ducts of the folli-
cles in some instances; in others, due to inflammation in
these follicles or glands, and consequent effusion of blood
and serum, which partially organizes. These polypi have a
resemblance to muscular tissue, though not firm and well
organized.
The single cyst is probably an immensely enlarged mucous
follicle or an effusion of serous fluid under the endometrium,
which is forced into the uterine cavity by the uterine mus-
cular contractions, in the same manner that the fibrous poly-
pus is formed, and becomes pedunculated by these contrac-
tions, and enlarges by means of continuous effusions. The
covering of these uterine cysts consists of mucous membrane
only. They resemble moles, which I will speak of separ-
ately, as they differ in some important respects.
Hydatids are transparent cysts or vesicles. Their con-
tents resembling pure water, they have been supposed to be
independent animals, and were called by Laennec "cysti-
cercus." Mr. M. Edwards, in his "Elémens de Zoologie-Animaux
sans Vertebres," says: "The hydatids are generally consid-
ered as the last link in the series of intestinal worms; but
the bodies described under this title are perhaps not real
animals, and seem rather to be mere pathological products."
They seem to be caused in the uterus by a sort of dropsy
of the chorion, which acts to destroy the life of the ovum.
Sometimes, 'tis true, the chorion is only slightly affected
with this cystic degeneration in these cases, and consequently
the embryo is not disturbed in its growth and perfect
development.
It is a question whether hydatids in the uterus are not
always the result of unhealthy or imperfect impregnation.
We know they are situated in the placenta in many instances,
and as they destroy the healthy circulation, or are the result
UTERINE POLYPI.
357
1
ovum.
of abnormal development of the vessels of the placenta,
they interfere directly with the nutrition of the impregnated
I would not, however, dare to say that the existence
of hydatids was positive proof of copulation having taken
place, as I have seen them discharged from a woman where
I had every reason to believe there had never been copula-
tion; and in another where copulation had been unknown
for upwards of two years. (The single cysts of the uterus
are not an indication of imperfect impregnation, as I have
seen them also in the class of cases just mentioned.) The
occurrence of hydatids in other organs and tissues is also evi-
dence that they are not caused from imperfect impregnation.
Diagnosis.
Symptoms of inflammation may or may not exist in
cases of uterine polypi. More frequently we have present
an alarming hemorrhage from the uterus at times, and the
dribbling of blood quite constantly, although during the
early development of the fibrous or cystic growths we may
have only an increase in quantity or duration of the ordi-
nary catamenia. These floodings are usually accompanied
with some pain in the uterus of a bearing down or expulsive
character. These symptoms go on increasing in severity till
the patient becomes alarmed, and the physician is consulted.
In some instances in the development of hydatids the men-
strual flow ceases, which induces a suspicion of impregnation
being the cause of the cessation of menstruation. The block-
ing of the internal part of the cervix by inflammatory action
or the development of abnormal growths may for a time
arrest the regular flow, and it may then come on with great
violence when no tumor is there. When tumors are present
in the uterus after the effort of nature to expel them from the
uterine cavity is established, and the contractions of the mus-
cular fibers in the body of the uterus are supplemented by a
relaxed condition of the cervix, there is an excessive flow.
358
EATON ON DISEASES OF WOMEN.
Sterility is, of course, the rule in all cases of uterine
polypi when developed to any considerable extent, and is to
be considered in the diagnosis of the case. The history
of the case aids us in the diagnosis in some measure. The
absence of the catamenia for several months, followed by a
flow free and almost continuous for a period of weeks, would
indicate a threatened abortion in the young married woman,
while in women aged from forty to forty-five years it might
be indicative of the climacteric period. There are, however,
exceptions in these cases where these symptoms are indica-
tive of miscarriage, even in women over fifty years of age.
And in the case of the unmarried we must bear in mind that
the condition of pregnancy is not an impossibility; and we
should also recollect that, in the case of the young married
woman, a tumor in the uterus is not impossible.
Debility, anemia, gastric disturbances, headache, backache,
uterine pains, etc., as well as the uterine hemorrhage, may be
due to either uterine polypi, intra-mural fibrous tumors of the
uterus, threatened abortion, retention of the placenta after
miscarriage, inflammation, or ulcerations of the uterus; hence
we have no means of making a positive diagnosis except by
physical examination. I may except some cases of mucous
polypi which are detached, and are discharged by the
contractions of the uterus, when we have evidence of the
nature of the difficulty without physical examination. In
attempting a physical examination we may find that touch-
ing the os uteri gives rise to considerable hemorrhage. This
fact is indicative of the granulation of the cervical canal,
vegetations of the endometrium, cauliflower excrescence or
cancerous ulceration, or mucous polypi, and must be differ-
entiated from the ulcerated condition of the cervix by spec-
ular examination.
The exact nature of the polypoid growth can only be
discovered in some cases by dilating the os and cervix with
sponge tents; sometimes, however, a mucous polypus, or sev-
UTERINE 359
-
POLYPI.
eral polypi of this variety, are felt protruding from the os.
In these varieties of polypi the uterus is felt not greatly
enlarged. If we make use of the speculum we may attempt
to pass the uterine sound, in case digital examination has
caused no flow, and we desire to diagnose the case more
clearly. If the history of the case shows several months
of hemorrhage, easily induced, even from copulation, we had
better, before introducing the sound, provide ourselves with
the Persulphate of Iron and a probe wrapped with cotton,
that we may be ready to arrest any excessive flow which
may be induced by the examination. In case of mucous
polypi, granulations of the cervix, and vegetations of the
endometrium, some hemorrhage is likely to be induced by
the introduction of the sound a half-inch inside the os uteri,
and I consider this evidence sufficient to make the diagnosis,
taken in connection with the history of the case, and the
slightly open condition of the os, and the slight enlargement
of the uterus.
When we find that the uterus is much enlarged, and
the history of the case shows that hemorrhage has existed for
many months, and there has not been any discharge of mu-
cous tumors or hydatids, we may be quite sure we have to
deal with a fibrous polypus. Upon inserting the sound in
this case no hemorrhage is induced while the sound is in
the cervix, and with care we may pass the sound up between
the tumor and the interior of the uterus. This will give
some information of the size of the tumor, when conjoined
with external manipulation, with one hand upon the hypogas-
trium. We may now gently sweep the sound around the in-
terior of the uterus and around the tumor, and by this means.
ascertain the location of its attachment and the size of its
pedicle. In case the tumor consists of a single cyst, or a
mass of hydatids, we will probably rupture the cyst or cysts
by the examination; and, perhaps, at first imagine we have
accidentally ruptured the waters of an impregnated ovum.
360
EATON ON DISEASES OF WOMEN.
We should not attempt the examination with the sound
till we are satisfied that there is no pregnancy in the case,
unless it be that a foetus has been expelled, and we desire to
learn what keeps up the flow. This flow might be caused from
a retained and partially attached placenta, as well as a fibrous
polypus, or a mass of hydatids. To make the diagnosis sure,
and at the same time make a point in treatment, we may di-
late the cervix with sponge tents, and then introduce one or
two fingers, and more clearly make out the nature of the dif-
ficulty. By doing this we lose nothing in any event, as the
case demands local treatment whatever cause may be operat-
ing to produce the symptoms; especially is this true if reme-
dies have been tried in vain before the examination is
attempted.
The dilatation of the cervix sufficiently to allow of the
introduction of one finger into its canal will enable us to
feel the round, smooth surface of the polypus, if it be of a
fibroid character. If the mass be hydatid, we feel it soft and
compressible to some extent, and probably the pressure of
the finger to determine its nature will break loose some of
the cysts, or lacerate them so as to allow of the escape of
their contents.
Some cases of uterine polypi may tend to cause ante- or
retro-version, ante- or retro-flexion; and in cases where these
displacements exist, we may have the train of symptoms pre-
sent in instances of these misplacements from other causes.
Inflammation of the uterus may be caused by the irritation
of the uterine polypus, and this inflammation may extend to
the cellular tissue, or to the peritonæum.
Differential Diagnosis.
The condition most likely to be mistaken for a fibrous poly-
pus is chronic partial inversion of the uterus. First, if we
feel the uterus round and smooth through the abdominal
walls, by placing one hand over the abdomen, and the other
UTERINE POLYPI.
261
pressing the organ up, with two fingers in the vagina, there
is no inversion. In inversion of the uterus the history of the
case must show a previous labor, followed soon by similar
symptoms to those now present, or the discharge (naturally or
artificially) of a fibrous uterine polypus, which might have in-
verted the fundus. One fibrous polypus having been thrown
off, or removed by art, we may know that if the time is not
long since past we have not a case of fibroid, but most likely
an inversion of the fundus of the uterus, simulating, by the
feel, the fibrous polypus.
The single cyst, or the hydatid mass, may be simulated
by a product of conception in the shape of a mole or a dead
foetus with the membranes intact. Whichever condition is
present is immaterial, as the indication in either case is to
remove the mass; hence time need not be spent to differen-
tiate at this stage of the case.
In cases where the fibrous uterine polypus of large size.
is expelled into the vagina the condition simulates complete
inversion of the uterus, and this displacement should be well
understood in order to differentiate between these two con-
ditions. If the extruded polypus is of small size there is
little or no danger of making a wrong diagnosis, as it may
be felt so easily that error is not likely to occur. The head
of a small foetus, having passed the os, might somewhat
resemble the small-sized polypus when expelled from the
cervix. But the feel of the head of the foetus is harder in
some spots than in others, while the polypus is of uniform
density. The history of the case aids the diagnosis. Trac-
tion upon the head of the foetus will soon deliver it, and
settle any doubt we may have had in regard to its nature.
We may also bear in mind that the fibrous polypus is insens-
ible, and does not bleed from its own surface; while the
inverted uterus is sensitive, and bleeds from its surface.
362
ΕΑΤΟΝ ΟΝ DISEASES OF WOMEN.
Prognosis.
The prognosis of uterine polypi is favorable, the efforts
of nature being sometimes sufficient to effect a cure, but in
other instances the resources of art are required to remove
the difficulty. In the fibrous variety of polypi their removal
is usually the end of the trouble. In the mucous variety,
as well as the granular, there is a disposition to return after
removal, and great thoroughness of treatment is necessary
to prevent their continuous formation. The single cyst is
seldom or never reproduced. The hydatid growth may be
again developed after removal. If left to themselves all
varieties of uterine polypi (except the fibrous with a pedicle
attached at or near the os, which hangs loose in the vagina)
are likely to exhaust the patient from loss of blood and
weakness induced by the anæmia consequent upon this
drain upon the vital fluid; hence the outlook is not encour-
aging for happiness and strength when the tumors are left
to themselves, although life may be prolonged for a long
time. Occasionally life may be lost, mainly on account of
the excessive flow caused by the presence in the uterus
of polypoid growths. Other diseases develop more readily
on account of the exhaustion produced by the excessive
hemorrhages induced by these growths.
Larcher* describes a case of spontaneous rupture of the
uterus from intra-uterine polypus. The patient died, after
having suffered from hemorrhage and from symptoms of
peritonitis. The autopsy revealed a polypus in the uterine
cavity, attached to the anterior wall; and the opposite side
was found ulcerated and torn through, and communicating
with the cavity of the abdomen.
Dr. Cockle reports a case of death resulting from a
fibrous uterine polypus which had partially decayed, and
some of the decayed matter had found its way through the
* Arch. Gén. de Méd., Nov., 1867.
† Med. Times and Gazette, 1863.
UTERINE POLYPI.
363
Fallopian tube into the abdominal cavity, causing fatal peri-
tonitis.
These cases of a fatal termination in this manner are ex-
ceedingly rare, however, and the rule is, that they do not ter-
minate fatally, except, as I have before mentioned, through
exhaustion, and the supervention of other diseases. In some
instances where the pedicle of the polypus is long, and it is
expelled into the vagina, the contractions of the cervix
strangulate the neck of the polypus, and it loses its vital-
ity, the pedicle sloughs and the tumor spontaneously drops
off. The pressure of a developing foetus may sometimes
destroy the polypus, and cause it to become detached from
the uterus, or soften and slough away. It is usual, how-
ever, that pregnancy does not occur in a case of uterine poly-
pus, and if it does, it is more common that the foetus is de-
stroyed, and a miscarriage is induced by the presence of
the polypus, instead of the polypus being destroyed by the
product of conception.
Treatment.
Usually the first indication is to arrest the hemorrhage.
For this purpose Aconite is the indicated remedy, if there is
fever, or rapid pulse; Nux, or Secale, if there is a slow pulse
with weakness and spasmodic contractions of the uterus; Ipecac,
if nausea or vomiting complicate the case; China, if there has
been great loss of blood, and great exhaustion is present; Ars.
alb., for chilliness, alternated with heat and hot flashes. . Cloths
wrung out of cold water applied to the epigastrium are of
service. Lemonade may be drank.
These means failing, the tampon should be used in the
vagina if the flow continues excessive. Formerly the tampon
was composed of a silk handkerchief, formed by pressing its
central portion up to the os, and distending it with bits of
cotton, or pieces of cloth, and this form of tampon may still
be used if we can not obtain anything better at the time.
364
EATON ON DISEASES OF WOMEN.
A more convenient method of tamponing the vagina is by
means of the gum elastic bag, or colpeurynter, having an elas-
tic tube attached, through which we may introduce the air,
and distend the bag to the full capacity of the vagina, then
tie the tube, or prevent the escape of the air, by means of a
stop-cock. This procedure enables us to take time to con-
sider, and also gives the patient an opportunity to regain
strength.
The tampon should be removed in twenty-four hours, for if
it was left much longer, the decomposition of the retained blood
might become very offensive, and even dangerous, from absorp-
tion. After removal of the tampon, if the patient is weak
and exhausted, we may reapply it, daily, for a week or so,
till the patient is in better condition.
Ferrum, China, Nux, Phos., or Secale, are often indicated
in this class of patients; under these circumstances beef tea,
soup, raw eggs, or milk, should be allowed. Let the patient
drink freely of cold water.
The next step in the treatment is to dilate the cervix
uteri, in either form of polypi, which are contained within the
uterine cavity. When they are found hanging in the vagina
attached to the margin of the os, or by means of a pedicle
attached within the uterine cavity, no dilatation of the cervi-
cal canal is necessary; but we may at once proceed to re-
move them by torsion, the ligature, with scissors, or the chain,
or wire ecraseur.
OPERATION.—Before deciding what means to use in the
removal of a polypus hanging in the vagina we should ascer-
tain the size of its pedicle. If the pedicle is as large as the
finger, or larger, there is no doubt but that the ligature or
the ecraseur is demanded. Even in case the pedicle is
as small as an ordinary lead pencil the ligature or ecraseur
is the safer plan, if the pedicle is firm, round, and rigid. In
case the pedicle is very thin, but as broad as the finger, the
ligature or ecraseur is demanded. If the pedicle is thin,
UTERINE POLYPI.
365
loose, and not more than a fourth of an inch in width, tor-
sion may be attempted. In removing a polypus by torsion
the tumor is seized with the long-handled uterine dressing
forceps, if it is of very small size (and if of the size of a
hickory-nut, or larger, with the vulsellum forceps, or the tumor
forceps), and the tumor is then twisted around and around
upon itself a half-dozen times; at the same time we make
slight traction. If the pedicle is not twisted off by this

STIEMANN-CO
FIG. No. 38.-NÉLATON'S TUMOR FORCEPS.
much effort we should desist in our efforts to remove it in
this manner, for serious cellulitis, metritis, or endo-metritis
might result from great violence in efforts to remove by
torsion. Torsion failing, we should remove with the ecraseur,
or the ligature, and scissors, as in cases of polypi with thick
pedicles.
SPONGE TENTS.-In case we feel quite sure in our diagnosis
of a fibrous polypus of large size, we should provide our-
selves with sponge tents of much larger size than are usually
kept for sale. We should have at hand some as large as
the finger, and others much larger, so that we may obtain
a dilatation which will enable us to get at the polypus. The
largest sponge tents kept on sale do not dilate the cervical
canal more than to about the size of the finger, and this is
not large enough to enable us to do more than to make
a positive diagnosis. We had better also be prepared to
proceed with the removal of the tumor as soon as the cervix
is dilated, in case the patient's strength is sufficient to jus-
tify the attempt.
The tent should be dipped into carbolized olive oil before
366
EATON ON DISEASES OF WOMEN.
it is inserted; and the tent should be inserted with the
sponge tent applicator.
be selected which can
be readily introduced.
This first tent may re-
(See cut.)
(See cut.) A size of tent should

G. TIEMANNE OR
FIG. No. 39.-EMMET'S APPLICATOR.
main from twelve to eighteen hours, when it should be re-
moved, and another inserted as large as can be introduced.
This may remain till fully expanded, then removed, and
have another still larger inserted, till we can seize the poly-
pus with the vulsellum forceps, and draw it down, or pass the
loop of an ecraseur chain over it, and by tightening it sever
the pedicle (the tent effectually controls the hemorrhage).
Sometimes voluntary uterine contractions come on, and
sometimes we may induce them by giving Secale cor., in doses
of twenty drops of the Flu. ext., or 3 doses of the Tr. in
warm water every half hour till three doses are used. In
this way the polypus sometimes is expelled into the vagina
like the head of a child in regular labor. I have seen them
delivered into the vagina of so large a size that they com-
pletely filled the pelvis, being as compact as the head of a
large child at full term. In this case the operation for
removal is very difficult, but it can be accomplished with the
use of some ingenuity.
In these cases the chain of the ecraseur is not long
enough to allow of making a loop large enough to pass over
the tumor, and we must lengthen it with a wire. We fasten
the extremity of the loop to a silver male catheter with
a thread, and carry it up by this means, having the ecraseur
held by an assistant, while we direct the catheter with the
right hand, and expand the loop of the chain with the fingers
of the left, and after getting the extremity of the loop up
over the tumor press the handle of the ecraseur up on the
opposite side of the polypus, and tighten the loop at the
same time by making traction on the chain till we have it
firmly adjusted about the pedicle, when we slip the chain
UTERINE POLYPI
367
into its fastening, and proceed to turn the screw, and sever
the pedicle.
When the polypi are not larger than the fist they may
be seized by the vulsellum forceps, and drawn down even ex-
terior to the body in some cases, bringing the pedicle into
view between the labia, when the ecraseur may be easily
applied, and the connection severed. We should then at
once examine thoroughly to see whether or not we have
inverted the uterus, and if so at once replace it. This will
not occur unless the attachment is near the fundus.
If the attachment of the pedicle is near the cervix the
drawing down of the uterus gives no trouble, as upon the
severance of the pedicle the organ is spontaneously replaced
through the influence of atmospheric pressure, and the elas-
ticity of the connective tissues put upon the stretch when
the womb is forcibly drawn down. The wire ecraseur is
recommended by some authors as less likely to break than
the chain; but I much prefer the chain, as there is less dan-
ger of hemorrhage with its use, and with care and skill
a chain is seldom broken. Formerly ligature was employed,
using it singly if the pedicle was not very large, and double
if large-i. c., transfixing the pedicle with a needle armed
with a double ligature, and tying one on either side, and
then cutting off the pedicle a short distance from the liga-
ture; of course, between it and the body of the polypus.
Others leave the polypus to drop off when the ligature has
caused a sufficient slough to enable it to do so. Others
have applied a ligature around the pedicle, and passed the
ends through a double canula, and tightened them daily as
they became loose from the cutting into the pedicle of the
loop around it.
OBJECTIONS TO THE LIGATURE.-The use of the ligature is
open to the following objections: 1st. it is unnecessary;
2nd. It is more liable to give rise to hemorrhage than when
the pedicle is severed with the chain ecraseur; 3rd. It is
368
EATON ON DISEASES OF WOMEN.
more liable to cause inflammation; 4th. It is tedious, and
causes offensive and irritating discharges, which are mostly
avoided in removal with the ecraseur; 5th. The proper use
of the ligature requires more' skill, unless the tumor is small
and can be drawn out of the vagina, in which case, it is bet-
ter to remove the polypus at once, in our opinion, than to
ligate it, and be troubled with the slough for some time after-
wards; 6th. In polypi with large pedicles they are usually
so short, that there is not room to cut off the tumor, without.
loosening the ligature, which might give rise to alarming, if
not dangerous hemorrhage, while in the use of the chain ecra-
seur, the tissues are crushed off, and the shreds of the torn
blood vessels arrest the flow of blood, and the lacerating
process as produced by the use of the ecraseur is well known
to be little likely to cause hemorrhage. I have never had
troublesome hemorrhage from the use of the ecraseur in the
removal of fibrous uterine polypi, though I have removed a
great number in this manner. And I believe this is the expe-
rience of all others who use the instrument.
ANESTHETICS.-The use of anaesthetics is not generally.
necessary in the removal of either variety of uterine polypi,
except in some cases of exceedingly nervous women, who
suffer so much from fear, that it is better to give them an
anaesthetic. In a few cases this is desirable during the use
of sponge tents on account of the suffering induced by their
dilatation; but this is not usually the case, as the expansion
of the tent does not, as a rule, produce severe pain. The
fibrous polypus being destitute of nerves, the severing of the
pedicle with the ecraseur gives little or no pain, even when it
is of large size.
VARIOUS KINDS OF TREATMENT UNDER VARIOUS
VARIOUS CIRCUM-
STANCES. Sometimes after we have severed the pedicle in the
uterus the tumor is not readily extracted through the os, and
it may become necessary to seize the tumor with the vulsellum
forceps and incise it freely in order to extract it. This is not,
UTERINE POLYPI.
369
however, absolutely necessary, for if we wait a few days
uterine contractions will come on and expel the polypus, which
is lying loose in the uterine cavity.
Sometimes the tumor is so large as to distend the vagina
severely, and it may become necessary to relax the os vaginam
with Bell. ointment and the inhalation of Chloroform, while we
extract the tumor with the ordinary obstetrical forceps.
In case we dilate the os uteri fully, and find the polypus
attached to the fundus by a broad, short pedicle, what is to be
done? First, we may attempt to pass the chain of the ecra-
seur around it, and for this purpose Edward's ecraseur is the
best (in our opinion), using Sims' guide to raise the chain into

+
=C-TIEMANN-KODE:
FIG. No. 40.-EDWARD'S ECRASEUR.
position. Should we fail in adjusting the chain around the
tumor properly we may incise the polypus and enucleate it
with the vulsellum forceps, or we may incise it and push into
the incision with a long probe, or uterine sound, a good sized
piece of lint, and leave it there several days, to establish sup-
purative or ulcerative action in the tumor. Or we may insert
a long sponge tent up by the side of the tumor, and thereby
excite uterine contractions, and hence exert great pressure
upon the polypus, which may cut off its supply of blood, and
strangulate it, causing it to soften and decay, when we may
take it away piecemeal with the vulsellum forceps, or we may
allow nature to slough it off.
To Dr. J. Marion Sims are we indebted for a knowledge
of the efficacy of sponge tents in destroying fibroid polypi.
He accidentally made the discovery by placing a sponge tent
in the uterus and forgetting it about a week, when, upon the
*Sims' Uterine Surgery.
24
370
EATON ON DISEASES OF WOMEN.
removal of the tent the polypus was found destroyed. I have
proven this to be an efficacious means of destroying those
fibrous polypi which we could not conveniently remove by
ordinary operation. I have not left a tent longer
than thirty-six hours in the uterus; but upon re-
moving it I have inserted another (after washing
out the vagina with injections of warm carbolized
water), and letting it remain another thirty-six
hours, and have thus caused the destruction of
large fibrous polypi, so that I removed them
piecemeal with the vulsellum forceps. Needles



G.TIEMANN & CO.
OTLEMANN=B÷CO

FIG. NO. 41-ELECTROLYSis Needles.
charged with electricity have been used to de-
stroy these polypi, as have injections of Tr. Iron
or Iodine; but we deem these measures inferior
to those previously described.
-
G.TIEMANN & CO.
FIG. NO 42.
AFTER TREATMENT. After the polypus has
been removed, there is usually little treatment
required beyond giving a nourishing diet and re-
quiring rest in the recumbent position. Should
there be great exhaustion China, Ars., Nux, Rhus, Sepia, Fer-
rum, Ignatia, Phos., or Canthar., may be indicated by the to-
tality of the symptoms. But the symptoms requiring these
UTERINE POLYPI.
371
remedies are to be considered complications indirectly caused
by the operation and not the result necessarily of it. I have
had cases complicated with torpid liver, jaundice, spinal irrita-
tion, worms in the intestines, etc., which conditions could not
more than indirectly be dependent upon the polypus, and not
in the least upon the operation; and we do not see the need
to mention every remedy in the Materia Medica because a
possible complication might arise demanding their use.
Treatment of Single Cystic Polypi.
If
We now
It is well in the case of the single cystic polypus of the
uterus to dilate the cervix to the size of the finger, that we
may more easily ascertain the locality of its attachment.
the tumor is ruptured we may ascertain this with the finger;
if not ruptured, we may gently insert the uterine sound (in
case we are sure, from the symptoms and history of the case,
that pregnancy does not exist); then, after ascertaining the
location of the pedicle, we rupture the sac and draw it out
of the cervix with a pair of straight, long uterine dressing
forceps.
Now introduce a Wocher bivalve or a Dawson's
improved Sims' speculum (see chapter on "Instruments"),
and bring the membranes of the sac into view.
pass into its interior a long brush or swab saturated with
Comp. Tr. Iodine diluted with Glycerine one-half, having the
patient lie upon the side to which we have found the tumor
attached, so that the Iodine may gravitate about the pedicle
on its interior. After allowing the Iodine to remain about
an hour, we wash out the sac with warm water, then seize
hold of the membranes with the forceps, and, after drawing
them down as far as possible, sever them with long scissors as
high up in the cervix as we can reach. This process keeps
the Iodine from direct contact with the uterine tissues, and
it operates to produce adhesive inflammation in the interior
of the pedicle. Three cases I have treated in this way have
proven successful.
One case was complicated with retro-
372
EATON ON DISEASES OF WOMEN.
flexion. The after treatment is to be conducted upon the
same principles as in the removal of the fibrous polypus of
the uterus.
Treatment of Hydatids of the Uterus.
The hydatid uterine polypus is to be treated by dilating the
cervix and breaking up the mass with the finger or the curette.
Usually when a part is thus broken, the uterus contracts and
expels the remainder. If it does not we may give Secale cor.
in doses sufficient to induce contractions, and we may aid their
production by frictions to the inner surface of the uterus with
the finger. After their expulsion we swab out the interior of
the uterus with Comp. Tr. Iodine diluted with Glycerine five
times, or Argent. Nit., five grs. to the oz., laying the patient
upon the side to which the pedicle was attached. This ap-
plication may be repeated two or three times at intervals of
two days.
Treatment of Vascular Uterine Polypi.
This polypus, which is very rare and bleeds from its own
surface (being largely supplied with blood-vessels), is really an
enlarged glandular polypus, whose covering (the mucous mem-
brane) has through inflammatory action developed large blood-
vessels over its surface, and requires ligation. It is usually
soft, and may be drawn out with forceps, and ligated after
dilating the cervix with sponge tents. Before the ligature is
applied, we should twist the tumor several times around, that
the blood-vessels of the pedicle may be made as tortuous as
possible.
The ligature may be most conveniently applied by means
of the double canula, but we should not tighten it too much.
The ligature should be just tight enough to strangulate the
pedicle, without cutting into it. Every two days the ligature
should be tightened, till a slough is caused, and the tumor
becomes detached; after which the case is to be treated with
UTERINE POLYPI.
373
homœopathic remedies, according to the total indications.
Warm water vaginal injections are always in order, after the
removal of either variety of uterine polypi.
Treatment of Mucous Polypi of the Cervix and Vegetations of
the Endometrium.
The general principles of treatment of these varieties of
polypi are the same.
Ipecac, Aconite, Nux, Ferrum, etc., are often indicated.
Usually patients affected with these small polypi do not
have such an excessive and alarming hemorrhage as in in-
stances of the larger varieties, although in exceptional cases
the hemorrhage is great from very small polypi.
Should there be very free hemorrhage, no time should be
lost before we introduce the sponge tent, and we should se-
lect the size which will fill the cervical canal before it begins
to expand, so that as it expands it will exert a decided press-
ure upon the growths situated in the cervical canal; this com-
presses the pedicles of those hanging out of the cervix, and
arrests the flow from those above the neck of the organ. The
tent should be dipped into carbolized olive oil before it is in-
serted. After using the tent, any small polypi hanging from
the cervical canal may be removed by torsion.
After obtaining a dilatation as large as the finger, we
should ascertain by digital examination whether or not there
are any growths in the uterus above the cervix; for this pur-
pose we may draw down the uterus with a strong tenaculum,
and insert the finger to the fundus uteri and thoroughly ex-
plore its cavity. If we are able to feel any growths in the
uterine cavity which appear to have slender attachments, we
may pass up by the side of the finger a slender pair of for-
ceps, seize the growths, and remove them by torsion. If the
attachments seem large or if the growths are numerous, the
interior of the uterus should be swabbed thoroughly with Arg.
Nit. 20 grs. to the oz., or even 30 grs. may be used if a few
374
EATON ON DISEASES OF WOMEN.
applications of the 20 gr. solution does not cause the growths
to drop off in a week or ten days, using the swab every two
days. (This is the method of treatment I used in the case
mentioned in general description of uterine polypi repre-
sented by Fig. No. 36.)
These large vegetative growths of the body of the uterus,
of the nature of enlarged mucous polypi, are of rare occur-
rence. Usually the mucous polypi are confined to the cer-
vix, and are destroyed by means of the pressure exerted
by the use of two or three sponge tents. Sometimes only one
tent is necessary to secure the complete destruction of these
growths, or of enlarged granulations in the cervical canal.
This treatment I like much better than the application
of the solid Nit. of Silver, which has been so extensively
used. The caustic gives greater danger of atresia following
its use (closing up the cervical canal, so that impregnation
is impossible), and in other cases where there is only partial
closure of the cervix, and pregnancy occurs, the danger of
laceration of the cervix becomes very great, and the impli-
cation of the bladder in the laceration is to be feared; hence,
caustic applications in the cervical canal should be avoided.
After we have destroyed the granulations, or mucous
polypi, of the cervix with the sponge tent, we should daily,
or every two days, pass a bougie, well oiled with Vaseline,
till the raw surface from which the polypi have been re-
moved is well healed, using a vaginal wash of Calendula and
water daily, and giving such internal remedies as the totality
of the symptoms demand, with such nourishment as will be
most easily digested and assimilated. This method of treat-
ment gives promise of no further trouble by reason of the
development of new granulations, or mucous growths, as by
these means we secure the development of the healthy
mucous membrane in the cervix, which if left without this
care after the use of the tents would probably soon produce
a new crop of polypi.
MOLES IN THE UTERUS.
375
CHAPTER XXVIII.
MOLES IN THE UTERUS.
MOLES in the uterus, sometimes called molar, or false
pregnancy, consist of a fleshy mass, to which is attached
a sac filled with fluid resembling the amniotic liquid. The
fleshy part of the mole resembles the fleshy part of the
placenta. Upon rupturing the sac no foetus, or even the
remains of one, are to be found. Moles develop to various
sizes, varying from an inch to four or five inches in diameter.
Etiology.
Authors speak of blighted conceptions, injuries to the
patient, etc., as causing moles, but I do not know that any
of them offer any satisfactory explanation of their causation.
I have a theory regarding them, which may be correct
or not; still, as good, perhaps, as any yet advanced. I
believe they result from the small number of spermatozoa
which penetrate the ovum. My reason for this idea is,
that I have found, and I am told by other physicians of large
experience that they also have observed, that moles most
frequently develop in those women who take pains to pre-
vent pregnancy by using a syringe after connection, or in
cases where the husband withdraws before the ejaculation
of semen (as he thinks, but probably a small portion is left
in the vagina, as it is also likely that in some instances
a small part of the semen is left after using the vaginal
syringe). I expect that future observations will also show
that in those cases where these attempts to prevent concep-
tion are not made the semen will be found to be deficient
in a normal amount of spermatozoa, and the deficient impreg-
376
EATON ON DISEASES OF WOMEN.
nation will be, in most cases, found dependent upon their
deficiency in numbers or strength.
We do not know whether or not a single spermatozoon
is sufficient to impregnate the ovum so as to cause the devel-
opment of a healthy foetus. I claim that it is not; neither
do I believe that a very small number can do it. The
requisite number I can not at present even approximate,
but I am satisfied it is large. One reason for my belief is to
be found in the development of moles under the circumstances.
named; and another is from the fact that nature produces
spermatozoa in such immense numbers; and it is reasonable
to suppose that nature does not waste her forces by producing
thousands when only one is needed. A single ejaculation of
semen was evidently intended for a single impregnation.
I do not think it reasonable that nature produces a hundred
times as much semen at each connection as is adequate to
produce healthy conception. All the secretions of the body
are furnished nearly in the amount required for the purposes
for which they are secreted; never, in health, very greatly
in excess. Why, then, should we imagine nature made such
a mistake as to furnish a hundred times as many spermatozoa
in a single ejaculation of semen as is required to produce
impregnation?
Constriction of the cervical canal tending to prevent the
free ingress of semen, is also a cause of the production of
moles by preventing the free ingress of the semen into
the uterus.
Diagnosis.
The diagnosis of a mole in the uterus is sometimes diffi-
cult. There are present in some cases symptoms indicative
of pregnancy, the menstruation being entirely suspended, and
the uterus becoming somewhat enlarged, with the occurrence
of nausea and enlargement and tenderness of the breasts.
In other cases there is only partial arrest of menstruation;
and in still other cases it is not at all diminished, and in a
MOLES IN THE UTERUS.
377
few instances the flow is excessive, and there is more or less
loss of blood during the interval between the times of the
regular catamenial flow. The uterus ceases to enlarge in two
or three months, and the patient complains of faintness,
weight in the pelvis, pain in the small of the back, etc.
These symptoms going on for six or eight months, and the
organ remaining about the size it would be when there was
a two or three months' pregnancy, give us good reason to
suspect a mole in the womb, especially if we know the patient
has been trying to avoid conception.
Still, these symptoms are not positive evidence of the
existence of a mole, as there might be a dead foetus remain-
ing in the uterus causing them, or there might be present
sub-acute metritis or endo-metritis. These diseases have,
however, other symptoms which should enable the physician
to differentiate.
In other instances the patient has noticed no peculiar
symptoms (this makes diagnosis more difficult), her com-
plaints being such as might result from displacement of the
uterus or from slight pelvic inflammation. I will relate a
case in illustration.
Not long since a lady came to me from Illinois suffering,
as she and her family physician supposed, from retro-flexion
of the uterus with dysmenorrhoea. Her trouble had been
of several years' standing, and although married (for ten
years) and well formed, she stated that she had never been
pregnant. In about two days after replacing the uterus with
the sound, which I had great difficulty in introducing, I was
surprised to be called to her in haste, when I found her suffer-
ing with symptoms of a threatened miscarriage. She had hard,
regular uterine contractions, but no hemorrhage. (Her men-
struation had been regular, though scant and painful, and she
being very anxious to become a mother, I had not thought
of the possibility of pregnancy, nor was there a single symp-
tom in her case to indicate it.) But here were the pains, and
378
EATON ON DISEASES OF WOMEN.
I could only diagnose a small uterine tumor of some kind,
though I had not found any enlargement of the uterus more
than is common in cases of retro-version. The pains went
on; in fact, I did not try to stop them, and my patient was
soon delivered of a mole, with the sac entire, about as large
as a very small hen's egg. On opening the sac I found it to
contain nothing but a liquid resembling the amniotic fluid.
No vestige of a foetus or placental chord could be discovered,
though there was the fleshy part resembling a placenta.
I have delivered, I think, six of these moles in my expe-
rience of over twenty years, which shows their rarity. All
of the others were, however, larger than this, but showed
the same anatomy and appearance.
Prognosis.
The prognosis is always favorable. Moles of the uterus
usually are expelled by the efforts of nature, and there is
little danger to life if the patient is not imprudent.
Treatment.
Upon the subject of treatment little can be said, except
to give the remedies homoeopathically indicated by the to-
tality of the symptoms in each case. Usually the positive
diagnosis of moles in the uterus can not be made, hence we
are not justified in instituting any operative treatment unless
sufficient time has elapsed to place conception out of the
question, or at least make us sure that healthy, normal ges-
tation is not going on. When this is sure, by the lapse of
time, and there are any urgent symptoms demanding prompt
action we may insert the uterine sound and break loose the
attachments of the mole, as we would separate an adherent
placenta after abortion, by sweeping it gently around the in-
ternal surface of the uterine cavity. Uterine contractions
will then soon come on and expel the mass.
In case the sac is accidentally ruptured before we see
MOLES IN THE UTERUS.
379
the patient, the treatment to be used is the same as if the
case was one of miscarriage. Uterine contractions are to
be excited by cold applied to the epigastrium, by irritat-
ing gently the interior of the cervix with the finger, by
giving Secale cor., in doses sufficient to strengthen any feeble
uterine contractions present. Tampon the vagina with the
gum elastic bag in case of excessive hemorrhage, and give
Aconite, if the pulse is rapid and wiry; Ipecac, if there is nau-
sea or vomiting; Bell., if there is passive hemorrhage with
dilatation of the pupils and the rapid soft pulse.
After the expulsion or delivery of the morbid growth,
China will usually be indicated if there has been great loss
of blood, and there is much exhaustion; Ferrum, for the pale
anæmic countenance; Nux or Phos. ac., when there is loss
of strength, poor appetite and weakness of nerve force; Ig-
natia, Bell., or Verat., if there is jactitation of the muscles,
or a tendency to spasmodic action; Puls., where there has
long been Amenorrhea, with weak digestion, and pain in the
small of the back or ovaries.
The patient should rest in bed in the horizontal position
for several days, after the expulsion or artificial delivery of a
mole, and nourishing, easily assimilated food should be freely
given. Stimulants, tea and coffee, should be avoided. Cool
water may be drank quite freely.
380
EATON ON DISEASES OF WOMEN.
CHAPTER XXIX.
CATARRH OF THE UTERUS AND VAGINA.
CATARRH of the uterus is by many authors discussed as
endo-metritis. It is true there is some inflammation of the
lining membrane of the uterus in cases of catarrh of this
organ. Still there should be a careful selection of terms, so
as to indicate the state of the case we wish to describe.
The term catarrh suggests to the mind the idea of exces-
sive, offensive discharge from the part affected. The term
catarrh of the uterus should, in our judgment, be restricted
to those acute attacks of irritation of the endometrium caused
from cold, coming on suddenly in women or girls previously
healthy, and sometimes affecting the whole system at the
same time.
The inflammation of the endometrium produced from
other causes than cold I would term endo-metritis.
The attack of endo-metritis may be acute; but it is not
characterized by the free discharge of mucus and muco-pur-
ulent, or bloody matter, as in cases of catarrh of the uterus,
or catarrh of the uterus and vagina combined. An inflam-
mation of the vagina caused from excessive coitus, strong
vaginal injections, ascarides, the wearing of a vaginal pess-
ary, or the introduction of irritating substances into the
vagina, could not properly be termed catarrh of the vag-
ina; hence we see the propriety of restricting the term ca-
tarrh of the vagina to cases caused from cold, and that the
term should indicate that the attack was sudden, and that
there was also a profuse leucorrhoeal discharge at the same
time.
CATARRH OF THE UTERUS AND VAGINA.
381
Etiology.
The main direct cause of catarrh of the uterus or vagina,
is cold; but there are certain predisposing causes as well.
The condition of the general system has much to do with the
liability of the patient to take cold at any time, and the con-
dition of the uterine organs at times is such as predisposes
to a cold, when under other conditions the parts would be un-
affected. Just before the menstrual period for a few days,
during the flow, or just after its cessation, women are most
likely to be attacked with catarrh of the uterus and vagina.
This is due to the heightened nerve sensibility of the parts
at this period, and, to the congested condition of the capil-
lary circulation before and during the flow.
This heightened nerve sensibility in the uterine organs
produces a sympathetic sensitiveness in the whole nervous
system. Hence the patient is not only more sensitive to
cold, but also, to all influences affecting the nervous and cir-
culatory systems.
The wearing of thin-soled shoes, and insufficient under-
clothing; going into the cold, from a warm room, whether it
be a theatre, church, or room in a private house, without a
sufficient amount of extra clothing, is a fruitful source of
cold, which in those persons predisposed to an attack of
catarrh of the uterus or vagina might develop either or both
of these diseases. Bathing in cold water, at the menstrual
period, or in a cold room in cold weather, is also very liable
to produce these diseases.
Diagnosis.
The attack of catarrh of the uterus or vagina is ordin-
arily characterized in its commencement by the occurrence
of a chill. This chill sometimes affects the whole body, and
sometimes is confined mainly to the hips, lower limbs, and
lower part of the back. This chilliness is often accompan-
382
EATON ON DISEASES OF WOMEN.
ied with nausea. In a period varying from half an hour to
several hours reaction comes on, and a fever follows. The
fever is sometimes quite continuous for several days, and
sometimes comes and goes at irregular intervals. The pa-
tient complains of weakness and lassitude, often with a dis-
position to sleep, with pain in the small of the back, and a
bearing down pain in the pelvis and lower part of the ab-
domen.
Within a day or two after the commencement of an at-
tack of catarrh of the uterus or vagina, or both, there ap-
pears a profuse slimy greenish or yellowish white vaginal dis-
charge, which is in some cases mixed with streaks of blood.
The discharge (if not at first) soon has an offensive odor. The
patient complains of headache and occasionally has some pain
in passing urine, which indicates the bladder complication in
the catarrhal condition. The eyes look blood-shot and watery,
the pulse is rapid and wiry. The patient is not inclined to
walk about. She complains of heat in the vagina, and some
pain in the uterus.
A digital vaginal examination reveals heat and tender-
ness in the vagina. The labia and vulva are sometimes.
swollen. If we introduce a vaginal speculum, we see the
os and cervix as well as the vaginal mucous membrane red,
and the capillaries congested; and if the catarrh affects the
uterus, there is a discharge oozing from the os uteri of the
character before mentioned. The examination with the spec-
ulum is usually very painful, and we may, in most instances,
omit it. The diagnosis is usually made correctly from the
history of the patient and the other symptoms enumerated,
aside from any physical examination of the parts.
Differential Diagnosis.
The disease most likely to be confounded with catarrh of
the vagina, is gonorrhoea. It is sometimes very difficult to
differentiate between them. Usually the history of the case,
CATARRH OF THE UTERUS AND VAGINA.
383
and the character, circumstances, and age of the patient aid
materially. In gonorrhoea, there is commonly more pain in
passing water, more intense heat in, and more swelling of,
the labia than in catarrh of the vagina.
We must, however, bear in mind, in considering the
history, the age, and character of the patient, that innocent
persons may have gonorrhoea. The wife may have innocently
contracted it from her husband; a vicious domestic may have
placed some of the gonorrhoeal matter from her own person
between the labia of a young girl, or she may have purposely
or accidentally smeared the seat of the water closet with
this matter. General symptoms of a cold are not present
in cases of gonorrhoea, and not always, 't is true, in vaginal
catarrh.
The discharge from a case of catarrh of the vagina,
resulting from cold, may produce inflammation in the urethra,
and in the glans penis of the husband, and produce such
a train of symptoms as to make it impossible for the physi-
cian to distinguish it from ordinary gonorrhoea from impure
connection. (The same may be said of the leucorrhoeal dis-
charge, caused from endo-cervicitis or endo-metritis.) Hence
the physician should be very cautious about disturbing the
peace of families by deciding a case to be gonorrhoea from
impure connection, unless he has good evidence to justify
him, and even then it may be better in most cases to give
the patient the benefit of any doubt he may have.
Treatment.
Aconite is usually the indicated remedy in the com-
mencement of an attack of catarrh of the vagina or uterus.
especially if there is dryness and heat of the skin, a rapid
and wiry pulse, thirst, nausea, etc.
Bell., when there is dullness and fullness of the head,
flushed face, and bearing-down pains in the pelvis.
Bry., if there are sharp stitches in the back, side, or chest.
384
EATON ON DISEASES OF WOMEN.
Sepia, Cal. carb., Can. sat., Cubebs, Copaiva, Cimicif.,
Cantharides, etc., are indicated after the first few days, giv-
ing them according to the totality of the symptoms. Cubebs,
Can. ind., Cantharides, or Copaiva are indicated for cutting,
burning pains in urinating, as is Sepia or Cal. carb., for the
profuse vaginal discharge.
Should the disease progress without abatement Ars.,
Sulph., or Rhus tox., are frequently indicated. (See reme-
dies for leucorrhæa.)
As adjuncts to the indicated remedies we will mention the
warm foot bath, warm water vaginal injections, and the warm
sitz bath, used daily or twice a day. The patient should
abstain from exercise, and recline a great part of the time.
Large quantities of cool water should be drank. The food
should be gentle, bland, and non-stimulating.
HERNIA OF THE OVARY.
385
CHAPTER XXX.
HERNIA OF THE OVARY-HERNIA OF THE UTERUS, OR
HYSTEROCELE.
HERNIA of the uterus (Hysterocele) is very rare, as is also
hernia of the ovary. In hernia of the ovary, the uterus is
displaced also, but does not pass through the inguinal ring.
The uterus may pass into the crural ring, producing crural
hernia of the uterus, but I can find but two cases on record.
One was congenital, the other in a woman aged eighty-two
years. The uterus is irreducible in these cases, and I men-
tion this condition simply to record the possibility of its
occurrence.
Hernia of the ovary is more frequent. It is most fre-
quently found as an inguinal hernia. This occurs as a result
of the formation of a processus vaginalis peritonai, like that
in the male, and directs the ovary into the labia.
Just how frequently this displacement occurs it is impos-
sible to tell, as the descriptions given by writers do not
clearly indicate (in many instances) whether the inguinal
hernia mentioned by them in connection with, and synono-
mous of, hernia of the ovary, were in all cases really hernia of
the ovary. Englisch, for instance, is reported by Schroeder*
as finding nine cases of double inguinal hernia in a total of
twenty-seven cases. Neither Englisch nor Schroeder say plainly
that these were cases of hernia of the ovary, although they are
mentioned under the head of inguinal hernia of the ovary;
and the presumption is that they were of this class.
In cases where the patient has had an inguinal hernia of
the bowels previous to gestation, hernia of the ovary is liable
to come on during labor.
* Ziemssen's Cyclopædia, Vol. X, p. 355.
25
386
EATON ON DISEASES OF WOMEN.
Hernia of the ovary may be congenital. In this case
the condition is somewhat the analogue of that in the male
when the testicle is retained in the abdomen. Crural, abdom-
inal, vaginal, and ischiatic hernia of the ovary are occasionally
found to exist.
Diagnosis.
The symptoms of inguinal hernia of the ovary are pain,
heat, swelling, etc., in the inguinal region. On examination
a hard tumor is felt, like an enlarged inguinal gland, for which
it is very liable to be mistaken. The tumor is pear-shaped,
and of about the size of a hen's egg. General symptoms of
inflammation are sometimes present, but not always. Vaginal
hernia of the ovary takes place after a rent is made in the
vagina from severe labor. The ovary is, of course, dis-
covered in the vagina by physical exploration. Abdominal
hernia of the ovary can not be diagnosed during life.
Differential Diagnosis.
Hernia of the ovary is liable to be confounded with hernia
of the bowel, and with enlargement of an inguinal gland. In
hernia of the bowel, the tumor is softer and usually larger
than in hernia of the ovary. When there is hernia of the
ovary, the tumor usually enlarges just before the menstrual
period, which, of course, is not the case in glandular enlarge-
ment. By passing a sound into the uterus, and moving the
organ, or moving it with the finger in the vagina, we feel the
tumor move at the same time, if it be a hernia of the ovary,
which would not be the case if it was a hernia of the bowel
or an enlarged inguinal gland.
Prognosis.
The prognosis of the hernia of the ovary must depend
upon the age of the patient and the possibility of its reduc-
tion. If it can be reduced, there is little danger to be appre-
hended. In quite old women the prognosis is more favorable
HERNIA OF THE OVARY.
387
than in the young or middle aged. In the latter classes there
is greater liability to inflammation in the tumor; in fact,
inflammation is almost sure to occur sooner or later. The
inflammation may result in resolution, suppuration, or undergo
cystic degeneration. Cancer of the tumor has also been de-
veloped in these cases in a few instances.
Treatment.
In cases of congenital hernia of the ovary while the girl
is young nothing is to be done; in fact, the displacement is
seldom discovered in girlhood. As puberty comes on, and
we find we can not reduce the displacement of the organ by
taxis, it is best to wear a cup-shaped shield, to protect the
tumor from injury.
If there is much tenderness, cloths wet with Tr. Aconite,
one part to four parts of water should be applied warm, and
the same remedy in attenuation given internally. The reduc-
tion of the hernia is out of the question in those cases which
are congenital; hence it is best that remedies be used to sub-
due as much as possible the normal activity of the circulation,
consequent upon the process of ovulation. These remedies are
the Bromides and Camphor. These remedies should be given
in attenuations sufficiently low to produce the desired effect,
and marriage should be forbidden. The sexual passion should
never be excited in these cases. Seclusion is the best for
girls so afflicted.
In those instances where hernia of the ovary comes on
during labor, an effort should be at once made to replace the
organ by taxis, using those means taught in works on sur-
gery for the reduction of inguinal hernia of the intestines.
Taxis failing, resort should be had to the shield to protect
the organ from external injury, and the remedies already
mentioned should be given, and sexual congress interdicted.
In cases where the pain is intolerable the ordinary oper-
ation for strangulated hernia of the bowels may be per-
388
ΕΑΤΟΝ ΟN DISEASES OF WOMEN.
1
formed. After opening the sac of the hernial tumor, if it be
found impossible to return the ovary into the abdomen, we
may ligate the ligament of the ovary and the vessels sur-
rounding it with catgut ligature, and remove the ovary with
the knife. We may then pass the pedicle back into the
abdomen if it can be easily done, or we may leave it in the
inguinal canal, closing the incision in the integument by inter-
rupted suture and adhesive plaster, and dress with Calendula
wash applied warm, using one part of Tr. Calendula to three
parts of water. Arnica should be given internally. This
operation is a grave one, and is not to be performed except in
cases of great urgency. Holmes,* Guersant,† and Englisch‡
operated with fatal results. Pott,|| Lassus,§ Meadows,T
M'Cluer,** Deneux,++ and Barnes have operated suc-
cessfully. || ||
In crural hernia of the ovary the same principles of treat
ment govern as in the inguinal variety. The displacement in
ischiatic hernia of the ovary is of secondary importance
should suppuration take place.
In cases of inguinal or crural hernia of the ovary, with
suppuration, the pus should be aspirated, and the sac injected
with Dilute Comp. Tr. Iodine, which should also be aspirated
from the sac in about fifteen minutes, and pressure with com
presses applied as firmly as possible.
In cystic degeneration, the ovary should be removed by
operation as before mentioned.
Vaginal hernia of the ovary is to be treated by replacing
the organ and stitching together the sides of the rent in the
vagina in a similar manner as is done in cases of vesico-
vaginal fistula, freshening the edges of the laceration, if it is
not recent.
* London Lancet, January, 1864. † Bull de Therap., 1865, page 28. Ibid.,
page 340. |Œuvres Chir., T. I, page 492. Pathol. Chir., Paris, 1806, II, page 98.
** Ibid. tt Ibid. Ziemssen's Cy-
¶ Trans. London Obs. Soc'y, III, page 438.
clopædia, Vol. X, page 357. Barnes' Diseases of Women, page 267.
!
4
PLATE XVI.

CYSTOCELE.
PROLAPSE OF THE VAGINA.
389
:
1
CHAPTER XXXI.
PROLAPSE OF THE VAGINA, CYSTOCELE, RECTOCELE, ENTER-
OCELE, AND OVARIOCELE.
THE vagina may prolapse in part or wholly. When the
anterior wall is prolapsed, and the bladder is prolapsed with
it, it is termed cystocele. (See Plate No. XVII.) When there
is prolapse of the posterior wall only, and the prolapsed por-
tion contains the rectum, it is termed rectocele. If the pro-
lapsed portion contains a portion of the small intestines, it
is termed enterocele; and the name ovariocele is given when
the ovary is contained in the prolapsed vagina.
*
In speaking of prolapse of the vagina, it is understood
that it is the lower portion which protrudes beyond the os
vaginam, and has no reference to the inversion of the tube,
which takes place in procidentia uteri. In ovariocele there is
probably always present a lateral displacement of the uterus
at the same time. Enterocele has been thought by some an
impossibility in this locality, but Fehling has reported a
case in which "the patient, in attempting to replace the
large prolapse of the vagina, ruptured the posterior vaginal
wall at the posterior cul de sac, and died in consequence of
the protrusion of the intestine, which could not be reduced.”
This case shows the possibility of such a dilatation and pro-
lapse of Douglas' cul de sac as to allow of vaginal enterocele.
Women are not liable to any form of prolapse of the va-
gina before being delivered of a child.
Etiology.
Severe straining during labor while the head of the child
is partially within the vagina, and while the vagina is not
* Ziemssen's Cyclopædia, Vol. X, p. 504; also in Arch. f. Gyn., B. VI, p. 103.
390
EATON ON DISEASES OF WOMEN.
fully relaxed, tends to produce this difficulty. The head of
the child may be impacted in the vagina, and in this state of
affairs the pains of labor are calculated to tear loose the attach-
ments of the vagina, or carry it down as the head advances,
and with it the bladder or rectum, or both; and sometimes
the uterus and some of the small intestines are pressed down
to the vaginal outlet. The laceration or stretching of the
pelvic connective tissue in these circumstances allows of the
prolapse of the vaginal walls.
The elongation of the vagina which takes place during
gestation tends to the giving way of its attachments, and
predisposes to vaginal prolapse after delivery is accom-
plished. The relaxed condition of the intestinal supports,
subsequent to labor, allows of their displacement downwards,
and tends to produce cystocele, and also allows of the disten-
sion and relaxation of Douglas' cul de sac and the production.
of enterocele or ovariocele. Rectocele is produced in part by
constipation, impaction and distension of the rectum, etc.,
causing severe straining at stool.
Diagnosis.
The general symptoms of prolapsus of the vagina are
similar to those in prolapse of the uterus. The patient com-
plains of a sense of weight in the vagina, of fullness at the
vaginal outlet, of difficult micturition in case of cystocele,
and of difficult defecation in case of rectocele. The pro-
truded mass may be felt or seen. In rectocele we are able
to pass a curved male sound into the anus and around for-
wards into the dilated and prolapsed rectum forming the
bulk of the tumor.
By emptying the rectum, we may discover the contents
of the prolapse of the vagina to be the ovary (if it be there),
by pressing the tumor between four fingers, placing two in
the rectum and two in the vagina. In this manner we make
out the presence of the ovary by its hard, egg-like feel;
PROLAPSE OF THE VAGINA.
391
likewise if the case be enterocele, we feel the intestine, like
a small, half-filled link of sausage, rolling between the rectal
and vaginal wall.
If we suspect cystocele we should pass a male catheter
into the bladder, and if it drains the protruded mass, and the
end of the instrument can be felt in it, we diagnose cystocele.
If upon emptying the bladder freely the anterior prolapse of
the vagina remains as large and fluctuating as before, the case
would be likely to be one of vaginal cyst. I not long since
had the case of a wealthy lady of this city who had what
appeared to be a cystocele. On passing into the bladder an
ordinary uterine sound it curved backwards, and appeared to
enter the sac within the prolapsed anterior wall of the
vagina; but upon passing the catheter, and evacuating all
the urine, the protrusion was found as large as ever, which
showed the case

to be one of vag-
inal cyst, and
G.TIEMANN-&CO
was proven to
be one by my
FIG. No. 43.-TROCAR.
passing a trocar into the sac, and evacuating it in this way,
and finding the contents of the sac to consist of a thick, oily
fluid, much like the white of a raw egg.
Treatment.
The principles of treatment of prolapse of the vagina are
in some respects similar to prolapse of the uterus. There
is a necessity in both classes of cases for taking off the weight
of the intestines. This can be accomplished by position (lying
with the body lower than the pelvis), or by means of a properly
adjusted abdominal supporter. (See Plate XII.) In replac-
ing a cystocele, or either variety of prolapse of the vagina,
the knee-elbow position is the most favorable, so that we
have gravity to assist us.
In cases of rectocele the impacted feces must first be
!
392
EATON ON DISEASES OF WOMEN.
removed. For this purpose it is sometimes necessary to use
a scoop. After removing all the accumulation of feces wash
out the rectum with cool water, and proceed to reduce the
prolapse of the rectum and vagina by gentle, steady pressure
upon the mass, after smearing it well with Vaseline.
When the replacement is accomplished we insert at once
into the vagina a large sized gum clastic bag, and inflate it
fully, so as to press the posterior wall of the vagina well up
into the hollow of the sacrum, and this will also carry up
any intestinal prolapse which may have occurred, as well
as lift the uterus as high as possible, and thereby lift up the
vagina in consequence of its attachment to the uterus. This
condition of affairs should be maintained for three or four
weeks, during which time the rubber bag should be removed,
washed, and replaced every four or five days. The bowels
should be moved by means of warm water enema daily,
always injecting a small quantity of cool water into the
rectum after the stool, which may be allowed to remain in
the bowels till the next day.
After four weeks of trial of this treatment we would
advise leaving out the inflatable rubber bag for a few days
(but still wearing the abdominal supporter), and see if the pro-
lapse of the vagina returned. If it did not, the patient may
be dismissed with the injunction to be careful not to lift
hard, or strain in any way, using an enema of warm soap
and water if the bowels do not move readily and regularly.
If we found the prolapse returned partially or completely.
we would repeat the treatment for another four weeks.
the end of this time, if the case is not cured, it may be
advisable to resort to an operation, called elytrorrhaphy, to
remove the superfluous tissue from the vagina. This, how-
ever, should not be done till all other means have failed.
At
During the treatment above mentioned remedies should
also be used calculated to build up the system. The follow-
ing remedies are indicated most frequently by the symptoms:
PROLAPSE OF THE VAGINA.
393
Ars., Bry., Rhus, Nux, Bell., Secale, Cantharides, Can. ind.,
Cal. carb., Ferrum., China, Sepia, and Kreosotum. Bathing the
parts with cold water, and keeping the bladder and rectum
empty, must never be neglected in these cases.
ELYTRORRHAPHY consists of incising and removing a piece
of vaginal tissue, so that when the opposite sides of the
vagina are brought into apposition by sutures, and adhesion
results, the size of the vagina will be materially lessened.
The operation is quite similar to that for vaginal fistulæ.
OPERATION OF ELYTRORRHAPHY.-All other means failing, if
the patient and friends desire, we may resort to the operation
for lessening the size of the vagina, called elytrorrhaphy. In
deciding upon an operation we should bear in mind the ob-
struction which the contracted vagina is liable to offer to
delivery, in case of future pregnancy. Of course, if the
patient is a widow not contemplating marriage, or if she has
passed the child-bearing age, this objection does not stand.
The piece of vaginal membrane removed should be from the
posterior wall in cases of rectocele, enterocele, or ovariocele; and
from the anterior wall in cases of cystocele. The piece of
membrane removed should be diamond shaped.
The patient should lie upon her right side upon the oper-
ating table, with the thighs well flexed in operating on the
posterior wall, and on the left side to reach the anterior wall.
Complete anesthesia should then be induced, and the keep-
ing up of the effect be intrusted to a reliable assistant.
Another assistant dilates the vagina with Dawson's improved
Sims' speculum, so as to bring the wall of the vagina we wish
to remove distinctly into view. We now map out the piece
we desire to remove by touching the membrane of the vagina
with the edge of the scalpel on the lines we wish to incise.
We next hook up the vaginal membrane, and making it a
little more tense, make the incision complete upon the upper
side of the diamond-shaped piece; seize this membrane now
where it is incised, and carefully dissect it off the diamond-
394
EATON ON DISEASES OF WOMEN.
shaped piece to be removed, then cut off the piece we have
dissected up.
We next place interrupted sutures, as in operating for
recto- or vesico-vaginal fistula, placing the one nearest the
uterus first. We use silver wire for the sutures, and twist
them with our wire holder and twister. (See chapter on "In-
struments," Plate VI.) The sutures should be placed about
one-third of an inch apart. After the sutures are placed the
patient should be carried to bed, and allowed to come out
from the influence of the anaesthetic. The sutures may as
well remain about two weeks. In removing the sutures the
physician should be very gentle about it, so as to disturb the
parts as little as possible.
Professor Beebe, of Chicago (now dead), used to recom-
mend the removal of a circular piece of vaginal membrane;
but before his death he stated in the Illinois State Society that
- he agreed with me in the advisability of removing a diamond-
shaped piece instead.
PAPILLARY TUMORS OF THE UTERUS AND OVARIES.
395
CHAPTER XXXII.
PAPILLARY TUMORS OF THE UTERUS AND OVARIES, AND
COCCYGODYNIA.
PAPILLARY tumors of the ovaries are seldom met with,
and demand no more than a mere mention, their development
being a bare possibility, and their diagnosis ante-mortem
being an impossibility. Ascites and rupture of the umbilicus
were found by Eberth and Gusserow* to be dependent upon
these papillary growths of the ovary; just how, I can not
understand.
Papillary tumors of the uterus are so designated by a few
authors. They ordinarily consist of enlargement of the pa-
pillæ of the organ from irritation long continued, as in chronic
sub-acute inflammation. They sometimes take on ulcerative
action, and have developed into malignant diseases in some
instances. They ordinarily produce hemorrhage on being
touched even slightly. The other variety of papillary tumors
of the uterus are really condylomata, are pointed, and result
from syphilitic contamination. Schroedert says from gon-
orrhæal matter, but I have never seen gonorrheal contamin-
ation cause condylomata of the uterus. These condylomata
are usually found in connection with the same development
in the vagina, or upon the external genital organs. These
growths sometimes coalesce so as to give somewhat the ap-
pearance of the cauliflower excrescence, for which they have
been mistaken.
Symptoms.
Generally there is a profuse leucorrhoeal discharge in
these cases, or a profuse watery flow, sometimes mingled
with blood, passes from the vagina.
* Ziemssen's Cyclopædia, Vol. X, p. 442.
†Ib., p. 269.
396
EATON ON DISEASES OF WOMEN.
!
Treatment.
The treatment of papilloma of the uterus of the variety
first described consists in the introduction into the cervical
canal of a sponge tent well carbolized. This exerts steady
pressure upon these tumors and the capillary circulation is
restrained by it. The tent may remain twelve hours, and be
followed by another. Tr. Iodine Comp. may be applied to
those external to the os uteri. Remedies such as are indi-
cated homoeopathically by the general symptoms should be
given. In the condylomatous variety Kali iod. and Merc. cor.,
are indicated. They may be ligated and cut off with scissors,
if few and long; or, if large, may be severed with the
ecraseur. Thuja, Acid nit., etc., are often indicated in this
disease.
COCCYGODYNIA.
To Sir James Simpson is due the honor of having first fully
explained this disease, and proposed efficient means of treat-
ment, though Dr. J. C. Knott, of New York, published short
reports of two cases in the New Orleans Medical Journal fif-
teen years before. Previous to Professor Simpson's publica-
tion of his work on "Diseases of Women," pain in the region
of the coccyx was supposed to be neuralgia purely. It is now
known to be, in many instances, due to inflammatory action,
and in some cases there is dislocation of the whole coccyx or
some of its pieces.
Etiology.
The difficulty is due in some cases to direct violence, as in
a fall or from a blow; in others from injury received from the
passage of the head of the child through the pelvis in labor,
bending the coccyx backwards, causing dislocation (or fracture
in case of the anchylosed condition of the coccygeal bones) or
lacerating the ligaments which hold the bones together or unite
the coccyx to the sacrum; or the glandula coccygea may be
}
COCCYGODYNIA.
397
:
injured in labor, and cause severe pain at this point, and even
an abscess may follow this inflammatory action. This disease
may also result from sympathy with disease in other parts or
be the result of reflex nerve action. Notably among these may
be mentioned almost all uterine and ovarian diseases and dis-
placements. Dr. Barnes has also seen it caused from fissure
of the anus.
The pain is sometimes in part due to the condi-
tion of the general system, where there is abnormal sensi-
tiveness of the entire nervous system, aggravated in this par-
ticular locality by slightly exciting causes.
Diagnosis.
in the extremity of the
she has to sit sideways.
The pain runs down the
Defecation is painful, espe-
The patient complains of pain
spine. It gives her pain to sit;
Has to change her position often.
limbs and sometimes up the back.
cially if there is constipation. Copulation is sometimes pain-
ful. When there is a partial dislocation of the coccyx or a
fracture of its parts, in cases where the bones have become
anchylosed, pressure upon the bone with the finger in the
vagina or rectum, also causes increased pain. The pain in
some of these cases in the region of the coccyx is truly piti-
able, and ordinary treatment for neuralgia is of little or no
avail, and the patient comes under our care after having be-
come almost discouraged at the failure of relief she has hoped
to obtain so often, and as often been disappointed. The
natural results of great pain long endured, are usually pre-
sent. The appetite, digestion, nutrition, etc., are impaired.
The nervous system is shattered, and altogether the case is
one calling for sympathy and prompt relief.
Treatment.
The first thing to do in the treatment of a case of coccy-
godynia is to ascertain its cause. If there is present displace-
ment or disease of the uterus, or ovaries, or fissure of the anus,
398
EATON ON DISEASES OF WOMEN.
these conditions should be treated at once, hoping that the
coccygodynia is dependent upon reflex nerve action, and that
by relieving the ailments upon which it seems to depend we
may at the same time relieve the coccygodynia itself. While
treating the displacement of the uterus, or ovaries, or diseases
of these organs, or the vagina or rectum, remedies should be
used according to the totality of the symptoms which homoeo-
pathically indicate them. Among the following remedies.
will usually be found the one indicated: Aconite, China, Ars.,
Merc., Ignatia, Nux, Colocynthis, Colchm., Rhus tox., Lyc.,
Bry., Thuja, Sulph.
Failing in relief from the means suggested, we may make
a subcutaneous incision over the point of the coccyx and
insert a tenotomy knife by the side of the bone, and divide
the tendonous and muscular attachments all around it; or we
may make a larger incision and extirpate the entire coccyx,
or the part broken off, in case it be fractured. Where the
bone stands in against the rectum, at almost a right angle to
the sacrum, extirpation is the advisable operation. Dr. J. C.
Knott prefers extirpation to the subcutaneous division of its
attachments in all cases requiring any operation. Simpson
also recommends extirpation when the division of the muscular
and tendoņous attachments fails of giving relief. When the
division of the tissues is thorough, the small nerve twigs
which supply Luska's gland (the glandula coccygea), are
severed, and this may explain the relief afforded in some
instances by the operation.
The operation (whichever is performed) is comparatively
simple, and free from danger; still the student should recol-
lect that it is a last resort.
I have recently treated a case sent me from Indiana
which had suffered severely from coccygodynia for over a
year. I found at once that the patient had prolapsus
uteri, the os resting against the rectum, with the fundus
partially ante-verted. I replaced the uterus, and in two days
COCCYGODYNIA.
399
the coccygodynia had disappeared. Her physicians had over-
looked the cause of the pain, and had thought it to be in the
rectum or coccyx. My error would have been mortifying
had I proceeded to divide the attachments of the bone or
extirpate it. Sitting in this case was extremely painful, and
defecation she described as almost death. She declared that
her genital organs were all right, and she believed her trouble
to be piles. By paying no attention to her opinion, and at
once making a thorough physical examination, I was able to
make a more correct diagnosis and relieve her at once; and
I was informed several months afterwards that the relief was
permanent. The treatment is often made easy by first mak-
ing a correct diagnosis.
400
EATON ON DISEASES OF WOMEN.
!
CHAPTER XXXIII.
CANCER AND CAULIFLOWER EXCRESCENCE OF THE UTERUS-
CARCINOMA-SARCOMA, ETC.
We have two varieties of cancer of the uterus, the scir-
rhous and the encephaloid, the former being much the more
frequent. The cauliflower excrescence, called carcinoma by
some authors, is a fungus caused often from syphilis, and ex-
erts some influence upon the general health by reason of
the sanguinolent discharge accompanying it. The fact of
its removal proving curative seems to disprove its cancerous
character. The disease was first accurately described by Dr.
John Clark, of London. It is rarely met with in America.
It springs from the mouth and cervix of the uterus. The
structure of cauliflower excrescence is fungoid, rough, granu-
lated, and bleeds easily, being very vascular. It is of a pale
flesh color.
Scirrhus of the uterus is most common in women who
have borne children, according to statistics by Glatter.* Out
of one thousand Vienna women affected with cancer of the
uterus, there were
Single
Widows.
Married.
•
229
268
....
503
1,000
Prostitutes show no special tendency to carcinoma, as
might be expected from the nature of their habits.
The cervix is usually the seat of cancerous disease in
the uterus. It sometimes extends to the body of the or-
gan, and very rarely commences in the body of the uterus.
* Ziemssen's Cyclopædia, Vol. X, page 275.
CANCER OF THE UTERUS.
401
It commences with induration of the lips of the cervix,
which feel tender, hard, and irregular, and bleed easily.
The lips of the mouth of the womb are everted usually.
After a time ulceration sets in and causes an offensive sani-
ous, watery, irritating discharge from the vagina, which ex-
coriates all the parts with which it comes in contact.
The encephaloid variety of the disease generally occurs in
the form of soft, lobulated masses which contain clots of
fibrin. They vary in size from an orange to a child's head.
Symptoms.
The symptoms of carcinoma are those of other tumors of
the uterus, with the excessive and almost constant hemor-
rhage which we have in non-malignant growths of the uterus,
but the nauseous, sickening odor of the cancerous tumor
when it reaches the stage of ulceration is distinctive, as is
also the cancerous cachexia.
In the commencement of the growth of a cancerous tumor
it may be impossible to diagnose it from fibroma of the neck,
especially when it only affects one lip; but soon its greater
readiness to bleed and the bad smelling discharge will indi-
cate its character. In carcinoma of the body of the uterus,
affecting the mucous surface, we have the bad smelling dis-
charge per vaginam, accompanied with almost continuous
hemorrhage, the introduction of the sound producing great
increase of the flow of blood. The os may for a time in
these cases remain quite normal in size and appearance.
It is usual that the patient dies within twelve or fifteen
months after ulceration is developed; and before death the
disease sometimes extends to the neighboring organs, pro-
ducing utero-vesical, or utero-rectal fistula, but more fre-
quently exhausts the patient before the disease extends
so far. The distinctive pains of cancer are sharp and lan-
cinating. They occur mostly at night, and very seldom by
day. Why this is so we can offer no explanation.
26
402
EATON ON DISEASES OF WOMEN.
Treatment.
In cauliflower excrescence we may hope for permanent re-
lief from amputating the fungus, in connection with a part of the
cervix uteri, unless there are great complications in the case.
The treatment of carcinoma of the body of the uterus
must be mostly palliative, unless we extirpate the uterus.
No remedy is known that will cure the disease. I have
more faith in the beneficial effect of Phytolacca decandra in
this disease (from my own experience) than any other.
I have seen it arrest the disease for a year or more; and
in cancer of the breast it has proved so beneficial as to be
worthy of great confidence, as I know of cases where the
nodulated tumor of the breast of large size has diminished
and remained without further development for several years
after the use of this remedy. The drug acts to purify the
blood. Conium is perhaps the best remedy we know of to
relieve the pains of cancer, except it be in those cases
of extreme, hopeless ulceration which require full allopathic
doses of Opium or Morphia. In this case I would use the
opiate for humanity's sake, as I would in case of a hopelessly
mangled body from external injury, not to cure, but to
benumb the sensibilities. Palliative remedies are, of course,
to be used as the various symptoms demand in each individ-
ual case, with nourishing, easily digested food, and attention
to all hygienic measures possible.
OPERATIVE PROCEDURE.-No operation short of entire ex-
tirpation of the uterus is of any avail, and this has not
often been attempted; and without the patient's urgent
solicitation it should not be undertaken. I will speak further
upon this subject while treating of extirpation of the uterus.
SARCOMA.
Sarcoma may effect the parenchyma of the uterus, or
exist as a degeneration of a fibrous polypus. To be brief,
SARCOMA AND TUBERCULOSIS OF THE UTERUS.
403
they resemble uterine fibroma in their symptoms, and are
not generally discovered to be sarcomatous growths till re-
moved, or the post mortem reveals their nature. They are
round, soft tumors, homogeneous in structure, and when cut
reflect the light uniformly. They are probably always degen-
erated fibroids. The pedunculated sarcomatous polypus may
be expelled from the uterus spontaneously. By some it is
classified as cancerous, but as it does not seem to depend
upon a depraved condition of the blood, and when thoroughly
removed does not return, I do not call it malignant. Of
course, when situated so as to render its removal impossible,
it may destroy life by reason of ulcerative action, but many
times this ulcerative action is so long delayed that the patient
has time to die of some other disease.
TUBERCULOSIS OF THE UTERUS.
Tubercular deposits in the uterus take place as they do in
almost all other parts of the body. They seldom attack this
organ primarily; and secondarily only very rarely. The
symptoms are those of ordinary chronic sub-acute metritis,
conjoined with the regular tuberculous cachexia.
Diagnosis.
The differential diagnosis, in some cases, is very difficult;
in others, the general tuberculous diathesis, with the history of
a character such as to suggest a possible hereditary taint, will
distinguish it from the ordinary sub-acute, chronic metritis.
There is generally a tendency to amenorrhoea; but, in some
instances, menorrhagia is present, together with the long train
of sympathetic affections accompanying uterine disease.
Treatment.
Those remedies are the most useful which aid activity of
the glandular system, such as Merc. cor., Protoiodide of Merc.,
Ars., China, Phy. dec., etc. Good nourishment, especially milk,
eggs, and sugar, should be given.
401
EATON ON DISEASES OF WOMEN.
CHAPTER XXXIV.
FEMORAL HERNIA, INGUINAL HERNIA, LABIAL HERNIA, VAGINAL
HERNIA, AND HYDROCELE.
Labial hernia is of very rare occurrence. Femoral hernia
is quite frequent; but is not peculiar to women, though it
occurs in the female oftener than the male; we will, there-
fore, refer the reader to works on surgery in regard to femoral
hernia.
Inguinal hernia in the female has some peculiarities.
Although the tumor is usually small, it has been known to
contain twelve feet of small, and two feet of large intestine.
When the intestine projects from the inguinal canal into the
labium, it is termed inguino-labial hernia. This form of hernia
may contain not only intestine and omentum, but the ovary
and Fallopian tube. The coverings of this hernia consist of
the skin, superficial fascia, intercolumnar aponeurosis, trans-
verse fascia, and peritonæum. The epigastric artery is usually
on the inner side of the tumor. Labial hernia is usually of
small size, situated in the inferior half of the labia majora,
and usually contains a portion of the bladder, though it has
been known to contain intestine.
In Vaginal Hernia the anterior form contains the bladder,
and is termed also cystocele. The posterior form contains
intestines. Either variety may contain an ovary and the
Fallopian tube.
HYDROCELE IN WOMEN.
This affection consists of a collection of serous fluid
around the round ligament. The affection may simulate
hernia of the inguinal variety. Dr. E. P. Bennett reports
*New York Med. Record, Nov. 15, 1870.
*
i
HERNIA AND HYDROCELE IN WOMEN.
405
a case of this disease in the female. It had been mistaken
for an inguinal hernia by an eminent surgeon. The tumor
was about the size of a turkey's egg.
turkey's egg. The round ligaments
in the female are analogous to the spermatic cords in the
male. They end in the labia majora. The peritoneal cover-
ing usually extends to the inguinal glands; hence, we may
understand how an irritation around the cord may cause
effusion in this locality.
Treatment of Hernia in Women.
Vaginal hernia is to be treated by restoring the displaced
parts or organs by taxis, and retaining them in situ with the
gum elastic bag in the vagina and the use of the abdominal
supporter. (See Plate No. XII.)
In strangulated labial hernia where taxis fails, we cut
down upon the sac, divide the stricture, and return the
hernia into the abdomen.
Inguinal hernia in the female is to be treated as in the
male, by taxis and the wearing of a suitable truss.
If nec-
essary to operate, recollect that we have no cremaster mus-
cle to cut through, as in the male.
Treatment of Hydrocele.
When the diagnosis is clearly made the treatment of
hydrocele consists in aspirating the sac, and then injecting
into it a ten-grain Solution of Iodine. A small amount only
of the injection need be used, when it also should be as-
pirated. We now apply a compress over the seat of the
tumor, and wait for adhesion of the walls of the sac. If
it again refills we should again aspirate it, and inject a
twenty-grain Solution of Iodine, and, after aspirating it, apply
compression as before.
}
406
EATON ON DISEASES OF WOMEN.
CHAPTER XXXV.
HYDROMETRA—PRURITUS VULVÆ— ABSCESS OF THE LABIA
CYSTS OF THE VAGINA — FIBROIDS OF THE VAGINA — POLYPI
OF THE VAGINA— PROLApse of the OVARIES.
HYDROMETRA.
HYDROMETRA is worthy of but a word of description and
comment. It is a term applied to an accumulation of serum
in the uterus, in cases where there is atresia of the vagina or
cervix uteri similar to the condition producing hæmatome-
tra, the effused fluid being serum instead of blood. This
condition could not result unless there was an absence of
normal menstrual flow. It is rarely met with, and is to be
treated the same as hæmatometra.
PRURITUS.
This term is applied to the itching of the female genital
organs. The disease is divided into several varieties by
some authors. 1st, indicating the part affected as pruritus
of the vagina, pruritus vulvæ, etc.; by others it is divided
according to its imagined causation, as menstrual pruritus,
when recurring at the menstrual period; climacteric, when
occurring at the change of life; pruritus of pregnancy, when
coming on while the patient is pregnant, etc.
The disease occasions extreme pain in the attempt to
suppress the desire to scratch and rub the parts, and when
the parts are violently scratched or rubbed, the skin and
mucous membranes are lacerated, or become swollen and in-
flamed. In some instances the internal surface of the vagina
is the seat of these severe sensations; in other cases the
Sometimes the
labia, mons veneris, or clitoris, is affected.
PRURITUS.
407
itching extends to the thighs upon the inside. The itching
comes on most frequently at night, and is so severe as to
prevent sleep. During the day the patient is somewhat
troubled, and the desire to scratch the parts is so great that
it almost drives the patient to distraction in some instances.
Etiology.
The causes of Pruritus are various. It has usually been
supposed that the itching of the parts was due to irritating
vaginal or uterine discharges and inflammation in the parts.
This is true in very many instances, but we believe that it
sometimes has its cause in reflex nerve irritation, and some-
times from congestion of the parts, caused from lack of
sexual congress, and sometimes from excessive copulation,
sometimes from onanism, sometimes irritation of the cloth-
ing, and sometimes from diabetes.
A large leucorrhoeal discharge does not, as a rule, pro-
duce pruritus. Neither do acrid uterine or vaginal dis-
charges invariably cause the disease. Still in some instances
these discharges seem to be the cause of the itching. The
supersensitive condition of the nerves of the entire system
seems to predispose to the complaint; hence we find that the
trouble is more common in women who are exhausted either
by long suffering from uterine or spinal disease, or from
nursing, in those cases where the difficulty apparently was
directly caused from irritating vaginal discharges. The reflex
nerve irritation is shown in cases of amenorrhoea when the
suppression arises from cold, in cases of metritis, ovaritis, and
uterine displacements; also occurring at the climacteric
period and during gestation, although in some of this class
of cases there is a more or less copious vaginal discharge;
sometimes, however, there is none observable, and there is
rather dryness of the parts than moisture.
Ungratified sexual passion, brought into activity by fond-
lings and caresses of the lover, in girls of full blood and
408
EATON ON DISEASES OF WOMEN.
strong animal nature, by exciting, first, erection of the clitoris,
and, secondarily, congestion of the adjacent parts, develops
a violent pruritus, which it is difficult to relieve unless reme-
dies are given to allay the passionate excitement, or the
patient marries. Pruritus resulting from excessive coitus
is due to continuous congestion, irritation, and bruising of
the parts.
Onanism, of course, develops a similar, though worse,
condition, because of the mental and consequent nervous
disturbance produced.
The pediculus pubis or crab, which sometimes infests
the hair upon the pubes, gives rise to similar symptoms as
ordinary pruritus. Not recollecting this, has caused many
a physician to lose a patient, because of the failure of his pre-
scriptions. The second physician consulted, having prescribed
something to kill the parasites at once, secured the patient
for the future, as well as earning her lasting gratitude.
Short stiff hairs upon the labia, situated on its margin,
may cause the itching. Occasionally girls, for some reason,
shave off the hair about the privates. As it grows again it
comes out stiff, and is liable to prick the opposite labium.
Diagnosis.
In the diagnosis of pruritus the important thing is to
determine the cause-the simple description of the complaint
by the patient is sufficient to enable us to name the difficulty
as pruritus. Still, to treat it successfully a physical exam-
ination is sometimes absolutely necessary. The pediculi
should be carefully looked for. If present they appear
a little smaller than a pin's head, grayish brown in color.
They have the appearance of specks of dirt, and adhere
very tenaciously to the cutaneous surface. When forcibly
removed they show signs of vigorous life by active move-
ments. They are circular, and cup-shaped, the outer part
being about flesh color. Sharp hairs can be readily detected
PRURITUS.
109
by the sense of feeling alone. When these conditions are
not found the aid of the speculum and sound may be needed
to make the diagnosis of the cause of the trouble. Testing
the urine for sugar should not be forgotten in these cases.
Treatment.
We are justified in some cases in attempting to treat
pruritus from the descriptions given by the patient, or a
friend, in order to not shock the modesty of the patient, as
it is one of the most embarrassing ailments for the patient
to describe to the physician, unless he has treated her pre-
viously for uterine ailments.
First, those things which seem to be aggravating the
disease should be forbidden, especially scratching or rubbing
the parts. Smearing the parts well with Vaseline or Olive
oil for a few days, with the daily use of warm water vaginal
injections, and placing a thin bit of raw cotton between the
labia, or even pressed up into the vagina, and giving Aconite
every hour, is commonly a good method to commence on
when we can not obtain a physical examination, and have
to prescribe for symptoms; the Aconite being indicated for
the feverish, nervous symptoms usually present.
Treatment of Pediculi.
When pediculi are found we prescribe Mercurial ointment,
diluted one-half with simple Vaseline. This may be perfumed
as suits the doctor's whim. Let it be applied with the ends
of the fingers, in small amount, each night for three days,
washing thoroughly each following morning with castile soap
and water. Now omit the ointment for about a week; if
then it is found that any of the parasites remain give them
another dose of the ointment, applied as before. Sometimes
an infusion of Tobacco, thoroughly applied to the parts a few
times, effects a cure by killing the parasites. It should be
washed off the same as directed after using Merc. ointment.
410
EATON ON DISEASES OF WOMEN.
Those cases dependent upon metritis, ovaritis, uterine or
ovarian disease, or displacement, should be treated by pallia-
tives till we can remove the cause. First, the parts should
be frequently bathed with soap and water, and the vagina
syringed with the same. Follow this with Carbol. ac. one part
to twenty of water, applying it to the part affected; or, in
some cases, use Aconite 1* as a wash to the parts, keeping the
labia separated with raw cotton.
Remedies.
Remedies must be selected according to the totality of the
symptoms in each case. Among the following we usually
find the one indicated: Aconite, Nux, Sepia, Sulph., Cal. carb.,
Conium, Arnica, Ars., Urtica urens, Bryonia, Apis, Puls., Ma-
crotis, etc.
When the parts are exceedingly swollen and tender, warm,
wet, soft cloths are soothing, and a poultice of ground flaxseed
or slippery elm is sometimes a great relief. Using a wash
of Kali chlo. ten grs. to the oz. of water is one of the most
serviceable applications. Strong caustic applications do more.
harm than good. Let them alone.
In case the cause seems to be ungratified sexual passion
or onanism, Kali bro., or Camph., in low attenuation, are
the remedies. Direct a cold sitz bath to be taken daily.
Bland, unstimulating diet should be given, and plenty of
exercise in good air should be taken.
The bowels should be kept regulated with indicated ho-
mœopathic remedies, and the use of the syringe if necessary.
The digestive, nutritive, and assimilative functions should be
noted and kept in as healthy action as possible.
ABSCESS OF THE LABIA.
Phlegmon in the Labia, etc.
Phlegmon, or boil in the labia, is somewhat different from
the disease when located in other parts of the body. In the
ABSCESS OF THE LABIA.
411
labia majora these gatherings form of small size usually, and
occur in succession one after another for several weeks or
even months.
They are found most frequently in anæmic, debilitated
women, who are troubled with uterine disease and leucor-
rhoeal discharges. At first a small pimple is observed on one
of the labia majora, usually upon the inner side. This en-
larges and inflames till suppuration takes place, which usually
requires five or six days to accomplish, when the matter
escapes by ulcerating through the mucous covering. By this
time others have commenced forming.
Abscess of the labia sometimes forms from distension of
Duverney's gland, from obstruction in its duct. It is usually
observed as a hard lump in the posterior part of the labia in
the region of this gland, for several weeks, and is not tender
to the touch for a time; finally, however, inflammation sets
in and suppuration follows, unless the nature of the difficulty
is discovered and proper treatment used before it becomes
inflamed.
The more common form of abscess of the labia occurs in
its center; usually only upon one side, though occasionally in
both labia at once. In this form of abscess the first thing
which is observed is swelling and tenderness of the labia.
On examination the part feels hot and looks inflamed, espe-
cially on its mucous surface. The patient is scarcely able to
walk, and can sit with great difficulty. Usually the general
symptoms indicate fever; there is a flushed face, rapid pulse,
and dry skin. These cases often go on for several days
before the physician is notified, and if called he is only
informed of the feverish symptoms, and, perhaps, told that
there is a pain in the stomach. (The patient imagining that
it is proper to say stomach when indicating any point between
the thighs and breast.) It has been my experience to see
these cases arise in young married women within a few weeks
after marriage, or where the husband and wife have been
412.
EATON ON DISEASES OF WOMEN.
reunited after a long separation, and occasionally in a prosti-
tute who had recently commenced a life of shame.
The locality of the trouble, the timidity of the patient
together make the disease particularly embarrassing. Still in
some cases it is excruciatingly painful, and something must be
done.
The cause of this form of abscess is, doubtless, the bruis-
ing of the parts by violent copulation in most cases, although
of course it may arise from bruising in any manner. I have
seen it arise from bruising the part against the post of the foot
of a low bedstead.
This form of abscess of the labia, as a rule, runs a rapid
course, and within three days from the commencement of
the attack suppuration takes place. The patient complains
of a chill, and all the symptoms are more marked, especially
the fever following the chill.
Care must be exercised not to mistake a case of inguino-
labial hernia for abscess of the labia. Here we might have
the fluctuating feel; but the possibility of partially or com-
pletely reducing the hernia, would indicate the nature of
the case.
In the inguino-labial hernia, there is swelling and
pain; but not the heat and redness and disposition to point,
which there is in labial abscess. In hernia we also frequently
have vomiting of fecal matter, which we do not see in labial
abscess.
Treatment.
In the treatment of the abscess in the centre of the labia
from bruising, we usually are not called till pus is formed in
considerable quantity, and the first thing to do is to evacuate
it by free incision through the mucous surface of the labia.
The incision has to be deep in some instances to reach the
pus. When it is reached and evacuated, the patient experi-
ences very great relief at once.
Fomentation with hops or poultices of ground slippery-
elm or flaxseed are to be applied, and such remedies given
ABSCESS OF THE LABIA.
413
Arnica is usually indicated.
If we are
as seem required.
called before pus has formed, we should apply warm, wet
cloths, saturated with Arnica and water; and Arnica, Aconite,
Bell., or Hamamelis should be given internally, as seem most
clearly indicated. A warm sitz bath should be used every
four hours. This plan sometimes aborts the abscess.
In cases coming on slowly and situated in the posterior
part of the labia, indicating obstruction in Duverney's gland,
from closure of its duct, an effort should be made to open the
duct with a small probe, if possible, in case there is not pres-
ent very much inflammatory action in the tumor. After we
get the duct pervious, we should attempt to press out the
accumulation in the gland; succeeding in this, we may be
content to simply apply Arnica and water, and give any indi-
cated remedy. If we can not introduce the probe or evacuate
the gland, we should apply a warm poultice of flaxseed
meal or slippery elm, and make another attempt after a day
or so. Again failing, the poultice should be continued, till
either the inflammation goes away by resolution, or suppura-
tion is accomplished, and the pus is evacuated, either by
ulcerative action, or artificially by the aid of the bistoury.
Usually in these cases there is a torpid glandular action
in the entire system, indicating some of the following reme-
dies: Podoph., Merc., Iod., Ars., Hepar, Kali, Sulph., Merc.
idro., Nux., or Cal. carb. These should be used singly, ac-
cording to their most prominent homoeopathic indications.
In phlegmon or boil, the general system must be put in
order, and usually Sulph., Kali., idro., Nux, Puls., Ferrum,
Merc., China, etc., are the indicated remedies. Locally a cloth
smeared with Vaseline is the most desirable dressing, or raw
cotton may be substituted for the cloth. Vaginal injections
of carbolized water should be used twice daily. The condi-
tion of the stomach and bowels should be especially noticed,
and such remedies prescribed as the symptoms may homoeo-
pathically indicate in each particular case.
414
EATON ON DISEASES OF WOMEN.
CYSTS OF THE VAGINA.
Description and Pathological Anatomy.
Vaginal cysts occur singly in most instances, though oc-
casionally they are multiple. The walls of the cysts are
sometimes tough and thick, sometimes thin. The tumor
produced by the cyst is situated either in the anterior or
posterior part of the vagina. Sometimes the vaginal cyst
in the anterior part of the vagina resembles a cystocele
sometimes it pouches down, so as to appear like a polypus,
owing to the relaxed condition of the anterior vaginal wall.
They usually are enlarged follicular glands of the organ.
Viet supposed them to depend upon a dilatation of the canals
of Gartner, and probably this theory may be in some cases
correct. The cyst contains a liquid varying in color and
properties to a considerable extent. Sometimes it is thin,
serous, and white; at other times it is found thick, white,
and albuminous; again, bloody, reddish, or yellowish brown.
In pregnant women small cysts of the vagina sometimes
occur which are filled with gas in part.
Etiology.
But little is known of the etiology of vaginal cysts.
Bruising of the vagina and extravasations of blood have
If this was so the contents
been thought to be the cause.
of the cyst would more frequently be found to be blood or
pus. Obstructed follicles from inflammation is all right in
theory, and may be correct in the majority of cases; but if
asked, Why should they so generally occur singly? we
would be at a loss for an answer. I am of the opinion
that slight serous effusion from circumscribed cellulitis, is a
more plausible theory of their causation than any I have
before suggested.
CYSTS OF THE VAGINA.
415
་
Symptoms.
Small cysts in the vagina present no symptoms. Large
ones offer obstruction to copulation, and when pendulous
interfere with walking. I removed one of this kind last
year; it protruded as large as a small orange from the vulva.
It had been treated as a cystocele by a reputable physician
of this city, unsuccessfully.
Diagnosis.
The main trouble in diagnosis is to distinguish a cyst of
the anterior wall of the vagina from a cystocele. This is
best accomplished by introducing a flexible catheter into the
bladder, and drawing off all the urine, while we press the
tumor well up into the vagina. If it be a cystocele the size
of the tumor will then be found materially diminished; if a
cyst of the vagina, not altered in size. The vaginal cyst in
the posterior wall of the vagina is easily diagnosed from
rectocele, with which it is possibly confounded, by combined
rectal and vaginal touch.
Treatment.
The treatment of vaginal cysts, when of a size sufficient
to incommode the patient, consists in drawing off the con-
tents of the cysts by means of an ordinary trocar; if the
cyst refills (which it is very likely to do) it must be again
drawn off, and the sac injected with dilute Comp. Tr. Iodine.
I dilute the Compound Tr. about one-half, and allow it to
remain in the sac about ten minutes, and then flow away
through the canula of the trocar.
After this is accomplished the sac should be compressed
so that its sides may adhere and its cavity be obliterated.
In order to accomplish this object the inflatable rubber bag
may be inserted into the vagina, and well inflated. In this
situation it should be allowed to remain several days, though
416
EATON ON DISEASES OF WOMEN.
it may be removed, cleansed, and re-introduced every two
days or such a matter. Should we find, after inserting the
trocar, that the contents of the sac were too thick to readily
pass through the canula, we may insert a small sized bougie,
or a probe, and break down the semi-liquid contents of the
cyst, after which we may use compression to force the con-
tents of the sac through the canula.
If by using these means we are unsuccessful in evacuat-
ing the cyst, we may withdraw the canula, and with a sharp-
pointed bistoury enlarge freely the puncture already made.
We now scoop out the cystic contents with the finger or a
spoon-shaped probe, and mop the interior of the cyst with
Tr. Iodine Comp. It is important, I have found (and rea-
son as well teaches), that the Comp. Tr., instead of the T.
of Iodine, should always be used in the treatment of all
cases where it is desirable to awaken adhesive inflammation
in cysts of any variety. The Tr., if diluted with water or
serum, precipitates the Iodine, and produces rather more in-
flammation in spots than is desirable, and much less than we
wish in the balance of the sac. The Comp. Tr. Iodine is
capable of any amount of dilution with water or serum with-
out precipitating the Iodine, so that from its use we obtain
an even effect upon the entire surface which it touches, even
if it gets somewhat diluted.
The effect of the deposit of free Iodine in crystal upon
the interior of any sac or cyst might develop dangerous in-
flammatory action, and still fail of affecting any ways favor-
ably the remainder of the cystic wall. What is wanted is
to excite an irritation in the lining of the sac which will be
just sufficient, and no more, than to cause adhesive inflam-
mation; and the effect should be uniform, and not burn a
piece of membrane in one place and produce no effect upon
the greater part of the cyst, as often results when the pure
Tr. is used.
The same remarks apply with almost equal force when
FIBROIDS AND POLYPI OF THE VAGINA.
417
we desire to use Iodine with a swab or brush; hence we un-
qualifiedly prefer the compound Tr. of Iodine when we use
Tr. at all, and in most cases a solution made with water in-
stead of alcohol is preferable, using 3 grs. of Kali hydriodi
cum to each gr. of Iodine. Maintaining this proportion, we
may make a saturated solution, or make one as dilute as im-
agination itself.
FIBROIDS OF THE VAGINA.
Schroeder speaks of fibroids of the vagina. I can find
no other author who has claimed to have seen one. The
tumor which he saw was of the size of a walnut, and was
situated in the right side of the vaginal cul de sac.
It oc-
curred in connection with a uterine polypus the size of a
child's head. He describes the tumor as soft. His descrip-
tion is not definite enough to make out a positive diagnosis
that it was a fibroid.
POLYPI OF THE VAGINA.
Polypi of the vagina are of exceedingly rare occurrence.
although papillary growths in the vagina frequently occur
(usually as a syphilitic symptom, however). One case is
quoted by Dr. Barnes, of London, † reported by Mr. Cur-
ling, which was attached to the vagina just above the mea-
tus of the urethra. It projected outside the vulva, and con-
sisted of dense fibrous tissue.
Treatment.
They may be removed by torsion if small, or with the
ecraseur or ligature and knife if of considerable size, the
same as fibrous polypi of the uterus.
cure.
PROLAPSE OF THE OVARIES.
Some cases of prolapse of the ovaries are very difficult to
These displacements often cause severe abdominal
* Ziemssen's Cyclopædia, Vol. X, p. 508. † Barnes' Diseases of Women, p. 758.
27
418
EATON ON DISEASES OF WOMEN.
}
ļ
pains. The prolapsed condition of the ovary does not always,
however, produce severe symptoms, and the more experience
I have the more I am convinced that the pain is more often
due to inflammation than displacement of the organs.
The
displacement is caused by increased weight in the ovary
itself in connection with relaxation of the broad ligament
upon the affected side, in cases where it is displaced inde-
pendently of the uterus. This displacement has in former
years received but little attention, but is worthy of notice,
in that it explains the difficulties encountered in the cure of
some obstinate cases, where the disease is obscure, from a
casual examination.
The diagnosis is to be made by means of the conjoined
method, with a finger of one hand in the rectum and two
fingers of the other hand in the vagina, when the pro-
lapsed and tender ovary is felt at the side of the poste-
rior part of the vaginal cul-de-sac. These displacements
become doubly painful during copulation, owing to the in-
creased congestion of the parts produced by the excitement
of the act.
The ovary is sometimes so extremely displaced as to be
denominated ovariocele, and in other instances hernia of the
ovary; but these conditions are treated of separately under
these heads, and are not considered under the head of simple
prolapse of the organs.
The ovary is displaced downwards in connection with pro-
lapsus of the uterus, and sometimes remains somewhat pro-
lapsed after the uterus is reinstated, and causes pain in the
pelvis and abdomen. Differentially it is very hard sometimes.
to distinguish cases of this kind from a circumscribed cellu-
litis. In the circumscribed cellulitis in the region of the
ovaries, the thickening of the tissues is broader in extent from
side to side than from before backwards, while the ovary feels
nearly round, though oblong in shape.
PROLAPSE OF THE OVARIES.
419
Treatment.
The treatment of prolapse of the ovary is not always
easy or satisfactory, on account of not using a sufficient
amount of reason in the application of means for its relief, or
on account of adhesions which have formed, and which bind
it down to its abnormal position.
The abdominal viscera should be lifted off the pelvic
organs as a first principle, either by causing the patient to
maintain the horizontal position with the hips elevated, or by
means of an abdominal supporter properly adjusted. The
next step is to elevate the uterus above its normal position,
This is well accom-
so that the ovary may also be elevated.
plished in many cases by means of the elastic inflatable rub-
ber bag. This should be used of large size, so as to quite
completely fill the pelvis. Place the patient in the knee-
elbow position before pressing up the uterus or inserting the
rubber pessary, so that there may be no pressure from
the weight of intestines to interfere with the rise of the
uterine organs. This crowds the uterus and ovaries up to a
normal position, better than any other means with which I
am acquainted. The support should be maintained for several
weeks, removing, cleansing, and readjusting the pessary as
often as is necessary for cleanliness. This also compresses
the cellular tissue, so that it may become more firm, and gives
the broad ligaments an opportunity to gain strength, so that
when we remove the support, and the uterus settles to
its normal position, the ovary may remain where it is and
should be.
In these cases we may have some inflammation of the
ovary to contend with not, however, resulting from the
treatment, but from the displacement. To relieve this the
Bromide of Potassium should be given sufficiently to be-
numb the passions. The sexual instinct should be, for the
time, kept in entire subjection and as dormant as possible.
420
EATON ON DISEASES OF WOMEN.
Rest and quiet, both to body and mind, should be enjoined.
Neuralgic dysmenorrhoea is likely to complicate these cases,
and give an indication for Macrotine, Puls., Cimicif., Acon.,
Ars., China, or Bell.
Should cellulitis complicate the case we are obliged to
trust to position and remedies, and we can not use the in-
flatable bag in the vagina, as the pressure from it could not
be tolerated, until the cellulitis had been relieved.
ABORTION.
421
CHAPTER XXXVI.
ABORTION.
THIS term is applied to the expulsion of the foetus at
any period of gestation previous to the seventh month.
Abortion is a fruitful cause of disease in women, and
should be understood, that its earliest manifestations may be
subdued, that the accident may, if possible, be averted. It
should be understood, that it may be conducted with safety
to the mother, in case it can not be prevented. It should
be understood, that we use no treatment or remedies upon a
patient who is pregnant calculated to cause her to abort; and,
finally, that we may treat properly the conditions caused by
the abortion, in case one has occurred.
We must consider abortion a disease, and the desire
among women to produce it is an evidence of a diseased
state of society, which of course is made up of individuals.
Hence the minds of these individuals must be diseased, or
at least perverted in judgment. Objection to maternity seems
to largely pervade the minds of American women. This
shows that a healthy sentiment has not pervaded society for
years past, and that unless a change occurs in this regard,
the very foundations of government are endangered. It
therefore becomes the physician's duty as a philanthropist
and patriot, as well as a physician, to use all his influence to
cause women to look upon maternity as a blessing, and that
in the proper training of children women have an oppor-
tunity to shape the destinies of nations. Their power in
this way is equaled by none on earth. Can they not see that
in this direction there is an opportunity for influence greater
than they can exert in any sphere as ladies of fashion in
422
EATON ON DISEASES OF WOMEN.
gay society? Here are in store for them honors as far ex-
celling those received by the gay butterflies of fashion, as
the noonday's sun excels in splendor the flicker of a fire-fly.
The extent to which criminal abortion is carried on in
this country (and I may add among some of the nations of
Europe,) is astonishingly large, and its magnitude will only
be fully realized at the judgment day.
This practice has destroyed the health of many a robust
woman, and made her a poor wreck of humanity unfit to
propagate or rear offspring.
We can not feel it just to omit to say, in this connection,
that the men of our time are by no means clear of blame in
this regard. They have failed to show their wives that they
appreciate the trials and pains incident to motherhood; have
failed to show their appreciation of children, of home, of
the home circle, by absenting themselves too much from the
companionship of wife and children, and have found too
much pleasure in the club, the lodge, or the saloon. Nor
is this all. Too often have they fallen into temptations
while from home which have resulted in contaminating their
blood with syphilitic virus, which has caused the wife to feel
she is doing humanity a service to refuse to be a party to
the passing down to posterity any of the contaminated blood
in her husband's veins.
There are, however, accidental abortions dependent upon
various causes, the
Etiology
of which we will now consider. They may arise from any
cause which produces a separation of the attachment of the
ovum to the interior uterine surface. This is most readily
accomplished when the attachment is feeble, as I believe
it is when a small number of spermatozoa penetrate the
ovum (as I have mentioned in connection with the discus-
sion of moles). There may reasonably be supposed to be, in
some instances, a deficiency in strength or vitality in the
ABORTION.
423
The
spermatozoa, as well as a deficiency in their number.
inflamed irritable condition of the endometrium, muscular tis-
sue, or nerves of the uterus may predispose to cause con-
tractions of the organ, and produce death of the ovum at
any stage of development after impregnation. Hard work,
lifting, straining, jumping, etc., excessive sexual intercourse,
cold, vaginal injections, drastic cathartics, or violent emotions
of the mind may cause death to the fœtus in utero, and con-
sequent abortion. The nursing of a child at the time gesta-
tion is going on may, by means of the exhaustion induced, as
well as from the stimulating effect upon the uterus, from the
irritation of the breasts through the sympathetic nerves.
cause abortion.
Symptoms.
Uterine hemorrhage or pain, coming on in the pregnant
woman, are symptoms of threatened abortion, as a rule. (In
very exceptional instances women menstruate moderately
while pregnant.) We must not consider a slight show, oc-
curring at regular monthly periods, as evidence of a threat-
ened abortion in all cases. This is not to be considered
a hemorrhage, but menstruation. But where the flow comes
on irregularly, and is sometimes quite profuse, accompanied
with occasional uterine pains, we can be sure an abortion is
threatened, if the woman is pregnant.
A considerable chill is often a symptom indicating the
death of the foetus, although the chill is not accompanied with
uterine hemorrhage or pain. In this case faintness, and in some
instances convulsions, come on, and still more clearly indicate
the nature of the impending crisis. By making a physical
examination we find the os uteri somewhat dilated, varying
in size according to the stage of gestation and the time
which the other symptoms of abortion have been going on.
As abortion progresses the os uteri becomes more dilated,
and the pains become more regular and severe. Hemorrhage
is not usually profuse when there are severe uterine contrac-
424
EATON ON DISEASES OF WOMEN.
tions. In some cases an immense amount of blood is lost
per vaginam, faintness comes on, there is coldness of the
extremities, and the blanched countenance, and still no pains
in the uterus. These symptoms not only indicate that abor-
tion is impending, but that death itself is hovering near to
claim its victim.
A gush of water from the vagina indicates the rupture
of the membranes and the escape of the amniotic fluid, and
shows that abortion is unavoidable, as is also evidenced by
the preceding train of symptoms. Usually, after the rup-
ture of the membranes, uterine contractions come on with
increased frequency and severity, and the hemorrhage is
much decreased, or entirely stopped. The danger to the
mother is now much less, but the saving of the foetus is out
of the question. There occasionally occurs a case which
might be at first considered as exceptional to this rule.
I refer to cases where the rupture of a single cystic polypus
of the uterus simulates the rupture of the membranes. I
have, however, never seen a case of this kind occur previous
to the seventh month of gestation. After the seventh month
I have seen several where there were severe uterine contrac-
tions, and the rupture of a single cyst, either connected with
the uterus or ovum, which seemed to threaten premature
delivery, but was averted by proper remedies and means;
and the women went on to full term, and were delivered of
healthy children. I do not remember that either case was
These cases were
complicated with uterine hemorrhage.
threatened premature delivery, and not threatened abortion,
as they occurred subsequent to the seventh month.
Puerperal convulsions are not very common in cases of
I rec-
threatened abortion; still, they do sometimes occur.
ollect a case where the patient was thrown into violent
puerperal convulsions after taking OIL OF TANSY to produce
an abortion upon herself. I have also seen them produced
by the death of the foetus from accidental causes.
ABORTION.
425
Diagnosis.
The diagnosis of a miscarriage is ordinarily easy from
the symptoms which I have given; but there are sometimes
cases which are very perplexing. These women have, per-
haps, been regular in their menstrual flow, though it has
been scant in amount for one, two, or three months before.
In these cases we have to rely upon the accompanying
symptoms to enable us to decide whether our patient is
really pregnant and is threatened with abortion, or whether
it is a case of dysmenorrhoea with amenorrhoea. The size
of the uterus aids us in some cases; in others, the uterus is
abnormally large from congestion or sub-involution, and it is
next to impossible to be positive in the diagnosis. In such
a case we should give the patient the benefit of the doubt,
stop the pains, and let time clear up the diagnosis.
Again, in women who have reached the climacteric
period, and have missed their catamenial flow for a period of
two or three months, and then are attacked with uterine
hemorrhage and pains, the diagnosis is difficult. Usually
these cases prove not to be pregnant, but I have seen a foetus
expelled from such a patient even at the age of fifty-three
years. So we do well to be on our guard even with these
old patients.
Uterine polypi may cause hemorrhage and uterine con-
tractions, and have, of course, an enlarged uterus to contain
them, and greatly simulate the case of threatened abortion.
The history of these cases will usually throw light upon the
diagnosis. Generally, in the history of a case of uterine
polypi there has been no period of cessation of menstruation,
the flow having been profuse instead of scanty. This is not,
however, proof positive, as in some instances of uterine
polypi the menstruation is for a time nearly or quite arrested.
In such a case we must also give time a chance to clear up
the diagnosis.
426
EATON ON DISEASES OF WOMEN.
In the attempted expulsion of the uterine polypus, as
well as the threatened abortion, the os uteri is found some-
what open. If dilated so as to admit the finger, and we can
feel the fluctuation of the water within the membranes, of
course we know, usually, that there is pregnancy and a
threatened abortion in the case. The polypus might, how-
ever, be soft, and deceive us; but this would occur seldom, if
ever, for the history of the case must always be taken in
connection with the physical evidences we find.
Prognosis.
We can usually prognose, that if the patient is like other
women she is likely to have trouble following, although years
of breath in the body may be allowed her, for want of care
of themselves is characteristic of women who produce this
state of affairs or upon whom it is brought accidentally.
The physician should warn his patient of the danger of care-
lessness after abortion, and induce her, if possible, to exercise
the greatest degree of caution against taking cold or taking un-
due exercise. Death may result directly from loss of blood, or
from convulsions, or from inflammation following the abortion.
Sterility may result, and a long train of female diseases may
be anticipated in very many cases, among the most prominent
of which I may mention sub-involution of the uterus, chronic
metritis or cervicitis, displacements of the uterus, uterine tumors,
and the long array of sympathetic symptoms, whose name is
legion. One abortion always predisposes to another, should
pregnancy follow the first.
Treatment.
The first thing to consider in the treatment of a case of
threatened abortion is, whether it is possible to prevent it.
In order to decide this question, it is necessary to take into
consideration the strength of the patient, the amount of
hemorrhage and pain which she has suffered, and the length
ABORTION.
427
X
of time which has elapsed since threatening symptoms have
been manifested. Some considerable uterine pain, with a mod-
erate amount of hemorrhage, may not make the loss of the
conception positive, and active means must be used to arrest
the pain and the flow, or at least we should be active in the
use of means. The first thing is to insist upon perfect rest,
in the horizontal position, and at once administer Secale cor.
6 dilution at hourly or half hourly intervals. Cool, wet
cloths should be applied over the epigastrium in cases of
severe hemorrhage, but where there is uterine pain without
severe hemorrhage the warm cloths are most desirable and
useful. Aconite, Bell., or Ipecac are indicated for the hemor-
rhage, with heat of skin or nausea. Arnica is useful if the
pains are the result of lifting, straining, a fall, or any trau-
matic injury, including excessive venery.
After the pains have ceased and the hemorrhage is
arrested, we must still enjoin perfect rest for several days;
and no violent exercise should be taken during the entire
course of gestation, for after one attack of pain or hemor-
rhage, from whatever cause, the patient is more liable there-
after to another attack. Cool drinks should be given and
the air of the bed-chamber should be as pure and fresh as
possible, with a careful regard to proper temperature, which
should always be maintained at a rather low standard.
If the case presents alarming symptoms when it comes
under our care, if convulsions are present, having been pre-
ceded by a chill or otherwise, if the uterine hemorrhage
is profuse and has been so for several hours, if the uterine
contractions have been frequent and severe for a long time,
or if the membranes have ruptured, we can not hope to save
the foetus, and we must try to save the mother. To do this
the sooner the uterus is emptied the better. But we can not
always accomplish this at will.
We may give Secale cor. in
mother T. 3, doses in warm water, every twenty minutes.
We may irritate the interior of the cervix by sweeping the
428
EATON ON DISEASES OF WOMEN.
finger around in it, by which means we also dilate it; still
hemorrhage may go on, and no uterine contractions be in-
duced to control it. It now may become necessary, in such
a case, to tampon the vagina. This may be conveniently
done with the elastic rubber bag, with tube and stop-cock.
If the bag is not at hand, a silk handkerchief may be pressed
up into the vagina, and distended with raw cotton or
pieces of cloth. This will arrest the hemorrhage, if the tam-
pon fills the vagina perfectly, causing a clot to form in the
cervix, and this holds the blood in check, as the uterus will
not dilate to any considerable extent in case the foetus is still
within the uterus. (After confinement at term or premature
delivery, and even in cases after an abortion of a six months'
gestation, this would be an unwise and unsafe mode of arrest-
ing hemorrhage.)
After a time, varying in different cases, uterine pains
usually come on actively, especially if stimulants are given,
or we wait a sufficient time for the forces of the system to
recuperate. We now remove the tampon in the vagina and
aid the expulsion of the foetus and placenta as much as possi-
ble, pursuing the same rules of practice which should guide us
in assisting a delivery at full term. (This does not include
going to sleep and letting the patient take care of herself,
as is the custom of some of those who have at their tongues'
end and are always repeating the old adage, that "meddle-
some midwifery is bad.")
After the delivery of the foetus, the utmost skill and
promptitude should characterize our efforts to secure the
A failure to
prompt and entire delivery of the secundines.
attend to this properly is likely to be followed by severe
hemorrhage, if not septicemia. Herein lies largely the im-
To obviate this we should
mediate danger from abortions.
see to it that uterine contractions are induced, and if they are
not sufficient to detach the secundines, a well curved uterine
sound should be introduced (in case we can not introduce a
ABORTION.
429
finger up to the attachment), and by gently sweeping it around
the interior of the uterine surface, we may detect the point of
the placental attachment, when we should endeavor to sepa-
rate it by gentle but steady pressure sidewise with the sound.
After it is detached its expulsion is readily secured, either
by uterine contractions, or by means of the fingers, or a
slender pair of uterine placental forceps. Rest, bland nour-
ishment, and quiet are now demanded, and we should give
such homoeopathic remedies as the symptom's indicate.
When called to a case where the placenta has been long
retained the same principles govern. (I have removed one
which had been retained for about eight weeks, the hemor-
rhage from which had nearly killed the lady.) In such
cases, of course, China, Ars., Nux, Rhus., etc., are the indi-
cated remedies, with nourishing diet, rest, and fresh, pure air.
In case metritis, peritonitis, leucorrhoea, or any other diseased
condition, remains as a sequence of abortion, these conditions
demand treatment peculiar to them, and are treated of in
this work under their appropriate heads.
Henry Minton,* A. M., M. D., of Brooklyn, says of the
treatment of abortion:
"In dealing with threatened or actual abortion, from
whatever cause it may arise, the patient must be enjoined
at once to the recumbent position, in a cool room, free from
all noise and excitement; and before any line of treatment
is adopted we should make a thorough examination of the
uterus and all the discharges. If we find the uterus empty,
or the fœtus and secundines among the discharges, we should
treat the case as one of ordinary labor at term. If, on the
other hand, we find that no portion of the ovum has been
expelled, though the os be slightly open, hemorrhage free,
and the pains severe, at once make a vigorous effort to avert
the threatened accident. Enforce absolute rest; this is nec-
essary to the success of the remedies you will then prescribe.
*Hom. Jour. Obs., Feb., 1880.
430
EATON ON DISEASES OF WOMEN.
"The physician unacquainted with the effect of potentized
remedies in cases of this kind will be both astonished and
gratified at the happy results following their administration.
"When prescribing give preference to that remedy which
best covers the nature of the discharge, the peculiarity of
the pains, the general habits of the body, and mental condi-
tion of the patient.
Remedies for a Predisposition to Abortion.
"Act. rac., Aletr., Apis, Asarum., Aur., Bapt., Calc. c., Caul.,
Ferr., Helon., Hyos., Kali c., Lyc., Puls., Sabina, Sepia, Silic.,
Sulph., Viburnum.
Threatened Abortion.
"Acon., Act. rac., Ambra, Apis, Arnica, Asarum, Bapt., Bell.,
Bry., Calc. c., Cannab., Camph., Caust., Caul., Cham., Chin.,
Cinnam., Coff., Crocus, Erig., Ferr., Gels., Helon., Hyos., Ipec.,
Kali c., Nux m., Nux v., Opi., Pod., Puls., Rhus t., Sabina,
Sang., Secale, Sepia, Silic., Stram., Sulph., Thuj., Trill., Verat. a.,
Viburnum.
Time of its Occurrence.
Second month: Apis, Kali c.
Third month: Crocus, Sabina, Secale, Thuj.
Fifth month to the seventh: Sepia.
In the early part of pregnancy: Apis.
In the last months of pregnancy: Opi.
Causes.
Anæmia: Alet., Calc. c., China, Ferr., Secale.
Congestion of the uterus: Act. rac., Bell., Canth., Caul., China.
passive: Caul., Secal., Ust.
with ulceration: Canth.
Constipation: Apis, Bry., Nux v., Silic.
Cystitis: Acon., Cannab., Canth.
Disposed to hemorrhages: Calc. c., Ham.
ABORTION.
431
Epidemic influenza, during Camph.
Exposure to cold or dampness, from: Dulc., Puls.
Fright: Acon., Gels., Opi.
when the fear remains, she can not get over it: Acon.
Gonorrhoea: Cannab.
Induration of cervix: Aur., Con., Sepia.
Inertia, uterine: Caul., Cimicif., China, Ferr., Puls., Sabina,
Secale, Ust.
Leucorrhoea: Calc. c., Camph., Lyc., Sepia, Sulph.
Nervous sensibility, excessive: Asarum., Ferr.
Plethora: Acon., Apis, Alet., Calc. c., Sabina.
Shocks, falls, bruises, or concussions: Arnica.
especially if she commences to
flow, with or without pain; or pain, with or without
flow: Arnica.
Spinal affections: Silic.
Strain of the loins, or over-exertion: Rhus. t.
Causes.
Strain in the loins, from a false step, or over-reaching: Cinna.
Sudden depressing emotions: Gels.
Suppressed grief: Ignat.
Syphilæmia: Aur., Merc., Nit. ac., Phytolac., Staph., Thuj.
Typhoid fever: Bap.
Character of the Discharge.
Black: Asar., Crocus, Kreos., Plat.. Puls., Secale.
and coagulated: Cham., Chin., Ferr., Crocus, Puls.,
Sabina.
in gushes: Puls.
mixed with foul-smelling coagula: Secale.
stringy: Crocus.
thick: Plat.
liquid: Secale.
432
EATON ON DISEASES OF WOMEN.
Black and offensive: Cham., Crocus, Krcos., Secale.
Bright red: Arnic., Bell., Cinna., Erig., Hyos., Ipec., Rhus t..
Sabina, Trill., Ust.
aggravated by motion: Sabina, Trill., Ust.
continuous: Hyos., Ipec.
feels hot as it passes: Bell.
in gushes: Sabina, Ust.
intermittent: Bell., Rhus t., Sabina, Ust.
Bright red, not coagulating: Ham.
or dark, with coagula: Sabina.
readily coagulating: Ipec.
with coagula: Arnic., Bell., Ipec., Sabina, Ust.
Coagulated: Arnic., Bell., Cham., Chin., Crocus, Ferr., Helon.,
Ipec., Plat., Puls., Sabina, Secale, Ust.
Comes suddenly, and ceases as suddenly as it came: Bell.
Continuous: Arnic., Cinna., Ham., Hyos., Ipec., Sabina, Ust.
but not profuse: Ust.
with nausea: Ipecac.
Dark: Bell., Bry., Cham., Chin., Crocus, Ferr., Helon., Kreos.,
Nux m., Plat., Puls., Sabina, Secale, Trill., Ust.
and aggravated by motion: Crocus.
mixed with coagula: Bell., Cham., Chin., Crocus,
Ferr., Puls., Sabina, Secale, Ust.
dark: Sabina.
foul: Secale.
fluid: Bry., Plat., Secale.
offensive: Cham., Crocus, Kreos., Sabina, Secale.
thick: Nux m., Plat.
Fetid: Bell., Cham., Crocus, Kreos., Sabina, Secale, Ust.
Gushes in Cham., Chin., Puls., Sabina, Secale, Ust.
Hot, feels hot as it passes the vulva: Bell.
Intermittent: Chin., Kreos., Puls.
Offensive: See Fetid.
Partly thin or watery, and partly black and coagulated: Ferr.
ABORTION.
433
Passive: Alet., Caul., Chin., Crocus, Ham., Helon., Secale, Ust.
Profuse Apis, Arnica, Bell., Cham., Chin., Cinna., Crocus,
Erig., Ferr., Helon., Ipec., Hyos. Sabina, Secale, Trill.
Scanty: Caul., Nux v.
Sudden: Bell., Cinna.
Suddenly ceases and as suddenly returns: Bell.
Watery: Chin., Ferr., Kreos., Sabina, Secale.
and mixed with coagula: Chin., Ferr., Sabina, Secale.
Worse from motion: Coff., Crocus, Erig., Sabina, Secale.
Character of the Pains — Hypogastric and Uterine Region.
Pain about the umbilicus, passing off into uterus: Ipec.
alternating with hemorrhage: Cham., Puls., Secale.
and distention: Chin., Lyc.
faint sick feeling in the abdomen: Sabina.
heaviness in: Cham.
motion in from something alive: Crocus.
excites a desire to defecate: Nux v.
great restlessness and agony: Cham.
in burning: Bry.
Cham.
colicky: Bell., Calc. c. Chin., Sepia.
cutting, with frequent desire to urinate:
crampy uterine: Cocc., Nux m., Vib.
with cutting stitches: Ignat.
labor-like: Apis, Bell., Calc. c., Caul., Cham.,
Hyos., Ipec., Kali, c. Nit. ac. Nux v., Nux m., Opi.,
Plat., Puls., Sabina, Secale, Sepia., Ust.
Puls., Secale.
alternating with hemorrhage: Cham.,
as if the pelvic contents would issue
through the vulva: Bell., Nit. ac., Sepia.
beginning in the back and extending
into the thighs: Kali c.
ovarian region: Podo.
28
434
EATON ON DISEASES OF WOMEN.
coming suddenly and
suddenly and as suddenly
vanishing: Bell.
extending to the sides: Cham.
thighs: Apis, Cham.,
Kali c., Sang., Vib.
periodical: Cham.
abdomen: Lyc.
shooting from right to left across the
spasmodic: Caul.
the result of injury: Arnica.
with frequent desire to urinate: Cham.
pressure on the uterus and rectum: Ipce.
shooting to the legs: Vib.
stinging in ovarian regions: Apis.
Sinking, empty feeling in: Ignat., Sepia.
Tremulous sensation in: Plat.
Weakness in: Phos.
Weight in: Alet.
Back.
Pains from, directly through the pubis: Sabina.
in aggravated by motion: Bry.
as if it would break: Bell., Kali c.
drawing: Rhus.
beginning in the back and extending into the
thighs: Kali c.
intolerable before passing water: Lyc.
paralytic, rendering the legs almost useless: Cocc.
severe in back and loins: Caul.
small of: Asar., Bell., Calc., Lyc.
Spinal affections: Silic.
attended with great weakness: Kali c.
Mental Condition.
Anxiety, great: Acon., Arnica Bell., Kali c., Secale.
and palpitation of the heart: Calc.
ABORTION.
435
11
sadness: Secale.
timorousness: Bell.
with great fear: Kali c.
nervous excitability: Acon.
Can not bear to be talked to: Hyos.
Confusion of mind: Bry.
Cries and trembles, does not know what to do: Coff.
Delirium: Hyos.
after severe flooding: Chin.
Depression of spirits: Ferr., Ignat., Lyc., Sepia, Ust.
Desire to talk about her condition: Nux v.
Dread of men: Puls.
Dull and stupid: Opi.
gloomy: Helon.
Ecstatic mood: Stram.
Fear of death: Acon., Apis, Coff., Gels., Kali c., Secale, Stram.
Acon.
is sure she will die from the hemorrhage:
is sure she will abort: Nux m.
Full of desires: Ipec.
tears: Puls.
Hysterical: Ferr., Hyos., Nux m., Phos., Sabina.
alternation of laughing and weeping: Hyos., Phos.
Illusions, every thing around her seems small, and every body
seems inferior to her: Plat.
Imperious manner: Lyc.
Irritable: Cham., Ipec., Nux v., Sepia.
Lascivious mania: Hyos.
Laughter, every thing seems ludicrous: Nux m.
Loquacious: Hyos., Stram.
indistinct muttering: Hyos.
Makes irrelevant answers: Hyos.
Mild, gentle, tearful, yielding: Puls.
Moans, which affords relief: Bell.
Momentary arrest of thoughts: Asar.
436
EATON ON DISEASES OF WOMEN.
1
Mood, suicidal: Aur.
Morose and serious: Bell.
Nervous: Asar., Cham., Chin., Ferr., Opi.
and hysterical feeling: Ferr.
irritable: Cham., Nux v., Opi.
Obstinate and passionate: Bry.
Over-sensitiveness: Bell., Nux v.
Quietly disposed: Trill.
Restless Acon., Bapt., Dulc., Rhus t.
anxiousness: Crocus.
quarrelsome: Dulc.
mental: Bapt.
Short time seems a long while to her: Nux m.
Sighing and sobbing: Ignat.
Startled easily: Bell., Cocc.
Stupid, half-asleep condition: Opi., Secale.
Taciturn: Nit. ac.
Tearful: Puls.
Thinks herself well: Kreos.
she is not at home: Opi.
Weeps much Kali c."
CYSTS OF THE BROAD LIGAMENT.
437
CHAPTER XXXVII.
CYSTS OF THE BROAD LIGAMENT, AND DISEASES OF THE FAL-
LOPIAN TUBES.
THE cysts which sometimes develop in the folds of the
broad ligament should be well understood, that if possible
they may be correctly diagnosed, as they are somewhat likely
to be thought to be ovarian tumors. This error of diagnosis
leads to an error in treatment, and the patient's life is en-
dangered by an operation for their removal, which is quite
unnecessary.
Etiology and Pathology.
The etiology of cysts of the broad ligament we are
unable to satisfactorily explain. They probably arise from
irritation between its folds. They sometimes exist of very
small size, and are only discovered at the post mortem. In
other instances they attain to an
they attain to an enormous size. They
contain a watery, slightly albuminous fluid. The sac is thin,
although sometimes thickened in a part of its surface from
deposit of fibrinous material. They seldom attain to the
immense proportions of some of the larger ovarian cystoma.
The small-sized cysts are supposed to be from the terminal
bulb of the tube. Cyst of the broad ligament is usually
pedunculated.
Diagnosis.
They develop in the iliac regions like ovarian tumors,
but are more fluctuating while yet small. (The ovarian
tumor is usually hard while small.) As they become larger
they may be felt fluctuating equally on all sides and in every
direction. When only of the size of an egg they may some-
times be felt in Douglas' pouch, soft and fluctuating. The
•
438
EATON ON DISEASES OF WOMEN.
symptoms complained of are weight in the pelvis, together with
tenderness, some nausea, prostration of strength, etc.; but
there is little disturbance of the menstrual function for some
time, and in some cases not at all.
cases not at all. When there is any
trouble in this direction it manifests itself by a more than
ordinarily free flow. (See page 301 for differential diagnosis.)
Prognosis.
The prognosis is favorable in the majority of cases of
cysts of the broad ligament. The cyst may rupture sponta-
neously and recovery take place without any very serious
symptoms, the contained fluid not usually producing any irrita-
tion of the peritoneum in case the cyst is not large. They
may be removed by tapping with but little danger to life, and
they are not liable to refill. When mistaken for ovarian cys-
toma, and an operation for their removal is attempted, the
dangers of the operation are greater than those to be appre-
hended from allowing the cyst to remain. Still, after the
abdomen is opened, the sac and contents better be removed.
Treatment.
The small cyst in Douglas' pouch may be evacuated with a
long trocar, with little risk, through the posterior vaginal wall;
but when they cause little or no inconvenience they should
be let alone. When of large size, so as to be cumbersome in
the abdomen, they should be evacuated with a canula or aspi-
rated through the abdominal walls. It has been recommended
to inject them with Iodine at once; but this is not necessary.
They usually do not refill after they are drawn off thor-
oughly. Should they do so, we may inject them after the
second aspiration with greater propriety, using a solution of
Iodine of about the strength of fifteen grs. of Iodine to the oz.,
which should be aspirated out of the sac after it has been
introduced ten minutes or so. There is always some danger
in these cases that the Iodine will escape into the peritoneal
DISEASES OF THE FALLOPIAN TUBES.
439
cavity, and produce peritonitis.
Hence we should not use
the injection unless we find the sac refills.
When aspirating a cyst of the broad ligament, the abdom-
inal many-tailed bandage should be applied and tightened by
assistants, that the patient may not suffer from the shock of
having so much pressure suddenly taken off the abdominal
muscles, as is caused by the evacuation of a large cyst of the
broad ligament. In case the abdomen is opened for the removal
of a fibro-cyst of the ovary, and the case is found to be a cyst
of the broad ligament, we may proceed to evacuate the cyst
with the Spencer Wells' trocar, ligate the pedicle of the cyst,
and remove the sac, dressing the incision, the same as after
ovariotomy.
DISEASES OF THE FALLOPIAN TUBES.
TUBAL DROPSY-TUMORS OF THE FALLOPIAN TUBE-HYDROPS TUB.E-FIBROIDS OF
TUBES MYOMA-CATARRH BLOODY TUMOR-INFLAMMATION-SALPINGITIS
PYOSALPINX-OCCLUSION
HYDROSALPINX-TUBAL PREGNANCY-CANCER
OF
THE TUBES-DISPLACEMENT OF THE TUBES-TUBERCULOSIS OF THE TUBES, ETC.
Description and Etiology.
The Fallopian tubes are liable to various diseases which
simulate somewhat disease in other organs, especially the
ovaries, and are present in many obscure cases where the
diagnosis is difficult.
Probably the most frequent of these diseases is catarrh
of the tubes. The diseases of the tubes have the peculiar-
ity of occurring in both at the same time, as a rule. These
diseases result most frequently from inflammation, and as a
rule are a result of the extension of inflammation already
established in the uterus or peritonæum.
The acute inflammatory condition is termed Catarrh of
the tubes or salpingitis. When chronic, it is termed inflam-
mation of the tubes. When the canal in the tubes becomes
partially or wholly obliterated, it is called occlusion. When
they are occluded at both ends and are open in their central
440
EATON ON DISEASES OF WOMEN.
portion, and there is an effusion of fluid into this open space,
it is termed "Dropsy of the tube;" Hydrops tubæ or Hydro-
salpinx, when the fluid is watery; and a bloody tumor when
it consists of blood. Tubal pregnancy signifies the impregna-
tion and lodgment of an ovum in the tube. It usually goes.
on till about the third month, when rupture of the tube is
produced from the distension, and the patient dies of inter-
nal hemorrhage. Fibrous tumors or Myoma are rare in this
locality, though they have been found. Simpson describes
one as large as a child's head. They are usually of smaller
size, however, and are not frequently discovered till after
death. When of considerable size and are discovered dur-
ing life, they are usually supposed to be ovarian tumors.
If they exist for years and remain about stationary in size,
the probabilities are that they are fibrous tumors of the
tube, or uterus; and it is sometimes impossible to tell which.
We are not justified in advising or attempting the removal
of either form of these moderate-sized tumors; hence we
sometimes have to be content without knowing their exact
attachment, which is immaterial so far as the management
of the case is concerned.
Pyosalpinx is the term applied to suppuration of the in-
ternal surface of the tube. This may lead to ulceration and
perforation into the abdominal cavity.
FORSTER, WAGNER, VAN DESSAUER and WYLIE have re-
ported cases. Perforations have also been known to take
place into the rectum and bladder.
Pyosalpinx must be preceded by inflammation, and it is
liable to result in occlusion of the tubes, and at least cause
barrenness. Cancer does not occur primarily in the tubes,
but may implicate them by its extension from the uterus.
Symptoms and Diagnosis.
The symptoms of diseases of the Fallopian tubes are usu-
ally obscure, and they are sometimes diagnosed by exclusion,
DISEASES OF THE FALLOPIAN TUBES.
441
i. e., by evidence which shows the disease is not anywhere
else.
First, we have sterility. This may be caused by various
conditions, but when we find that the vagina and uterus are
normal in development, location and secretions, and when we
observe evidences of healthy ovulation, we must conclude
that in the married woman (who desires offspring, and who
has a healthy husband) there must be disease or absence
of the Fallopian tubes.
When inflammation has pervaded the pelvic organs, and
we find all evidence of its presence has passed away from
the uterus, cellular tissue, ovaries, etc., and there is still
some tenderness upon pressure in the lateral portions of the
vaginal cul-de-sac, we may strongly suspect salpingitis or in-
flammation of the tubes.
Where ovulation appears to go on normally, and still
there is no impregnation, and no evidence of other disease
is present, we may suspect occlusion of the tubes.
If there has been no evidence of disease of the parts, in
the history of the case, we may suspect congenital occlusion
of the tubes.
Tubal pregnancy is to be suspected when we have the
ordinary symptoms of pregnancy, including a partial arrest
of the catamenia, with pain in the region of the tubes and
no enlargement of the uterus, and especially if at about the
third month symptoms of collapse come on, and the patient
dies suddenly.
Fibroma or myoma of the tube may be suspected when
we can discover a solid tumor in the iliac regions of both
sides, and we find that the development only reaches a
moderate size.
In dropsy of the tube we may sometimes feel the en-
larged tube by digital examination per rectum, or if of large
size in the iliac regions. The enlarged tubes in these cases
feel nodulated or bulbous, like a string of beads the size of
442
EATON ON DISEASES OF WOMEN.
hickory-nuts. We have barrenness, of course, with all these
varieties of diseases of the tubes, if affecting both, which is
most usual.
Sometimes the post-mortem reveals the first real knowl-
edge we have of disease of the tubes.
Prognosis.
The prognosis of tubal disease is quite positive in its
development of barrenness, except in tubal pregnancy, where
no further conception is likely to follow, as death is the rule.
Occlusion is, of course, incurable. All the diseases of the
tubes are little amenable to treatment; and the recuperative
powers of nature are well shown in recoveries from salpingitis,
hydrosalpinx, and pyosalpinx, recovery from pyosalpinx being,
however exceedingly rare. Cases may recover, and we never
know what the real disease was; hence, it would be very diffi-
cult to prove, or show by argument that pyosalpinx had existed
and recovery had taken place. Dropsy of the tubes is not so
likely to end fatally. It may end in resolution or absorption,
or remain for years without causing death. When the dis-
tension is so great as to cause rupture of the tube death re-
sults, as in rupture of the tube from tubal pregnancy.
Treatment.
In dropsy of the tube, when the distension is so great
as to produce much annoyance to the patient, it should be
aspirated through the vaginal cul-de-sac. If of small size
it may be allowed
be allowed to remain; and remedies should be
given according to the indications. Usually Ars. alb., Dig.,
Secale, Apocyn. can., or Spigelia will be found indicated.
The bloody tumor of the tube may be aspirated, and then
injected with a weak Solution of Iodine.
In tubal pregnancy, we recommend that in cases where
the diagnosis is clear the best treatment is to operate as in
ovarian tumor, and remove the ovum, together with the tube.
DISEASES OF THE FALLOPIAN TUBES.
443
This, in our opinion, offers the patient a chance for life,
which she has not, if allowed to go on to spontaneous rupture
of the tube. The trouble arises in making a diagnosis of
the case.
When this can be made positively I am quite
clear in the conviction that an operation for its removal
is desirable. I have never attempted the operation, nor do
I know that it has ever heretofore been recommended, but
I am disposed to try it on the next case of tubal pregnancy
which comes under my care.
If the physician is at hand soon after rupture of the
tube has taken place, my opinion is, that it is his duty to
open the abdomen at once, pass a ligature about the tube,
and remove the part of the tube containing the foetus.
Sponge out the abdominal cavity and remove the blood which
is found there as gently as possible. Close the incision care-
fully and perfectly with interrupted suture and adhesive
plaster. Stimulate the patient as actively as possible with
egg-nog, brandy, beef tea, etc. In this way a life may some-
times be saved.
Fibrous tumors of the tubes do not usually require re-
moval; and when they do the operation is the same as in
the removal of ovarian tumors, to which the student is
referred.
Cancer of the tubes, occurring, as it does, in connection
with cancer of adjacent parts, requires no special mention
here. No treatment is likely to avail any thing when the
disease becomes so extensive as to implicate the Fallopian
tubes.
DISPLACEMENTS OF THE TUBES.-The Fallopian tubes may
become displaced from various causes, the chief being from
traction made upon them in cases of displacement of the
uterus, and in cases of tumors of the ovaries or uterus.
These displacements are of little account, except as they
tend to produce barrenness; and in other cases when they
have become adherent in the pelvis they offer an obstruction
444
EATON ON DISeases of women.
to the rise of the uterus into the abdomen in pregnancy.
Tumors of the tube itself may also cause displacement.
TUBERCULOSIS OF THE TUBES.-Tuberculosis of the tube
sometimes occurs before puberty, and might prove a cause
of amenorrhoea; and it may develop at any period of life.
I know of no way to make a diagnosis before death. It is
most common that tuberculosis in the tubes is accompanied
with the disease in some other part or organ, and does not
often exist as a primary affection in the tubes.
DISEASES OF THE URETHRA.
445
CHAPTER XXXVIII.
DISEASES OF THE URETHRA.
URETHRITIS, CARUNCLES OF THE URETHRA, IRRITABLE URETHRAL CA-
RUNCULE, ULCERATION, FISSURES OF THE NECK OF THE BLADDER,
OR MEATUS URINARIUS INTERNUS, LACERATIONS OF THE URETHRA
FROM DILATATION, PROLAPSE OF THE URETHRA, URETHRAL POLYPI,
ETC.
DISEASES of the urethra are not very well understood by
most practitioners, and even specialists are sometimes charged
with overlooking them. These diseases are usually termed
bladder or kidney troubles by the busy practitioner, and the
people labor under the same error very often. It is time the
profession took note of the fact, that diseases of the urethra
are as important as any. Painful micturition is a matter of
great moment to a patient who suffers in this way for years.
(I removed a urethral polypus from a lady two years since,
and effected a perfect cure, who had suffered untold tortures
from its presence for over twenty years, her physicians having
failed to make a correct diagnosis.)
Etiology.
Cold and the irritating qualities of unhealthy urine de-
velop most, if not all, the diseases of the urethra, except
laceration. Inflammation of the part, called urethritis, is
the first development, and from the enlargement of the mu-
cous follicles arise the urethral polypi, and the irritable urethral
carunculæ. Foreign bodies passed into the urethra by intent
or accident may cause inflammation, and lead to ulceration.
Diagnosis.
Chronic cases of painful micturition should be subjected
to ocular examination. In irritable urethral carunculæ, digital
446
EATON ON DISEASES OF WOMEN.
meatus.
examination reveals the presence of enlargements around the
The irritable carunculæ are extremely sensitive to
the touch. Occasionally urethral polypi may be felt hanging
from the urethra;

Fig 1
they are not usu-
G.TIEMANN &CO.
ally sensitive to the
a
Fig 2.
touch, but produce
straining after mic-
turition, and fre-
Fig 3
G.TIEMANN
FIG. NO. 44.—SKENE'S URETHRAL ENDESCOPE.
quent desire to
urinate, if they are
attached within the
urinal canal. By
ocular examination we discover their attachment and nature.
They are usually bright pink in color, and vary in size from
one-eighth of an inch to an inch in diameter. These tumors
may be found single or multiple.
If we find no external tumors in or around the urethra,
we should inspect the interior of the canal as thoroughly as
possible. An ordinary urethral speculum, with two small
blades is usually sufficient for this purpose. (See Fig. 45.)
Dr. Skene, of Brooklyn, has invented a cylindrical speculum,
through which the urethral canal may very well be examined
by the aid of a movable mir-
ror in its interior. Dr. A.
R. Jackson has also a cyl-
indrical urethral speculum,
tapering at one end.

W.F.FORD
FIG. NO. 45.-URETHRAL SPECULUM,
Whichever instrument
we use, we must try to be
sure to find any urethral
polypus which may be in
the canal. The chief objection to the use of the cylindrical
speculum is, that the polypus is likely to be pushed up into
the bladder, or at least pressed upwards in the urethra, by
DISEASES OF THE URETHRA.
447
introducing the speculum. These polypi, being soft and com-
pressible, are not detected while in the urethra, without con-
siderable care and skill. For the discovery of a polypus of the
urethra in the female, I prefer the bivalve speculum, consisting
of two slender blades. We may distend the urethra, first from
side to side, and examine the upper and lower sides of the
canal, and then turn it one-quarter way around, and examine
the lateral walls. A probe should always be at hand, that we
may lift up any apparently loose tissue discovered, and ascer-
tain if it be a polypus. By means of this examination we
may also discover inflammation, laceration, or ulceration of
the urethra if they exist.
Fissure of the neck of the bladder, or internal meatus,
can best be discovered by making a visico-vaginal fistula,
and drawing the meatus into view through the fistula by
means of a tenaculum or with forceps. Lacerations from at-
tempted dilatation of the urethra affect the mucous and sub-
mucous tissues, and cause active and sometimes alarming
hemorrhage.
Fissure of the internal meatus may sometimes be diag-
nosed by passing a probe which is somewhat curved near
the end, which is introduced into the bladder, and then
withdrawn till the curve at the end presses the neck;
then gently move it from place to place, and press gently
downwards. If we find no pain is produced, except at one
or two points, this examination, taken in connection with
the history of the case and the smarting, burning pain in
passing water, is very good evidence of fissure, if there is
an absence of other conditions calculated to cause these
symptoms. The pain in urinating caused from inflammation
of the urethra, fissure, and laceration, is smarting, burning,
or cutting. The pain from cystitis and urethral polypi, is
bearing down, straining, with frequent desire, and unrelieved
feeling after the water has passed.
448
ΕΑΤΟΝ ΟN DISEASES OF WOMEN.
Prognosis.
The prognosis is hopeful; when proper treatment is em-
ployed urethritis may recover without special treatment.
The other diseases of this canal are not likely to do so well
if let alone. We know of no difficulty to which women are
liable, which is likely to be so poorly or improperly treated,
and hence many a case supposed to be inflammation of the
bladder goes on for years unrelieved.
Treatment.
The treatment of simple urethritis is much the same as for
cystitis, as regards the indicated remedies.
They are Can-
thar., Cubeb., Acon., Bell., Cun. ind., Cal. carb., Bry.
Aconite being indicated for the acute attack, with dizzi-
ness, a wiry pulse, aching of the bones, etc.
Bell., where the disease is recent, and there is dullness
of the intellectual faculties, tenderness over the lower part
of the abdomen, etc.
Bryonia, when the disease is accompanied with evidence
of general affection of the mucous membranes throughout the
system, with cutting pains, sharp, piercing pains, etc.
Cubebs, Canthar., or Can. ind., where the disease is
chronic.
Cal. Carb. where there is a leucorrhoeal complication.
Caruncles, or the irritable urethral carunculæ, are to be
treated much like piles about the anus. The local application
of Calendula or Hydrastis wash, applied warm by means of
soft cloths saturated and applied to the parts, gives much
relief, as does Bell. ointment. Hamamelis, externally and inter-
nally, is also an excellent remedy.
The polypi in the urethra, if protruding from the external
meatus, may be seized with forceps, and removed by torsion,
always having ready the Ferri persulph. to apply with a roll
of cotton, or some other convenient means, in case much
DISEASES OF THE URETHRA.
449
hemorrhage follows the operation. If these polypi are en-
tirely within the urethra, we dilate the canal as gently as
possible, till we can seize and remove them by torsion as
before.
Lacerations of the urethra from accident, or from forcible
distention, may require the local application of hæmastatics
to arrest the hemorrhage; and placing a gun elastic catheter
in the bladder to keep the urine from coming in contact with
the raw surface, is a desirable means of obtaining healing
by first intention. Internally Arnica is a useful remedy in
these cases.
Ulceration in the track of the canal of the urethra, if
syphilitic, must receive treatment such as is given chancre
in other localities. The non-specific sore or ulcer is to be
stimulated by local applications of a Solution of Iodine, two or
three grains to the ounce, and then leaving for a time a tent
smeared with Vaseline in the urethra, using these applications
every one or two days. To treat readily these ulcerations
and internal polypi of the urethra, as well as fissures at the
meatus internus, we dilate the urethra with sponge tents.
These may be medicated with advantage, and should be
long, so as to dilate the entire canal. Hydrgr. chlo. mit.
is a fine application to the ulcer or fissure in this tube.
The powder may be sprinkled upon the tent after it is
moistened with Glycerine, and applied directly to the affected
part by inserting the tent. The tent should not remain
more than two hours before it is removed. Internally, Merc.
cor., Kali idro., Thuja, Cal. carb., Sulph., etc., are usually
indicated. (Canthar., Cubeb., etc., are of little or no use in
these cases.)
When we are unsuccessful by these means in curing the
fissures of the neck of the bladder we may resort to an arti-
ficial vesico-vaginal fistula, which we have described in con-
nection with the treatment of chronic cystitis.
In the case of fissures, they should be freshened when
29
Uor M
450
EATON ON DISEASES of women.
they can be brought into view through the fistula; or, we
may apply the sharp point of a stick of Argentum nit. to the
bottom of the fissure every three or four days; or, apply
the Hydrgr. chlo. mit. dry to them by means of a sound
wrapped in cotton. Generally there is some chronic cystitis
in these cases, and the injections of warm water, with castile
soap in it, passed through the fistula daily, are of much serv-
ice. When the fissure and cystitis are cured, place a catheter
in the bladder through the urethra, and let the fistula heal
if it will. If we find it will not heal in a few weeks we
freshen the edges, and stitch them together, as in an ordinary
case of vesico-vaginal fistula.
TUBERCULOSIS OF THE VAGINA.
451
CHAPTER XXXIX.
TUBERCULOSIS OF THE VAGINA-STENOSIS OF THE UTERUS..
TUBERCULOSIS of the vagina is worthy of but little remark,
as but two cases are recorded, Virchow mentioning one and
Klob another. In these cases the disease was associated with
tubercular deposits in other parts of the body. Tuberculous
deposits in the vaginal membrane may sometimes be diag-
nostic of the real difficulty in disease of the liver, urinary
organs, or bowels, which would otherwise be harder of diag-
nosis. They may also teach us how the tuberculous ulcer
develops, and possibly in time may aid in suggesting the
proper treatment in tuberculosis, which is to-day very un-
satisfactorily treated by all schools.
Symptoms.
We have in tuberculosis of the vagina the general symp-
toms of tubercular disease affecting other parts of the body,
most prominent among which are the tuberculous cachexia,
evident faulty nutrition, the sallow, pale hue of the skin with
a bright flush on the cheek, the hopeful state of mind, etc.
Locally we have a feeling of irritation in the vagina. On
examination indurated spots are felt like the eruption in
small-pox. After several weeks or months these hard nod-
ulated spots soften and burst open, and an open ulcer is the
result.
Prognosis.
The prognosis is, in the present state of our knowledge,
unfavorable, though life may continue for years.
Phytolac. Dec., Iod. of
the indicated remedies.
Treatment.
Ars., Merc. iod., Ars. alb., etc., are
Locally a weak solution of Iodine
452
EATON ON DISEASES OF WOMEN.
applied with a soft brush every day, using warm water vag-
inal injections once or twice a day, are useful; giving good
nourishment and allowing the purest air, with frequent bath-
ings with salt tepid water, and rubbing the surface of the
body with the naked hand are found to be the most useful
hygienic measures which can be instituted, conjoining with
these moderate exercise in the open air.
STENOSIS OF THE UTERUS.
Description and Etiology.
Stenosis of the uterus may be congenital or acquired.
The seat of constriction is usually at the external os in
stenosis, rarely at the internal os; occasionally it affects the
entire cervical canal, while in flexions of the uterus there
is very often constriction at the internal os only. Stenosis
may be caused from inflammatory action in the virgin
state, or be caused after one or more gestations, from in-
flammation of the cervix and narrowing of its canal, espe-
cially, when the preceding labor has been severe, or it may
result from the use of caustics or instruments passed into
the cervix to cause miscarriage, or for other purposes. Lac-
erations of the cervix in labor may heal so as to cause
stenosis. Many cases supposed to have been congenital may
have resulted from inflammation in the cervical canal in child-
hood or early youth.
Diagnosis.
Where the disease is congenital, or has resulted from
some cause in early life, the cervix uteri is felt projecting
more sharply than natural into the vagina, and the os is felt
as a very slight indentation, or not felt at all. The eyesight
in some cases can scarcely discover the os when the cervix
is brought into view with the speculum, and we find that
In stenosis coming
only a small probe will enter the os.
on later in life, after one or more confinements, the os is
STENOSIS OF THE UTERUS.
453
felt a little more open than already described, but upon at-
tempting to pass the sound we are baffled, and find that
only a small probe can be introduced. These are the positive
diagnostic symptoms of stenosis. Dysmenorrhoea is a symp-
tom indicative of stenosis, although in a few cases where
the flow is moderate the blood may find its way out without
causing much pain. In the married, sterility is a symptom
that may lead us to suspect stenosis, whether there is dys-
menorrhoea or not.
Prognosis.
This is not grave in but few instances, and only then as
it tends to cause complete atresia of the cervix, and wears
out the patient from painful menstruation. By means of
dilatation we may expect complete relief, not only to the
dysmenorrhoea, but the sterility as well.
Treatment.
REMEDIES. These are Secale cor., Puls., Bell., etc. In the
majority of cases dilatation by mechanical means is our only
resort. Various measures have been devised for this pur-
pose. Some incise the cervix with an instrument called a
metrotome or hysterotome. (See page 145.) Others dilate
the cervical canal forcibly and almost instantly with a dilator
with two blades. Some dilate and incise at the same time.
My own preference is, however, for dilatation with bougies
till we are able to insert a sponge tent, and use that, to ac-
complish a free dilatation, and at the same time dilate grad-
ually; by this means I have been very successful in relieving
the dysmenorrhoea, and in many cases who married, or who
were already married, pregnancy afterwards resulted. Of
course, the usual care necessary in introducing sponge tents
in any other case must be observed.
I protest against incising the cervix in these cases.
Incision without dilatation is a fraud. The incised surfaces
are bound to heal and form a cicatrix, which makes the latter
454
EATON ON DISEASES OF WOMEN.
condition worse than the first, unless the parts are kept
dilated till healed. With incision, there is more risk of
inflammation and septicemia following.
If the stenosis is complicated with elongation of the
cervix to a great degree, it is best to amputate a part of the
cervix at once, taking care to insert a tent into the os during
the healing of the cervix. (See page 169.) The amputation of
the elongated neck may remove all the constricted portion of
the cervical canal, and consequently make dilatation unneces-
sary. Treatment by means of bougies alone will usually
prove curative. The treatment must be carried to the ex-
tent of being able to introduce a very large size. Gradual
dilatation by bougies or sponge tents is in accordance with
nature, and is to be preferred, in all cases, in my opinion.
The cicatrix formed after incision, even when it is made suc-
cessful by dilatation, greatly endangers laceration of the cervix
in labor if pregnancy should ensue, and it is to be hoped that
incision of the cervix, as a rule, in cases of stenosis, will soon
fall into merited disuse.
CYSTITIS IN WOMEN.
455
CHAPTER XL.
CYSTITIS IN WOMEN.
CYSTITIS, or inflammation of the bladder, is not peculiar
to women; but some of the causes which give rise to this
disease in women are peculiar to them, and particularly
interest the gynaecologist.
Symptoms.
Among the first and most prominent symptoms of cystitis
is painful micturition, with a frequent desire to pass water,
which is accomplished with much straining and difficulty.
the water being passed drop by drop in some cases. Soon
in the history of the disease mucus is thrown off from the
lining membrane of the bladder in large quantities. This is
tenacious, and adheres to the bottom of the vessel in which
the urine stands for any length of time. Sometimes streaks
of blood are mingled with the mucus.
These symptoms, together with a wiry pulse, some fever,
or alternating chill and heat, loss of appetite, constipation,
and headache, characterize a case of acute cystitis; but the
disease often becomes sub-acute and chronic, in which case.
the symptoms moderate in intensity, although the mucus
discharged is often very large in amount.
Etiology.
The causes which produce cystitis which are common to
both male and female are cold, external violence, irritating
qualities of the urine, stone, gravel, etc. Those causes oper-
ating in women only, are retro-version, ante-version, and ante-
flexion of the uterus, long continued pressure of the head
•
456
EATON ON DISEASES OF WOMEN.
of the child in confinement, extension of inflammation from
the uterus, ovaries, or cellular tissue in cellulitis, or from
peri-metritis.
When cystitis is caused from displacements of the uterus
the irritation generally commences in the urethra, and extends
over the entire bladder if not arrested. In this case it is pro-
duced from the pressure of the uterus against the urethra be-
hind the pubis, causing a frequent desire for micturition.
In
some cases this is the most prominent symptom which the
case presents of ante-flexion or ante-version. I will relate
one case, which is an example of many I have seen.
9
Mrs.
a very wealthy lady of this city, mother of
four children (youngest nine years of age), native of Ger-
many, of robust constitution, aged about thirty-four years,
consulted me eighteen months since. She stated to me that
soon after the birth of her last child she had commenced to
be troubled with frequent desire to pass water, that she had
been under treatment almost constantly ever since without
getting any relief; for upwards of three years a prominent
physician of Cincinnati had the treatment of her, and that
she then went to Philadelphia and New York, and finally to
Paris and Vienna, where she had employed those physicians
of greatest celebrity. She felt entirely discouraged, having
endured the severest ordeals, all having addressed their
treatment to the relief of cystitis. Every thing had ap-
parently been done, which her physicians could think of.
She came to me with her husband, who seemed to deeply
sympathize with her, and who told me that on account of
my having cured a friend of theirs of a chronic ailment they
had concluded to try again to see if any thing could be done,
the matter of expense being no object. I proceeded to make
an examination, and found a condition of chronic sub-acute
inflammation of the bladder, and besides that, and causing
the trouble, an ante-verted uterus, firmly pressed down by a
pendulous abdomen.
I proceeded to raise the abdominal
CYSTITIS IN WOMEN.
457
viscera with a silk elastic abdominal supporter, and in a few
days replaced the uterus; gave internally Cantharides 6 for
a week, and then Can. ind. 3 for a week, and then Nux 6.
She fully recovered in six weeks, and remains well yet.
The ante-version of the uterus was clearly the cause of the
cystitis in this case, and it had been entirely overlooked.
I should remark, in excuse for the oversight, that the lady
had no backache, and menstruation had been easy, normal
in amount, and regular.
Treatment.
Cantharides, Can. ind., Cubebs, Copaiba, etc., are the re-
medies for chronic cystitis, after removing the exciting cause,
which is of the first importance in all cases of this as well as
other diseases. In acute attacks of cystitis caused from cold,
Aconite, Puls., or Bell., are chiefly indicated.
In acute attacks, caused from external violence, or from
the pressure of the head of the child in confinement, Aconite
and Arnica are the remedies needed.
Of cystitis caused from stone in the bladder, I will speak
in the next chapter.
When caused from the irritating qualities of the urine, or

W.F.FORD
FIG. No. 46.—REVERSIBLE Catheter.
gravel, the analysis of the urine will reveal the remedies
needed. In some cases it is found that remedies to chemic-
ally change the constituents of the urine are demanded; at
other times this may be accomplished through improved di-
gestion and assimilation. Works on renal diseases should be
consulted in these cases.
Locally we sometimes obtain benefit in chronic cases from
458
EATON ON DISEASES OF WOMEN.
washing out the bladder by means of a Davidson's syringe,
attached to a reversible catheter. (See Fig. No. 46.) The
object of this washing is to remove the thick mucus or pus
from the bladder, and perfectly evacuate all the urine, as the
retention of the urine is a great source of irritation. This
retention of the urine is occasioned by the blocking up of the
urethra with this matter, causing tenesmus and a frequent
desire to micturate; for this injection clear tepid water,
or water containing a small amount of castile soap may
be used, and after the bladder is thoroughly washed out, a
solution of about ten drops of carbolic acid to the ounce of
water may be injected, and enough used to slightly distend
the bladder. This may be accomplished by stopping up the
external opening of the double catheter. After the water is
retained in this way about five minutes it may be allowed
to flow away. Little or no good results from any kind of
anodyne injections. They very often do not relieve the pain
at all.
In some extreme chronic cases, where the tenesmus is un-
endurable, and the inflammatory action affects the kidneys and
other abdominal organs, as well as the bladder, and remedies
and injections prove of no avail, it is advisable to establish a
vesico-vaginal fistula by operation, keeping it open till the
cystitis is cured. By this means the free evacuation of the
mucus, pus, and stale urine is accomplished, and we have
access directly to the diseased surface.
Operation.
The operation for making a vesico-vaginal fistula is
quite simple; still there are some practical hints which we
may make for the benefit of the student. There is a space
between the bladder and the vagina where they lie in direct
contact, being separated by little or no cellular tissue;
and on account of their near and intimate juxtaposition it
is advisable to establish the fistula at this point, so as
CYSTITIS IN WOMEN. ·
459
to prevent the infiltration of urine into the cellular tissue,
which would lead to cellulitis. This point is in the shape
of a triangle with the base upwards, reaching from the ori-
fice of one ureter to the other, the apex downwards at the
commencement of the urethra. Within this triangle the an-
terior wall of the vagina and the posterior wall of the bladder
lie in contact. Just outside of the line of the ureters, which
are about an inch apart, we have blood-vessels. These we wish,
of course, to avoid; hence the incision should be directly in
the median line, and within the triangle just described.
Having now some understanding of the anatomy of the
parts, we proceed with the operation. The patient is placed
upon the operating table, and the bladder made slightly
tense by injecting into it tepid water; we now administer an
anæsthetic, and lay the patient upon the left side. After
this we introduce into the bladder a short, grooved staff, bent
nearly at right angles, about four inches from the end which
we introduce; this is held in position by an assistant, when
we dilate the vagina with a large-sized Sims' speculum, so
as to bring into view the anterior wall of the vagina. We
now insert the index finger of the left hand into the vagina,
and by its side a sharp-pointed bistoury, with its edge di-
rected backwards, held in the right hand. We now feel for
the staff, and pierce the vaginal and vesical tissues at one
thrust, till the point of the bistoury strikes into the groove
in the staff about one and one-half inches from the meatus
externus. We now press the bistoury upwards, keeping it
firmly in the groove of the staff (first noticing that the staff
is held in the median line), cutting upwards about an inch.
We may now seize each side of the slit tissue with the for-
ceps (after withdrawing the bistoury and finger), and with
the scissors snip off a fourth of an inch or a little more from
each side of the incised surfaces. This makes the opening
more oval-shaped, and tends to prevent healing of any con-
siderable portion of the cut surfaces.
460
EATON ON DISEASES OF WOMEN.
Usually there will be very little hemorrhage from the
operation, if the directions I have given are closely followed.
If, however, by accident the incision is made to the side of
the triangle described, or is carried too far upwards, the large
blood-vessels of the bladder may be wounded; they lie in the
sulcus just outside the line of the ureters. Should we find
that there is much hemorrhage, we should seize the bleeding
vessel with the artery forceps and twist it around four or
five times (this is called torsion); or we may apply the Pulv.
Persulph. of Iron. If these means fail, we must apply a
ligature to the incised vessel.
This establishes a condition for the patient truly pitiable,
't is true, but one of comparative comfort, by the relief which
it brings in stopping the tenesmus, pain, burning, scalding
and fever, and enables the general system to recuperate, and
the bladder is relieved from the irritating qualities of the
urine.
*
Prof. Emmet, of New York, is the first to have per-
formed this operation. The idea was suggested to him by
Dr. Sims. Prof. Parker had, however, in 1850 operated
upon a similar principle for the relief of chronic cystitis in
the male. Dr. Emmet operated on his first case in this man-
ner in 1861. In 1858 Dr. Sims made the suggestion to leave
a vesico-vaginal fistula open for the relief of cystitis.
Dr. Bozeman claims priority in this operation. He
operated also in 1861, successfully. Dr. Emmet had carried
out the principle in 1858 by advice of Dr. Sims. All seem
to have obtained the idea from Dr. Parker's operation on the
male performed in 1850. Professor Montrose A. Pallent
recommends opening the bladder in these cases with a red hot
iron, called the Paquelin thermo-cautere.
We are of the opinion that burning human flesh emits too
* Emmet's Diseases of Women, p. 728.
† New York Jour. Obs., January, 1871.
Amer. Jour. Obstet., Vol. XI, April, 1878.
CYSTITIS IN WOMEN.
461
much the odor of the dark ages, and we can wish for no
return of their experiences. The object of using the hot
iron is to prevent the closure of the fistula. It can be accom-
plished by other means. In fact, it is not often very fast to
heal if left to itself; and, as the treatment after establishing
the fistula is to wash out the bladder freely by some means
daily through the fistula, it is not likely to heal rapidly. We
therefore dispense with the hot iron in toto. After curing the
cystitis, which may take six months or two years, we close
the opening, as in any ordinary accidental vesico-vaginal
fistula.
Indications for Remedies in Cystitis.
Aconite.—Painful urging to urinate; urine passes drop
by drop, is scalding; red or dark colored, with a hot, dry
skin; restlessness, etc.; fear and alarm.
Arsenicum Alb.-Blood in the urine; burning in ure-
thra during micturition; involuntary discharge of urine; gen-
eral congestion; sad moods; cold, with hot flashes; thirst, etc.
Belladonna.-Congestive condition; pain in the blad-
der; flushed face; sense of fullness in the head; intoler-
ance of light.
Cannabis Indicus.-Painful micturition; large amount
of mucus in the urine; mucus adheres to the vessel when
cold; excessive sexual desire; general coldness of the body;
frightful dreams, etc.
Cantharis.—Intolerable tenesmus in the bladder: cut-
ting pains in the urethra; bloody urine; constant desire to
urinate; retention of urine.
Copaiba.—Painful urging to urinate; bloody mucus in
urine, with dysentery; pain in the ovaries, etc.
Digitalis.-Constant urging to urinate; great weakness;
itching all over the body; coldness of the skin, with palpita-
tion of the heart.
Pulsatilla.—Tenesmus in the bladder; urine very offen-
sive, bloody and slimy, with amenorrhoea from cold.
462
EATON ON DISEASES OF WOMEN.
CHAPTER XLI.
STONE IN THE BLADDER AND URETERS.
STONE in the bladder is peculiar to no age or condition,
cystin calculi being more common in the very young, and
phosphatic calculi in those older. The uric acid calculi is the
most common in the male and the phosphatic in the female.
Without doubt, the condition of the urine has much to do
with the formation of stone in the bladder, ureters, and pelvis
of the kidney (where they are called gravel). These gravel
forming in the pelvis of the kidney sometimes lodge in the
lower part of the ureter, and increase in size by deposits from
the urine; or they may pass into the bladder. Gravel may form
in the bladder primarily from the long continued retention of
the urine, in cases where this secretion is heavily loaded with
elements favorable to the formation of calculi; or they may
form in the pelvis of the kidney, pass through the ureters
into the bladder, and there increase by a sort of incrus-
tation process from the deposit on their surface of the pecu-
liar elements which are in excess in the urine.
The effect of the imperfect evacuation of the bladder,
from any cause, seems greatly to tend to the production of
stone. Emmet relates a case, occurring in 1868, who was
paralyzed in her lower limbs from an injury to the spine.
caused by a fall. Four months after the fall urine began to
escape per vaginam, and in a few days calculi enough
passed this way to fill a large sized tumbler. He says, the
condition of the bladder had been neglected, and it had been
allowed to be distended for much of the time, and the urine
being highly phosphatic, had given rise to the formation of
* Emmet, Diseases of Women, p. 741.
STONE IN THE BLADDER.
463
calculi, which by their pressure upon the vesico-vaginal sep-
tum had produced a slough (on account of the impaired vital-
ity of the parts), resulting in the vesico-vaginal fistula, through
which the urine and calculi passed.
The formation of stone in the bladder has sometimes fol-
lowed in a year or two after the operation for vesico-vaginal
fistula; a bit of wire or thread which had been cut, but not
entirely extracted, acting as a nucleus. Sometimes an irreg-
ular adjustment of the tissues in the operation for fistula
serves as a cause of the retention of a part of the urine, and
favors the formation of calculi.
In some cases, a calculus is the cause of vesico-vaginal
fistula, it becoming wedged in between the pubis and the
head of the child in labor causes a slough, which results in
a fistula. The fistula might not be large enough to allow of
the discharge of the calculus through it; and if it is closed
by operation without an examination for stone, we will some-
times find that a calculus is in the bladder; and it will be a
surprise that the stone formed so soon, whereas, really the
stone was there at the time of the operation, and was the
prime cause of the fistula, as just mentioned. In view of
this fact, I scarcely need mention the advisability of passing
the finger into the bladder, and making a thorough exploration
for a stone, before closing a vesico-vaginal fistula, which has
resulted from labor.
Symptoms.
The symptoms of stone in the bladder are somewhat simi-
lar to those in cystitis, in some cases, as stone in the bladder
causes some irritation of the organ, and in so far would, of
course, produce cystitis. In other cases, there is little pain,
but the urine is obstructed in its flow, passing freely in a good
stream for a moment or two, and then is suddenly arrested
while the bladder is still distended. This is caused from the
stone being forced against the meatus urinarius internus, so
as to suddenly and completely close the orifice.
464
EATON ON DISEASES OF WOMEN.
Diagnosis.
To make a positive diagnosis, we fill the bladder with
water, after placing the patient upon her back with her thighs
flexed upon the abdomen, the knees separated, and the
patient placed under the influence of an anesthetic, we
pass into the bladder a steel silver-plated sound, when we
may hear the click as the sound hits against the calculus.
Placing the index and middle fingers of the left hand in the
vagina and pressing against the bladder, may, in some in-
stances, greatly facilitate the exploration. The distention of
the bladder with water previous to the examination is im-
portant, as otherwise the stone might be enveloped in the
folds of a collapsed bladder, and we would fail to find it.
The shortness of the urethra in women and the opportunity
to press the bladder with the fingers in the vagina, make
the diagnosis of stone in the female bladder comparatively
easy.
Treatment.
The first thing in the treatment of stone in the bladder
is to correct the secretions and excretions, and secure healthy
digestion and assimilation; otherwise, if the calculus was
removed, others would form in many cases. Citric acid is
perhaps most frequently indicated. Sometimes the urine
may be changed, when chemically too acid, by the adminis-
tration of alkalies, and when the urine is alkaline by giving
acids.
In some cases, where there is an excessive acid reaction in
the urine, acids are beneficial in correcting the secretions; and,
secondarily, are useful in treatment. It is mainly in those
districts of country where lime water is used for ordinary
drinking and culinary purposes that acids have been found
most beneficial in cases of stone or gravel (for gravel is very
similar to stone in its etiology, the term stone being applied
to those urinary calculi which are too large to pass by the
STONE IN THE BLADDER.
465
urethra; and the term gravel is applied to small stones which
pass by the urethra readily).
The removal of stone from the bladder in women is not
so difficult as in men, owing to the shortness of the urethra,
and also owing to the great distension which the urethra in
the female is capable of enduring. This facilitates the use
of instruments for crushing the stone, and sometimes admits
of its removal entire through this canal. This is the oldest
method of removing stone, and in most cases the best.
Some skill is needed in the manipulation, but no more, I
think, than is required in other operations. The instrument
used to crush stone in the bladder is called a lithotriptor.
(See Plate VIII.)
The operation for the removal of stone in this way by crush-
ing is called lithrotrity. The operation through the vagina
is called lithotomy. Extracting the stone without crushing
it through the urethra is called lithectasy. In performing
the operation of lithectasy it is generally necessary to first
dilate the urethra. This is accomplished with a sponge tent
smeared with Belladonna ointment. The Bell. ointment takes
away much of the sensitiveness of the parts, and is no im-
pediment to the expansion of the sponge. Or, we may dilate
the urethra with a three-bladed dilator, which is rapidly
screwed up while the patient is under the influence of chloro-
form; or, a two-bladed dilator will do very well. (See for-
ceps, Plate VIII.)
INCISION.In some cases, where we find the urethra hard
to dilate, we may aid the dilatation by incising the mucous
and muscular coats of the urethra. The incision should be
made downwards and outwards. We may safely dilate the
urethra to the size of the index finger, and extract a stone
about three fourths of an inch in diameter.
The size of the stone may be determined by the distance.
the handles of the forceps are separated when seizing it,
having measured their expansion previous to being intro-
30
466
EATON ON DISEASES OF WOMEN.
duced, while seizing different sized objects. In seizing the
stone care must be used to move it from side to side, to be
sure we have not taken hold of a fold of the bladder as well
as the stone. In extracting the stone we should use a rotary
motion and not use direct traction.
Should we find we have mistaken the size of the stone,
and we are unable to extract it entire, we should let go with
the forceps and introduce the lithotriptor, crush the stone, and
wash the crushed pieces out of the bladder; and, in case we
find there are some pieces too large to be washed out we
may extract them with the forceps, or again introduce the
lithotriptor and crush again. In using the lithotriptor it is
necessary to take great care not to seize a fold of the blad-
der and crush that as well as the stone.
A reversible catheter, of large size (see page 457), with
both ends open fully, may be used to wash out the débris,
pumping tepid soaped water into one tube and letting it flow
out through the other. Dr. H. J. Bigelow has invented an
evacuating apparatus which fulfills all the requirements admi-
rably. The apparatus consists of an elastic bulb with a glass
tube at one end for receiving the fragments of stone, and at the
other an elastic tube communicating with a large canula intro-
duced into the bladder through the urethra. The bulb is
filled with tepid soaped water, by pressing out all the air, and
then placing the end of the tube in a basin of water (resting
on a chair or table, and with the bulb on the floor). We
then insert the canula, compress the bulb, and force the
water into the bladder; then relax the pressure, and the fluid
with some particles of the stone will pass out into the bulb.
The particles of stone now gravitate into the glass tube be-
low. We may now press upon the bulb and force the water
again into the bladder, and again it is allowed to pass out
into the bulb with other pieces of the stone, and so on. We
are able to see in the glass tube how much of crushed stone
* Amer. Jour. Med. Sciences, January, 1878.
STONE IN THE BLADDER.
467
we have washed out, and also observe when no
discharged.
Lithotomy.
more is
There are two approved methods of performing this opera-
tion, the vaginal and the supra-pubic, the latter being re-
sorted to in the male for the removal of stones of such
extremely large size that they could not be removed by the
perineal operation or by lithotrity.
In women the ease of diagnosis of urinary calculi, together
with the great dilatability of the urethra, will make it very
seldom necessary to perform the supra-pubic operation; be-
sides, a very large stone may be removed by the vaginal
method; much larger than could be removed entire by the
perineum in the male.
If for any reason the supra-pubic operation is advisable
in a case where we have atresia of the vagina as a complica-
tion, or for other reasons, we make an incision about two and
a half inches in length in the median line, commencing at
the pubis, the bladder being distended with tepid water
previously injected and a sound introduced by an assistant.
or at least retained by him, and the urethra compressed to
aid in the retention of the water. The sound carried up
above the pubis will serve as an index to the point at which
we should incise the bladder, having previously divided the
attachment of the pyramidales and pushing upward the peri-
tonæum, and having the dissection carried through the cel
lular tissue. After a small opening is made in the bladder,
we next enlarge it towards its neck, pass in the lithotomy
forceps, seize the stone and extract it. While doing this it
is well to have an assistant seize the edges of the bladder
with small forceps on either side, and lift them a little out of
the wound.
·
After extracting the stone we should pass in the index
finger and feel for more calculi. Several calculi of large
size are sometimes found in the bladder at the same time,
468
EATON ON DISEASES OF WOMEN.
and the oversight would be very mortifying, if we fail to
extract them all at one operation.
After extracting all the calculi, we draw off the water with
the self-retaining catheter, which must be left in the urethra
to allow the urine to drain away, and the use of a catheter
not over three inches in length is most desirable (see Plate
No. XIII), as, if it is longer, it might pass through the in-
cision and fail entirely to perform the intended service for
which it is retained. Placing about two sutures of silver
wire in the walls of the bladder I consider preferable to
leaving it open. One end of the suture wire may be left long,
after the wire is twisted, and be brought out of the lower
portion of the external incision. After four or five days we
can pass in sharp-pointed, strong scissors, and by a little care.
find the loop of the suture, cut it and withdraw the entire
wire. After taking the sutures, as suggested, in the bladder,
we close the external opening with interrupted suture and
adhesive plaster, letting the plaster be applied first in strips
about six inches long between the sutures, and then shorter
ones over and between these, so as to completely cover the
cut. In this way the short strips may be lifted up on the
third day, the sutures removed, and the plasters reapplied.
The vaginal method is easy of performance. A straight
grooved staff is first passed into the bladder, the patient
lying upon her side with the vagina distended with Sims'
improved speculum. We then incise the anterior wall of the
vagina and posterior wall of the bladder with a sharp-pointed
scalpel at a point just above the meatus urinarius internus,
pressing the point of the scalpel through the tissues till it
reaches the groove in the staff, holding the edge of the
scalpel away from the director, then slitting the tissues up-
wards on the director an inch or an inch and a half, accord-
ing to the size of the stone to be removed. We now with-
draw the staff, pass the index finger of the left hand through
the incision, then pass the forceps along the side of the
STONE IN THE BLADDER.
469
finger, and remove the stone, taking care after seizing it
with the forceps, that we have not taken hold of a fold of
the bladder as well. We may assure ourselves of this, by
moving the forceps around in the bladder after we have
grasped the stone, and making sure that we have it free in
the forceps. If there is much hemorrhage, styptics must be
used first trying cold water, then ice, and if these are not
efficient, we use the liquid persulphate of iron. After ex-
tracting one stone, we must never forget to examine for
others, and remove them also, if present.
A catheter is to be now placed in the urethra and re-
tained, and the incision closed by interrupted sutures, of sil-
ver wire or silk, placed very close together-I think every
quarter of an inch not too near-setting the stitches deeply
enough to include all the tissues down to the walls of the
bladder; and I prefer that two of them include the cystic
walls also (it being very desirable to obtain union of all
the incised tissues by first intention). The two sutures
which we take in the cystic walls should be placed first, and
the ends cut longer than the smaller sutures, so that they
may be recognized and sooner removed than the others."
These longer and deeper sutures should be removed on the
fourth day, while the smaller ones may remain nine or ten
days.
•
Foreign bodies of almost any kind, like hair-pins, pieces
of a stick or straw, when introduced into the bladder pro-
duce irritation somewhat similar to a calculus. They soon
become encrusted with phosphatic material, and serve as the
nuclei for calculi, as I have mentioned before; hence it is
necessary to remove them soon, which can usually be done
with the forceps (by exercising some patience and skill).
CALCULUS IN THE URETER.
Calculi have sometimes lodged in the ureters, and when
of such a shape as to entirely block up the passage they
}
470
EATON ON DISEASES OF WOMEN.
produce more serious consequences than when they are sit-
uated in the bladder. There is more backache, owing to the
distension of the kidney with urine, which is secreted, but
not expelled. There is a sense of weight and great ten-
terness over the kidney and abdomen, conjoined with the
symptoms present in cystic calculi.
In these cases we may detect the stone with the sound
at one time and utterly fail at another, on account of its
projecting into the bladder at one time and not at another.
The operation for their removal is similar to that just men-
tioned for ordinary lithotomy. It will be seen at once that
lithrotrity is not applicable in these cases, as the lithotrite
could not be applied while the calculus was lodged in the
ureter.
Treatment after the Operation.
After the operation for the removal of stone has been per-
formed, by either method, perfect quiet in bed should be in-
sisted upon. After lithotomy the patient should continually
lie upon the side-for four or five days at least-after litho-
trity the position in bed is immaterial. After placing the
patient in bed, Arnica 3* should be given every hour for two
or three days, unless the patient is asleep. If the pulse
rises, and there is evidence of inflammatory action, Aconite
should be given without delay. The patient should partake
of the mildest nourishment for two or three days, after which,
if no fever is manifested, more substantial food may be taken.
Remedies for Stone in the Bladder, Gravel, etc.
Aconite, Arnica, Ars. alb., Bell., Puls., Canth., Dulc., Can.
sat., Nux v., Opii., Phos., Phos. ac., Cal. carb., Lycopodium,
Sulph., Kali carb., etc., are sometimes useful.
Aconite is indicated where there is restlessness, with
fear, frequent desire to urinate, fever, thirst, nausea, etc.
Arnica is indicated where the gravel passes with pain,
STONE IN THE BLADDER.
471
and is followed by bloody urine, burning in the urethra after
the bloody urine has passed, etc.
Ars. Alb. is indicated where there is alternating heat and
cold, thirst, suppression of urine, etc; nausea; great weak-
ness; aching in the lower limbs, or over the entire body;
tongue coated white.
Bell.-In suppression and retention of urine; pain in the
bladder; urging to urinate; pain in the back; flushed face;
dullness of the brain; dilatation of the pupils; fever; dizzi-
ness, etc.
Puls. From effects of cold at menstrual period, causing
amenorrhoea; suppression of urine; painful micturition; mu-
cus in the urine, with leucorrhoea, indigestion, loss of appe-
tite, etc.
Cantharides. In burning in the urethra; constant urg-
ing to urinate; pain in the back of the head and neck.
•
Dulc. Urine turbid; burning in the urethra; strangury;
constant desire to urinate; symptoms worse in damp weather.
Can. Sativa.-Sharp pains in urethra; urine scanty and
passed with burning pain; stitches in the urethra; mucus
in the urine.
Nux.-Painful urging to urinate; tenacious mucus in
the urine; constipation, hemorrhoids, indigestion, etc.
Opium.—Urine scanty, brown, or cloudy; retention of
urine; dulness of intellect; face red and hot; constipation;
cold sweat on the face and head.
Cal. Carb.—Urine offensive, dark colored; profuse dia-
phoresis; anxiety, with palpitation; vertigo; deposit of earthy
salts in the urine; weakness; in women of fair complexion.
Lycopodium.-Gravel, with nephritis, or catarrh of the
bladder; symptoms aggravated in the afternoon; red sand in
the urine; flatulence, with pain in the abdomen.
Sulph.-Worse after midnight; burning in the urethra;
urine copious, offensive, excoriating; violent itching in the
rectum; despondent mood; fretfulness, etc.
472
EATON ON DISEASES OF WOMEN.
CHAPTER XLII.
SYMPATHETIC EFFECTS OF DISEASES OF THE UTERUS AND ITS
APPENDAGES.
THERE are certain affections that are dependent upon and
caused by morbid conditions of the uterus and its append-
ages, which are not properly considered hysterical, and
deserve special mention. It has been my lot to see many
cases of this character in my experience while resident physi-
cian of the city hospital of Chicago in 1859 and 1860, and
since that in an extensive private practice, largely consisting of
chronic ailments of women, as well as observations in cousul-
tation with other physicians, and in observing cases in hos-
pitals in NEW YORK, PHILADELPHIA, ST. LOUIS, NEW ORLEANS,
and CINCINNATI.
I am convinced that many sympathetic affections are mis-
taken for special diseases, and the treatment of which is
unsuccessful from a failure to discover the real ailment and
remove the difficulty which exists in the uterus or append-
ages. Patients in these cases will sometimes give no inti-
mation that they have any disease or difficulty of the uterus,
either organic or functional; and it is only by comparison of
symptoms, the history of the case, careful examination of the
patient, and differential diagnosis, as well as by much study
and patience, that we are enabled to arrive at a correct diag-
nosis in this class of cases.
In some instances the patient will assert and insist that
the uterine functions are normal, and that they are sexually
perfectly healthy. This is sometimes owing to the modesty
of the patient, and sometimes they do honestly believe they
are well in this respect. They complain of want of appetite,
1
SYMPATHETIC AFFECTIONS.
473
nausea, biliousness, constipation, headache, cold hands and
feet, pain in the side, palpitation of the heart, amaurosis,
painful or frequent micturition, sciatica, pain in the hip or
ilio-sacral articulation, chilliness, hot flashes, pain in the top
of head or occiput, pain in knee, ringing in the ears, languor,
inability to swallow hard substances (caused from spasmodic
irritation of the oesophagus, this being produced from uterine
disease), sensation of some foreign substance (like a fish bone
or pin) in the throat, cough, congestion of the lungs, liver, or
other organs, anemia, chlorosis, pruritus vulvæ, etc. We may
also have anesthesia or hyperesthesia, paraplegia or hemi-
plegia, as sympathetic affections.
When any or several of these symptoms are present in a
case before us, and we can not find other reasonable expla-
nation, we may look for the cause in the uterus or its
appendages.
It may be either organic or functional, the result of
inflammation or displacement of the uterus, of tumors of
uterus or ovaries, or even of an arrest of normal action, as
seen in amenorrhoea, the peculiarity of these cases being, that
in many of them they refer no pain directly to the parts or
organs primarily affected.
As I have mentioned under the heads of "inflammation,"
"amenorrhoea," "displacements," etc., we have these symp-
toms complained of sometimes; but what I wish to impress
upon the student's mind is, the fact that we may have these
symptoms as a result of uterine disease, and have no sugges-
tion from the patient of any uterine difficulty whatever;
and many times when inquiry is made, we are rather abruptly
told that they are all well in this respect, intimating by voice
and manner, at least, that they feel we might better have
omitted the question.
Years of experience will cause us to be persistent in
ascertaining the true cause of these complaints; and espe-
cially so when their history shows them to be chronic, and
471.
EATON ON DISEASES OF WOMEN,
that they have been subjected to much treatment without
relief the treatment I refer to being directed to the relief
of the particular symptoms complained of, and not directed
to the relief of the real cause of these symptoms. I believe
I have seen patients complaining of all the symptoms above
enumerated, which were caused by uterine disease or dis-
placement, while the patient believed herself healthy in this
regard. I will mention as examples two or three cases.
In December, 1863, I was called to see Mrs. R., aged
about forty years, widow of a prominent judge of Illinois,
robust in appearance, light complexion, nervo-sanguine tem-
perament. She complained of pain in one knee, and of
inability to walk. She stated that she had been suffering
for two years in the same way, and had had the best allo-
pathic physicians in Chicago, who had leeched and blistered
the knee, and she showed me a large iron splint they had
recently used to straighten the limb, and again flex it by
means of a screw. (I still have in my possession the appa-
ratus as a curiosity.)
On examination of the knee I determined that there was
no trouble here, and I judged that the trouble was from reflex
action produced from some trouble with the womb, and so
stated to my patient, who rather indignantly replied, "I am
perfectly healthy in that respect." I replied that if this was
so, then I knew nothing of her case.
I prescribed temporarily, and left her. In about two
weeks she sent for me again, and stated that as I took an
entirely different view of her case from her other physicians,
she had concluded to employ me, and let me see if I was
correct in my diagnosis.
I accordingly proceeded to make a thorough examin-
ation of the uterus, and found it as large as at three
months in pregnancy, and retro-verted. On introducing the
sound, which I did without hesitation (as her difficulty had
been for two years troubling her with equal severity), I
SYMPATHETIC AFFECTIONS.
475
found a single polypus. I restored the position of the
uterus, removed the polypus, and had the satisfaction of
seeing her walk in six weeks without the aid of crutches
or cane. I used no local treatment to the knee, no elec-
tricity to the limb, no internal medication. I accidentally
met her at the Southern Hotel in St. Louis in 1875, and
she assured me she had had no trouble in walking since I
had removed the tumor, twelve years before. She had never
had pain in the pelvis, had menstruated regularly, and not
too profusely.
Such a case will not often be seen, but it goes to dem-
onstrate the ideas I am trying to impress, that we may
have serious uterine difficulties and have no complaint of
pain in the organ, no interruption or excess of menstru-
ation, and still have serious symptoms in other parts. Why
we had no disturbance of menstruation in this case I am
unable to say. Her strength of general system by inher-
itance and education was far above the average, and may
have been a reason why she suffered so little in general
health; and her decided assertion that she was perfectly well
in all respects regarding her sexual organs, would have de-
terred most physicians from insisting upon an examination
of them; still, the result proved its necessity.
CASE SECOND, April 7, 1876.-Miss N., aged about thirty
years, native of Illinois, was brought to me by her sister
(whom I had cured the year previously of hemiplegia and
loss of sight in one eye by restoring a retro-verted uterus).
who stated to me that she had persuaded her sister to come
to me from a distant city, that I might try to relieve her,
though she had been treated by seven different physicians
during the past four years, but that her trouble grew worse
instead of better. The general appearance of my patient
was good, excepting an inclination to be morose, and I caught,
occasionally, the wild stare of the eye seen in the insane.
She had an idea that she could not swallow any hard or
476
EATON ON DISEASES OF WOMEN.
solid food, and had subsisted upon milk, soup, and the like.
She insisted that there was a fish-bone lodged in her throat
so high up she was angry that no one could see it. In other
respects she seemed to be in good health. Her menstruation
was regular and normal.
Although I at once suspected her complaints to be sym-
pathetic, I concluded to make a thorough examination of the
throat and oesophagus, which I did, and found no obstruction
or difficulty. I gave some medicine to indicate my sincerity
in my efforts to relieve her, and as an excuse that in the
event of its failure to relieve her, it would be necessary to
make a vaginal examination. Of course, the medicine failed;
and with the combined persuasions of her sister and my own,
she consented to a vaginal examination, which revealed a
prolapse of the uterus almost complete. I restored and
maintained the organ in situ, and in three days her difficulty
of swallowing solid food had vanished. I attended to the
case a little for about six weeks, when I found the uterus
remained in position, and I dismissed her.
or more afterwards from her sister that she was still well.
This patient might have deceived us in saying she had no
pain of any kind, owing to her modesty. But I relate the
case simply to show that we sometimes must investigate for
ourselves in these obscure cases.
I learned a year
These cases may serve as examples of reflex or sympa-
thetic nerve action, though in the first case it might be
claimed as direct nerve irritation from pressure of the en-
larged and retro-verted uterus upon the nerves and ganglia
in the pelvis; but why the manifestation in the knee?
We speak of reflex and sympathetic nerve action. They
are terms which signify a theory of nerve action, but are as
incomprehensible as the term electrical current.
We may
study the phenomena of nerve action, and theorize upon them,
but the whole matter is little understood. I am mortified
in this, as in other things, at the little known by the pro-
SYMPATHETIC AFFECTIONS.
477
fession. Malaria, for instance; how often mentioned and
blamed for its effects, but how little understood, never
having been discovered by chemical analysis. There is still
a wide field for investigation and discovery in physiology,
pathology, and therapeutics, though in therapeutics Hahne-
mann has discovered a law for the selection of remedies.
which has already been of great benefit to mankind, and its
advantages and reliability as a guide in treatment are bound
to be universally acknowledged. Still, in this field we need
more careful provings of some remedies.
Treatment.
In regard to the treatment of these various sympathetic
affections, it may be readily inferred that no treatment is
likely to avail except that which is directed to the removal
of the cause, i. c., no other treatment is likely to be more
than palliative; and he who can the most keenly discern the
cause of these ailments will be the most successful in re-
lieving them.
One word just here, which I feel should be said in all
kindness, and with due respect to the average practitioner.
We feel that the habit which some have of denominating
those ailments which they fail to comprehend nervous or hys-
terical, and making no effort for their removal, is cruel and
unbecoming the profession we represent. If after every in-
vestigation no lesion or disease be discovered in the physi-
cal frame, we may have to resort to the theory of nerve de-
rangement, either functional or organie; still these poor suf-
ferers demand, and humanity demands, the kindest and most
considerate treatment at our hands.
I might go into the detail of all the several sympathetic
ailments I have mentioned, and many more; but the treatment
of all must have reference to the cause, and it is needless to
go into the detail of symptoms, which may better be studied
in our works on therapeutics, in relation to proper remedies.
478
EATON ON DISEASES OF WOMEN.
I have omitted to mention the mental affections produced or
aggravated by uterine diseases. Some of them come under the
head of Hysteria, others that of Insanity. Under Hysteria,
and Puerperal Mania, may be found more extended remarks
on the influence of uterine diseases upon the brain.
Whether or not it is possible that uterine diseases should
produce insanity, is to-day somewhat in dispute. We are in-
clined to the opinion that they may, but whether it is a direct
or reflex action, or in what way nerve irritation produces in-
sanity, I will not attempt to explain further than to suggest
that the pain experienced in some of these affections tends
to exhaustion of nerve force as well as muscular strength,
that the anæmic condition produced by the derangements of
the functions of digestion, assimilation, and excretion (caused
from uterine disease or otherwise) may seriously affect the
brain substance, as well as tend to produce disease of its
meninges. We are still, as a profession, greatly in the dark
in relation to the pathological condition in insanity, and till
we know more of it we are neither able to assert or deny
theories of its causation. Still we see no good reason why
diseases of the uterus may not cause insanity. I think we
have evidence that they do, in the fact of the co-existence
of insanity and uterine disease, and the fact that the men-
tal aberrations disappear many times when the uterine diffi-
culties are removed. Still this might have been a coinci-
dence; but there is no more reason to call this a coincidence
than in many other diseases where the symptoms disappear
when the uterine difficulty is cured.
It seems to me in entire accord with the economy of na-
ture that the brain should be affected by uterine disease,
from the fact of the known influence of the brain upon ges-
tation and the foetus itself as well, all the processes of
nature, all glandular and muscular action being dependent
upon nerve power.
Hence it is reasonable to expect that disease or displace-
SYMPATHETIC. AFFECTIONS.
479
ment of the generative organs, especially the uterus, might re-
flect an irritation back upon the great nerve centers. Hence
we suggest that in mental derangements in women, we be
very careful to ascertain if there is any uterine disease or
deviation which might be a cause of the disturbance; if so,
we will do well to rectify it in the commencement, if pos-
sible. That the fretful nature of some women is sometimes
due to uterine disease, we may be sure; but as fretfulness
is not classified as a disease, we will pass it by with the
remark that if the symptom seems to need a remedy, we
will keep in mind the possibility of its being caused from
uterine disease.
Before closing this chapter, I will call attention to a class
of patients who are more of a wonder to me than those we
have been considering. I refer to those who have complete
procidentia, tumors of the uterus, etc., etc., and suffer no in-
convenience worth mentioning. I know a lady now who has
a polypus as large as a small hen's egg attached by a pedicle
to the mouth of the womb, and she suffers no inconvenience.
Another had a cystic tumor of the vagina which gave her
no trouble, except as it interfered with sexual congress;
several had complete procidentia who were perfectly well, so
far as their feelings would indicate. So we see that con-
ditions which will produce serious symptoms in one may not
in another. Therefore we would gauge the necessity of treat-
ment by the effects produced, and not by the actual condition
present. After awhile the system seems to become tolerant
of abnormal conditions, and they produce little trouble, in
some instances, as I have mentioned.
Electricity is a valuable agent, used in mild current, to
tone up and strengthen the whole system, and especially the
weakness consequent upon uterine disease. Mildness of the
current, my experience confirms, is the most useful and de-
sirable. Shocks are in my judgment injurious, the same as
large allopathic doses, or as too low a potency of the indicated
•
1
480
EATON ON DISEASES OF WOMEN.
The electro-mag-
remedy might be, and are to be avoided.
netic current I prefer. It is so generally applicable to weak-
ness and loss of functional strength, I do not think it neces-
sary to specify the minutiae of its applicability in these cases.
Remedies.
The remedies must be chosen from the totality of the
symptoms, corresponding with their pathogenesis. They.
will be found in the cerebral and spinal groups. Among them
the most useful are Aconite, Bell., Verut. viride, Camph., Can.
ind., Hyosc., Opi., Conium, Gelsem., Ignatia, Nux, Secale,
Cimicif., Plat., Puls., Caul., Colcynth., etc. They must be
selected according to the peculiar correspondence of the
symptoms in each case to the homoeopathic pathogenesis of
the drug.
If we should enter into the description of all the symp-
toms which might arise, and name all the remedies which
might possibly be applicable, this work would properly be
termed a Materia Medica. We expect that the student will
study the pathogenesis of remedies from works on Materia
Medica, Symptomatology, etc.; and understand, that when
we name a remedy, we mean that it should be given in
accordance with its homoeopathic indications. It takes too
much time and space to continually repeat the pathogenesis
of each drug. By naming the remedies we have found indi-
cated most frequently, the student has a guide to the study
of the remedies which are likely to be required. I do not
say that possible complications may not arise, requiring other
remedies, which the practitioner will, of course, have the judg-
ment to use in case they are demanded.
HYPERÆSTHESIA.
Hyperæsthesia may be local, i. e., confined to a small
part of the body, or one side; or may affect the entire body,
as a result of uterine disease. In this condition the part
SYMPATHETIC AFFECTIONS.
481
affected exhibits no evidence of disease in itself, and its
occurrence in connection with uterine disease or displacement,
and its subsidence when such disease or displacement is
cured, is evidence of its dependence upon the uterine trou-
ble as a cause. Patients so affected are almost thrown into
spasms from the slightest touch. A striking and common
manifestation of this condition is found in the supersensitive
condition of a small spot beneath the left breast in women
affected with congestion, displacement, or inflammation of the
uterus. It does not occur in every case of uterine disease;
but I have never seen it exist without uterine disease; some-
times one side of the entire body is affected by this hyper-
aesthetic condition, and the opposite side and limbs remain
of normal sensibility. I have seen this condition present as
a result of both acute and chronic metritis.
Etiology and Pathology.
This condition of supersensitiveness of the affected part
seems to depend upon an inflamed and supersensitive condi-
tion of the uterus. There may be in connection with this
inflamed state some displacement or not. It sometimes occurs
in connection with the sudden suppression of the menstrua-
tion, which also causes congestion and inflammation of the
uterus. Onanism may also produce hyperesthesia.
The irritation of the uterine nerves causes irritation of
the spinal cord through continuity of nerve tissue. Why
this irritation is communicated to one side and not the en-
tire cord we are unable to explain. It is one of the mysteries
of nature as yet unsolved. This irritation is communicated
to the nerves given off from the side of the cord affected;
and hence the hyperesthesia of these nerves, which are
distributed to the opposite side, as those familiar with anat-
omy will readily understand. This supersensitive condition
is mainly exhibited in the extremely minute nerve filaments
upon the surface distributed to the cuticle.
31
482
EATON ON DISEASES OF WOMEN.
Where only a small part of the body is affected by this
supersensitiveness we find a theoretical explanation in the
sympathetic or ganglionic nervous system. This system is
so complex that it has not as yet been well understood. We
can do little more than observe its complicated and astound-
ing phenomena, and be aware of the sources from which they
originate.
This, however, is something. For at this point, and even
before reaching it, scientists have to pause and acknowledge
they can go no further. What does the astronomer do more
than observe the motions of the various planets, and give
names to the various constellations? Why the planets re-
volve in their regular orbits, and are sustained there, can he
explain more than to say they do so in obedience to God's
laws, or the laws of nature (in case he thinks himself so
wise as to think it smart to discredit the existence of God)?
What does the philosopher know of the laws of gravitation
or cohesion? He knows from observation that these laws
exist. Can he do more than name them, and describe their
phenomena? Here we gain a little comfort in the fact that
if we are quite ignorant of the exact action of the sympa-
thetic nervous system, when we are able to note and appre-
ciate their phenomena manifested through this system, we
need not be ashamed in the presence of students of other
departments of science, though we have accomplished much,
very much, less than we desire.
Diagnosis.
The pa-
The diagnosis of hyperesthesia is quite easy.
tient usually gives us due and timely warning of the extreme
pain she experiences from very slight pressure upon the
affected part.
This tenderness may be due to disease in the
part, and it becomes our duty to ascertain if there is any
disease of the portion of the body thus supersensitive. If
so, of course, the diagnosis is made according to the local
SYMPATHETIC AFFECTIONS.
483
affection. In case there is no local affection, no swelling,
no redness, or heat of the part, we diagnose the case super-
ficially as hyperesthesia. We desire, however, that the
student should understand that we do not consider hyper-
æsthesia a disease, but simply one symptom of some dis-
ease of the spinal cord, or of disease or displacement of
the uterus. Hence, the diagnosis of the disease causing the
hyperæsthesia is quite another thing. I mention disease of
the cord in this connection simply to guard the student
regarding the diagnosis of the cause operating to produce the
hyperæsthesia, not to enter into the discussion of the diseases
of the cord, further than to mention that some irritation is often
produced in it, on account of uterine disease or displacement.
The main affections of the cord the student will study in
other works. We would have him always bear in mind that
in the treatment of diseases of women spinal irritation, in
slight or great degree, is a very common symptom, and that
the symptom of hyperesthesia is particularly a symptom of
the uterine origin of the spinal irritation in these cases.
Prognosis.
The prognosis in cases of chronic hyperesthesia (which
term is applicable to those of many months' standing) should
always be guarded. First, because the supersensitiveness
may be so great that we may be precluded from making, at
least for some time, any physical examination of the internal
female genitalia, unless the use of anaesthetics be brought in
to aid us, which we can not always use for fear of their
effects upon an already shattered constitution.
Again, the difficulty of using the appropriate treatment,
on account of the hyperesthesia, and on account of the friends
of the patient failing to appreciate the nature of the case.
and the necessity of uterine treatment, makes the prognosis
less hopeful.
Again, the prognosis should be guarded. on account of the
484
EATON ON DISEASES OF WOMEN.
possible existence of cellular, ovarian, or uterine irritation in
the case, which we may at first overlook.
Treatment.
In some
cases Hyoscyamus, Bell., Asafoetida, Puls., or
Macrotis will give prompt relief if used according to their
homoeopathic indications. The warm full bath, taken daily,
is of some service in about all cases, though we would not
claim it as sufficient to rely upon entirely in any case. The
onanist should receive a liberal supply of Brom. in low atten-
uation. As soon as possible we should ascertain if there be
any displacement of the uterus, and if so, try to rectify it.
If there is amenorrhoea, menorrhagia, metritis, cellulitis,
ovaritis, or other disease in the pelvis these diseases should
be treated as well as possible, according to suggestions given
under their appropriate heads.
PARALYSIS.
PARAPLEGIA AND HEMIPLEGIA.
Paraplegia is used to designate a condition of paralysis
of a part of the body. It may be large or small in extent,
affecting simply the muscles of one side of the face, or one
or both of the lower limbs.
Hemiplegia is a term applied to a paralysis of one-half of
the body and one arm and one of the lower extremities cor-
responding to the half of the body paralyzed. We do not
find the arm upon one side and the lower limb of the oppo-
site side simultaneously affected. Sometimes the muscles of
the face are affected, and sometimes not. When affected
they sometimes correspond to the side of the body paralyzed,
and sometimes the opposite. In some instances sensation is
perfect, and the power of motion is lost, and vice versa; in
others, both sensation and motion are lost. These attacks
usually come on suddenly without premonition.
SYMPATHETIC AFFECTIONS.
485
Etiology and Pathology.
These attacks result from apoplexy, softening, or pressure
upon the substance of the spinal cord, medulla oblongata or
brain, and from sympathetic action, or irritation in uterine dis-
ease. It is only the latter cause which I desire to discuss in
this volume. The process is somewhat similar to that which
is present in the production of hyperesthesia, which I have
already mentioned, with this difference, that while in hyper-
aesthesia there is irritation sufficient to cause tenderness of the
nerve only, in paralysis there is irritation sufficient to cause
some effusion under the membranes of the cord, and conse-
quent pressure is exerted sufficiently to interfere with mo-
tion, or both motion and sensation. Why one side is
affected, and not both, is not easy to demonstrate.
We can
not explain this, any more than we can the periodicity of
intermittents. We simply observe that it is so. We have
to acknowledge that there is a large field before us in the
discovery of nerve action, which is at present almost entirely
in darkness to our short-sighted vision. Sudden suppression
of the menstruation, or its delayed appearance from taking
cold, I have seen develop hemiplegia, which lasted about two
weeks, till the menses came on, and the inflammation of the
womb had subsided.
Diagnosis.
We will suspect paraplegia or hemiplegia (from sympathy
with uterine disease), when we find a paralysis of a part of
the body; and the history of the case excludes the probability
of its being caused from apoplexy; and an effusion of blood
beneath the membranes of a part of the cord, or, medulla
oblongata; or of its being caused by softening of the nerve
substance of the cord itself. We are justified in making
further examination to discover if there is any uterine inflam-
mation or displacement in these cases. We may find both-
486
ΕΑΤΟΝ ΟN DISEASES OF WOMEN.
*
quite certainly inflammation. Pain in the pelvis, and tender-
ness over the lower portion of the abdomen, with some fever,
and a wiry pulse, which is much more rapid than normal, will
usually be found. Often the attack is ushered in by a dis-
tinct chill. There may, or may not, be some incoherency of
speech. Sometimes there is a hysterical condition in connec-
tion with these cases. This is mentioned by Prof. Flint as
Hysterical Paralysis." Hysterical paralysis is transient,
passing off very soon; while paraplegia or hemiplegia, caused
from sympathy with uterine disease, continues for weeks, or
even months in some instances.
66
Treatment.
In the first place, attention must be given to treating the
condition upon which the paralysis depends, and not to the
paralysis itself; i. e., let other symptoms be considered
mostly in the selection of remedies. In cases of sudden
cold with chill, Gelsem., or Aconite in low dilution is usually
indicated. Where chilliness and fever alternate every few
minutes, or occur at the same time with thirst and nausea,
Ars. alb. is the remedy. After the active inflammatory
symptoms have subsided, Puls., Bell., or Macrotine is usu-
ally indicated. In some cases, where there are sharp pains,
Bry. or Cimicif. is indicated. Nux, China, Rhus, Baptisia,
etc., may be indicated later.
Locally the warm sitz or foot bath may be used, or the
patient may at once be put into a warm pack. To give a
warm pack, spread a pair of flannel blankets upon the bed,
then wring a sheet out of very warm water and spread over
the blankets; now place the patient, divested of all her
clothing, upon the sheet, and wrap the hot, wet sheet first
snugly around her, and then envelop her completely in the
blankets, pinning them tightly around the neck, leaving the
arms alongside the body wrapped in the sheet and blankets.
This pack usually causes profuse perspiration, and the patient
SYMPATHETIC AFFECTIONS.
487
may remain in it three or four hours, when she should be
taken out and thoroughly rubbed with dry towels and re-
placed in her clothing, having the temperature of the room up
to about 80° for a time, though the air should be fresh by the
admission of out-door atmosphere indirectly. The tempera-
ture of the room may now be allowed to go down to 68° or
70°. During the time the patient is in the pack, she may
drink all the cool water she may desire.
On general principles the inflammation of the uterus or
the displacements of the organ should be treated as in other
cases where they occur. The hemiplegia or paraplegia will
disappear as the uterine difficulty is removed.
INDIGESTION, TYMPANITES, TORPID ACTION OF THE LIVER AND KIDNEYS
AS SYMPATHETIC AFFECTIONS FROM UTERINE DISEASE.
Imperfect digestion is one of the most frequent sympa-
thetic affections of uterine disease. It very commonly results
from suppression of the menstruation, from dysmenorrhoea.
menorrhagia, displacement of the uterus, or inflammation of
the uterus in either form, etc., etc.
Tympanites is a result of this imperfect digestion. Torpid
or deficient action of the liver and kidneys sometimes results
from the prostration of the nerve strength, induced by uterine
disease first affecting the digestion in many instances; in
others, affecting the spinal cord primarily, producing debility
of nerve power. This weakness of nerve power then causes
torpidity of all glandular action, notably in the liver and often
affecting the kidneys; this torpidity of the liver, causing
constipation, and tending to prevent complete digestion, also
thereby causes tympanites.
Treatment.
Nux, Col., Merc. iod., China, Ars. iod., Lycopodium, Puls..
etc., are usually the indicated remedies; though in inflamma-
488
EATON ON DISEASES OF WOMEN.
:
tory conditions of the uterus, Aconite, Bell., Gelsem, Verat.
vir., Ars. alb., Bry., etc., may be required.
Nux is indicated (sòmetimes in alternation with Col.) for
indigestion with constipation, loss of appetite, pains in the
small of the back, etc.
Col. is indicated especially for sharp, twisting pains
around the navel or in the colon, where there is gas in the
intestines.
Merc. Iodid. is indicated by the lymphatic tempera-
ment, sallow complexion, coated tongue, with torpidity of
the liver and kidneys.
China is indicated especially in case of menorrhagia,
with debility, loss of appetite, etc.
Ars. Iodid. is indicated in the scrofulous diathesis, with
loss of strength, insufficient flow of urine, with headache, in-
digestion, etc.
Puls. is indicated by loss of appetite, with amenorrhoea
or dysmenorrhoea, headache, nausea, etc.
Lycopodium is indicated in constipation, with disten-
sion of the stomach after eating, etc.
Aconite is indicated when there is tenderness of the
uterus or stomach, loss of appetite, inability to sleep quietly,
fever, thirst, etc.
Ars. Alb. is indicated by pains over the whole body,
suppression of urine, thirst, alternate heat and cold, loss of
appetite, etc.
Bell. is indicated when there is tenderness of the uterus
or ovaries, dull pain in the head, especially over the eyes,
sense of weight in the pelvis, insufficient flow of urine,
flushed face, tenderness over the kidneys, etc.
Gelsem. is indicated by a tendency to congestion in any
part, loss of appetite alternating with great desire for food,
thirst, with alternate dry and moist skin.
Verat. Vir. is indicated where there is tenderness over
SYMPATHETIC AFFECTIONS.
489
the entire abdomen, pain in the spinal cord, fever, thirst, pain
in the stomach, etc.
Bry. is indicated for constipation with mucous discharges.
from the bowels, vagina, etc., and in case of indigestion with
sharp stitches in the side or head, tenderness of the scalp,
sharp pains in the ovaries, pains in the limbs or back of a
darting character.
Of course, the most prominent indication is to cure the
uterine trouble upon which these diseases depend.
490
EATON ON DISEASES OF WOMEN.
CHAPTER XLIII.
PUDENDAL HEMORRHAGE—PUDENDAL HÆMATOCELE—THROM-
BUS—RUPTURE OF THE BULBS OF THE VESTIBULE.
BOTH pudendal hemorrhage and pudendal hæmatocele are
of rare occurrence. Fatal cases have, however, been known.
Simpson records several cases where from slight rupture
of one labium fatal hemorrhage resulted.
Etiology.
The causes of pudendal hemorrhage may be divided into
predisposing and exciting. The predisposing cause is a vari-
cose condition of the veins, which may be induced by preg-
nancy or a large pelvic tumor. The direct or exciting cause
is usually external violence, though Prof. Simpson reports a
case due to straining at stool.
External violence may be received by the labia in falling
upon some hard object or by the breaking of a pot de chambre
upon which the patient is sitting, or by receiving a blow which
may cause an incised or punctured wound. When an incised
or punctured wound is received, the hemorrhage may be free.
When the external violence or muscular effort causes a rupt-
ure of the veins of the part the blood is infused into the
tissues, and a pudendal hæmatocele is produced, or as some
term it, a Thrombus is formed, which is a very good term,
signifying a coagulation of blood.
The anatomy of the parts needs to be understood that
we may appreciate the liability to these accidents in women.
Around the vulva are situated a network of veins termed
the Bulbs of the Vestibule, plexus of veins of the vestibule,
*Obstet. Works, Vol. I, p. 277, Amer. ed.
PUDENDAL HEMORRHAGE.
491
or pars intermedia.
It is on account of the rupture of these
veins around the vulva that the hemorrhage is so profuse in
cases of accident to the labia or vulva. They may be acci-
dentally ruptured in confinement from distension of the parts
by the head of the child, or in the careless use of instru-
ments in delivery.
Diagnosis.
The hemorrhage from the part in cases of incised or
punctured wounds which penetrate deeply enough to injure
the bulbs of the vestibule readily make the diagnosis clear.
In cases of Thrombus or pudendal hæmatocele a sense of
fullness, soreness, etc., is complained of in the labia, and on
physical examination a tumor is felt, varying in size from a
walnut to an orange, near the vulva and distending the labia.
If recent, the tumor feels soft or semi-solid. If several
weeks have elapsed, the tumor is rather solid in its feel, un-
less suppuration has taken place, in which case the feel is
fluctuating, accompanied with tenderness in the part, on
pressure.
Differential Diagnosis.
Thrombus of the labia or pudendal hæmatocele is liable
to be confounded with
Abscess of the Labia,
Labial Hernia,
Inflammation of the Labia,
Edema of the Labia, etc.
In abscess of the labia there must be a preceding history
of inflammation of the parts-heat, tenderness, swelling, etc.
In labial hernia, gurgling in the bowel, which is pro-
truded, the possibility of its replacement and its becoming
smaller or entirely disappearing after lying down several
hours, distinguishes it from pudendal hæmatocele.
In inflammation of the labia usually both are affected,
and the swelling is more uniform, the tenderness and heat
much greater than in thrombus or pudendal hæmatocele.
492
EATON ON DISEASES OF WOMEN.
The
In Edema of the labia, both are usually affected.
entire labia are thickened and puffy, and there is no circum-
scribed tumor as there is in pudendal hæmatocele.
Prognosis.
If the effusion of sanguineous fluid is small, it may disap-
pear spontaneously by absorption. When the effusion is great,
there is a liability of the formation of a labial abscess, and puru-
lent infection may be feared, if the abscess is not freely evac-
uated. Should there be a tendency to the formation of an
abscess some degree of inflammation in the part will precede
the development of pus, and the general system may largely
be affected from this process-chilliness, fever, etc., are liable
to occur, together with nausea, constipation, etc. In some few
cases the effused blood becomes encysted, and remains for years
without producing any effect upon the general health, and
when of small size may inconvenience the patient but little
or none at all. In pudendal hemorrhage there is usually no
very great difficulty in arresting the flow of blood.
Treatment.
Pudendal hemorrhage may usually be controlled by the
application of cold and compression. Cold wet cloths or
pieces of ice may be firmly applied to the part by means of a
T bandage. If this proves ineffectual in controlling the
hemorrhage the Ferri Persulph. may be used and pressure
continued.
In pudendal hæmatocele of recent occurrence it is best
to either freely evacuate the blood by incision and apply
styptics, or evacuate with a trocar and inject through the
canula some cold water, and apply compression as in a case
of pudendal hemorrhage; and if hemorrhage continue after
that, inject the liquid Ferri Persulph., well diluted, and
again apply the compress.
If an abscess forms either before or after the discharge
PUDENDAL HÆMATOCELE.
493
of the blood, the pus should be freely evacuated. Brush out
the interior of the abscess with a Solution of Iodine, and apply
pressure to cause adhesion of the walls of the abscess.
Thrombus or encysted blood-clot may be left to itself if
small. When large, so as to greatly inconvenience the pa-
tient, it may be enucleated by first incising the mucous tis-
sue, and peeling out the entire tumor, using the fingers and
the handle of the scalpel for this purpose.
Remedies indicated in the hemorrhagic diathesis, or for
varicose veins, may be given as indicated by homoeopathic
pathogenesis.
494
ΕΑΤΟΝ ΟN DISEASES OF WOMEN.
CHAPTER XLIV.
PUBERTY- AND THE CLIMACTERIC PERIOD.
THE age of puberty in girls signifies the time when ovula-
tion and menstruation commences, though they do not always
occur simultaneously, ovulation having been known to occur
before the establishment of menstruation, as shown by
the occurrence of pregnancy before the appearance of the
catamenia.
Just how frequently ovulation is established previous to
menstruation it is impossible to determine (as but few are
exposed to possible impregnation at this age). Still there
are reasons to justify the belief that ovulation precedes the
appearance of the menstrual flow for several months in very
many cases. The most prominent of these reasons is the
uneasiness, pain, bearing down in the pelvis, sometimes accom-
panied with backache and headache, nausea, etc., occurring at
intervals, sometimes irregular at first, varying from four to
six or eight weeks, gradually becoming more regular in their
recurrence every four weeks, when the flow also appears.
In some cases, however, the flow comes on without these
premonitory symptoms, which are indicative of ovulation,
either complete or imperfect.
The development of this function is a critical period in a
woman's life, a period when her whole being seems to change.
The romping, rude girl becomes the reserved, modest young
lady. The breasts develop, the whole form becomes rounded
and symmetrical. The mental changes are about as marked
as the bodily. Thoughtfulness and comprehension of deep
subjects are manifested in place of the careless thoughtless-
ness of childhood and want of understanding which usually
mark the age of youth.
PUBERTY.
495
Generally this change takes place in girls at about the-
fourteenth or fifteenth year, sometimes coming on at twelve;
or even at nine in warm climates, and is sometimes delayed till
seventeen or eighteen years are attained in colder latitudes.
During the intervening period from the time the symp-
toms of commencing ovulation first appear to the time men-
struation is regularly and fully established, various symptoms
are manifested with which the student should become familiar;
for, otherwise, he might be led into errors, both of diagnosis and
treatment, in frequent instances, entailing upon himself much
ridicule (especially on the part of the old ladies), which might
be remembered and told of him for many years. I will not
discuss here the various theories regarding menstruation and
ovulation, as this belongs more particularly in the department
of physiology; but will consider the manifestations which this
change develops in the system. Dr. Emmet has occupied
much space in giving tables indicating the age at which men-
struation was developed, the barrenness or fruitfulness of
each, etc., etc., which are of interest as statistics, but of no
practical value; as the average age of puberty is shown to be
fourteen years, with a variation from ten to twenty-three
years of age in exceptional instances.
From all experience we learn that there is no exact time.
for the period of puberty to become established. It occurs
earlier in warm climates than in cold; earlier in cities
than in the country, owing to the greater excitation of the
nervous system, often 'tis true at the expense of the
muscular. Civilization and a luxurious mode of living doubt-
less tend to the early development of this function.
As ovulation commences the girl shows more irritability
of temper, is peevish and fretful, restless and sometimes
sullen; the appetite is capricious, longings for unnatural arti-
cles, like chalk, slate pencils, etc., are common. Disorders of
digestion are often manifested, eruptions on the skin appear.
notably in the form of pimples on the face. Pain and tender-
496
EATON ON DISEASES OF WOMEN.
ness in the lower abdomen, with painful micturition are some-
times complained of, in connection with severe pains of a
spasmodic character in the epigastrium or groins. These
symptoms in the girl of suitable age, manifesting the some-
what rounded form, with the growth of hair upon the mons
veneris, and having no menstruation, we may conclude are
indicative of retarded development of the menstrual functions,
and we should treat the case accordingly.
If neglected in this regard serious inflamination may
supervene, and mental derangement is sometimes produced
from this cause. Many cases of sterility, I believe, are due
to the inflammation developed in these cases before the ap-
pearance of the catamenia, causing thickening of the investing
membrane of the ovary, disease of the endometrium, contrac-
tions of the cervical canal, or occlusion of the Fallopian tubes.
66
THE CLIMACTERIC PERIOD, OR MENOPAUSE, ALSO TERMED THE
CHANGE" AND "L'AGE DE RETOUR.”
These terms signify the time of cessation of the functions
of menstruation and ovulation. This occurs about thirty
years after the establishment of the function. Usually,
when it commences early, it also terminates early, and vice
versa. Exceptional cases occur where the term of menstrual
activity is longer or shorter than thirty years.
At the climacteric period the changes in the system are
as marked and critical as at the development of puberty, and
the dangers to health and life are as great, though from differ-
ent conditions; and the results are as serious, though of a
different character.
The cessation of the menstrual flow is sometimes sudden,
but most frequently it becomes irregular as to length of
intervals in its recurrence, as well as to time of duration and
quantity discharged. This irregularity is sometimes mani-
fested for a year or more before the flow ceases.
Upon the first arrest, or suppression of the flow, the patient
THE CLIMACTERIC PERIOD.
497
usually suffers from the same train of symptoms as occur
in cases of suppression from other causes earlier in life, but
with less intensity; sometimes, however, for a few months,
the arrest of the flow produces no serious disturbance in the
system, and with a few women the change of life produces
no effect whatever. These cases of exemption from disturb-
ance in the system from cessation of menstruation are the
exception; and it is usually found that a very considerable
effect is produced, as might be expected, from the reten-
tion in the system of more sanguineous fluid than it has
been accustomed to.
Generally, as a first effect of the menstrual cessation, the
uterus may be felt congested and enlarged, and it is likely
the ovaries and entire pelvic viscera are in a measure con-
gested also. This congestion and over-fullness of the blood-
vessels in the pelvis, especially in the uterus, causes irritation
of the nerves of these parts, which is communicated to the
spinal cord and sympathetic ganglia, which explains some-
what the manifestations of diseases peculiarly common at
this epoch.
The train of symptoms sometimes developed includes
almost if not all the sympathetic and hysterical manifesta-
tions to which women are liable, as well as the actual
derangement of functions which do occur in these cases.
As perhaps the most common result of this congestion, con-
tinuing for several months, we have profuse floodings, follow-
ing several months of suppression. These floodings are in
some cases very exhaustive to the system, and even danger-
ous to life.
The next most common disturbance in the system is
derangement of digestion, causing pain, colic, heartburn, etc.,
etc., accompanied sometimes with diarrhoea, and sometimes
with constipation. Backache, headache, neuralgia in various
parts of the body, sciatica, etc., are very frequent at this
period. This condition of congestion of the parts gradually
32
498
EATON ON DISEASES OF WOMEN,
gives place to atrophy of the uterus and uterine organs. The
congestion continues for a time, and may result in chronic
inflammation of some part of the uterus or ovaries, and the
consequent development of ovarian or uterine tumors; or
we may have a profuse leucorrhoea, which is caused from
this irritation of the organs, and which for a time seems to
be vicarious of the regular catamenia. Epistaxis, hemor-
rhoids, etc., sometimes seem to relieve the system vicariously
in recompense for the absence of menstruation.
The effect of the climacteric upon the mind is sometimes.
marked. The patient is taciturn, fretful, forgetful, easily
angered, changeable, sometimes exhibiting various forms of
mental derangement, at other times manifesting a childish
disposition, exhibiting a great love for showy dress, and
occasionally in widows causing an almost uncontrollable sex-
ual passion, manifested in the most imprudent conduct and
unblushing expression of a desire to marry, much to the
mortification of friends and relatives. Sometimes the desire
to bear a child in old age becomes so strong that she imag-
ines herself pregnant. This condition is termed pseudocyesis,
or false pregnancy. The increase of adipose tissue common
at the climacteric period aids in the illusion, conjoined with
the disorders of digestion so frequently present. The delu-
sion is embraced as a sweet phantom, as an evidence of
sexual vigor; and it is sometimes almost or quite impossible
to disabuse her mind of her mistake. The cessation of men-
struation, nausea, increase in size, as well as the movement
of gas in the bowels (simulating movements of the foetus),
all tend to confirm her wish that pregnancy might exist.
Treatment of Conditions Arising at Puberty.
First, when the age and development of the patient in-
dicate that puberty is reached, and there are present the
various symptoms described, and there is no show of mens-
trual discharge, Puls., Macrotis, Bell., Sepia, Aconite, Ars.,
PUBERTY- AND THE CLIMACTERIC PERIOD.
499
China, etc., should be studied. Puls. or Macrotis are indi-
cated for the non-appearance of the menstruation without
special symptoms for other remedies. Bell. is indicated for
bearing down pains with tenderness of the epigastrium.
Sepia, when the patient has a leucorrhoeal discharge. Acon-
ite, in case nervous symptoms predominate, with chilliness
or fever. Ars. for nausea, complicated with hot flashes.
China for weakness, trembling of the limbs, vertigo, etc.
Attention should be given to these cases regarding dress,
to see that they wear sufficiently warm clothing about the
feet and limbs. Warm foot baths, or the warm hip bath,
may often be of service. A useful adjuvant is found also
in the mustard plaster to the small of the back and epigas-
trium in case much pain is felt in these regions. Horseback
exercise is often highly beneficial.
If after several months of trial of remedies the flow is
not established and the symptoms are of a serious charac-
ter, and the patient having reached an age somewhat ad-
vanced beyond that when the catamenia ordinarily appears,
it is advisable to institute a sufficient physical examination to
determine whether there is an imperforate hymen or an atresia
of the vagina or cervix uteri, and, if so, to establish a normal
condition. If the parts are found normal, we must wait and
continue the use of remedies, and place the patient in favorable
hygienic conditions. Sometimes going into company is good
in these cases, calculating to divert the mind and restore
equilibrium in the nerve forces. Cessation from hard men-
tal labor is in some cases a necessity, as the excessive ac-
tivity of the brain may so divert the nerve forces in the
system as to cause atony of the genitalia, as mentioned in
treating of "Vaginismus" and "Amenorrhoea."
Treatment of Disorders of the Climacteric.
For the condition of suppression of menstruation occurring
in the married, we are debarred from very active measures
500
EATON ON DISEASES OF WOMEN.
on account of the possibility of the existence of pregnancy.
In cases where we are sure pregnancy does not exist, we
may use remedies as we would in an ordinary suppression,
as mentioned under the head of "Amenorrhoea," especially
if the system seems to be suffering on this account. Gen-
erally Aconite or Ars, alb. will be indicated in these cases,
as they usually suffer from congestion in some part of the
body, if they suffer at all; Ars. being indicated if there is
congestion without fever, or if the fever is of short dura-
tion, alternating with chilliness, thirst, restlessness, want of
sleep, etc.; Aconite being indicated when the congestion
merges into an inflammatory condition, with fever, dryness
of the skin, etc. Bryonia or Verat. vir. may be indicated
if the pulmonary symptoms are marked, showing congestion
in the lungs. The warm foot bath with warm applications
to the epigastrium and small of the back are calculated to
aid in establishing the equilibrium of the nerve force and
the circulation of the blood as well. Gastric symptoms, in-
digestion, constipation, etc., are to be treated as if arising
from any other cause, with Ipecac, Puls., Nux, Sulph., etc.
Should uterine hemorrhage set in, and be excessive, the
recumbent posture must be maintained, cool drinks must be
given, and all stimulants avoided. The remedies are Secale
cor., Nux, Ipecac, Aconite, Bell., Trillium, Nit. ac., China,
etc., choosing the one whose pathogenesis most closely re-
sembles the case in hand. I have named remedies in the
order in which I have found them most frequently indicated.
This class of patients should be treated with great con-
sideration, not only on account of their difficulties, but on
account of their age and the delicacy and solicitude the pa-
tient always feels regarding her condition at these times.
She should not be disputed with or opposed more than it is
impossible to avoid. Her idiosyncrasies should not be men-
tioned by her friends to others in her presence, as at this
period the lady is often over sensitive about the good opin-
PUBERTY—AND THE CLIMACTERIC PERIOD.
501
ion of her acquaintances, though she may pretend to ignore
and despise the opinions of others, and does not like to think
that old age is approaching. She does not like, therefore, to
be told that this is the climacteric period with her.
It becomes the physician's duty to enjoin great care on
her part to avoid taking cold; and exposure to damp, cold
atmosphere, especially at night, as well as fatigue, should be
avoided. My opinion is that often the menses disappear
before the climacteric period is reached, on account of various
causes independent of the natural cessation of ovulation and
consequent stoppage of uterine activity; hence, it is the plan
most conducive of good to our patient to keep up the function
of menstruation as long as possible. In this way I think
much of the tendency to the development of uterine tumors,
cancer, phthisis, etc., is avoided by maintaining the function
of regular menstruation as long as possible, and much of the
liability to excessive hemorrhages is also avoided. We also
have less development of nervous symptoms, digestive de-
rangement, etc., if the function is maintained regularly to the
utmost limit. When this is accomplished the system will
suffer little from the absence of menstruation. The sexuality
is, in a measure, lost; sexual passion is lost, or much weak-
ened, and the uterus becomes atrophied; the vagina shrinks
and becomes dry. Under these circumstances the only symp-
tom likely to develop will be weakness, showing a loss of
vitality as well as virility. In these circumstances Nua,
China, Ars., etc., are usually the indicated remedies.
502
EATON ON DISEASES OF WOMEN.
CHAPTER XLV.
ATRESIA OF THE VAGINA, AND CERVIX UTERI— HÆMATO-
METRA, ETC.
CLOSURE of the vagina or cervix uteri may result from
adhesive inflammation from cold or from traumatic lesion, or
it may be congenital. In these cases of absence or atresia
of the vagina the menstrual blood sometimes finds exit
through the rectum and sometimes through the urethra.
In some of these cases, where the os uteri has opened
into these canals, pregnancy has resulted when these canals
have been used for copulation.* Generally, for some reason,
the urethra is relaxed and greatly enlarged in cases of atresia
of the vagina. Dr. Emmett mentions the case of a young
woman who, after being married several years without a men-
strual flow, was found to have copulated with her distended
urethra, and neither her husband or herself had suspected the
true condition.
After opening up the vagina the urethra usually contracts
to a normal size. The closure of the vagina must, of neces-
sity, cause a retention of blood in the uterus; and this con-
dition is called hæmatometra. In cases where vicarious
menstruation is not otherwise established, sometimes hæmat-
emesis, hæmoptysis, or epistaxis seem to take the place of
the catamenia and become vicarious menstruations; at other
times hemorrhage from the rectum takes place as a vicarious
menstruation, when there is no communication between the
uterus and bowel.
The occlusion may exist as a transverse septum in the
* Barnes' Diseases of Women, page 203.
† Emmet's Prin. and Prac, of Gynæology, page 207.
ATRESIA OF THE VAGINA.
503
vagina (see Fig. 47), or it may affect the lower portion only,
or the os uteri externum or internum may be the seat of the
occlusion, or it may affect the entire cervical canal. Either
FIG. NO. 47.
ATRESIA OF THE VAGINA
WITH HEMATOMETRA.
condition may develop hæmatometra, which
will be situated above the location of the
adhesion.
Professor Emmet relates a case of
double uterus and vagina with atresia of
one of the vagina. (See Fig. 48.) He
says: "Some years since I was consulted
by a woman about nineteen years of age,
who had never menstruated regularly, and
wished relief from a sense of pressure and
bearing down which had existed for several
years. She was exceedingly nervous; I
had great difficulty in completing a thor-
ough examination, and was not a little puz-
zled to make out a diagnosis. To the left of the vagina was
felt an accumulation of fluid extending as high as the finger
could reach, and from the rectum an
elastic and nearly globular body could
be felt, closely attached to the uterus.
After satisfying myself as to the posi-
tion of the fluid and its connection with
the uterus, I unfortunately suggested to
introduce an exploring trocar, to ascer-
tain the character of the accumulation.
It seemed I had already lost my pa-
tient's confidence, from the length of
time I had taken to form an opinion as
to what her difficulty was, so that my
proposition was refused, on the ground
that she would not be experimented with any longer. I never
saw the case again, and know nothing of her subsequent
*Emmet's Prin. and Prac. of Gynecology, page 208.


FIG. 48.
DOUBLE UTERUS AND VAGINA,
ONE VAGINA CLOSED.
504
EATON ON DISEASES OF WOMEN.
history." Dr. Emmet claims this as a case of double uterus
and vagina; but the symptoms he relates might be produced
by hæmatocele; hence the cut and diagnosis both draw upon
the imagination.
The doctor might have been right in his diagnosis; he had no
opportunity to confirm it. He relates, on page 209, a case
which he saw with Dr. Watts, in Roosevelt Hospital, where
there existed a sinus which passed up by the side of the
vagina, and communicated with the uterus. There was but
one uterus, and these two outlets were converted into one by
dividing a thin septum. The doctor assumes a similarity in this
case to the one first related; and, therefore, claims the first
as a case of double uterus and vagina, mainly because the
menstrual flow was irregular, occurring not less than eight
weeks apart, hence concluding that the menstruation occurred
one month into one side of the double uterus, and the next into
the other. He claims this without knowing positively that
there existed a double uterus or atresied vagina in the case.
Abnormal developments should have a better basis of fact to
stand upon than this.
Etiology of Atresia of the Vagina and Cervix Uteri.
Congenital malformation may present this deformity, but
it is more frequently the result of a cicatricial process from in-
flammation, sloughing, ulceration, or laceration; or it may
result in the vagina or os uteri, from the use of caustic appli-
cations, causing adhesive inflammation, or from inflammation
following labor.
Rokitansky describes a sort of concentric
occlusion resulting from advancing senile atrophy.
The os is also occluded from want of care to maintain the
opening after amputation of the cervix.
The external and internal os sometimes become occluded
after the cessation of menstruation, and the mucous secretion
of the endometrium accumulates within the uterus, causing
nervous symptoms, which promptly vanish upon the re-estab-
ATRESIA OF THE VAGINA,
505
lishment of the normal passage. This has occurred in my
own practice, but I do not recollect it to have been men-
tioned by any other work on Diseases of Women. Barnes
mentions that in infants and young girls atresia of vagina and
hymen may produce serious consequences, and require an
operation, on account of the retention of-the secretions above
the adhesion.
Abrupt flexions of the uterus may cause atresia at the
internal os, when accompanied with inflammation and exuda-
tion, or granulation. The same may also result from the
development of intra-mural fibrous tumors in the cervix, or
lower part of the body of the uterus. Inflammation of the
vagina in childhood may cause atresia; hence, cases of leu-
corrhoea in young giris must not be neglected (as the leucor-
rhoea is but a symptom of vaginitis, endo-cervicitis, or endo-
metritis).
Symptoms.
In congenital atresia of the vagina or cervix uteri there
is, of course, non-appearance of the catamenia. If the ovaries
and uterus are normal the blood is effused, but retained above
the point of the atresia, called hæmatometra, and gives rise
to the symptoms about to be mentioned; and in acquired
atresia, hæmatometra is a result. This arrest of menstrua-
tion, or its entire non-appearance, must be present in every
case of atresia, whether congenital or acquired (if the uterus
and ovaries are normal). But the absence of menstruation.
does not positively indicate atresia, for it might be caused
by absence of the uterus or ovaries, or want of action in
these organs.
once.
A physical examination would show the condition at
If no obstruction was found in the vagina the attempt
to pass the uterine sound would reveal the atresia of the
cervix if it existed. Just here some care is necessary not to
fall into an error in diagnosis, as a contraction of the cervical
canal or a flexion of the uterus might offer much obstruction
506
EATON ON DISEASES OF WOMEN.
}
to the passage of an ordinary uterine sound. Generally,
however, we will not feel it necessary to attempt this thorough
examination till there is evidence of hæmatometra constituting
a tumor of considerable size.
At first the patient may only suffer with monthly pains for
a day or two, accompanied with some nausea or vomiting and
epistaxis. A sense of fullness and bearing down in the pelvis
is felt; and from month to month the epigastrium enlarges.
Often the poor, innocent patient is suspected of pregnancy,
on account of the increase in the size of the abdomen, and
the tendency to nausea experienced. When the atresia is
in the lower portion of the vagina, the pressure of the hæm-
atometric tumor may press so hard against the urethra as to
cause retention of the urine, and upon the colon so as to
cause obstinate constipation. Sometimes, when the atresia
is not quite complete, there is an oozing of the serous por-
tion of the retained blood at irregular intervals. Such a
fistulous opening may for a time do much to prevent the
severity of the symptoms caused from the retention of the
flow, and will tend in a great measure to retard the develop-
ment of the hæmatometra.
Prognosis.
*
The prognosis is, as a rule, unfavorable if the case is left
to itself; still, there are exceptional cases on record where
the patient has maintained good health, although the uterus
was distended with retained menstrual blood. Simon relates
such a case. Usually, however, with an operation, if prop-
erly performed, the prognosis is favorable, especially if free
evacuation of the vagina and uterus be accomplished. These
cases are most likely to die from neglect, on account of an
incorrect diagnosis, mistaking the hæmatometra for dropsy,
ovarian or uterine tumors.
*Mon. f., Geburtskunde, 1851.
ATRESIA OF THE VAGINA.
507
Treatment.
Atresia being an organic obstruction, the treatment re
quired is mechanical or surgical, though remedies are valuable
in the treatment of the conditions of the general system
dependent upon the retention of the effused blood and its
reabsorption into the circulation. These remedies must be
selected in accordance with the symptoms in each case on
the general plan of homoeopathic therapeutics. But for the
relief of the atresia an operation is required. Surgeons
formerly fell into the error of making small incisions, and
making two or three operations to complete the breaking up
of the adhesions, and evacuating the hæmatometra, which
allowed of the introduction of air, and the decomposition of
the retained blood. At present surgeons are unanimous in
the opinion that the operation should be completed at one
time, and the retained blood be freely evacuated, followed
by a thorough cleansing of the uterus.
Operation for Atresia or Absence of the Vagina.
The patient is placed under the influence of Ether comp.
while lying upon the back with the thighs flexed upon the
abdomen. A lateral incision in now made in cases where
there is no depression to indicate the location of the vagina.
If there is a depression, make the incision vertical, and
reaching from a point about one-half inch below the meatus
to within an inch of the anus. We next introduce a steel
sound into the urethra. (See Plate V.) It should be about
eight inches in length, of large size, and bent at a right
angle; about three inches from the expansion of the handle
is the best, as it distends the urethra more, if large, and its
bent form enables the assistant to hold it more out of the
way.
The assistant now seizes the handle of the sound and
holds it firmly, as well as steadying the limbs, when the
508
EATON ON DISEASES OF WOMEN.
operator passes one finger of the left hand into the rectum,
and with the index finger of the right hand attempts to
force a passage between the rectum and the bladder, bear-
ing in mind the natural backward curve of the vagina. If
unable to force the finger through the tissues, the handle of
a scalpel may be passed by the side of the finger, and its
movement from side to side may greatly aid in breaking
through the tissues. When bands of tough fibre are met, the
blunt-pointed bistoury may be introduced to divide them, al-
ways making the incisions laterally and keeping close to
the rectum, so as to avoid wounding the bladder. When we
arrive at the sac of the hæmatometra we may puncture it
with the long curved trocar (see page 125), or Simpson's
Hysterotome. (See Plate V). After the puncture is made
and the fluid somewhat drained away, the opening should
be enlarged laterally, so that at least two fingers may be
introduced.
The uterine sound should be now inserted gently to
ascertain if the cervix is pervious, and to note the size and
position of the uterus and make sure that no blood is re-
tained there. Usually in these cases we find the os uteri
dilated by the retained blood, and we pass the finger readily
into it. Sometimes the distension is so great as to make the
os three or four inches in diameter.
We next introduce the tube of a Davidson's fountain
syringe into the newly made vagina, or even into the uterus
itself (using the vaginal tube), and thoroughly wash out the
interior with carbolized warm water, placing a bed-pan under
the patient, if it has not already been done.
After the washing out is completed, we smear the parts
through which we have torn or cut with Vaseline or carbolized
ointment, and introduce into the vagina one of Sims' vaginal
glass dilators of good size, smeared with Vaseline (see Plate
No. VI). This is retained with a T bandage, directing that
the nurse hold it in position with the fingers in case the
ATRESIA OF THE CERVIX UTERI.
509
bandage has to be removed for the calls of nature. Every
twelve hours the dilator should be removed, the vagina
washed with carbolized warm water and the dilator replaced,
till the parts are thoroughly healed.
After the operation is completed and the dilator inserted,
the patient should be placed in bed in a room of a temper-
ature at 70°, and suitably wrapped to maintain the heat of
the body. The recumbent position should be maintained for
about two weeks. The character of the fluid in the hæma-
tometra merits a word. It is usually of dark color and rarely
coagulated, owing to the deficiency of fibrine. The quantity
varies in different cases, according to the length of time it
has been accumulating. Leatherby analyzed forty oz., which
gave water $75.4, albumen 69.4, globulin 49.1, hæmatosin
2.9, salts 8.0, fat 5.3, extractive 6.7.
Occasionally this fluid undergoes decomposition, and ulcer-
ation is established, ventilating the abscess into some of the
adjacent cavities. Each case of this kind must be treated
upon its merits.
Generally speaking it is best to proceed
with the establishment of the normal opening, if the patient
is not in a condition of too great depression, for it is probable
that with the establishment of the normal canal the fistulous
opening would close by the natural restorative powers of the
system. It has formerly been recommended to evacuate the
hæmatometra with a trocar through the rectum, an operation
which is open to serious objections, and one entailing more
danger than the establishment of the normal vagina, and it is
now discarded.
Treatment of Atresia of the Cervix Uteri.
After opening up the vagina, we may find the cervix im-
pervious; or it may be closed in cases where the vagina is
of normal size. The adhesions in the cervix
may sometimes
be divided by pressing into it the ordinary uterine sound.
In other cases, it is necessary to use some instrument
510
EATON ON DISEASES OF WOMEN.
more pointed.
Some recommend the piercing the cervix
First,
with a long slender-bladed, sharp-pointed bistoury; but I
prefer the long uterine trocar. (See Fig. No. 49.)
we should take care to ascertain that there is no version
or flexion of the organ, as well as we may do by digital
rectal and vaginal, as well as conjoined, examination. This
is usually not very difficult, as the distension of the uterus

FIG. No. 49-UTERINE TROCAR.
makes the examination more easy. The distension also, in
most cases, produces a considerable shortening of the length
of the cervix, especially if the atresia be confined to its lower
portion. After introducing the trocar (which can usually be
well done without anaesthesia), it is well to wash out the
cavity of the uterus with warm, carbolized water through the
canula, after the contained fluid is drained off; and to pre-
serve the opening, a carbolized sponge tent may be inserted,
to dilate it for six or eight hours, after which, I introduce a
good sized bougie, anointed with Vaseline, once a day, till the
cervix is thoroughly healed.
BANDAGING After operating on any case of atresia of the
vagina or uterus, where there has been a large hæmatometra
formed, it is best to apply a large full compress over the epi-
gastrium, and maintain it with a firm abdominal bandage.
FISTULÆ,
511
CHAPTER XLVI.
FISTULE.
VESICO-VAGINAL FISTULA-RECTO-VAGINAL FISTULA—RECTO-VESICAL FIS-
TULA-VESICO-CERVICAL FISTULA-URETHRO-VAGINAL FISTULA—IN-
TESTINO-VAGINAL FISTULA—URETO-VAGINAL FISTULA-VESICO-UTER-
INE FISTULA PERITONEO - VAGINAL
FISTULA
PERINEO - VAGINAL
FISTULA-BLIND VAGINAL FISTULA- FISTULA IN ANO.
To save space and time, as well as to make clear these
various fistulæ and their appropriate treatment, I will discuss
them in connection with each other.
Fistula in ano is not peculiar to women, but results from
an abscess in the cellular tissue surrounding the rectum, and
is sometimes a result of cellulitis in the female as well as in
the male. Fistula in ano may be complete or incomplete,
internal or external. In complete fistula in ano there is a
fistulous opening from the bowel to the external part of the
perineum, or posterior to, or beside, the anus. In incom-
plete fistula in ano the opening may only be external, in
which case it is termed external fistula in ano; and when
it opens into the rectum, and has no external opening, it is
called internal, or blind, fistula in ano. When opening an
abscess into the vagina, it is termed blind vaginal fistula.
Vesico-vaginal fistula signifies an opening between the
bladder and vagina, allowing the urine to pass into the
vagina.
Vesico-urethral fistula signifies an opening between the
urethra and the vagina, allowing the urine to pass into the
vagina, as in vesico-vaginal fistula.
Vesico-cervical, or vesico-uterine, fistula indicates a fistulous
512
EATON ON DISEASES OF WOMEN.
opening between the bladder and cervix uteri, allowing the
urine to flow through the cervical canal and vagina.
Recto-vaginal fistula signifies a fistulous communication
between the vagina and rectum.
Ureto vaginal fistula is one where the ureter opens into
the vagina, either as a congenital deformity or as a result of
laceration or ulceration of vesico-vaginal tissues.
Intestino-vaginal fistula consists of a fistula between the
small intestines and vagina, and may be applied to a recto-
vaginal fistula also.
Recto-vesical fistulu consists of a communication between
the bladder and rectum, through an occluded or atresied
vagina.
Vesico-vaginal fistula is the most common form of vaginal
fistula.
Recto-vesical fistula is but little known. Simpson relates
two cases. Most authors are silent upon this subject. It is
usually, if not always, caused from an abscess in the upper
part of the vagina, when there is complete closure of the
lower part, and the abscess opens into both the rectum and
bladder, allowing of the escape of the urine through the
opening in the bladder into the vagina (which is occluded),
and which has become in this case the cavity of the sac,
and thence through the rectal opening of the abscess into
the rectum. Fecal matter may pass into the bladder through
this form of fistula.
Etiology of Fistulæ of the Vagina, Intestines, Bladder, and
Rectum.
Protracted labor is the most frequent cause of fistula in
the vagina, although they sometimes occur as a sequence of
labors which are not of so very long duration as to be con-
sidered tedious or protracted; in these latter cases being
caused by want of attention to the proper evacuation of the
bladder during the progress of the labor, or to the presence
VAGINAL FISTULÆ.
513
in the bladder of a calculus, which gets lodged between the
head of the child and the pubis. The use of Ergot is, to be
blamed for many cases of vaginal fistulæ, especially when
administered to the patient before the os uteri is largely
dilated, and before the head of the child has engaged in the
superior strait. This agent produces such continuous con-
traction of the uterus that unless the conditions of the os uteri
and vagina are such as to allow of rapid delivery various
injuries are liable to result, the most prominent of which are
vesico-vaginal fistula and lacerations of the os uteri and
perineum. It may be caused from a pessary cutting its way
through, or from its long continued pressure causing an ulcer,
and finally a fistula.
Recto-vaginal fistula is more seldom produced than vesico-
vaginal, it being found in less than six per cent of the total
number of cases of vaginal fistula on record. The presence
of internal piles serves as a cause of the recto-vaginal fistula.
It may also be caused by instruments used in operating for
atresia of the vagina. Recto-, vesico-, or urethro-vaginal, fist-
ulæ may result from accident in the attempt to establish a
normal vagina in cases of atresia, or where it is congenitally
absent.
The use of the obstetrical forceps has been blamed for
producing vaginal fistulæ more than any other cause. It is
true, a vaginal fistula has followed sometimes after instru-
mental delivery with forceps, even when they have been
used by skillful and experienced hands; but still it is not
clear to my mind that the instruments were the cause of
the fistula.
I am of the opinion that the long continued pressure
of the head of the child upon the bladder and urethra,
for a great length of time, causes the sloughing and the
resulting fistula. My own opinion is (and I know the
same opinion is entertained by many eminent obstetricians),
that if the forceps were used more frequently, and without
33
514
EATON ON DISEASES OF WOMEN.
waiting for forty-eight or sixty hours to elapse before
using them after their necessity was evident, the cases
of vesico-vaginal, or urethro vaginal, fistula would become
exceedingly infrequent. I might mention several excellent
reasons for their early use, but the discussion of the advan-
tages of the use of obstetrical forceps does not come under
the department of medical literature upon which I am now
engaged. I desire simply to record here my belief in the
fact that obstetrical forceps have been too much blamed for
the causation of vaginal fistula. In corroboration of this I
will say that during the past ten or fifteen years vesico-vag-
inal fistula are becoming less and less frequent; and the use
of obstetrical forceps has very largely increased in that time.
Vesico vaginal fistula is sometimes established artificially
by the surgeon for the relief of chronic cystitis, as men-
tioned under the head of cystitis. Dr. Emmet reports six-
teen cases of this kind.
Accidental incised wounds or lacerations from the break-
ing of a glass syringe in the vagina may cause either vesico-,
urethro-, or recto-vaginal fistula, and vesico- or urethro-vag-
inal fistula; or they may be caused accidentally, in opera-
tions for the removal of a stone from the bladder. A pelvic
abscess may ulcerate through, so as to cause either a vesico-,
blind-, or recto-vaginal fistula.
Vesico-vaginal fistula has been known to result from a
calculus in the bladder upon which no operation had been
attempted, and which had no connection with labor. Schroe-
der* mentions a case, reported by Simon, in a girl eight
years old. Intestino-vaginal fistula may result from lacera-
tion of the cervix in labor, extending to and including the
posterior vaginal wall in its upper part, allowing the pro-
trusion into the vagina of a knuckle of intestine through the
rent, this being followed by inflammation, strangulation, gan-
grene, and sloughing, a fistulous opening or an anus præter-
* Ziemssen's Cyclopædia, Vol. X, page 515.
VAGINAL FISTULAÆ
515
naturalis is established. Falls upon sharp sticks, penetrating
the vagina, syphilitic or cancerous ulceration may cause
either of these fistula of the vagina. Ulcerative action in
the bladder, or syphilitic, or diphtheritic ulceration in the
vagina may also cause them.
Vesico-cervical or vesico-uterine fistula may be caused
from laceration of the cervix in confinement, implicating the
vesical wall. The vagina and lower part of the cervix heal
and the vesico-cervical fistula remains. This is sometimes
carelessly termed vesico-uterine fistula.
Diagnosis.
Generally the first symptom which is noticed in vesico or
urethro-vaginal or vesico-cervical fistula is a dribbling of
urine from the vagina. This the patient at first supposes is
the result of inability to hold it on account of weakness of
the parts. Soon she finds that upon attempting to pass her
urine little or none passes through the natural outlet, but
passes through the vagina, and she takes alarm and con-
sults her physician. The diagnosis of the exact nature
of the difficulty is made out by a conjoined exploration
with a finger of the left hand in the vagina and with
the sound in the urethra or bladder. Sometimes the fist-
ula is so small as to make it impossible to pass the sound
through it, and it then becomes necessary to examine the
vagina with a Sims' improved speculum (as invented by Daw-
son), or a trivalve, thus bringing the anterior wall of the
vagina into view, as well as the os uteri. If the urine be
found dribbling from the os uteri, this fact is conclusive of its
being a case of vesico-cervical fistula.
Recto-vaginal fistula is discovered by the passage of
flatus and fecal matter per vaginam. The examination
made with a finger in the rectum, and a sound or probe intro-
duced through the vaginal opening of the fistula till it pene-
trates the bowel through the rectal opening, is necessary to
516
EATON ON DISEASES OF WOMEN.
determine its exact locality and size. Either of these fistulæ
may be large enough to admit of the passage of a finger
through them, but this is not often the case.
Intestino-vaginal fistula is diagnosed by finding the rectum
intact, and discovering the fistula in the upper and posterior
part of the vagina, conjoined with the character of the dis-
charges, which are thin and bright yellow mingled with par-
ticles of food or fecal matter.
Treatment.
RECENT CASES.-In the treatment of recent cases of vesico-
or urethro-vaginal or vesico-cervical fistula the patient should
lie uninterruptedly upon the side (if the laceration or fistula.
is situated to either side of the median line in cases of
vesico-vaginal fistula the patient should lie upon the opposite.
side), that the urine may be retained in the bladder for some
time without passing through the fistula.
A silver self-retaining catheter should be placed in the
bladder by passing it through the urethra (a small size should
be used if the fistula communicates with the urethra so as
to not stretch the canal in the least). The catheter should
be removed and cleansed every two or three days to prevent
incrustations of phosphatic deposits on the surface. Making
sure that the urine in the bladder is all discharged, we may
daily turn the patient from side to side, and use a warm vag-
inal injection of water and castile soap.
Attention should be given to the diet and various hygienic
means to place our patient in as good a general condition of
health as possible, and such remedies given as seem to be
homoeopathically indicated. By following out this plan
very many cases will spontaneously recover in periods of
time varying from two to six weeks.
I am pleased to see that Professor Emmet encourages
conservative treatment in these cases. He says: "In arti-
* Emmet's Prin. and Prac. of Gynecology, page 618.
VAGINAL FISTULE.
517
ficial fistula the raw edges are kept in a healthy condition
by the frequent use of the injections (warm water) and free
from the irritation always exerted by a deposit from the
urine. Whenever this is done the largest sized artificial
opening will often rapidly close of itself." He relates two
cases which were sent to the hospital immediately after
delivery, who were suffering from fistulæ of the vesico-vag-
inal variety, of a size large enough to admit of the introduc-
tion of the index finger into them, which healed rapidly
under the treatment of warm vaginal injections.
If there is present any inflammation of the bladder or
abnormal condition of the urine, we may introduce the warm
water directly into the bladder through the catheter, or by
way of the vagina through the fistulous opening. In cases
of several months or of years' standing, an operation is
usually necessary to cause union of the edges of the fistula.
Sometimes, however, they may be cured by remedies and
local applications to stimulate granulations.
We must be guided much by the circumstances of the
case and the wish of the patient and friends in the treat-
ment. We can usually promise a good hope of a cure from
an operation, but some patients have a serious objection to
an operation who are willing to suffer a great amount of incon-
venience and great loss of time, and be put to any amount
of expense in order to avoid an operation. In this class of
cases it is advisable to make an attempt to cure the case
by other means. These measures must have for their end the
cleansing of the vagina and the fistula from all phosphatic or
other deposits, causing the urine to flow through the normal
canal and causing granulations to develop around the fistula,
so as to approximate its edges, and, finally, to cause union.
thereby obliterating the fistula by this process.
It is really
aiding nature to pursue the same process which it under-
takes so successfully in the recent case, as I have learned
from experience it will do, and as I have quoted from Dr.
518
EATON ON DISEASES OF WOMEN.
Enimet to show that it has been seen in the experience of
others.
First, then, if we are to make the attempt to heal the
fistula without operation, we must attend to the cleansing
and healing of the vagina, for in some cases the parts be-
come exceedingly inflamed, and in some instances ulcerated.
In some patients, where the urine is very heavily loaded with
the phosphates, even the thighs on the inside and the but-
tocks become inflamed and ulcerated, and it is best to relieve
these parts of the inflammation and heal the ulceration be-
fore proceeding to apply treatment to the fistula, otherwise
the pain which we would cause in attempts to get at the
fistula would be almost unendurable. For this purpose the
flow of urine through the fistula must be arrested. This is
to be accomplished by placing the patient upon her side and
introducing into and leaving in the urethra a suitable cathe-
ter (some prefer silver, some gum elastic), and retaining it
there and cleansing it often, as in the recent case, and ad-
ministering to the patient remedies calculated to restore the
urine to a normal condition.
Remedies.
The following remedies should be studied in the Materia
Medica, and prescribed according to the totality of the symp-
toms:
Sepia, China, Dig., Puls., Cal. carb., Nit. ac., Sulph., Spon-
gia, Phos., Phos. ac., Ferrum, Terebinth., Ant. cru., Merc., Sol.,
Ars. iodid. Acidulated drinks may be freely used, that, if
possible, the urine be kept in a normally acid condition.
The incrustations must be washed or wiped away, using a
very soft cloth or sponge saturated with warm water, to
which a very little castile soap is added. After washing
away the incrustations, the parts inflamed or ulcerated
should be bathed with Calendula wash, made by adding
about four ounces of water to a table-spoonful of Tr. Calen-
VAGINAL FISTULÆ,
519
dula. This should be repeated four or five times a day till
the parts are healed. It is well to use Vaseline over the
parts when almost healed, to soften them and prevent the
formation of a cicatrix around the point ulcerated.
After the vagina has been healed so that nothing remains
abnormal but the fistula, we introduce into the vagina a
Dawson's improved Sims' speculum, so as to bring the vag-
inal portion of the fistula into view; then with a syringe
which has a long, curved nozzle inject the bladder through
the fistula (if it be vesico-vaginal) with warm soap and water
daily. After the free use of the water we pass a sound wrap-
ped with cotton saturated with Iodine through the fistula,
15 grs. to the oz., taking pains to apply the Iodine to the
margin of the fistula thoroughly, but not so freely as to al-
low it to drop into the bladder or vagina.
If the fistula is vesico-cervical, we pass the Iodine up into
the cervix to the point of the opening of the fistula, and hold
it there for a few moments, turning the patient a little on to
her face, so as to aid the Iodine in passing into the fistula.
In case the os uteri is not large, dilate it with sponge tents,
so that the sound wrapped with cotton may pass without
being compressed, so as to drain off the Iodine before it reaches
the fistula.
In case the fistula is urethro-vaginal, the edges of the
fistula may be touched with a brush saturated with the Iodine,
after thoroughly cleansing the parts with the warm water and
soap, by means of a soft sponge. The strength of the Iodine
must be increased if we find after two or three weeks that
no granular inflammation is established in the walls of the
fistula. After granulations have become well established (and
the fistula is a large one) we gain much time by taking two or
three stitches with silver wire, to draw the edges of the fistula
together. The patient will sometimes be willing to submit to
our placing two or three sutures, after she has been treated
some time, who would not submit to an operation at first.
520
EATON ON DISEASES OF WOMEN.
Operation for Vesico-vaginal Fistula.
In the very recent case of vesico-vaginal fistula, if the
patient be willing to submit to an operation, the sooner it is
performed the better, if the patient's strength is sufficient to
allow of it. The bowels should first be freely evacuated by
enemæ of warm water. No anaesthetic is usually required, in
the recent case, a good drink of Sp. Vin. Fermenti being suffi-
cient to brace the nerves for the operation. The patient
should be clothed in flannel drawers and under vest, with a
night dress over, which should be drawn up around the waist.
She should lie upon her left side with the thighs flexed upon
the abdomen. She should lie upon a high operating chair or
table, high enough so that the operator may sit conveniently.
(It is next to impossible to perform the operation satisfac-
torily with the patient upon an ordinary bed or lounge.) A
Sims' speculum should be introduced and held in position by
an assistant, so as to bring the fistula into view. If the
speculum does not readily bring the fistula into view, a re-
tractor must be introduced to draw back the perineum and
posterior part of the vagina.
We now proceed to inspect the parts, and determine what
plan to pursue. If the edges of the fistula appear healthy,
and appear to have vitality enough to promise a prospect of

FIG. NO. 50.-SIMS' NEEDLE HOLDER.
adhesion taking place when they are placed in apposition, we
may proceed at once to stitch them together, placing the
sutures (which should be of silver wire) in the position which
VACINAL FISTULÆ.
521
will most conveniently draw the edges together. The stitches
should be placed about three-eighths of an inch apart, and
may or may not be set deeply enough to include the vesical
mucous membrane. I prefer to include this membrane in
placing the suture, using the semi-circular vesico-vaginal

G.TIEMANN & CÔÍ
FIG. NO. 51.-EMMET'S COUNTER-PRESSURE HOOK.
needle; and have the wire threaded, into the needle, at least
eighteen inches long. Seize the needle near the eye with
a long-handled pair of straight, slender needle forceps, if the
longest diameter of our incision corresponds with the median
line; but if the longest diameter of the incision is transverse
the vagina, we use our curved needle holder. (See chapter on
Instruments; also Plate VI.) This enables us to grasp the
needle so as to insert it in a direction corresponding to the
median line very conveniently.
By using my needle holder we see clearly what we are
doing, as the handle of the holder is to one side of the vagina
while we insert the needle. This needle holder is curved
simply in the blades which grasp the needle, holding it at
right angles, with the handle of the holder, and with its con-
cavity directed towards the operator as he holds the needle
in the grasp of the holder ready for use. Pierce the tissues
on the upper side, about one-fourth of an inch back from the
fistula, press it through till about one-half the needle emerges
from the fistula; then let go the end of the needle, and seize
it in the portion emerging from the fistula, as far back towards
the eye as we can, and draw it through, and then insert the
needle in the opposite side by entering the needle into the
fistula, and bringing it out one-fourth of an inch to the side of
the fistula, opposite the one we at first pierced. Now seize
the needle with the forceps and draw it through till it is out-
side the body, pressing back the tissues with the counter-
522
ΕΑΤΟΝ ON DISEASES OF WOMEN.
pressure hook, or Nott's Depressor (see Figs. 51, 52); tak-
ing care to hold on to the end of the wire, that it be not
drawn entirely through.
Now we have the stitch inserted and both ends of the
wire within our grasp.
Pass both ends of the wire through
the eyes of an instrument I have invented, called a wire holder
and twister. (See chapter on Instruments, and Plate VI.)
Holding on to the ends of the wire passed through the eyes

G. TIEMANN.CO.
FIG. No. 52.-NOTT'S Depressor.
of the instrument with one hand, we carry the wire holder
down to the fistula with the other, steadying it there by the
handle. We now seize the ends of the wire and the handle
of the holder and twister, pressing the holder down firmly
upon the vaginal tissue, and drawing the wire a little tightly
we approximate the edges of the fistula by this movement;
and we have but to turn the instrument round in our fingers
three or four times, and the wire is firmly twisted.
Now remove the holder and cut off the wire with a long
pair of scissors about a half-inch from the vaginal tissues.
Other sutures are to be placed in the same manner till the
fistula is closed.
The stitches should be allowed to remain for about ten
days or longer, and every day we may make an application to
the edge of the fistula of Tr. of Iodine to excite adhesive in-
flammation, using a Sims' speculum gently, to bring the parts
into view. The vagina and bladder should be daily injected
with Calendula wash, and the patient should be kept upon
her side with a catheter retained within the bladder, passed
through the urethra, removing and cleansing it, however,
every two days, to prevent incrustation upon its surface of
phosphatic deposits. If pain is complained of, Arnica or
Cantharides are usually indicated. If inflammation arise with
VAGINAL FISTULÆ.
523.
fever, Aconite is the indicated remedy at first, usually fol-
lowed by Bryonia. Generally these four remedies are the ones
required, unless complications arise, which must, of course,
be treated according to the most prominent indications.
Operations in Chronic Cases of Vesico-vaginal Fistula.
Chronic cases have to be treated somewhat differently
from the recent case. In chronic cases the fistula has be-
come incrusted with urinary deposits, and a sort of mucous
membrane has formed around the fistula. This must be cut
away, and a raw, fresh surface made before the sutures are
inserted, in order to secure union by first intention, or even
rapid union by granulation. For this purpose the long-handled,
curved-bladed scissors are the most convenient. After the
preparatory treatment previously mentioned in operations on
the recent case, and having cleared the parts from incrusta-
tions and applied Calendula wash till the vagina is in a
healthy condition, the patient having been for some time
kept on her side with a catheter in the urethra to secure
the free drainage of the urine from the bladder, that it may
not pass through the fistula and keep up the irritation. Due

GTIEMANN & CO
FIG. No. 53.—Bozeman'S CURVED SCISSORS.
attention should be given to the general health of the pa-
tient, that there may be as much plasticity of the blood as
possible; the bowels kept open by injections of water and
indicated homoeopathic remedies.
The operator should have four reliable, intelligent assist-
ants, and see to it that warm and cold water in suitable ves-
sels is at hand, with towels, napkins, rags, sponges, hema-
statics, needles, and other instruments he may require, not
524
EATON ON DISEASES OF WOMEN.
forgetting Spts. Ammonia and Nit. Amyle (for the prompt use
of these remedies may save a life, which otherwise might be
lost by the administration of anaesthetics).
Every thing being in readiness, the patient may be placed
under an anaesthetic while in bed, and after anaesthesia is
partially induced, the operating table and instruments may
be brought in from an adjoining room, where they have pre-
viously been prepared, together with the other conveniences.
already referred to. After anaesthesia is quite profound, the
patient may be lifted upon the operating table, taking care
to keep her head as low as her body, for otherwise death
might make further steps in the operation quite unnecessary.
The patient is to be placed upon her left side, with her
head low, and an experienced physician given charge of the

FIG. No. 54.
keeping of the patient under
the effect of the anaesthetic
properly. The Sims' specu-
lum and retractor is to be
used as before mentioned.
The right limb should be
supported upon a large pillow
to separate the limbs. We
now seize one edge of the
fistula with the tenaculum,
raise it slightly, insert the
scissors or slender scalpel,
and freshen the margins of
the fistula, making the open-
ing in the vagina somewhat
elliptical, or diamond-shaped,
as represented by the dotted line in Fig. No. 54. This
enables us to adjust the edges more evenly than we could by
leaving the margin of the fistula round or irregular in shape.
In freshening this surface with the scissors, it is best to ex-
ercise a little care to not include the cystic tissue, for great
VAGINAL FISTULÆ.
525
hemorrhage would be likely to ensue, and defeat, for a time
at least, the success of the
operation. 'T is true, Simon in-
cluded the vesical mucous membrane in his incisions; but
how he could succeed in preventing troublesome and dan-
can not see.
gerous hemorrhage we
Prof. Peaslee lost a
case from this cause. Prof. Emmet came near losing two
patients in this manner.
If we should accidentally incise the bladder in making
these incisions to freshen the edges of the fistula, we should
saturate a handkerchief in a small part of its central portion
with liquid Ferri Persulph., and insert it by means of the
finger or a sound through the fistula into the bladder, and
then pack cotton into its interior till strong pressure is ex-
erted against the walls of the fistula, especially the incised
portion.
When, however, we have succeeded in freshening the
vaginal tissues without cutting the cystic membrane and
causing excessive hemorrhage, we may, as soon as the little
hemorrhage commonly present is arrested with cold applica-
tions, proceed to insert the sutures, as described in the treat-
ment of the recent case; and the after treatment is about
the same, save that there is no need in these cases of ap-
plying any Iodine to the seat of the fistula, for the freshen-
ing of its edges has placed it in a condition to heal by what
is termed first intention, while in those cases called recent,
the union is usually produced by the throwing out of granu-
lation, the cases being of several days' standing.
After the operation is completed, wash all blood out of
the bladder with the reversible catheter and a syringe.
Now, the patient should be placed upon her side in bed,
and allowed to come out from under the influence of the
anaesthetic. The catheter should be retained, as previously
mentioned, and the patient kept upon the side for at least
ten days or two weeks. The Calendula wash may gently be
injected into the vagina and bladder each day, and the bowels
526
EATON ON DISEASES OF WOMEN.
may be moved by warm water enemæ.
Aconite, Arnica,
Hamamelis, Canthar., or China may be indicated.
Operation for Urethro-vaginal Fistula.
The same general principle of treatment holds good in the
treatment of urethro-vaginal fistula, as I have just described
in the treatment of vesico-vaginal fistula. The laceration is
usually at the upper portion of the urethra, and extends
somewhat into the bladder, the peculiarity of this condition
being the amount of protrusion of vesical tissue which pro-
lapses through the fistula into the vagina, making it neces-
sary to modify the steps of the operation somewhat from that
just described in the treatment of vesico-vaginal fistula.
Fortunately the parts are more easily reached than where the
fistula is situated higher up in the
vagina, and consequently the pro-
lapsed tissue can be more readily
replaced than it could be if it oc-
curred in vesico-vaginal fistula.
The patient should be prepared
for the operation the same as in
vesico-vaginal fistula. The prepa-
ration of the clothing, table, and in-
struments about the same. A good
sized sound should be introduced
into the bladder through the urethra
and held by an assistant; or a ca-
theter may be used in place of the
sound, which saves the necessity
for the removal of the sound and
the introduction of the catheter after
the completion of the operation,
which is certainly some advantage. If the case is a recent
one, and the vaginal edge of the fistula has granulating sur-
faces, we at once proceed to stitch them together with the

FIG. No. 55.
VAGINAL FISTULÆ.
527
silver wire, using the semi-circular vesico-vaginal needle to
carry it. Care must be taken in placing the sutures, that
we turn back into the urethra the redundancy of tissue which
protrudes through the fistula; for,
should we cut it away, we would
deprive the patient of retentive
power in the bladder, as it is this
redundancy of tissue, which serves
in place of a true sphincter muscle
at the neck of the bladder; and be-
sides the cutting away of this ap-
parent excess of tissue would very
likely cause alarming hemorrhage.

FIG. No. 56.
Either the straight
There is, perhaps, more skill re-
quired in the placing of the sutures
in urethro-vaginal fistula than in
cases of vesico-vaginal fistulæ. The
needle must be inserted, so that
when the suture is tightened the
protruding tissues are turned back
into the urethra, and the vaginal
membrane is brought together over them.
or my curved needle holder may be used, as the rent is sit-
uated longitudinally or transversely to the axis of the vag-
ina-the straight holder being most convenient in inserting
the needle from side to side (see Fig. No. 55), and my curved
holder if we have to insert it from above downwards, or
vice versa. (See Fig. No. 56.) After the wire is inserted
the ends of the wire are passed through the eyes of my wire
holder and twister (Plate VI), and the wire tightened as
we draw gently upon the ends of the wire, and carry the
holder down firmly against the vaginal tissues, at the same
time aiding the turning in of the prolapsed vesical tissue
with the finger of the left hand while we hold the twister
with our right, at the same time grasping the wires, together
528
EATON ON DISEASES OF WOMEN.
with the handle of the instrument. Twisting the wires once
around the index finger of the right hand, enables us to
make traction upon the wire, and press the instrument up
against the fistula firmly, and gives us the use of the left to
turn in the excess of tissue at the same time. After the
raw vaginal surfaces of the opposite sides of the fistula are
brought together the twister is to be turned around about
three times to secure the suture, when the instrument is
withdrawn and the wire cut as before.
In case the urethro-vaginal fistula is of several months or
years standing it becomes necessary to freshen the edges of
the fistula before taking the sutures. In this part of the
operation care is to be exercised not to cut the prolapsed
cystic tissue. A small tenaculum is convenient to lift up the
vaginal tissue around the fistula, so that we can incise it with
a pair of scissors. (The long, slightly curved scissors, page
523, are the most convenient.) After freshening the vaginal
edge of the fistula the superabundant prolapsed tissue is to be
rolled back into the urethra, and the sutures placed as just
mentioned in the treatment of the recent case. After the
operation the patient is to be treated in all respects as after
the operation for vesico-vaginal fistula.
Treatment of Recto-vaginal Fistulæ.
There are sometimes serious obstacles in the way of the
treatment of recto-vaginal fistula. When the recto-vaginal
fistula is caused from syphilitic ulceration no operative pro-
cedure can be of any use, on account of the want of plas-
ticity in the tissues. In this instance remedies given inter-
nally for the syphilitic condition of the blood, together with
local applications of Calendula wash to the vaginal membrane
to heal it, and of Tr. of Iodine directly into the fistula to
stimulate granulations around its margin, is the advisable
treatment.
In cases of cancerous ulceration, causing the recto-vag-
VAGINAL FISTULÆ.
529
X
inal fistula no operation is advised. The application of
Kreosote 1 locally, with the internal use of Phytolac. dec.,
Thuja, Merc. cor., Nit. ac., etc., is most commonly the indi-
cated treatment. We may say, incidentally, that this plan
of treatment is applicable to either form of vaginal fistula
caused from syphilitic or cancerous ulceration.
Where the recto-vaginal fistula is the result of direct
injury (called traumatic lesion) we should at once cleanse
the parts thoroughly, and evacuate the bowels freely with
enemæ. Give remedies to cause a cessation of peristalic action
in the bowels, and prevent their moving for a week or so,
keeping the patient nourished with beef tea, and maintaining
the horizontal position in bed, that every thing may be favor-
able to the healing of the wound by first intention. If in
three or four days we make a careful examination of the
parts, and find they have not healed, stimulating local appli-
cations may be made to the lacerated surfaces to aid in pro-
moting adhesive inflammation or granulation; and the bowels
should be still longer kept inactive, and the diet of beef tea
continued for perhaps two weeks more. If by this time we
find we have failed in securing union of the edges of the
wound we had better allow the bowels to move, and restrain
them again for two weeks, especially if we find the appear-
ance of the fistula indicates that by that time it may become
closed. During this time the daily use of warm water vag-
inal injections is of great service.
It is advisable to stitch the lacerated tissues together in
some instances where they are extensively divided. To do
this the patient should lie upon the back, with the thighs
flexed upon the abdomen. (See chapter on Lacerated Per-
ineum.) The vagina is conveniently dilated with two of
Dawson's improved Sims' speculums, one on either side,
screwing open the divided blade to give room to examine the
laceration, and to take the stitches. The same instruments
are required as in operating for vesico-vaginal fistula, except
34
530
EATON ON DISEASES OF WOMEN.
that no freshening of the edges of the fistula is required in
the very recent case. Where the injury has been received

O
W. F. FORD
FIG. No. 57.-('URVED SCISSORS.
several weeks or months
previous to the time we
are called to take charge
of the case, or to operate,
it is necessary to freshen
the edges of the fistula
before stitching them together; and here we may use the
curved scissors. (See Fig. No. 57.)
Cases of recto-vaginal fistula which have been caused
from an abscess between the vagina and rectum may require
a somewhat modified treatment if they are of long standing.
The collapse of the sac of the abscess, and the adhesion of
its walls in some instances, causes the vaginal walls to be-
come so firmly adherent to the rectum and sides of the pelvis
that it is necessary to loosen them from their attachments
before the edges of the fistula can be brought together with-
out using an undue amount of traction, which would be likely.
to cause the sutures to cut through before union had taken
place. It then becomes necessary to separate or dissect up
the vaginal tissue, so that it is capable of being drawn by
the sutures enough to promote union of the edges of the
fistula without causing the sutures to cut through the tissues.
For this purpose we seize a portion of the vaginal mem-
brane nearest the fistula with a tenaculum, or a pair of dress-
ing forceps, after having freshened the edge of the fistula,
and with a scalpel dissect up the membrane a short distance;
then insert the handle of the scalpel, or use the end of the
finger, to further divide or peel up the membrane, sweeping
the finger around the circle of the fistula till the vaginal
membrane is quite free for a distance of an inch and a half
or so on either side of the fistula, after which we may bring
the edges together with interrupted suture. The vaginal
membrane again unites to the rectum and sides of the pelvis,
VAGINAL FISTULÆ.
531
but in a different position. It now forms a wall for the
vagina, and partially for the rectum as well; and finally a
true mucous membrane is formed over the new vaginal patch
of membrane on its rectal side, curing the rectal opening in
this way. When, however, the opening of the fistula in the
rectum is directly opposite the one in the vagina we may at
the first operation divide the recto-vaginal septum slightly.
hook out the rectal membrane with a tenaculum, slightly
freshen the edge of this membrane, place two or three sutures
in it, and on the tenth day remove these sutures, and com-
plete the operation by closing the vaginal opening of the
fistula, as just described.
TIME TO OPERATE.-About four or five days after the
menstrual period is usually the best time to select for oper-
ating upon either variety of vaginal fistulæ, and should not
be within ten days of the expected commencement of the
menstrual period. The reason for this is obvious.
RECTO-VESICAL FISTULA.
This form of fistula in the female is very rare, as I have
stated, and can not exist independently of atresia of the
vagina. Keeping the patient on her side, with a catheter
retained in the bladder for several weeks, may effect a cure
of the cystic portion. It is well to restrain the action of
the bowels at the same time. The menstrual flow might
then take place through the rectum, if that part of the
fistula remained open. We may operate for the atresia first,
and afterwards for the fistula, which would then become
vesico-vaginal and recto-vaginal, and may be treated in a
similar manner as when present singly, as a result of severe
labor.
VESICO-CERVICAL, OR VESICO-UTERINE, FISTULA.
It has been suggested to artificially cause occlusion of
the vagina in this form of fistula, but the operation must
532
EATON ON DISEASES OF WOMEN.
always prove unsatisfactory, on account of the retention of
stale urine in the superior portion of the vagina not occluded.
Occluding the lower part of the cervix uteri is, to my mind,
a much more desirable operation. To do this we draw out
slightly a little bit of the cervical membrane, and clip it
with scissors, having previously drawn down the uterus with
a stout tenaculum to the os vaginam, which should be held
there by an assistant holding the tenaculum upwards against
the pubis. We may now seize the clipped piece of the
lining of the cervix, and dissect it out all around; then
insert a silver wire suture so as to draw the lips of the os
uteri quite firmly together. Leave the suture seven or eight
days. If atresia of the cervix results the menstrual flow
may pass away through the bladder. Frequent evacuation
of the urine must always be attended to, that it does not
back up into the uterus.
Treatment of Ureto-vaginal Fistula.
If acci-
If congenital this difficulty can not be cured.
dental the ureter is attached to a piece of the vesical mem-
brane; and the ureto-vaginal fistula may be treated similarly
to the vesico-vaginal, of which it is a complication, if it
exists at all. We must, however, be cautious not to include
the ureter in our sutures. Taking care not to do this, we
treat the case exactly as an ordinary vesico- or urethro-vag-
inal fistula.
Treatment of Intestino-vaginal Fistula.
Very small fistula of this variety may be treated by
frequent applications of solid Argent. nit. If large the edges
of the intestine should be freshened and stitched together.
When union of the edges of the fistula has taken place.
so far as the intestine is concerned, the vaginal rent may
be freshened (after returning the prolapsed intestine) and
stitched, as in recto- or vesico-vaginal fistula.
VAGINAL FISTULÆ.
533
Treatment of Fistula in Ano.
This difficulty, arising from an abscess caused by pelvic
cellulitis, is to be treated by remedies and means to cause irri-
tation in the cavity of the abscess; and, consequently, closure
of both abscess and fistula. Sometimes the injection of dilute
Tr. Iodine comp. into the abscess, and repeated every two
days, conjoined with pressure against the perineum, cures
these cases readily. Merc., Cal. carb., Sepia, Nux, etc., are
the usually indicated remedies. If all these means fail, free
division of the tissues with the bistoury and applying some
irritant to the fistula itself, is the means to be used in very
obstinate cases of complete fistula in ano. In incomplete
fistula the treatment is similar, except that sometimes it is
necessary to make an incomplete internal into a complete
fistula in ano, by making an external opening, so as to eva-
cuate perfectly all the matter contained in the sac, which is
often situated at the extremity of an internal blind fistula, and
then to treat the case as in ordinary complete fistula in ano.
Sometimes the insertion of a thread into or through the
fistula, bringing it out through the anus and tying it, and then
moving it from day to day, causes an irritation, which pro-
motes the throwing out of granulations; and, consequently,
causes a cure of the fistula. In works on surgery this fistula.
is usually well described, and its treatment fully laid down.
I will say, however, that I have cured many cases without a
resort to incision, or the use of the seton or ligature, by means
of the treatment first suggested.
Results of Treatment of Vaginal Fistula.
Taken altogether the result is usually satisfactory; much
is dependent upon the extent of the loss of tissue from
sloughing, and the skill of the physician, as well as the willing-
ness of the patient to co-operate in the treatment. Professor
534
EATON ON DISEASES OF WOMEN.
Emmet has given us some valuable and interesting records
of cases, which I take the liberty to abridge and record here.
He reports but one death out of 171 cases of vesico-vaginal
fistulæ operated on. In 6 cases the result he reports un-
known, improved 11, not improved 4, cured 149. These
were, I understand, all chronic cases, except two, which re-
covered without operation. Doubtless even this favorable
result may be improved somewhat in a general average of all
cases which may hereafter be recorded, owing to a better un-
derstanding of the difficulty by the profession at large. The
operations for vesico-urethral fistula show about as good suc-
cess, though the number recorded is much smaller.
Other Methods of Operating in Vesico-vaginal and Urethro-
vaginal Fistulæ.
SIMS' OPERATION.-Professor Sims' operation, as described
by Thomas,† is somewhat different. He prepares the parts for
the sutures by freshening the edges in a similar manner, and
then takes stitches with silk thread first, and then, after they
are inserted, he attaches the silver wire to the end of each
silk ligature, then draws the wire through the tissues with
this, cuts off the silk from the wire, then twists the wires
with his wire twister, which has a slit in it to hold the wires
(a sort of fork in shape). We think the introduction of silk
sutures, to draw the silver wire suture through with, is quite
unnecessary and is liable to many embarrassments.
First. As he inserts all the silk sutures before he attaches
a wire there is confusion among the threads.
Secondly. The silk suture may break when drawn upon
firmly enough to draw through the loop of the wire.
Thirdly. We sometimes find it impossible to make the
wire come through the opening in the tissues made by the
needle.
* Emmet's Principles and Practice of Gynæcology.
† Diseases of Women.
€
PLATE XVII.

UTERUS DRAWN DOWN, TO BRING INTO VIEW A VESICO-VAGINAL FISTULA,
FOR CONVENIENCE OF OPERATING.
VAGINAL FISTULE.
535
Fourthly. This plan leaves the fistula entirely open till
all the sutures are placed, and we have trouble in selecting
the right ends to twist together, or get the other wires twisted
in with the suture we are attempting to secure.
SIMON'S OPERATION. He places the patient on her back,
with the hips at the edge of the table, and resting upon a
He
large, hard pillow-uses wide specula as retractors.
incises the vesical mucous membrane in freshening the edge
of the fistula, as I have before mentioned. When possible to
do so he draws down the uterus exterior to the body, thereby
inverting the vagina and bringing the fistula into view, which
simplifies the operation materially. (See Plate XVII.) He
places two rows of sutures, one to approximate the edges of
the fistula, and the other, inserted further back from the
laceration, to take off any strain on the first sutures.. He
objects to the retention of the catheter in the bladder.
Removal of Sutures.
In about ten or twelve days the sutures may be removed.
Some operators remove them sooner, even as early as five or
six days; but we prefer to wait ten or twelve days, so as to
secure as firm a union as possible before they are removed.
Sometimes there exists a small fistula on the sixth day which

CONTO THOOM W
FIG. No. 58.-CUTLER'S FORCEPS AND SUTURE CUTTER.
O
will be healed by granulation by the twelfth day; and if we
removed the sutures on the sixth day in such a case we would
be likely to make the fistula larger by drawing out the wires,
536
EATON ON DISEASES OF WOMEN.
and cause a necessity for a second operation. To remove the
sutures pass the index finger of the left hand into the vagina
and feel for the highest suture; then with Cutler's suture cut-
ter and forceps we cut and remove it; then the next below,
and so on. This instrument is the invention of Mr. W. P.
Cutler, a student of mine, and is very convenient. It is
made about seven inches in length, with a cutter placed on
one side of the upper blade. The lower blade is made
probe pointed to insert under the suture more readily.
METHOD OF USING THE INSTRUMENT.-Insert the index
finger of the left hand into the vagina till we feel the highest
suture; then insert the forceps with the right hand, keeping
them closed, using the finger already introduced as a guide;
insert the point of the lower blade under the suture to the
right of the twist, open the blades a little, so as to allow the
wire to pass between them; then close the forceps which cuts
the wire and grasps the twisted end and holds it firmly, when
we gently lift the suture out of the tissues. The cutting and
grasping of the suture is done with one pinch of the forceps.
CAUTIONS. If there is considerable hemorrhage the wash-
ing out of the bladder must not be neglected after the opera-
tion is completed, as a large clot of blood in the bladder
might cause much trouble. In removing the stitches be
careful to remove them entire and not cut them on both sides
of the knot, and leave a part of the suture to drop into the
bladder and serve as a nucleus for a calculus. With Cutler's
suture forceps this can hardly occur, as they cut the suture
and hold on to one end of it at the same time.
ELYTROPLASTY.—Elytroplasty resembles rhinoplasty per-
formed by surgeons upon the face. It consists of freshening
the edges of the fistula, as heretofore described, and then
dissecting a flap from the wall of the vagina or buttock, and
placing it into the fistula and making it adhere there by
stitching it carefully to the freshened margin of the fistula.
The operation has, of late years, fallen into disuse.
ند
VAGINAL FISTULÆ.
537
EPISIORRAPHY.-Where there is very extensive ulceration
of the vaginal walls, and the case is complicated with ex-
tensive cicatricle adhesions, episiorraphy is sometimes per-
formed. It is comparatively an easy operation, and consists
in paring the inner surface of the labia majora and stitching
the opposite sides together; or cutting the margin of the
vulva and placing sutures so as to bring its sides together,
and thereby obliterate the vaginal outlet. For at least ten
days after the operation the patient should lie on her stom-
ach with a self-retaining catheter in the bladder (which
must, of course, be removed and cleansed every two or three
days), so as to prevent the urine from accumulating in the
vagina before adhesions have formed. The menstrual flow
thereafter must pass through the urethra with the urine.
KOLPOKLESIS.-Kolpoklesis is similar to episiorraphy. In
this operation the vagina is obliterated higher up, leaving per-
vious as much of the vagina as possible. Professor Simon is
the originator of this operation, and claims that over fifty
operations have been perforined in Germany with success.
SIMPLE VAGINAL FISTULE.
These forms of fistule open into the vagina, but do not
communicate with either of the natural outlets of the body.
They may be
Blind fistula,
Perineo-vaginal fistula,
Peritoneo-vaginal fistula.
The blind vaginal fistula is usually caused from a cellu-
lar abscess opening into the vagina. It may be situated on
the anterior, posterior, or lateral sides of the vagina, but is
most frequent on the lateral or posterior sides. They may be
treated by injections of Calendula diluted, or, if chronic,
be injected with Solution of Iodine every two days till granu-
lations are developed. Another good way to treat them is
to wrap a sound or probe with raw cotton. and, after satur-
may
538
EATON ON DISEASES OF WOMEN.
ating the cotton with Solution of Iodine, swab out the fistula
thoroughly with it, repeating the application every two days.
PERINEO-VAGINAL FISTULA.
This form of fistula of the vagina opens through the
perineum externally. It may be caused from traumatic in-
juries to the parts, or be left after operations for lacerated
perineum, on account of a failure of adhesion of a part of
the surfaces which have been brought in contact. The treat-
ment is similar to that in cases of blind vaginal fistula.
Granulations must be stimulated till the fistula is closed.
PERITONEO-VAGINAL FISTULA.
This is rarely seen. It sometimes may result from the
leaving of a drainage tube too long after operations for
ovariotomy. The fistula communicates from the vagina to
the peritoneal cavity, and allows of the introduction of at-
mospheric air into this cavity, and through it portions of in-
testine may protrude into the vagina.
The TREATMENT consists in returning the intestine and
stitching the fistulous walls together in the vagina after
freshening the vaginal membrane around the fistula, or
arousing adhesive inflammation by stimulating applications.
Remedies.
Cal. carb., Merc. iodid., Ars. alb., Phytolac., Nux, etc.,
may be indicated in this class of cases, on account of the
condition of the general system homoeopathically indicating
their use. Warm vaginal injections of Calendula water are
usually of benefit, as well as being pleasant to the patient.
LACERATIONS OF THE CERVIX UTERI.
539
CHAPTER XLVII.
LACERATIONS OF THE CERVIX UTERI.
LACERATIONS of the cervix uteri in labor are of somewhat
frequent occurrence, and are, doubtless, one cause of the ar-
rest of normal involution of the uterus after confinement,
and, consequently, one cause of sub-involution of the organ
and of Areolar hyperplasia of the uterus as well. Their
agency in the causation of these conditions has until quite
lately been ignored or overlooked, and they are still but
imperfectly appreciated by the mass of the profession.
Lacerations of the cervix are liable to occur in cases
where there is a rigid os uteri in labor, where drugs are ad-
ministered to hasten delivery without giving sufficient atten-
tion to causing relaxation of the os; also, in the use of for-
ceps without first seeing that the os is fully dilatable, or in
performing pedalic version and delivery under the same cir-
cumstances.
One object of this chapter will be accomplished if we
can arrest the attention of the student so as to impress upon
his mind the necessity of attention to the dilatability of the
os, before giving Secale cor. to increase labor pains, or using
forceps or resorting to pedalic version (except in extreme
cases) until the os uteri is fully dilated or dilatable. In
this way much may be done to prevent the sad consequen-
ces resulting from disregard of these precautions.
Lacerations of the cervix uteri may be slight or exten-
sive. They may occur singly or multiple. The laceration may
implicate the bladder and cause cervico- or, as it is sometimes
called, utero-vesical fistula, or it may exist upon the posterior
or lateral aspect of the organ, and affect the peritonæum so
540
EATON ON DISEASES OF WOMEN.
as to cause Puerperal peritonitis or pelvic cellulitis; or it may
be slight and cause little trouble apparently for a time, un-
til it is discovered that chronic metritis or Areolar hyperla-
sia of the uterus, or hypertrophy or induration of the cervix
are present, and the fact is evident on physical examination
that these conditions were caused by laceration of the cervix
in confinement.
The fact that such results follow laceration of the cervix
has caused me to be opposed to forcible, rapid dilatation of
the cervical canal, or of incising it, as has been the practice.
of some upon (as it seems to me) every slight pretext. The
tearing of the tissues with instruments, or incising them, is
little less objectionable than their accidental laceration.
Still, incision of the cervix and scarification of this part is
a favorite and constant practice with some. I am glad I
never fell into this practice, which seems to me more and
more objectionable the more experience I have in the treat-
ment of the diseases of women.
Prof. Emmet, who has paid more attention to this sub-
ject than any other physician living, so far as I can learn,
says:
"During the Autumn of 1862 I accidentally recognized
the importance of this lesion, and at once instituted a surgi-
cal procedure for its relief. The operation then devised has
stood the only true test-that of time-and has been but
little modified. From the above date I have continued to
operate frequently, in both public and private practice.
66
February 8, 1869, I described the operation fully in a
paper read before the Medical Society of the County of
New York. Before the same society, on September 28, 1874,
I presented an article on 'Lacerations of the Cervix Uteri
as a frequent and unrecognized cause of disease.' This last
Emmet's Prin. and Prac. of Gynecology, p. 445.
"'Surgery of the Cervix,' American Journal of Obstetrics, February, 1869.
"American Journal of Obstetrics, November, 1874.
LACERATIONS OF THE CERVIX UTERI.
541
paper was soon after translated by Dr. M. Vogel, and pub-
lished in Berlin, June, 1875. Prof. Breisky, in the following
year, published a favorable criticism* on the paper translated
by Dr. Vogel, together with the report of fourteen cases suc-
cessfully treated by him.
"Etiology of Lacerations of the Cervix Uteri.
"Previous to collecting the statistical material for this
work I had recognized and treated two hundred and nineteen
cases of lacerations of the cervix in my private hospital.
This shows that a little over sixteen per cent of all women
who had passed under my observation, and had been impreg-
nated, were found to have had laceration of the cervix. This
proportion will seem to many a large one, and yet, as the
record extends over thirteen years, doubtless many cases
during that period were not recognized. It was fully six
years after my first operation before I had gained experience
enough to detect this lesion under its varied forms, while the
treatment itself was not perfected until several years later.
To arrive at more definite results as to the frequency
of this injury I have taken from my case-books the records
of the last five hundred fruitful women coming under my
care in private practice. The result is reached that 32.80
per cent of all women under observation, who had been im-
pregnated, and had suffered from some form of uterine dis-
ease, were found to have laceration of the cervix. It is, of
course, possible that this increase in the percentage is due in
a measure, but not wholly, to the fact that cases were sent
to me by general practitioners. But in few instances had
there been a diagnosis made.
The average age of puberty for women who had lacera-
tions was, as will be seen by table XXXIII, 14 years, and
"*Zur Würdigung des Narbenektrodiums des Muttermundes, und dessen
Operativer Behandlung nach Emmet, von Prof. Briesky in Prag. Wiener Med.
Wochenschrift, No. 49, bis 51, 1876.
51429
EATON ON DISEASES OF WOMEN.
Since last pregnancy,
in years...
Criminal Abor-
tion.....
Miscarriages...
Large children.
Craniotomy....
CHARACTER OF THE LABOR WHEN INJURED, AND MODE OF DELIVERY.
TABLE XXXIII.-SEAT OF LACERATIONS OF THE CERVIX UTERI.
AVERAGE AGES AT
Turning.
Forceps...........
Tedious…………………………
Rapid.....
Natural......
Percentage for ench
lesion.
Total
each lesion..
number
for
tion...
First consulta-
6
4.80
5
1
1
5.30
19
5
5.91
10.50
1
I
4.21
I
1
2
2.97
Total number.
164
21
BS
50
20
9
B
10
2
10
Average or percentage 14.00 21.47 33.32
.....
12.19
12.74 22.56 30.48 12.19 5.18
.06
7.92
1.21
6.09
5.21
To the left side...
14.00 21.26 | 31.98
67 40.85
2
19
21
23
10
+
To the right side.
Through both sides.
13.78 21.52 33.60
23
14.02
2
4
ર
14.00 21.04 34.62
50
30.48
9
7
17
6
4
Backward.
Circular
15.00 22.25 42.50
2.38
19
2
I
1
13.81 21.60 30.81 11
6.09
2
13
تن
Not stated.
14.44 21.44 33.33
5.48
+
1

Marriage.........
Puberty.........
LACERATIONS OF THE CERVIX UTERI.
543
To es-
at marriage 21.47 years. These averages approximate so
closely to those of all women under observation, that it is evi-
dent neither the time of puberty nor of marriage had any
bearing on the cause of the lesion. These women first came
under my observation at about the average age of thirty-
three years and four months, the greatest deviation being for
those who had suffered from backward laceration. While the
number of cases is too small to give any importance to the
circumstance, it is not entirely an accidental one, since it is a
form of laceration which would produce the least disturbance,
and then only later in life as the vagina becomes changed in
shape. In one of the columns of the table will be found the
number of the different forms of laceration, and their relative
frequency. It will be seen that the injury on the left side is
the most common, and double laceration the next.
tablish with some degree of accuracy the character of the
labor most likely to result in laceration of the cervix, would
be an important advance. I endeavored with great care to
ascertain from each of these women the prominent features of
the labor in which it was supposed the accident occurred.
Notwithstanding I had so intelligent a class to deal with, I
feel that the information gained is to be accepted only as
approximating to the truth. The testimony of a patient as
to her labors, and particularly the first one, to be of value,
must be confirmed by careful observation on the part of the
attending physician. From a priori inference I had been pre-
pared to learn that rapid labor was the most common cause of
laceration of the cervix. The contrary, however, has proved
to be the case, as more than thirty per cent of the lacera-
tions were attributed to tedious labor. This proportion would
be greatly increased by the addition of the forceps cases,
which properly should be placed under the head of tedious
labor, since, we may assume, forceps were only employed for
delivery after the labor had been prolonged. It will be
noted that two instances of laceration occurred from mis-
544
EATON ON DISEASES OF WOMEN.
carriage, and ten as a consequence of criminal abortion.
Since my attention has been directed to this subject, I have
found the cervix lacerated in every instance where the patient
admitted the fact of exposure to malpractice. And my sus-
picions have been verified several times by the patient ac-
knowledging the charge which I felt justified in making
whenever I detected a laceration produced by discharge of
the uterine contents before full term. It can readily be un-
derstood that laceration of the cervix would occur under these
circumstances as well as in rapid labor where the parts are
so quickly dilated; but as the result of a tedious labor, it is
not so clear, since sloughing would then be a more likely
consequence. If the delay was in the first stage of labor, with
the os tardy in dilating, a condition of the soft parts might
be established which would readily admit of the occurrence
of this accident. But, as a rule, the effect of a tedious labor
would scarcely be asserted until long after full dilatation of
the cervix had been accomplished. I can not divest myself
of the conviction that rapid labor will be found, on further
observation, to be a far more important factor in causing this
lesion than has been indicated by this record. The propor-
tion of rapid labors, as given, is much more likely to be cor-
rect than the contrary. For it is a very natural error for a
woman to exaggerate the time, and to regard a labor as
tedious, although it may have been a natural one in every
respect.
·
"We will now complete the consideration of Table
XXXIII by reference to the last column, in which is re-
corded the average duration, or the interval, since the last
pregnancy. The average length of time in all forms of lacer-
ation was found to be rather more than five years. The
relative duration of this interval, with respect to any one
special form of laceration, is not sufficiently marked for com-
ment, with the single exception of the backward lacerations.
In this form the state of quasi-sterility had existed for twice
LACERATIONS OF THE CERVIX UTERI.
545
the length of time given for any other form of the injury.
The proportion of these cases, as we have already noted, is
smaller than any other, but the sterility was naturally pro-
duced by the greater or less degree of retro-version, which
existed as a result of the laceration extending into the pos-
terior cul-de-sac, and causing contraction of the parts or tissues
located posteriorly.
"MENSTRUAL CHANGES.-The average duration at puberty
of the menstrual flow for the 164 women who suffered from
laceration of the cervix was 4.78 days, while that on the
general average for 2,080 women was 4.82 days. These
averages are essentially the same, and, as there was no marked
difference in the early history of menstruation, either as to
the degree of pain or regularity, it is evident the condition
at puberty would furnish no indication of subsequent liability
to this lesion.
66
Diagnosis.
'Lacerations through the neck of the uterus are of more
frequent occurrence than has been supposed. In fact, I
doubt if a woman can give birth to her first child without
partial laceration taking place; but if it is slight it heals
rapidly and causes no difficulty afterwards. Even most ex-
tensive tears are seldom recognized at the time of labor.
The tissues are then so soft that, unless the rent has passed
beyond the cervix into the vagina and connective tissues, it
can scarcely be detected by a mere digital examination.
Indeed, the occurrence of the accident, in all probability, will
not even be suspected, unless an unusual amount of hemor-
rhage should exist.
"Lacerations in the median line are the most frequent,
and those through the anterior lip are more common than
those in the posterior one. When in the median line and
confined to the cervix, these lacerations generally heal rapidly.
leaving scarcely a cicatricial line to mark their course. This
is due to the fact that the necessary recumbent position of
35
546
EATON ON DISEASES OF WOMEN.
the patient, which is enforced for some time after labor, keeps
the raw surfaces in close contact by the pressure of the
lateral walls of the vagina until they have become firmly
united.
"No serious consequences, therefore, are likely to follow
this accident through the anterior lip of the uterus, unless the
rent passes beyond the cervix through the septum into the
bladder. Even when most extensive, the line may heal
throughout, as there will have been no loss of tissue from
sloughing. This will frequently be the result if proper atten-
tion has been paid to cleanliness, by the use of vaginal
injections of warm water, so as to prevent phosphatic deposits
from the urine on the raw surfaces.
"But, as a rule, when the tear has been so extensive, a
small vesico-vaginal fistula will be left in front of the cervix.
Or the laceration through the neck will heal from above
downward, and leave at the bottom of the fissure a sinus,
along which the urine will escape from the bladder into the
uterine canal. Under the proper head this form of fistula
will be treated of at length. Lacerations through the ante-
rior lip generally occur in women who have borne a number
of children, and in whom there exists great relaxation of the
abdominal walls, and anterior obliquity of the uterus.
"Lacerations through the posterior lip unite as readily,
and the accident may not be suspected, unless the fissure
should have extended sufficiently into the posterior cul-de-sac
to set up an attack of inflammation. When cellulitis occurs
at this point, and from this cause, it always induces a most
intractable form of retro-version. Even when a laceration
has been superficial on the vaginal surface, the cicatricial
band, felt as a cord, will contract, and so shorten the cul-de-sac
as to render it impossible to adapt any form of pessary to it.
To restore the uterus to its natural position, a surgical pro-
cedure has to be resorted to for the removal of this band,
often with most unsatisfactory results.
LACERATIONS OF THE CERVIX UTERI.
547
"The history of the cases suffering from this form of
laceration would indicate that the occurrence of the injury is
due to the position of the occiput towards the sacrum. It
is very rare for bad effects to remain after laceration either
backward or forward, and when they do occur it is excep-
tional. When, however, the laceration is in a lateral direc-
tion, and extends beyond the crown of the cervix, a condi-
tion at once arises which will defeat all the reparative efforts
of nature. In practice, therefore, we have to deal chiefly
with the consequences of lateral lacerations, and the effects
are more marked when the lesion is double than when con-
fined to either side. Whenever the rent has extended to the
vaginal junction, or beyond, there will exist a tendency for
the tissues to roll out from within the uterine canal as soon
as the woman assumes the upright position. The posterior
lip of the cervix naturally catches on the posterior vaginal
wall, as the uterus after a recent delivery is larger than
natural, and lower in the pelvis from its increased weight.
When the flaps formed by the laceration are once separated,
their divergency becomes increased by the anterior lip being
crowded forward in the axis of the vagina. This will he
towards the vaginal outlet in the direction presenting the
least resistance, while the same force naturally crowds the
posterior lip backwards into the cul-de-sac. From thus fore-
ing the flaps apart a source of irritation is at once established.
which arrests the involution of the organ. The angle of lacer-
ation soon becomes the seat or starting-point of an erosion.
which gradually extends over the everted surfaces. With
the increased size and additional weight of the uterus, in-
duced by congestion, the tissues gradually roll out as far as
the neighborhood of the internal os. As the laceration fre-
quently occurs in consequence of rapid labor, or from its hav-
ing been necessary to apply the forceps or to use traction.
the perineum is frequently ruptured.
"Sometimes the laceration heals while the woman remains
548
EATON ON DISEASES OF WOMEN.
in bed after her labor, but when she gets up the surfaces
soon become the seat of an extensive erosion, which bleeds
readily. As the uterus begins to increase in size a profuse
cervical leucorrhoea follows, and, in consequence of a frequent
show, the patient seeks relief. She will state her inability to
stand with comfort, complaining of a continual backache,
with pains down her limbs, sometimes irritation of the blad-
der, and, as a rule, marked nervous disturbance.
"Until recently, this condition of laceration was univer-
sally mistaken for ulceration, and sometimes for the early
stages of epithelioma, and for corroding ulcer of the uterus.
To heal this 'ulceration' would long baffle every mode of
treatment, or, if any improvement took place in the patient's
condition after a protracted rest in the recumbent position, a
relapse would follow again and again, with every attempt at
exercise. Such a case passed from one physician to another,
until eventually the leucorrhoea ceased, and the profuse men-
struation diminished as the surfaces, from the frequent appli-
cation of caustics or the cautery, became cicatricial in char-
acter. Nevertheless, a woman in this condition gradually
became a confirmed invalid while the hypertrophy of the
uterus remained, and from impairment of her general health
the nervous element became most prominent.
"When the laceration has been complete, but confined to
one side, the rolling out is not so extensive, nor is the appar-
ent size of the cervix so large as in the previous condition,
but it is difficult often at first sight to detect the injury. A
partial obliquity of the uterus in the pelvis is thus produced
by crowding the cervix towards the uninjured side, and this
surface and the flattened lacerated portions may present a
common plane to the posterior wall of the vagina on which it
rests. As the flaps separate, the two edges and the unin-
jured side form a tripod, with two legs shorter than the third
one, so that the fundus must necessarily be tilted toward the
injured side. Cellulitis is a most common result of this
LACERATIONS OF THE CERVIX UTERI.
549
accident, and is generally situated between the folds of the
broad ligament on the side of the laceration. The effect of
the cellulitis is to shorten the ligament, and the fundus will
be fixed towards the injured side. This causes the parts which
have been torn down to the vaginal junction, or beyond, to
project into the passage, and as they are covered by a reflex-
ion of the vaginal tissue over this part of the uterine body.
just above the terminating point of the laceration, the effect
to the eye is a length of cervix on that side equal to the
uninjured portion. The apparent os is always more patulous
than in health, and this condition is readily accounted for
from the evident existence of disease within the uterine
canal. Moreover, the deception is still maintained by the
passage of the sound in the median line to the fundus, for
its use gives no indication of the true condition. The explan-
ation is, that the sound passes through a patulous os, along
the angle of the rent on one side of the cervix to the horn
of uterine canal on the opposite side. So deceptive is the
condition that I have been frequently consulted as to the pro-
priety of amputating an enlarged or enlongated cervix. when
if a small portion only of the apparent enlargement had been
removed the peritoneal cavity would have been opened.
The cervix is never so large as it seems to be, and the line.
of junction with the vagina is equally deceptive. It is,
therefore, a wise procedure, in any doubtful case, to place the
patient for examination on her knees and elbows. On the
introduction of the speculum the vagina becomes distended
by atmospheric pressure, and by the aid of gravity the uterus
is brought into its proper position. The true line of junction
with the vagina will be then well marked, and only the actual
length of the cervix will project above the vaginal surface.
In a case of laceration on one side, extending to or beyond
the vaginal junction, the fissure will be detected without diffi-
culty in this knee-elbow position. By the weight of the
uterus its axis in the pelvis will be brought in line to cor-
550
EATON ON DISEASES OF WOMEN.
respond with that of the vagina, so that the depth of the
cleft through the tissues can be appreciated at a glance."
Treatment.
As before remarked, these lacerations sometimes exist,
and are not discovered for a long time. The normal healing
process is ordinarily sufficient to cause healing of the lacer-
ated surfaces, either by adhesion of the opposing tissues or
by the formation of mucous membrane over them. When
the lochia is continued three or four weeks, it is advisable
to make a physical examination to discover if laceration of
the cervix be the cause of the discharge, and, if so, we may
apply some stimulating local application to the unhealed lac-
erated surface. A solution of Iodine, 10 grs. to the oz., is
perhaps as good an application as can be made, using a soft
brush to apply it, and making an application every three
days. This is ordinarily all the treatment required.
The operations performed by Prof. Emmet in cases of
laceration of the cervix are, to my mind, objectionable.
With high regard for the eminent service he has rendered
the profession and humanity, we still believe he has allowed
his zeal in this direction to carry operative procedure fur-
ther than the necessities of these cases require. The cut-
ting away of some of the tissue of the cervix in order to
make a fresh surface, causes loss of substance, which is very
objectionable in its relation to future gestations and deliv-
eries, by reason of the impediment which is thereby offered
to the free relaxation of the muscular fibers surrounding the
os and cervical canal. The cicatrix formed by the union of
the lacerated tissues of the cervix is some impediment to
the delivery of children, in future pregnancies at best; and
the cutting away of any part of them and then securing ad-
hesion, can but increase the difficulty. We do not appre-
ciate the need for these operations. They can do little to
lessen the hypertrophy or Areolar hyperplasia of the uterus,
LACERATIONS OF THE CERVIX UTERI.
551
sometimes very largely caused by them, but not necessarily
remedied when the laceration which is already healed is cut
and stitched together.
Rest, good diet, cleanliness, pure air, etc., are the neces-
sities in these cases, combined with such remedies as are
homoeopathically indicated by the symptoms in each partic-
ular case.
These suggestions apply especially to recent
cases. Cleanliness of the parts and healing is to be secured
by semi-daily injections into the vagina of tepid castile soap
and water, followed by Calendula water.
The chronic case (if found healed) is certainly better let
alone, so far as cutting is concerned. The resulting indura-
tion, ulceration, hypertrophy or Areolar hyperplasia, may
demand treatment; but as a laceration, we are of the opin-
ion it needs none.
552
EATON ON DISEASES OF WOMEN.
CHAPTER XLVIII.
DISPLACEMENTS OF THE UTERUS.
THERE is no disease to which women are liable of so much
importance, and which, in my opinion, is so poorly under-
stood (excepting cancer and phthisis), as Uterine displace-
ments.
As this is read by the general practitioner, I feel sure he
will at first be disposed to differ with me. He will at once
say that it is very easy to diagnose cases of displacement,
and he may be sanguine enough to think he knows how to
treat them. This is likely to be the case if he has had but
little experience. Most young physicians are sanguine on
all departments of medicine, but especially so upon the de-
partment of "Diseases of Women." And if there is one dis-
ease they imagine they understand it is displacements of the
uterus. I hope their opinion is well founded, for they will
have need enough for their knowledge in actual practice.
The student should first familiarize himself with the nor-
mal condition of the uterus and its appendages by dissec-
tion, after having studied thoroughly the anatomy of the
pelvic and abdominal organs. I say abdominal organs, for
there is as much depends upon a knowledge of the anatomy
of the abdominal viscera in diagnosis and treatment as there
is upon an understanding of the anatomy of the pelvic
viscera.
Just here, to my mind, appears the error into which so
many fall. They fail to take into account the influence
which the abdominal organs exert in producing displacements;
neither do they take it into account in the treatment.
Hence, many failures result where success might be just as
DISPLACEMENTS OF THE UTERUS.
553
50%
well achieved, if the case was properly understood. They
seem to proceed as if there was a division membrane, like
the diaphragm, between the pelvis and abdomen. I was told
not long since by a medical gentleman of some pretensions
that there was such a condition of the anatomy of the parts
that the abdominal viscera never could press upon the pel-
vic. This he stoutly maintained against the expressed views
of several medical gentlemen then present. We can only
wonder where he obtained such erroneous ideas. Still, I have
seen very many physicians who practice in these ailments as
if they believed in this kind of anatomy of the parts.
The ordinary practice in these cases seems about as absurd
to me as the former indiscriminate use of venesection, which
is now so generally abandoned. I hope that within the next
decade the universal use of pessaries will also be given up
(as I believe caustic applications will also be), which have had
their day of almost universal use by the old school (would that
homœopaths had kept entirely clear of their employment).
Some homoeopaths have gone to the other extreme, of
depending entirely upon internal remedies in the treatment
of displacements. This practice is about as unwise as the
other. Great good is accomplished with the use of homoeo-
pathic remedies in this class of cases, by relieving congestion
and inflammation, and also in giving tone and strength to the
tissues of the uterus and its appendages. They may also do
very much to aid in the treatment of displacements by re-
storing the normal functions in the liver, kidneys, spleen, etc.,
which may in some cases be remote causes of the difficulty.
But remedies alone are not adequate to rectify a very large
proportion of the displacements of the uterus with which we
meet. I have taken pains to test this matter, and have had
very good opportunities to do so, and did so in good faith,
desiring, if possible, to cure without mechanical appliances of
any kind.
But I can not commend the reliance upon remedies alone;
554
EATON ON DISEASES OF WOMEN.
but claim for them the credit of being very great aids in the
cure of displacements. I very much prefer, however, the
physician who depends upon remedies alone to the one who
relies wholly upon pessaries (especially the great number of
hard pessaries which have been invented and used), as they
do very much injury in very many cases, and good only in a
very few; whereas, remedies are a benefit in all cases when
properly selected. I have made a cut to represent the normal
position of the pelvic viscera and small intestines in the ab-
domen (see Plates I and II).
Plate II represents the bladder as partially distended.
When empty the uterus is inclined a little more forwards in
the pelvis than is represented in the cut. The vagina and
rectum are represented as distended partially, that they may
be understood; but the student must recollect that ordinarily
the folds of the vagina fill it up, though the vaginal walls
are loose and flabby; and he will also bear in mind that
sometimes the rectum is more distended, at others empty
and collapsed.
He will please note that a line drawn from the promon-
tory of the sacrum to the lower portion of the pubis would
intersect the cervix uteri at a point just above the vaginal
juncture; (he will also notice) that the os uteri is directed
backwards and downwards, towards the hollow of the sacrum;
that by taking a pencil and making a line from the fundus of
the uterus to the os, through the uterine cavity, and thence
through the centre of the vaginal canal to the os vaginam,
he would have the arc of a circle.
It is always well to bear in mind this circular shape.
He will also please notice that when the rectum is distended
it will press against the cervix, that when the bladder is dis-
tended it presses the uterus backwards; also, and most im-
portant of all, that the small intestines rest in contact with
and upon the uterus and bladder.
Now, in case the uterus is displaced, the intestines also
DISPLACEMENTS OF THE UTERUS.
555
become displaced, and fall into the space normally occupied
by the uterus. It is easy by studying the Plate to see how
women, by compressing the upper portion of the abdomen
with corsets and dragging it down with the weight of clothing
worn by many fastened about the waist, have pressed the
intestines down upon the uterus, and thereby displaced it.
Now, if the physician forcibly replaces the organ and presses
it upwards with pessaries in the vagina, the uterus is placed
between two pressures, one from above, another from below.
This double pressure would likely produce a flexion, or a
bending of the organ upon itself, or cause inflammation.
Now, it has for many years appeared to me to be a rational
and philosophical practice, to lift up the abdominal viscera
by some means, and give the uterus room to occupy its
normal position. If this is not sensible and philosophical
practice, then my judgment is entirely wrong. Holding this
view, I deem it of vital importance to study in the outset
how this can best be accomplished. Why this idea has been
so universally ignored by writers upon the diseases of women
I can not conceive. The great aim seems to have been to
demonstrate the advantage of some particular pessary to press
the uterus forcibly into position, irrespective of the superin-
cumbent weight resting upon it.
Dr. Emmet seems nearly to have grasped the idea,
which I had already published in 1878 in the Cincinnati
Medical Advance, viz.: The influence of atmospheric pressure
in maintaining the uterus in situ. He says: "I often give
my patients instructions to assume the position on the knees
and elbows at night, and after taking out the instrument
[pessary, I suppose, though he does not mention, either di-
rectly or indirectly, what he means], to open with the fin-
gers the outlet of the vagina while in this position, so that
the uterus may be carried well up into the pelvis by atmos-
pheric pressure."
*Emmet's Prin. and Prac. Gyonecology, p. 129, 1879.
556
EATON ON DISEASES OF WOMEN.
Well, why not open the vagina while the patient is erect?
Does not the atmosphere press with as much force upwards
as downwards? Now, it is clearly the result of taking off
the weight of the abdominal viscera by the knee-elbow posi-
tion that enables the atmosphere to act so forcibly upon the
uterus in its replacement; but he gives no hint of this, nor
does he or any one else mention that lifting off the abdom-
inal viscera by position, causing them to draw away from
the pelvis, thereby creating a partial vacuum in the lower
abdomen, is the main cause of such favorable results from
atmospheric pressure. I therefore claim this idea of the pro-
duction of a partial vacuum, by lifting up the abdominal vis-
cera, in connection with atmospheric pressure as a support to
the uterus, as original, in the treatment of displacements,
though Dr. Sims, in 1854, in a public lecture, and later in
his work on surgical diseases of women, presents the idea of
atmospheric pressure aiding in the reposition of the retro-
verted uterus when the patient is placed in the knee and
elbow position. He fails to mention that thereby a partial
vacuum is produced by the weight of the bowels falling for-
wards and upwards while in this position.
Now, if the uterus is pressed into position, as both Profs.
Emmet and Sims say it is, while the patient is in the knee
and elbow position, and the vagina is dilated for the admis-
sion of air, why not lift up the abdominal viscera, create a
partial vacuum while the patient is erect, and let the atmo-
sphere act as a pessary? If not, then why not?
Prof. H. F. Campbell, of Georgia, has invented a glass
tube similar to a glass speculum, bent at its upper extremity
for the purpose of admitting atmospheric air in cases of pro-
lapse; but I find no mention made of the necessity of con-
joining with its use some means to lift up the abdominal
viscera, and leave a partial vacuum into which the uterus
might readily rise while the patient is in the erect position.
All must concede that the atmosphere presses upwards
DISPLACEMENTS OF THE UTERUS.
557
with as great a force as downwards; and if we can maintain
the abdominal viscera in a position upwards towards the
chest, as is effected while the patient is in the knee-elbow
position, we may have the assistance of the atmosphere at
all times, if we will but admit it into the vagina. How to
accomplish this is the next question.
Herein lies the difficulty; but it must be accomplished,
or little success will attend our efforts to cure many cases
of displacements of the uterus. The gynecologist must give
to this matter personal and careful attention in each patient;
and he must use ingenuity in the application of means to
various cases, and secure the co-operation of his patient.
as well.
There are patients with small abdomens, especially in the
spare built, which may baffle the most experienced and skill-
ful, in which instances rest in the recumbent position upon
the side, with a pillow placed under the hips, and a small
speculum in the vagina (a part of the time), will be the only
alternative; but with those whose abdomens are of some
size an elastic abdominal supporter (called by my friend,
Prof. Ludlam, abominable supporter, and sneered at by many
others) is the efficient means to accomplish the lifting of the
abdominal viscera off from the uterus, and leaving space for
it to occupy its normal position. An improvement of the
"London Abdominal Supporter," which I have had made
by Max Wocher & Son, of Cincinnati, I find the most desira-
ble, except in cases of extremely pendulous abdomens, when
the silk elastic band is preferable. (See Plate XII.)
In adjusting my supporter care must be taken that it is
not too large. It should be small enough so that when
adjusted, nearly the whole length of the elastic straps pass-
ing around the body is required, as otherwise we have not
sufficient elasticity to make them comfortable. The lower
straps must always be buckled tighter than the upper, so as
to cause pressure upon the extreme lower part of the abdomen,
558
EATON ON DISEASES OF WOMEN.
and as the straps are tightened to lift the abdomen upwards.
This necessitates the discarding of corsets and all clothing
fastened about the waist, having it supported from the shoul-
ders instead. Conjoin with this the insertion into the vagina
during the day, for an hour or two, of a round speculum,
having the knees widely separated, with the patient reclining.
This makes up the plan of treatment which I have suc-
cessfully followed for about twenty years, using means to
replace versions, prolapse, and flexions, which I will mention
in connection with the special description of each, occasion-
ally resorting to the inflatable rubber pessary in cases where
we can not secure the co-operation of the patient in the former
mode of treatment.
What I have written I intend as simply a statement of
the general principles of treatment applicable to all displace-
ments, and inflammation of the uterus or cervix as well;
yes, and I may say in cases of inflammation of any of the
pelvic viscera, but not in cases complicated with peri-metritis
or peritonitis, as in these cases the pressure of the sup-
porter (elastic though it is) can not be endured; and we
must resort to the recumbent position till the tenderness is
removed.
I can only account for the contemptuous remarks which
have been made against abdominal supporters on the suppo-
sition that where they have been recommended it has been
left to the patient to purchase and adjust them, and the
patient, failing to appreciate the object of their use, has
made of them abdominal compressors, instead of abdominal
supporters, in which case the term abominable is very cor-
rectly applied by Prof. Ludlam, as compressing the abdomen
in its entirety, or from above, would tend to produce dis-
placement, if it did not exist, and prevent a cure where it
already existed. But the fact that their improper use would
do harm, does not prove that their proper use could do no
good. If it did, then on the same theory, we could condemn
DISPLACEMENTS OF THE UTERUS.
559
every mechanical appliance in gynecology and surgery, as well
as every remedy in the materia medica.
SUPPORTS OF THE UTERUS. The uterus is made, by an All-
wise Creator, freely movable in the pelvis and lower abdomen
to subserve the purpose of gestation; for this reason the
folds of peritoneum, called the broad ligaments, are loose
and freely movable. They, in a state of health, offer no
impediment to the rise of the uterus in the abdomen when
enlarged from pregnancy or other causes, and can offer little
resistance to its displacement downwards, backwards, or for-
wards, though they in some measure act as stays to prevent
lateral displacement. These, with the vaginal walls and the
connective tissue, have been considered the supports of the
uterus. They appear rather flimsy, to say the least, and I
never felt satisfied that I understood the supports of the
uterus till I thought of the influence of atmospheric pressure
in sustaining it in its normal position. Whether right or
wrong, I present the idea to the profession, hoping its truth
or falsity will be demonstrated more fully by others. Of
the correctness of the plan of treatment of displacements on
the general principles, which I have stated I have no doubt,
having verified it by twenty years of trial.
The weight of the abdominal organs must be removed in
some manner from pressing upon the uterus, or it is very
evident the supports of the uterus will give way. Normally
the folds of peritoneum covering the intestines with the con-
nective tissue, serve to maintain their weight; but when
pressed upon from above with corsets or considerable weight
of clothing, the folds stretch out and the intestines rest as a
dead weight upon the uterus and bladder. Their treatment
has been sometimes better than the theory regarding them.
Physicians have been in the habit of introducing enough
atmospheric air, I judge, by their frequent use of the spe-
culum and by means of various pessaries used; and when
they have made the patient recline most of the time, they
560
EATON ON DISEASES OF WOMEN.
have met with some success. They were unwittingly using
atmospheric pressure, and gave the credit to the pessary.
The beneficial effect of atmospheric pressure upon the
engorged capillaries of the uterus and vagina present in most
cases of displacements of the uterus is well described by Pro-
fessor Emmet. He says, after speaking of the advantage of
the knee-elbow position, and the effect of atmospheric
pressure in replacing the uterus when the patient is in this
position, with the vagina dilated to admit the air, "that the
vessels are to a great extent emptied by the pressure of the
atmosphere and by gravity. The pressure also is uniform
and not confined to a portion of the tissues, as would be the
case with an instrument. But more particularly from the
natural elasticity of the pelvic tissues, there would be no
persistent traction exerted on the veins to compress them,
since this same elasticity would soon establish an equilibrium
by expelling a sufficient quantity of air from the vagina."
The relief of this capillary congestion is one of the
objects to be attained in the successful treatment of dis-
placements.
THE CELLULAR TISSUE.-Without doubt the cellular or con-
nective tissue normally exerts considerable influence in sus-
taining the uterus in situ. In displacements this tissue is
more or less torn or stretched, and cellulitis is not an infre-
quent complication of displacements. Very often, however,
when the cellulitis is mild in degree, it is overlooked; but its
results are manifested in adhesions which in chronic cases
· are so often found, and which very materially interfere with
the means used to replace and maintain the organ in position,
and sometimes offer resistance it is impossible to overcome.
In other cases, the efforts at replacement break loose the
attachments formed, and cause a new attack of cellulitis. Of
course, it is not to be expected that atmospheric pressure
will be sufficient to tear loose the uterus where these attach-
* Emmet, Diseases of Women, p. 129.
DISPLACEMENTS OF THE UTERUS.
561
ments have formed; but it may sustain the uterus after it is
replaced by other means, if the weight of the abdominal vis-
cera is removed; and after a time the cellular tissue will
become healed, and attached in its normal position.
ments.
Symptoms.
There are certain symptoms which are generally indica-
tive of displacements of the uterus, and which should lead
the physician to make a physical examination to determine the
nature of the difficulty, which may also be produced by inflam-
mation, in part, it is true; but when taken in connection with
the absence of differential symptoms of heat, fever, etc., pres-
ent in inflammation, may be quite characteristic of displace-
I will mention pain in the pelvis, a, sense of weight
or bearing down in the pelvis and lower part of the abdo-
men, pain in the small of the back, constipation, painful and
frequent micturition, pain in the iliac region, nausea, impaired
appetite and digestion, painful menstruation, colicky pains in
the abdomen, etc., as among these symptoms. When we have
a considerable number of these symptoms present in the case,
whose history shows that it has been somewhat chronic (and
in some recent attacks), we may conclude that there is pres-
ent some displacement of the uterus, and feel justified in
making a vaginal examination to confirm the diagnosis, and
the better to determine the means to be used for its relief.
The diagnosis of the various forms of displacement I will
mention under their proper heads.
Etiology.
Falls, jumping from a carriage or from any elevation, lift-
ing heavy weights, constipation, neglect to empty the bladder
at suitable intervals, tumors in the walls of the uterus or in
its cavity, inflammation of the organ, pregnancy, rising too
soon after confinement or a miscarriage, unskillful attention
in confinement, the compression of the abdomen with corsets
36
562
EATON ON DISEASES OF WOMEN.
or otherwise, great fatigue, general debility, etc., etc., may
tend to cause uterine displacements.
Treatment.
General principles of treatment have been mentioned in
the general remarks I have made upon displacements, as
regards the necessity of taking off any superincumbent weight
resting upon the organ, and the advantages of atmospheric
pressure when conjoined with proper position of the patient,
so as to take off the weight of the bowels at the same time,
or using means to keep them up in the abdomen till their
attachments grow strong, and capable of holding them up.
I will now mention some other points in treatment which are
applicable to all cases of displacement, leaving the discussion
of the treatment of special forms, for consideration under
their several heads. First, rest is an important injunction.
Repeat it often. Secondly, the use of the warm hip bath,
and warm water vaginal and rectal injections, repeated about
twice a day, are of general application and benefit.
Thirdly,
keep the feet and limbs warm if possible, the mind quiet, the
digestion and appetite good. Attention to these points will
be of use in every form of displacement. Generally Nux,
Bell., Acon., Sepia, Hyosc., or Cim. are indicated remedies.
Aconite, for nervousness; tenderness; fever, etc.
Bell., for the stupid, tired feeling; pain in forehead;
pressing pain in the bladder, etc.
Cim., for pain in the ovaries.
Hyosc., for despondent symptoms; disposition to weep;
loss of energy; hysterical symptoms, etc.
Nux, for weakness; loss of appetite; constipation; pain
in back, etc.
Sepia, for pain in the loins and back, accompanied with
a leucorrhoeal discharge.
PLATE XVIII.

COMPLETE INVERSION OF THE UTERUS.
INVERSION OF THE UTERUS.
563
CHAPTER XLIX.
DIFFERENT FORMS OF DISPLACEMENTS OF THE UTERUS-
INVERSION OF THE UTERUS.
DISPLACEMENTS may be downwards, backwards, forwards.
sidewise, or upwards.
Downward displacement of the uterus is termed prolapsus
uteri. If complete, so as to appear externally, it is termed
procidentia (though the terms prolapse and procidentia were
formerly used as synonomous).
The displacement of the fundus backwards into the hol-
low of the sacrum is termed retro-version, and when the uterus
is bent backwards upon itself in the form of a half circle, it
is termed retro-flexion.
When the fundus is bent heavily forward against the pel-
vis, and somewhat prolapsed also, the os being carried back-
wards into the hollow of the sacrum, it is termed ante-version.
When bent upon itself forwards, it is termed ante-flexion.
When tipped to either side, it is termed lateral version.
When carried too high in the abdomen, it is termed up-
ward displacement or elevation.
When turned inside out, it is called inversion of the
uterus.
INVERSION OF THE UTERUS.
Inversion of the uterus may be partial or complete. (See
Plate XVIII) In partial inversion the fundus is turned
into itself. In complete inversion, the entire organ is turned
inside out, or completely inverted. In order that inversion
may take place, it is necessary that the organ be enlarged.
In its normal and unimpregnated state it can not become in-
verted. Inversion will not often occur in the practice of
564
EATON ON DISEASES OF WOMEN.
the careful, skillful physician; but he may be called upon to
treat a case which has resulted from the carelessness or igno-
rance of some one else. As a result of tumors in the fundus
it may become inverted in occasional instances, although the
patient has never been pregnant. B. Langenbeck exhib-
ited the inverted uterus of a woman who had never been
pregnant. On the inverted fundus was seated a fragile sar-
comatous, heterologous growth of broad basis the size of a
walnut. Inversion of the uterus is most likely to result in
the puerperal state after delivery, while the uterus is en-
larged in its entirety, and the tissues are flabby.
Inversion of the uterus may be acute or chronic. In the
acute or recent state, while the os is dilated, it is of the
utmost importance to recognize the difficulty and restore the
organ immediately, as in the chronic state it is very hard to
replace, and the patient is liable to die from shock or hemor-
rhage in a very short space of time after its occurrence.
There are cases, however, where very little disturbance.
is produced in the system by inversion, owing usually, I
think, to the anæmic condition of the patient, and want of
nervous sensibility. A woman once walked into my office
with a completely inverted uterus dangling between her
limbs (thinking it to be a falling of the womb), and stated
that she was attended by a midwife in confinement about
three weeks previously; that before she rose from her bed
this tumor began to appear, and the midwife had pressed it
up into the vagina several times, but it would not stay. On
examination I found the case to be one of complete inver-
sion of the uterus, with the necessary prolapse of the blad-
der and vagina. I proceeded to replace the organ at once,
which I succeeded in doing without much trouble in less
than an hour. I know that subsequently she had two chil-
dren; but for the last ten years I have lost sight of her.
Some authors represent complete inversion as occurring
* Med. Centr. Zeitung, 1860; also, in Barnes, p. 623.
INVERSION OF THE UTERUS.
565
entirely within the vagina. Such cases must be very rare.
Generally, the uterus is very large in cases of inversion, and as
it is inverted and is pressed downwards, it emerges from the
os vaginam and drags with it the vagina and bladder, the broad
and round ligaments, the ligaments of the ovary, and in some
instances portions of intestine into the cavity of the inver-
sion. The rarity of the difficulty may be learned from the
remarks of Dr. West. He says: "No instance of uterine
inversion in the recent state has come under my observa-
tion." "The Annals of the Dublin Lying-in Hospital and
those of the London Maternity Charity illustrate the rarity
of the accident, since it was not once met with in a total of
140,000 labors."
Etiology.
It is ordinarily supposed that inversion of the uterus is
due to traction made upon an adherent placenta; but it may
occur independently of this cause.
Dr. Schroedert says:
“Inversion is doubtless brought about in this way: the uter-
ine foundation, or base of the tumor, which consists of normal
uterine tissue becomes atrophied (either disappearing or un-
dergoing fatty degeneration), by means of the pressure which
the tumor exerts. A gap is thus formed in the firm contractile
tissue, the tumor sinks into the cavity of the womb, and is
driven towards the mouth by its own weight and the con-
tractions of the organ. The os then opens and the tumor
sinks into the canal of the cervix, and thus, the adjacent por-
tions of the uterine wall being drawn down, a complete ever-
sion is gradually accomplished. In some cases, however.
after the tumor has sunk a certain distance into the cavity
of the uterus, the inversion is rapidly accomplished by means
of uterine contractions."
This is a very good description of the modus operandi
of inversions occurring from tumors in the fundus. It may
West, Diseases of Women, p. 231.
†Ziemssen's Cyclopædia, Vol. X, page 215.
566
EATON ON DISEASES OF WOMEN.
be added, that traction upon a uterine polypus whose pedicle
is attached at the fundus may invert the organ. We may
also say that pressure with two or three fingers upon the
fundus through the abdominal walls, soon after delivery may
indent the fundus, and the process of inversion may go on
gradually, as it does in cases of tumors of the fundus, till
the organ is completely inverted.
This indentation may be made by the patient, or the nurse;
or a child climbing over the bed of its mother might put its
little hand upon its mother's abdomen, and the force which
it could exert, might start an inversion (if the mother had
not been long delivered). This is a point of much import-
ance in medical jurisprudence, or would be in case the physi-
cian had a case of inversion on his hands, and also a suit for
malpractice for producing it in the delivery of the placenta.
unskillfully. This indentation by the mother, the nurse, a
child, or any one, might not produce for a time any more
serious symptoms than pains of an intermitting character, which
might readily be mistaken for ordinary after-pains, and hence
the physician would fail to recognize the partial inversion
which perhaps he is blamed for, as well as for producing it
by unskillfulness, when in reality he is not in the least to blame.
Besides, there might be a thickened condition of the tissues
of the fundus, tending to the formation of an intra-mural fibrous
tumor, or there might be already existing a tumor of some size in
the walls of the fundus, which caused the depression in it,
as soon as the uterus was left empty by the delivery of the
child and placenta; and inversion may also result from irreg-
ular contractions of the muscular tissues of the womb.
By these remarks, I do not wish to deny that inversion
may be produced by undue traction upon a placenta which
is adherent to the fundus. I most cheerfully acknowledge
this might be the case; but I wish to impress the student with
the idea that it occurs from various causes independently of this.
INVERSION OF THE UTERUS.
567
Diagnosis.
The diagnosis of a case of inversion is not so easy as
might at first be supposed, especially if the case be one of
long standing. It is most likely in a chronic condition to be
mistaken for a fibrous polypus. The fibrous polypus is desti-
tute of feeling, while the inverted uterus is usually somewhat
sensitive. This is not always the case, however, as it some-
times becomes lost to sensibility. While partially inverted
it has much the appearance of a polypus. We can pass the
uterine sound into the os two or three inches, and sometimes
further, and sweep the sound around the apparent tumor,
and seem to feel the attachment of the pedicle at the fundus
of the uterus.
Sometimes in these cases we can make out the diagnosis
by rectal examination, and be able to pass a finger into the
circle formed in the inverted fundus, and feel the sound
passed into the bladder. In other instances it is impossible
to do this, and we have to rely partially upon the history of
the case.
In uterine polypi we usually have a history of frequent
and profuse hemorrhages, dating back several years, while in
inversion, although we sometimes have much hemorrhage,
the time elapsing since its commencement is shorter (generally
but a few weeks), for if of long duration complete inversion
would have occurred. And even here we may be mistaken,
for I have known a uterine polypus to produce no hemorrhage
till of considerable size. A slight menstruation usually takes
place from the surface of the tumor if it be the inverted
uterus, which never occurs from the surface of a fibrous poly-
pus. The recent case following confinement is usually easily
recognized if complete, by its size, its bleeding surface, or the
partially adherent placenta, the shock to the system, taken
in connection with the recent delivery of a living child, and
the impossibility of a large polypus being retained in the
568
EATON ON DISEASES OF WOMEN.
uterus during healthy gestation, and by the fact that the
tumor was not present when the child was delivered.
Complete prolapse of the uterus may simulate complete
inversion, but in this case the differential diagnosis consists
in that the prolapsed uterus presents an os into which we can
pass the sound three or more inches, while the inverted
uterus presents an oval surface, with no opening in its depend-
ent portion.
The tumor is larger in its lower portion in inversion, and
tapers upwards, while in prolapse the lowest portion is the
smaller. The uterus, which is inverted after confinement,
will contract and become much smaller if it remains long
inverted, though it remains larger than in its normal state-
i. e., complete involution does not take place in the inverted
organ.
Retention of urine is a symptom in some cases of in-
version.
*
Dr.
Several eminent physicians, surgeons, and gynecologists
have made mistakes in diagnosis in cases of inversion.
Emmet says: "I have myself tightened the chain of an
ecraseur around the pedicle of a supposed polypus, which
was attached to the fundus at a distance of over two and
one-half inches from the cervix, where on further investiga-
tion the case proved to be one of inversion. Dr. M. A.
Petit had a patient in the hospital at Lyons which six
experienced surgeons decided had a polypus, which proved
to be an inverted uterus. Dr. Wm. Hunter tied what he
thought was a polypus; the woman died, and the tumor was
found to be an inverted uterus. Dr. Dubois reports two
cases of inversion which were mistaken for polypi by emi-
nent surgeons of Paris. Dr. Denman made the same mis-
take." Drs. Velpeau and Gooch fell into the same error.
Most of the gentlemen in this country who have made this
Emmet's "Diseases of Women," p. 410.
† Barnes's "Diseases of Women," p. 627.
INVERSION OF THE UTER US.
569
mistaken diagnosis have kept their own counsels; therefore,
I mention no names.
The little effect produced upon some women by inversion
of the uterus is truly wonderful, while in others there is a
profound impression made upon the system from shock, like
that which results from severe traumatic lesions. This
shock or depression of nerve force, either with or without
hemorrhage, is sometimes so great as to prove suddenly fatal.
Even simple depression of the fundus has caused shock from
which the patient never rallied.
The symptoms of simple depression are ordinarily pain in
the part with some hemorrhage from the uterus. As inver-
sion progresses the pain is more and more intense, and hemor-
rhage is sometimes profuse, and at other times it is arrested,
in great part, as the uterine surface is firmly compressed
against the cervix in its descent through the cervical canal.
In cases following soon after confinement, the inversion may
take place suddenly with but a small amount of pain,
but the shock in these cases is very great. A weak pulse,
clammy skin, cold extremities, nausea, fainting spells, etc.,
are the symptoms most frequently present in cases of sud-
den and complete inversion, and should cause the physician
to at once institute a physical examination; and, if he does
not feel competent to decide the diagnosis and institute
prompt and efficient measures of relief, he should call for a
consultation at once. In complete inversion the uterus is
found as a tumor in the vagina, or protruding from the os
vaginam, its size ranging according to the condition of the
uterus.
Treatment.
Until within the last thirty years the replacement of the
inverted uterus was thought to be impossible after the lapse
of twelve hours. In 1847, Dr. M'Coy,* of Harrisville, Ohio,
reported a case he had reduced two days after delivery. In
Amer. Jour. Med. Sciences, July, 1847.
570
EATON ON DISEASES OF WOMEN.
the same year M. Valentine* succeeded in reducing one of
sixteen months' standing (Med. Chi. Review, November, 1847).
Dr. Quackenbush, of Albany, in 1855 † performed the first
successful operation for chronic inversion in this country,
though he did not publish the case till 1859. In 1858 Dr.
J. P. White, of Buffalo, reported a case that he had success-
fully reduced which had existed for sixteen years.‡
There are three classes of cases with which we are liable
to meet, and I think it advisable to discuss their treatment
separately. They are, the recent inversion after delivery; the
chronic inversion following delivery, and inversion, either recent
or chronic, caused by a fibrous polypus.
In the case of recent inversion, accompanied with faint-
ness, coldness, hemorrhage, etc., as is usual in cases following
delivery, the indication is clear to apply warmth to the feet
and limbs, and give stimulants freely, though not to the
extent of producing the depression consequent upon excessive
stimulation. These things can be attended to by the nurse,
and we should be busy ourselves in compressing and attempt-
ing to replace the inverted organ.
In the case of complete inversion immediately following
confinement, with the placenta still adherent, it is best at
once to detach it by inserting the fingers between it and the
uterus, and taking it off as we would an orange peel from an
orange. Then seize the uterus in its most dependent part
and compress it upwards, after placing the patient upon her
side with her hips elevated and her thighs flexed upon the
abdomen, having the shoulders and head low. In this posi-
tion, with one limb held up by the nurse, we grasp the
extruded bleeding mass without fear or hesitation, with both
hands, and carry it into the vagina; then, with one hand
grasping the mass, we proceed to carry it upwards by firm,
* Rankin's Abstract, January, 1848.
† Reports, New York State Med. Soc'y, 1859.
† Amer. Jour. Med. Sciences, July, 1858.
INVERSION OF THE UTERUS.
571
continuous pressure, compressing the mass all the while with
the fingers all that we can, at the same time we press upwards
steadily.
This effort is to be persevered in till the hand passes
with the mass up through the os uteri, and still onwards till
the organ is reinstated. Just before this is accomplished
the fundus springs into place, leaving the hand free in the
cavity of the uterus. Do not withdraw the hand at once,
but retain it there for a time, so that by its presence it may
stimulate uterine contractions, and we may be sure that with
the coming on of contractions the inversion does not again
result. As the uterus contracts around the hand, allow it to
slip out, or rather be expelled by the uterine contractions.
Rest, good diet (which, of course, must be mild at first),
and good air complete the cure, if we wait long enough. Still,
to hurry convalescence, China, Ars., Nux, Merc. iod., Ars.,
etc., are useful in giving strength to the patient, if used
according to their homoeopathic indications.
Ars. Alb. is indicated if there is great prostration with
nausea, excessive thirst, etc.
Ars. Iodid.-Prostration, with arrest of the secretions,
scanty, dark urine, torpid bowels, loss of appetite, etc.
China is specially indicated where there has been great
loss of blood, and there is great weakness, difficult respir-
ation, feeble pulse, blanched countenance, etc.
Merc. Sol. Great weakness, with diarrhoea, impover-
ished blood, coated tongue, with profuse leucorrhoea.
Nux Vom.-Prostration, with colicky pains, constipa-
tion, loss of appetite, general nervousness, exhaustion, trem-
bling of the limbs, tendency to paralysis, etc.
Treatment of Chronic Inversion of the Uterus.
After twenty-four hours the inversion may be considered
chronic, as the organ has by this time contracted (including
the cervix) so that it will be impossible to reinstate it with
572
EATON ON DISEASES OF WOMEN.
}
the hands, as just described in treating the recent case, or,
it is at least impossible to carry the hand within the os and
complete the reinstatement, though the same principle of treat-
ment is applicable.
In the chronic case, especially the one which has existed
for years, a considerable amount of perseverance is neces-
sary to accomplish the reposition of the organ.
repeated trials, aided by anaesthesia.
It may take
OPERATION TO REINSTATE THE UTERUS IN CHRONIC INVERSION.-
In the first place, the bowels and bladder should be freely
emptied just previous to the commencement of the attempt
to reinstate the organ. The patient should lie upon the side,
with the hips elevated, the patient's face being turned a lit-
tle downwards from a side position. This draws the abdom-
inal viscera away from the pelvis about as well as the knee-
elbow position, which we can not adopt in this case on
account of the length of time required in the operation, as
well as the anaesthetic, which it is advisable to give till
complete anæsthesia is produced. One limb should be held
up by an assistant, and the well-oiled hand should grasp the
tumor and carry it up into the vagina; still maintaining the
grasp around the mass, press upwards.
We now insert a repositor, as represented, with a cup-
shaped extremity (see Fig. 59), to fit over the inverted fun-
dus, with a handle about fifteen inches long. This may be
made of hard rubber or hard wood turned into proper shape,
or an old-fashioned wood stethoscope may be used, if noth-
ing better can be conveniently obtained. Dr. White has
invented a similar apparatus, with a spiral spring attached to
the handle to press against the body of the operator. (See
Fig. No. 59.) With this repositor we continue to make
steady pressure, still maintaining the grasp of the hand
around the mass as high up as possible.
Now, expand the thumb and index finger as widely as
possible, thereby dilating the cervix by pressing against the
INVERSION OF THE UTERUS.
573
vaginal wall at its junction with the uterus. Thus, by ex-
panding the ring through which the fundus has to pass, and
compressing and forcing up the mass with the hand and the
elevator we gradually return it within the os. We should

Fig.2
Fig.1.
g
FIG. No. 59.-WHITE'S UTERINE REPOSITOR.
now have at hand a smooth, round piece of hard rubber, an
inch in diameter and about fifteen inches in length. This
insert into the cervix, and carry the fundus before it till it
jumps away from the pressure, as it will when almost rein-
stated.
After the fundus is within the os, we may sometimes
complete the operation with a finger carried up into the cer-
vix; but often the finger is not long enough, and we can not
in this way exert the force we desire, and which is found
to be necessary to complete the turning. Prof. Emmet rec-
ommends "stitching the os together when the restoration is
so far accomplished as to get the mass into the os uteri in
cases which make it desirable to discontinue the anaesthetic
on account of the length of time consumed in the operation,
in order to retain what advantage he has gained to start on
574
EATON ON DISEASES OF WOMEN.
at his next attempt."* I believe if we have the round ele-
vator I have just described at hand, of a size just large
enough to enter the cervical canal, we may complete the op-
eration at the first trial, as it is getting the fundus up through
the os, which is usually the most difficult. Dr. Emmet also
recommends the pressing of two fingers into the depression in
the uterus from above through the abdominal walls, and press-
ing it from one side to the other, dilate it, so as to admit of
the return of the inverted portion.
It is always desirable when the physician is about to
attempt to reinstate the chronically inverted uterus, to have
two or three skillful assistants to relieve him from time to
time in making the necessary compression upon the mass to
be returned, as well as to give the anaesthetic. This need
not be continued all the time; it is better for the patient
that she come out from its effect for a short time every half
hour or so. After the reinstatement of the organ the patient
should be kept in the recumbent position for several days, and
Secale cor. should be given in large enough quantity to obtain
its secondary effect (that of inducing contraction).
If the uterus does not contract when a reasonable quan-
tity has been given, the finger should be introduced into the
cervix, and by frictions attempt should be made to excite
the contraction of the muscular tissues. When this contrac-
tion commences administer Secale to increase it, giving the
remedy in twenty-drop doses of the Flu. ext. in warm water
every twenty minutes till three doses are taken; then wait
for results. Generally speaking the case is to be now treated
as an ordinary one of sub-involution.
Treatment of cases of Inversion caused from Tumors of the
Uterus.
In case of inversion from traction upon a tumor attached
to the fundus, or from the efforts of the uterus to expel it,
* Emmet's Prin. and Prac. of Gynecology, p. 426, 7.
INVERSION OF THE UTERUS.
575
the first indication is to remove the tumor with the ecraseur,
if pedunculated, or by enucleation if not pedunculated, and
proceed to reinstate the organ as in the chronic inversion just
described, though if there is not much hemorrhage we may
well wait till the wound caused by the removal of the tumor
has healed.
In the recent case following delivery, where there is a
small intra-mural fibrous tumor in the fundus, I would smear
the uterus with Ferri persulph., make an incision, remove the
tumor by enucleation, and proceed to restore the organ by
taxis, as before described in treating of recent cases of inver-
sion. Take no sutures in the lips of the incision.
Other Methods of Operating.
SIMPSON'S AND THOMAS' METHOD.-" This consists in making
an incision through the abdominal wall, so as to get at the
constricted os uteri from above, and then apply a dilating
force." Dr. T. G. Thomas has been bold enough to put this
suggestion into successful practice in two cases; one of these,
however, resulted fatally, from peritonitis.
BARNES METHOD -"In 1868, Dr. Barnes having failed
by ordinary means in the reduction of a case of inversion,
passed a slip knot of tape over the inverted uterus and drew
it down. He then made three incisions in the neck of the
uterus and reinstated the organ by Emmet's plan. No mate-
rial inconvenience followed." "Drs. Sims and Thomas ‡ have
put this plan in practice, and it is also recommended by Sir
James Simpson."
+
WATTS' METHOD.||-"Recently, Dr. Robert Watts, of New
York, has succeeded in reducing a case of inversion at the
Roosevelt Hospital, in the following manner: He first drew
down the uterus, so as to make it protrude partially from
* Emmet's Principles and Practice of Gynecology, page 417.
†Thomas, Diseases of Women, page 636.
Emmet, page 418.
Emmet, page 418.
576
EATON ON DISEASES OF WOMEN.
the vaginal outlet, and then passed two fingers into the rec-
tum. He then pressed a finger into the depression formed at
the seat of inversion. Then by means of the hand grasping
the uterus at the mouth of the vagina, the organ was gradu-
ally pushed down on to the finger, which, of course, carried
before it a portion of the anterior rectal wall. He then suc-
ceeded in getting two fingers through the ring, when it be-
came sufficiently dilated for the fundus to be pushed up on
the point of the index finger. Without further difficulty the
restoration was completed."
SPONTANEOUS REDUCTION.-Strange as it may seem, there
are several cases of spontaneous reduction of the inverted
uterus reported by Dr. Meigs. I can not understand and
will not attempt to explain how it is accomplished. Of these
cases Dr. West remarks: "It is easier to conceive that an
experienced man should commit an error of diagnosis than to
understand how any efforts of nature could cure a chronic
inversion of the womb."
AMPUTATION OF THE INVERTED UTERUS.-Amputation should
be only recommended when the life of the patient is placed
in the greatest peril from non-interference. The statistics,
however, are not so formidable as one might imagine they
would be. From cases collected by Schroeder* and Scan-
zonit we have the following results: "Total, sixty-nine am-
putations, forty-nine recoveries."
Simple removal.....
Simple ligature...
Ligature and removal....
Total.
Deaths.
14
8
26
29
7
LO
5
I will suggest that care be used not to amputate the
entire organ; simply cut off the fundus and a part of the
cervix. The application of a ligature of wire is perhaps
preferable to any other, tightening it from day to day, and
removing the greater portion of the tumor with the ecra
#Ziemssen's Cyclopædia, Vol. X, page 221.
† Emmet's Diseases of Women, page 440.
INVERSION OF THE UTERUS.
577
seur or knife an inch or so from the ligature, after two or
three days. Dr. Emmet says he would not perform the
operation under any circumstances, though he has known
three amputations in the practice of others to recover.
ANOMALOUS CASES.-Gerard de Beauvais relates a case
of recent inversion where death resulted from the strangula-
tion of the intestine in the uterus. One case related by
Guyon had existed twenty years without disturbing the
health. Dr. Comstock relates a case of inversion where
the patient followed the occupation of a dairy-maid. Dr. H.
Miller, of Louisville, Ky., relates a case where the uterus,
ovaries, and ligaments were torn out by a midwife, and the
patient recovered. He believes in amputating the womb.
THE UTERUS HAS BEEN KNOWN TO SLOUGH OFF. E. Cle-
mensen § reports a case of complete inversion where the
uterus separated by gangrene, and the patient recovered.
ELEVATION OF THE UTERUS-UPWARD DISPLACEMENT.
Upward displacement is not of so frequent occurrence as
other varieties. It is produced by hæmatometra in cases of
atresia of the lower portion of the vagina or imperforate
hymen, and from recto-vaginal hæmatocele, especially when
the hæmatocele is developed in the cellular tissue below
Douglas' cul-de-sac. Occasionally peritoneal attachments, oc-
curring during the latter months of normal gestation, serve to
retain the uterus in an unnaturally high position in the ab-
domen. It may also be displaced upwards by tumors in the
pelvis.
Treatment.
The treatment consists in removing the cause produc
ing it.
* Acad. de Medecine, 1843.
† Jour. de Chir. et de Med., 1861.
Boston Med. and Surg. Jour., Vol. VIII.
Louisville Med. Jour., 1870.
¿ Barnes' Diseases of Women, page 624. Hospital Tidende, 1865.
37
578
EATON ON DISEASES OF WOMEN.
.
CHAPTER L.
RETRO-VERSION AND RETRO-FLEXION OF THE UTERUS.
RETRO-VERSION and retro-flexion are of frequent occurrence,
though often not recognized by the physician, an error of
diagnosis being more frequent in retro-flexion than in retro-
version. This is my own experience, though Prof. Emmet
gives only twenty-nine cases of flexures of the body of the
uterus backwards out of three hundred and forty-five cases
of displacements. He, however, records one hundred and
eighty-two cases of flexures of the cervix, without saying
whether they were backwards or forwards. I infer that he
found most of these flexures of the cervix backward, which
would make a total of two hundred and eleven cases of
backward displacements out of a total of three hundred and
forty-five cases. This would approximate my own experi-
ence, though I have kept no exact record of cases (never
having intended to publish them). 52.75 per cent of all
flextures he found to be in the cervix, and 47.25 per cent
in the body of the uterus. I have found that most flexions
were at the juncture of the body and the cervix. Dr.
Barnes says: "Retro-version is not nearly so frequent as
retro-flexion." This is also my experience.
Retro version and retro-flexion may be congenital or ac-
quired. By retro-version is meant the tipping backwards
of the body of the uterus into the hollow of the sacrum, the
os being carried forwards nearly or quite against the pubis.
so that the axis of the organ is transverse in the pelvis.
Retro-flexion signifies the falling backwards of the fundus
* Emmet's "Diseases of Women," p. 327.
† Barnes's "Diseases of Women," p. 599.
PLATE XIX.

RETRO-VERSION OF THE UTERUS.
RETRO-VERSION AND RETRO-FLEXION.
579
against the rectum, the os remaining in its normal position
or being carried slightly forwards. In these cases the uterus
is in a sort of half-moon shape, its concavity looking down-
wards and backwards. Sometimes the uterus is bent upon
itself at an almost acute angle, and is still termed retro-flex-
ion if its concavity is backwards or downwards or both.
Both in retro-version and retro-flexion the fundus of the
uterus presses upon the rectum.
Until the present century little was known of displace-
ments of the uterus. Simpson and Kiwisch have the honor
to have instructed the profession more than any others in
regard to displacements, mainly on account of the facility of
diagnosis gained by the use of the uterine sound.
Etiology,
Retro-version and retro-flexion are the result of similar
causes, except that the flexure occurs where the uterine tis-
sues are flabby and relaxed.
These displacements are usually the result of enlargement
of the body of the organ, more particularly upon or within its
posterior wall (due to inflammatory action or the development
of small tumors in the muscular tissue), and the condition of
sub-involution, or enlargement in pregnancy, or from the
growth of polypi within its cavity, conjoined with a relaxed
condition of the broad ligaments, and also a relaxed condition
of the peritoneal folds, which ordinarily support the intestines.
This relaxation of the supports of the intestines and the broad
ligaments of the uterus takes place in pregnancy to allow the
uterus to rise in the abdomen; and when the product of con-
ception is expelled, and the uterus contracts, these supports
to the intestines are left weak and of unusual length; and if
the patient. rises too soon after confinement, and the intestines
press heavily upon the uterus, this weight of intestines, con-
joined with the sub-involuted condition of the uterus, and the
relaxed condition of the pelvic connective tissue and vaginal
580
ΕΑΤΟΝ ON DISEASES OF WOMEN.
*
walls, together with the distended condition of the colon from
accumulation of fecal matter, all tend to produce retro-ver-
sion or retro-flexion. I should also mention the distension of
the bladder as a cause of retro-version.
In this condition a jolt of the body might bend the fundus
of the uterus backwards underheath the promontory of the
sacrum, causing either a case of retro-version or retro-flexion;
and the pressing downwards of fecal matter in the rectum
would increase the flexion or version. This possible effect
of the over-distended bladder should be constantly recol-
lected.
The student should constantly bear in mind also that not
only in retro-version, but especially in retro-flexion, there is
some prolapse of the entire organ as well. Many cases of
retro-flexion are overlooked for this reason.
The physician makes a digital or specular examination,
and finds the cervix lower in the pelvis than normal, with the
os directed a little forwards, and concludes there is prolapse
(as is evident), and so diagnoses the case. He next attempts
to replace the organ by pressing the os upwards, and inserts
some kind of a pessary to keep it up. This allows the fundus
to come downwards more and more, and the patient gets no
relief. Another and another pessary is tried without avail.
The patient consults other physicians, who try a wad of cot-
ton saturated with Glycerine, or make local applications to the
cervix with a brush (which by this time is much inflamed and
enlarged). There is probably by this time considerable dis-
charge from the os, indicating endo-cervicitis or endo-metritis.
This recital possibly looks a little overdrawn to some,
but it is a true picture of many cases which have come
under my observation, and if it was simply loss of time
and money to the patient it would not be so bad; but it
has often broken the constitution of the patient, impaired
digestion and nutrition, and caused cellulitis, peri-metritis,
ovaritis, or some ailment which will sooner or later terminate
..
PLATE XX.

RETRO-FLEXION OF THE UTERUS.
RETRO-VERSION AND RETRO-FLEXION.
581
,
fatally, all of which might have been avoided by a correct
diagnosis and proper treatment in the outset.
It is not often that the unmarried woman has retro-ver-
sion or retro-flexion, but occasionally cases do occur among
this class.
Rectal adhesions are said by Dr. Barnes to be a cause
of retro-version. These rectal adhesions may result from
cellulitis, either with or without the occurrence of recto-
vaginal hæmatocele. While this hæmatocele exists it crowds
the uterus forwards and upwards; but when it is evac-
uated through ulceration or artificially, the uterus is liable to
bend backward against the rectum in the space recently
filled with the hæmatocele, and there being present some
inflammatory action, adhesions are liable to occur, and the
uterus is permanently retro-verted or retro-flexed.
I must not fail to mention the great influence which gen-
eral debility has in causing these displacements. General
debility certainly tends to produce them, and in turn is pro-
duced by them, and increased by this condition when dis-
placement already exists. Inattention to the calls of nature,
leaving the bowels heavy, tends to depress the organ, when
the accumulation of fecal matter in the rectum presses down
the fundus. Heavy lifting or a sudden strain, while the
bladder is distended, may tip the uterus backwards.
Flexions occurring after the climacteric period are due to
atrophy and atony of the uterine tissues. They do not. how-
ever, produce as much effect upon the patient at this period
as during the time of menstrual activity.
Diagnosis.
}
The patient complains of constipation, frequent desire to
micturate, pain in the back, nausea upon rising in the morn-
ing, a sense of weight and bearing down in the pelvis, pain-
ful menstruation. If married, she also frequently complains
of dyspareunia. These symptoms will quite clearly indicate
582
EATON ON DISEASES OF WOMEN.
a case of retro-version, but the positive diagnosis can only
be made by a physical examination. In retro-flexion we
have a similar train of symptoms, with the exception that
there is not so much vesical irritation, the cervix not being
carried far enough forwards to irritate the urethra or base
of the bladder to any great extent. These symptoms may
come on suddenly after some sudden fall or effort at lifting
or jumping, constituting an acute case, or they may come on
gradually, and be of long duration.
In these latter chronic cases there is usually present a
considerable leucorrhoeal discharge, often excoriating in char-
acter, producing vaginitis and vulvitis. The derangement
of digestion is usually marked, and the patient is troubled
with tympanites. The patient has usually had much treat-
ment for prolapsus, and is thoroughly discouraged. Often
there is a severe cough complained of, frequently caused by
the derangement of the stomach, produced by the displace-
ment and not connected with any disease of the lungs more
than a slight bronchitis, which has resulted from the cough
rather than being the cause of it. A thorough physical ex-
amination will clear up the diagnosis, and is, of course, nec-
essary to rectify the displacement.
In retro-flexion, a vaginal examination reveals the os in its
normal position, save that it is carried a little forwards and
downwards. (I will just here say that the physician should
have his patient evacuate the bowels and bladder just pre-
vious to the examination, if possible). If she has recently
menstruated, and there is no fear of pregnancy in the case,
we next proceed to introduce the uterine sound, the patient
lying upon the back with the knees drawn up, and covered
with a sheet (of course.) We first attempt to pass the in-
strument with its concavity forwards, as it would need to be
if the uterus was in its normal position; in case the instru
ment is arrested in its course, we turn it over till its con-
cavity looks backwards; if, then, it will not advance, we
RETRO-VERSION AND RETRO - FLEXION.
583
should press up the fundus through the posterior wall of the
vagina or through the rectum with a finger of the left hand,
while we still attempt to introduce the sound with the right
hand. Generally, in retro-flexion the sound passes up about
an inch in nearly a normal direction. In retro-version, we
direct the sound backwards from the start. The os being
rather tightly pressed against the pubis and rather inclined
upwards, we sometimes have to push up the fundus either
through the vagina or rectum before we can get the sound to
enter the cervix. In case the sound enters the fundus while
directed backwards, it is conclusive proof of the backward
displacement.
When we introduce the sound, and it passes readily up
into the uterus in its normal position, we know that the
symptoms in the case are due to some other cause than dis-
placement. If we can detect a globular body posterior to the
cervix, which we had thought to be the fundus, and which
we have by the sound found to be something else, we should
at once try to ascertain what the tumor is. It might be
impacted feces-the ovary enlarged and displaced-a tumor
on the posterior wall of the uterus, or it might be a recto-
vaginal hæmatocele of small size, or indicate the commence-
ment of cellulitis.
The aid of the speculum is not required in the examin-
ation of cases of displacement.
In case pregnancy is suspected or known to exist, and
we have symptoms strongly pointing to retro-version as the
difficulty, we must depend upon the information we may
gain by digital examination per vaginam and rectum. Gen-
erally we are aided in the diagnosis by the suddenness of
the attack, and the enlarged size of the uterus, as well as
the irritation of the bladder being more severe on account of
the pressure being greater than in cases where, the uterus is
unimpregnated, owing to the uterus being longer, and conse-
quently forcing the os harder against the urethra. This is
581
EATON ON DISEASES OF WOMEN.
especially the case if the uterus is retro-verted.
In case it
is retro-flexed we have to depend upon rectal examination,
in connection with the symptoms and the history of the case,
to make out the diagnosis.
In some instances adhesions take place in the cervical
canal at the point of greatest flexure, and in all cases the
cavity of the cervix is lessened in size, at the point of flex-
ure, which in part accounts for the dysmenorrhoea, so gen-
erally complained of, especially if the flexure is at all
abrupt. It particularly affects the unmarried and sterile in
this way. Those who have had children are not so frequently
troubled with painful menstruation, even though they have
a retro-flexion of the uterus.
Various nervous symptoms of a sympathetic character often
complicate cases of retro-version or retro-flexion. One descrip-
tion so admirably given by Dr. Barnes* I quote on this point:
"The nervous system, often so susceptible in women, will
exhibit the most marked aberrations. The nervous centers
respond to the slightest impressions. Hysteria breaks out in
all its manifold eccentricities. Neuralgia appears in one or
more of its various forms, as sciatica, lumbago, tic-douloureux,
rheumatism; headaches and a disposition to vertigo or syn-
cope frequently recur; emotional, moral, and intellectual
disturbances as manifested in irritability, despondency, melan-
choly, loss of command over feelings and thoughts are often
developed. Many of these phenomena may be thus traced to
bad nutrition; but there is good reason to believe that espe-
cially the nervous phenomena are more directly induced, or
are, at any rate, aggravated, by the influence of the displaced
uterus upon the nervous centers."
The congested displaced organ is a constant source of ner-
vous irritation and exhaustion; it is constantly pressing upon
the sacral plexus; it is constantly sending painful impressions
to the nervous centers; constantly using up in a morbid
* Barnes' Diseases of Women, page 608.
RETRO-VERSION AND RETRO-FLEXION.
585
direction the nerve force which is wanted for the performance
of healthy function.
A not uncommon form of nervous disorder, induced by
retro-version, is severe, almost constant, pain in the lower
part of the spine; sometimes most intense in one fixed spot.
Many such cases have been treated as sufferers from
spinal disease, and have been confined to the couch, wearing
various spinal instruments for months and years under the
erroneous belief that the spinal suffering was primary and
organic, its sympathetic character not being suspected. With
or without marked spinal pain, a sense of numbness, and
want of power, especially of inability to walk, are often com-
plained of, and tend to confirm the belief in spinal disease.
Brown Sequard distinctly traced paraplegia to a retro-flexed
uterus.
I can well imagine the surprise with which the reference
of these formidable consequences to retro-flexion of the womb
will excite in the minds of those physicians who are igno-
rant of the pathology of the pelvic organs. They perhaps
will exclaim, "Such are the extravagances of specialists."
Yet, I would ask, is not the sequence of events as nar-
rated quite in harmony with sound pathology? I am very
sure they are in harmony with accurate clinical obser-
vation. If this be doubted by those who are ignorant of
gynæcology, may it not be because they have thought it
might be possible to study successfully diseases in women,
whilst omitting to take note of the diseases of those organs
which make women what they are? The test of treatment
confirms the conclusion drawn from diagnostic explorations.
In the great majority of cases the evils enumerated as found
in association with retro-flexion are relieved and finally re-
moved when the retro-flexion and its local consequences
are cured.
UTERINE CHANGES CAUSED BY FLEXION OF THE ORGAN.-
Obstruction to its circulation brings congestion. This leads to
586
EATON ON DISEASES OF WOMEN.
hypertrophy of its walls, especially of the body, the vaginal
portion often partaking only slightly in this change.
The obstruction to the escape of menstrual and mucous
secretions from the cavity of the uterus increases the conges-
tion, and leads to increased secretion, These being retained
uterine contractions are excited to expel them, the os inter-
num being more or less closed, the uterus contracting as a
sphere upon its contents. There is, then, in proportion to the
extent of the obstacle opposed in the os internum, dilating
force applied to the mouths of the tubes. These gradually
yield, and a retrograde dilatation of the tubes sometimes will
follow.
The dilatation of the cavity of the retro-flexed uterus is
always attended by some amount of chronic inflammation of
its mucous membrane. Perhaps the term inflammation is
illy chosen; the condition is rather one of constant engorge-
ment, leading to rapid shedding of epithelium and increase
of mucous secretion.
The retention of the mucus causes uterine colic. A cer-
tain quantity of mucus must accumulate before the uterus
becomes so distended, as to excite it to contract. This quantity
in many women is remarkably definite, taking in some cases
a week, in others a fortnight, to collect. Why the expulsive
colic simulating dysmenorrhoea occurs midway between two
periods, is simply because the uterus being emptied at the
menstrual epoch, the secretions begin to gather again from
that time, and cause contractions when it becomes filled up.
Not seldom a little blood is mixed with the mucus. This is
not to be interpreted as the result of ovulation, but is simply
hemorrhagic and the product of engorgement.
It is a common history we hear from women suffering
from uterine obstruction, that they have periodical gatherings
like an abscess in the womb, attended by severe colic and ex-
pulsive pains, which are relieved by the "bursting" and
escape of a quantity of discharge. These cases are of the
RETRO-VERSION AND RETRO-FLEXION.
587
kind above described, although they may not exhibit equally
regular periodicity.
Treatment.
There are three classes of cases of retro-version and retro-
flexion, which require a somewhat different treatment. In
retro-version we expect to be more successful than in retro-
flexion. This is due to the flaccid condition of a part or a
whole of the uterine tissue in most cases of retro-flexion, and
causes a return of the difficulty more readily. The three
conditions which require modified treatment are:
The recent case which is not pregnant,
The case complicated with pregnancy,
The chronic case not pregnant.
and
In the recent case of retro-version or retro-flexion (which
is usually caused by a strain, jolt, or fall) we have little diffi-
culty in effecting a complete and rapid cure, for in these cases
the abdominal viscera are not so much displaced, and the
attachments of the intestines have not given way so much,
as in chronic cases. We, therefore, need pay but little at-
tention to lifting up the intestines, and need use no pessaries.
Ordinarily, when the uterus is reinstated in these cases, it
stays.
OPERATION FOR REINSTATING THE ORGAN.-First, have the
bowels and bladder evacuated. The patient may then be
placed upon her left side, with her hips upon a pillow, shoul-
ders and head low, and the thighs flexed upon the abdomen;
or she may rest upon her knees and chest, called the knee-
elbow position. The hips in this position are elevated at an
angle of about forty-five degrees, and the weight of the
abdominal viscera draws them away from the pelvis, and
leaves a space for the uterus to occupy its normal position.
Either of these positions of the patient is desirable. (I have
often, however, in recent cases replaced a retro-verted uterus
with the patient reclining upon the back; but it is more diffi-
cult, and I do not recommend it.)
588
EATON ON DISEASES OF WOMEN.
I next pass the index finger of the left hand into the vag-
ina to ascertain the position of the os, and direct the sound,
which is to be held in the right hand, with the concavity
directed backwards as regards the patient. Insert the sound
gently to the fundus; then withdraw the finger from the
vagina, and insert the middle finger into the rectum, and press
the fundus upwards and forwards, at the same time carrying
the handle of the sound backwards. After carrying the sound
as far back as the perineum will allow, turn it gently over in
the fingers, so that its concavity will be forwards; this move-
ment lifts the uterus out from the hollow of the sacrum, and
throws the fundus forwards into its normal position, if we at
the same time carry the whole organ upwards after we have
turned the fundus forwards by withdrawing the finger from
the rectum, and inserting it into the vagina, pressing upwards
at the same time, with the finger against the os, and the
sound resting against the interior of the fundus. Or, instead
of the sound, we may use Elliott's elevator (see chapter on
Instruments, Plate XIV).
In using the sound for the purpose of replacement of the
retro-verted or retro-flexed uterus, as we make the rotary
motion to change the point of the instrument from looking
backwards to looking forwards, the movement should be steady
and firm, but gentle. When the position of the patient is
favorable, so that we have gravity to assist us, with atmos-
pheric pressure utilized, by the partial vacuum caused by the
gravitation of the bowels upwards, and the opportunity given
the air to enter the vagina during the manipulation for the
replacement of the uterus, it (the atmospheric pressure) does
more to correct the partial prolapse than it does to restore the
retro-version or retro-flexion. The attachment of the vagina
to the cervix uteri is so near the os uteri, and the posterior
cul-de-sac of the vagina is so small, that even the hardest
upward pressure against the fundus of the uterus, if exerted
through the vaginal wall, will fail, unaided, to restore a retro-
}
RETRO-VERSION AND RETRO-FLEXION.
589
version or retro-flexion. The atmosphere aids us, then, only
as it elevates the uterus in the pelvis; it can not change
the axis of the organ, or rectify a flexion, unaided.
After the uterus is reinstated the patient should lie as
quietly as possible. It is best that the patient be upon her
bed when the operation is performed. Strictly enforce the
reclining posture, and direct that a pillow be placed under the
hips, and that she lie upon her side, using a bed-pan for the
calls of nature, and not rising to the erect posture for several
days. This plan may be carried out in some cases, but in
others it can not be. If we find it is impracticable to restrain
the patient in the recumbent posture we had better use pre-
cautions in other ways to prevent a relapse of the displace-
ment, as I will mention in the treatment of the chronic case
of retro-version or retro-flexion. (See chapter on Instruments,
regarding the use of Elliott's uterine elevator, and my im-
provement of the London abdominal supporter.)
Treatment of Retro-version or Retro-flexion Complicated with
Pregnancy.
In these cases we are precluded from using a sound or
uterine elevator passed into the uterine cavity, on account of
the danger of producing a miscarriage; hence, we must reduce
the displacement by taxis, aided by gravity and atmospheric
pressure.
The patient should, as before, be placed either upon her
left side, with the hips elevated and thighs drawn up, or in
the knee-elbow position (after having freely evacuated the
bladder and rectum). Insert the first two fingers of the right
hand into the vagina, and press the cervix backwards, while
we insert one or two fingers of the left hand into the rectum.
and press against the fundus through the anterior wall of the
rectum, crowding it upwards and backwards. We, of course,
have more freedom of motion with the fingers in the vagina
than with those in the rectum; and we may gain much advan-
590
EATON ON DISEASES OF WOMEN.
tage by a sudden backward motion against the cervix when
the fundus is pressed forwards and upwards as far as we are
able with the finger in the rectum.
Should we for any reason fail by this style of taxis to
reinstate the uterus, we inay with great advantage insert an
elastic air bag into the rectum, and carry it up with the finger
so it is just back of the fundus. After it is carried as high
as possible with the finger in the rectum the bag should be in-
flated by an assistant, while we give to the cervix the sudden
backward motion before-mentioned. This will usually prove
efficient, and the patient should be kept in the reclining pos-
ture, the same as recommended in the recent variety uncom-
plicated with pregnancy. After the lapse of two or three
weeks the liability to relapse is slight, and the patient may be
allowed to rise and walk about.
This freedom from liability to relapse is due to the size of
the womb having increased during the time it was displaced
and during these weeks of rest, so that if it did have a ten-
dency to become again displaced backwards, the fundus
would rest against the promontory of the sacrum and prevent
a retro-flexion or retro-version. These manipulations, if gentle,
need not endanger a miscarriage. No pessary is usually re-
quired in this class of cases, though it is sometimes desirable
to wear a nicely adjusted abdominal supporter for a few
weeks, when the patient commences to go about.
Treatment of the Chronically Retro-flexed or Retro-verted Uterus.
In the chronic case of retro-version or retro-flexion, we
have to contend with a relaxed condition of the supports of
the intestines and the consequent displacement of them down
upon the displaced uterus. In connection with this we have
in some cases attachments formed, more or less strong, be-
tween the uterus and the cellular tissue situated between the
vagina and rectum. Conjoined with this we have the relaxed
condition of the uterine muscular tissue and debility of the
RETRO-VERSION AND RETRO-FLEXION.'
591
entire system, caused by the pain, the discharges, the inflam-
mation, indigestion and constipation, so common in these dis-
placements; hence it is that a very different treatment is
required in the chronic case from what is efficient in the
recent one.
On account of the various difficulties we encounter in the
treatment of these chronic displacements, we must be upon
our guard in giving a promise of speedy and certain relief.
The long time required for the complete cure of this class
of cases, makes it unwise to compel the continuous resort to
the recumbent position; hence in the outset we must devise
means to lift up the abdominal viscera and retain them from
pressing down upon the uterus, until such time as the attach-
ments and supports of the intestines become strong. Upon
our skill in accomplishing this object will largely depend
our success in the treatment of these displacements.
Different patients must be treated in different ways. In
a few cases we may be unable to succeed, but in the great
majority we may be successful. It is not worth while to
fritter away valuable time in efforts to cure the inflammation
in the cellular tissue or the endometrium, or the dyspeptic
or hysterical symptoms present, till we have adjusted the
displacement and secured its stability, when in many in-
stances the sympathetic symptoms leave.
First, then, let us secure a properly adjusted abdominal
supporter, and see to it that it acts as a supporter, and not as
an abdominal compressor. This may usually be accomplished
with my improved London supporter made by Wocher & Son,
Cincinnati (see chapter on Instruments), or by means of the
silk elastic abdominal band. Sometimes in using either of these
it is necessary to apply a pad of cloth under them against
the lower abdomen to get sufficient pressure, to lift the vis-
cera upwards when the band is tightened. The upper part
of the band must be left loose so that the abdomen may rise
upwards and forwards, and rest upon the supporter. When
592
EATON ON DISEASES OF WOMEN.
1
this is accomplished we have caused a partial vacuum in the
lower abdomen, and the replacement of the uterus and its
maintenance in situ is made comparatively easy.
We may then proceed to reinstate the uterus in the same
manner as in the recent case, using taxis, the sound or uter-
ine elevator of Elliott in the uterus and the air bag of Gariel
in the rectum. This air bag or elastic pessary is made of
soft elastic rubber of various sizes and shapes, with a tube
attachment about eighteen inches long, by means of which
the bag is to be inflated, after being introduced in a collapsed
state. This throws the fundus forwards, as explained before
in the treatment of the recent case of retro-version or retro-
flexion. When attachments have formed of so strong a char-
acter that we are unable to restore the organ by using gentle
force, we must abandon the attempt and use such means and
remedies as the most urgent symptoms demand.
After succeeding in the replacement of the organ I prefer
to apply a wad of cotton saturated with Hydrastis and Gly-
cerine to the cervix, and beneath it insert the elastic pessary
just mentioned. This is especially necessary if our patient
is compelled to at once assume the erect posture, and we are
not sure of the perfect action of the abdominal supporter;
but in case the patient can remain in the reclining posture
for two or three weeks, we can dispense with the pessary
in toto; and we can lay aside the abdominal supporter also
till the patient is about to rise. Put it on before she rises,
whenever that is, whether it is one day, a week, or a month
after the operation. Keep the hips elevated. Daily, or twice
a day, have the round glass speculum introduced into the
vagina, and allow it to remain for an hour or so, to allow of
the free ingress of atmospheric air. Give the patient good
air to breathe and good food to eat, keeping the whole body
warm.
Examine once in two or three days per vaginam to see
that the os is in position. If found too far forwards insert the
RETRO-VERSION AND RETRO – FLEXION.
retrO
593
sound, and ascertain if there is a partial return of the dis-
placement; if so, rectify it at once. The cotton wad may
well be removed and renewed for several days, once in
twenty-four hours, or oftener, if the discharge is profuse.
Nux is a remedy almost universally demanded in these cases,
though when there is any tendency to inflammatory action or
high nervous excitement Aconite is indicated, and Hyoscyamus,
Verat. vir., or Gelseminum if the symptoms are hysterical.
Electricity in gentle current passed through the abdomen
and uterus is of some service. Tepid bathing of the hips,
back, and loins, with warm vaginal injections, are useful.
Bell. is indicated when there is a tendency to stupor,
with a flushed face and bearing down pain in the pelvis and
abdomen.
Cal. Carb., for a sense of exhaustion and debility, im-
proved after rest.
Rhus Tox., for the tired, sore feeling not relieved by
rest, tenderness of the muscles, etc.
Pessaries in the Treatment of Retro-version and Retro-flexion.
In general terms, I can say of pessaries in the treatment
of these displacements, that as they have been used they
have proven themselves a delusion, and have doubtless done
much more harm than good. I am gratified to see that Pro-
fessor Emmet,* of New York, speaks emphatically against the
intro-uterine stem pessary, and I hope that erelong the pro-
fession will abandon many other forms now in use. Dr. E.
says: "Unfortunately members of the profession are fre-
quently advocating the use of the stem pessary, regardless
of the experience of those who have gone before them, until
they, in turn, have to learn that they have not been the wiser
in their day.
"As soon as the true condition comes to be appreciated,
the use of the intra-uterine stem will be abandoned as a
Emmet's Prin. and Prac. of Gynecology, page 352.
38
594
EATON ON DISEASES OF WOMEN.
;
most irrational instrument. Experience will at last teach
every one that no permanent benefit is ever derived from
its use, that no degree of tolerance is ever established, but
that sooner or later in almost every case mischief will re-
sult. I have long taught that its use in a flexure would be
as irrational as the introduction of a straight steel sound
into the urethra for the relief of an existing chordee; the
penis might be straightened by force, but the cause of the
difficulty would certainly not be removed.
66
Were we to straighten out a flexure of the cervix by
means of an intra-uterine stem, the end of the instrument
would make continued pressure on the posterior walls of the
vagina, on account of the want of space in the canal. So
much disturbance, in American women at least, would be
excited in the vagina and uterus, that inflammation would
certainly become established if its use were persevered in.
Then, as soon as the instrument is removed, the neck will
return to its original condition.
"If this instrument be employed with a flexure of the
body of the uterus, the disturbance is likely to be even
more marked. A condition exists which so closely resembles
an inflammatory one, that the slightest provocation is often
sufficient to establish cellulitis, and even general peritonitis.
"Whenever, by sanction of a merciful Providence, the
stem has been tolerated for a time, even in this condition,
no more progress will have been made toward removing the
existing cause of the flexure than would be accomplished
by the sound in a case of chordee. Moreover, were its use
entirely successful, so far that the canal remained perfectly
straight and patulous afterwards, the cause of the flexure
would remain, and the pain of menstruation would in all
probability be increased in consequence of such disturbance."
My own opinion is, that the use of nearly all vaginal
pessaries is open to nearly the same objection. This is em-
phatically true where no effort is made to take off from the
RETRO-VERSION AND RETRO-FLEXION.
595
uterus the superincumbent weight of the displaced abdom-
inal viscera, and the uterus is pressed from above against
the hard substance of the pessary in the vagina.
There are two ways in which vaginal pessaries have been
made useful. The ring pessary has allowed the more free
ingress of atmospheric air. It acts as a vaginal dilator. It
can never act as a uterine supporter directly, for, if small
enough to just reach around the cervix, it will fall to the
lower portion of the vagina; if large enough to distend the
vagina, the uterus might partially prolapse through it, and
become constricted. This condition is bound to occur when
the weight is considerable upon the uterus, and the patient
is allowed to go about. The soft rubber disk pessary of
soft rubber inflated is the best of this form, if one must be
used. The inflatable gum-elastic bag, egg-shaped and in-
flated with a tube from the outside of the patient after the
bag has been introduced and well pressed up anterior to the
cervix and inflated while this pressure is maintained, fills
the vagina, presses the cervix backwards, and tends greatly
to prevent a recurrence of retro-flexion or retro-version when
we conjoin with its use the abdominal supporter, or confine
our patient to the recumbent posture.
Still, even these soft pessaries are objectionable if con-
tinued long, in that they by their presence obstruct the cir
culation, and retain offensive and irritating discharges. I
only use them till I can get the abdominal support properly
applied, and the patient instructed as to its proper use, or in
case the patient shows no judgment and will not co-operate
in the proper treatment. In these cases we must personally
remove, cleanse, and replace it every day or two.
If we
trust the patient to do this, she will be as likely to get the
pessary behind as in front of the cervix, and, consequently.
rather do harm than good with its use.
The cup pessary, which sustains the uterus in a cup, which
is attached to a steel bar, curved properly and attached in
596
EATON ON DISEASES OF WOMEN.
front to a band around the waist, can be worn by but few,
and is very liable to produce inflammation of the cervix;
still may be required in obstinate cases in old women.
Plate VII.)
(See
INCISIONS OF THE CERVICAL CANAL IN CASES OF FLEXION.-
This operation was first proposed by Prof. Simpson, of
Edinburgh. But I presume that Dr. Sims, of New York, has
most frequently performed it. It is one I have never found
necessary to adopt in the treatment of flexions of the cervix,
or any part of the uterus. There may, however, occasion-
ally be found a case where a slight incision at the point
of acute flexure might be of service in allowing the more
easy introduction of a sound or uterine elevator, and facilitate
the introduction of the sponge tent, if its use should be nec-
essary, to dilate the stricture of the cervical canal at this
point. Prof. Emmet says: "Since the practice of indis-
criminate division of the cervix was first introduced by Prof.
Simpson, more malpractice has been perpetuated throughout
the world in the name of this simple operation than from
any other procedure known to the profession." Prof. Emmet
has, however, performed the operation, which he does by in-
cising the entire cervical tissue through posteriorly. Any
uterus into the cervix of which we can readily introduce either
a hysterotome or scissors, does not need incising. If there is
any canal at all it can be found with a small uterine probe,
and its size gradually increased by dilatation. If there is no
opening the case is one of atresia, and must be treated
accordingly. I will, therefore, give no directions for the
performance of an operation I do not believe is absolutely
demanded.
THE USE OF SPONGE TENTS IN FLEXIONS.-Sponge tents may
be demanded to dilate a stricture of the cervical canal
caused from a flexure, as well as to facilitate the use of the
uterine sound or elevator. They in a slight measure may
* Emmet's Diseases of Women, page 351.
RETRO-VERSION AND RETRO-FLEXION.
597
aid in straightening the flexed cervical canal; at any
rate, they help to make the canal larger, and, consequently,
prevent much of the dysmenorrhoea caused by flexions with a
contracted cervical canal. In using the sponge tent the
applicator is desirable. (See Fig. No. 60.)
This sponge tent applicator has a spring slide upon it, so
that by pressing upon this spring we can withdraw the in-
strument without mak-

ing any traction upon
the sponge itself, as the
G.TIEKANIKE CO
FIG. No. 60.-EMMET'S SPONGE TENT APPLICATOR.
spring slide presses against the sponge, and tends to press
the tent further in, rather than to withdraw it, when we
remove the applicator.
The sponge selected must be of the smallest size and curved
to correspond to the flexure, as nearly as possible. Turn
the concavity of the sponge backwards. Press the sponge
well into the cervix, and retain it in position with the appli-
cator for ten or fifteen minutes, to give the sponge time to
get moist and a little expanded. Allow it to remain from
twelve to twenty-four hours, and upon its removal insert a
second, larger one with a sharp point, unless we find the
first has dilated the cervical canal sufficiently to allow of the
introduction of the sound into the body of the uterus. If so.
the use of the tent may be abandoned. In the use of the tent
here, as in other cases, it should be dipped into carbolized
Glycerine before it is inserted.
598
EATON ON DISEASES OF WOMEN.
CHAPTER LI.
ANTE-VERSION AND ANTE-FLEXION OF the uterusS.
ANTE-VERSION is the term given to the position of the
uterus when displaced nearly transversely in the pelvis, the
os uteri looking backwards towards the sacrum, and the fun-
dus directed towards the pubis, or directly against it and the
urethra and bladder. In ante-version the fundus is moved
downwards and forwards, and the os carried backwards, or
backwards and upwards.
If the case is one of ante-flexion we find the os uteri in a
normal position, or a little backwards and downwards, the
fundus pressing forwards and bent upon the cervix, and, con-
sequently, pressing upon the bladder and carrying it down-
wards, as well as causing some prolapse of the anterior wall
of the vagina.
Some authors contend that ante-flexion and ante-version of
the uterus do not and can not exist. In this position I am sure
they are much mistaken, as these displacements are of frequent
occurrence. 'Tis true, the normal position of the uterus is
with the fundus slightly inclined forwards. But normally it
does not press against the bladder with any considerable
force, and does not prolapse the anterior wall of the vagina.
Sometimes in ante-flexion the amount of prolapse is very con-
siderable, pressing the cervix down against the posterior por-
tion of the floor of the pelvis; at other times, the flexure is
quite abrupt, and not accompanied with much prolapse. The
most common seat of an ante-flexion is at the juncture of the
cervix with the fundus.
The effect of ante-version is to cause sterility, dysmenor-
rhoea, and dyspareunia. According to the best and most com-
PLATE XXI.

ANTE-VERSION OF THE UTERUS.
:
.
:
.
PLATE XXII.

ANTE-FLEXION OF THE UTERUS.
ANTE – VERSION AND ANTE-– FLEXION.
-
599
plete statistics I can gather, over fifty per cent of sterile
women have ante-version or ante-flexion of the uterus. My
experience is that in ante-flexion the angle of flexure is more
acute in the majority of cases than in retro-flexion.
Etiology.
The principal causes of ante-version and ante-flexion are
the weight of the intestines resting too heavily upon the
uterus, owing to the relaxed condition of their supports, con-
joined with lifting or a sudden jolt or fall; the thickening
of the anterior wall of the fundus from inflammation, or the
presence of tumors in the anterior wall; the use of corsets
tightly laced; the weight of clothing supported by a band
around the waist, pressing the intestines down upon the
uterus; ante-version being produced when the uterine tissues
are firm, and ante-flexion when they are relaxed. If the
uterus maintained its normal height in the pelvis, and was
ante-flexed upon the bladder, the filling of the bladder would
temporarily replace the uterus; but it is found by experience
that instead of the bladder becoming filled, and replacing the
ante-flexion, the ante-flexion prevents the filling of the blad-
der, and its walls are so compressed and irritated that the
bladder will contain but little before it contracts to expel
what is in it.
Faulty nutrition in the anterior portion of the cervical
juncture with the fundus has been thought to be a cause of
ante-version, but the theory is hard of demonstration. The
condition of sub-involution and pregnancy may also tend to
cause ante-version and ante-flexion.
Diagnosis.
The symptoms which may lead us to think of anterior dis-
placement of the uterus are more especially, irritation of the
bladder, frequent and painful micturition, dysmenorrhoea with
leucorrhoea, dyspareunia, etc., in connection with the ordinary
symptoms of displacements, both general and local. Frequent
600
EATON ON DISEASES OF WOMEN.
and painful micturition may, however, be due to retro-version
or inflammation of the bladder. Hence, it will require a
physical examination per vaginam to determine the exact
nature of the displacement.
In ante-version we discover by digital examination that
the os uteri is displaced backwards, and looking towards the
hollow of the sacrum. The fundus is felt (through the ante-
rior vaginal wall) in the upper part of the vagina as a globular
or pear-shaped body, generally pressing the urethra hard
against the pubis. The axis of the vagina is changed from
an oblique upward direction to one almost transverse from
before backwards.
In ante-flexion we find the os generally somewhat lower
in the vagina than normal, pointing downwards, but situated
a little further backwards than in the natural state. The
fundus of the uterus may be felt apparently occupying a
transverse position at nearly a right angle with the cervix.
To positively determine the uterus is ante-flexed, it is nec-
essary to introduce the uterine sound (which can be done if
there if no possibility of pregnancy). If the sound enters
the body of the uterus with the point only slightly inclined
forwards from the direction necessarily given it in its intro-
duction into the cervical canal, we may know that the bunch
which we first thought to be the fundus is a tumor in the
anterior wall of the fundus, an enlarged and displaced ovary,
an induration resulting from cellulitis, or a large cystic cal-
culus, and not a case of ante-flexion at all. But should we
find that the sound is arrested when inserted into the cervix
about an inch, and we have to turn it abruptly forwards in
order to enter the cavity of the body of the uterus, we may
know the case is one of ante-flexion.
Treatment.
The first object to accomplish in the treatment of ante-
version or ante-flexion is to take off from the uterus the
ANTE-VERSION AND ANTE - FLEXION.
601
weight of intestines pressing upon it. This may be done by
placing the patient upon her back or side, with her hips ele-
vated and the shoulders low. We may next proceed to cor-
rect the displacement.
If it be ante-version, we may attempt to pass one or two
fingers behind the os uteri and draw the cervix forwards.
If we can not do this readily, we may hook the point of the
curved uterine sound into the os, guiding the instrument by
the fingers already in the vagina, and as we draw the cervix
forwards allow the sound to ascend in the cervical canal, and
proceed in this way till the uterus is turned and lifted into
place. We now withdraw the sound and insert into the vag
ina a common glass speculum of suitable size so as not to dis-
tend the vagina so much as to be painful, and allow it to remain
for several hours to admit the atmosphere freely; or a watch
spring ring pessary may be inserted to accomplish the same
object. The patient should be much of the time with the
knees drawn up and separated. The recumbent position on
the back must be maintained for some time, or a nicely ad-
justed abdominal supporter may be applied, and the patient
be allowed to rise.
In ante-flexion, after we have introduced the sound into
the uterus we turn its point backwards gently, to lift up the
fundus, or use the uterine elevator for the same purpose.
After it is replaced, we may treat the case similarly to the
one affected with ante-version, which has been replaced.
The passing of the electrical current through the uterus,
using the finger for an electrode, while applying it to the
cervix, is an efficient means of strengthening the relaxed
tissues in these cases.
In those cases which are continually relapsing, it is nec-
essary sometimes to introduce the soft rubber pessary pos-
terior to the os uteri, and inflate it, and remove and replace
it every few days for some time, still using the abdominal
supporter and such remedies as the case seems to demand.
T
602
EATON ON DISEASES OF WOMEN.
much prefer, however, to entirely dispense with all vaginal pes-
saries, and I have found that we can do so in most cases
where we have an intelligent patient who will co-operate in
the treatment, excepting in a few cases where adhesions
have formed which require some regular, even force to break
up and stretch, which may sometimes be done when they
are not very firm.
Much care and attention, as well as perseverance, is requi-
site in these cases, in keeping the organ in situ, and in keeping
it from being pressed upon by the intestines, and allowing a
free ingress of the atmosphere into the vagina. Remedies must
not be overlooked. There is very often a condition of con-
gestion of the parts in these cases which gives rise to the
feeling of tenderness, weight, and bearing down sensations.
which indicate Bell. as the remedy; the pain in the small
of the back and temples indicates the need of Nux.; pain
in the ovarian region indicates Cimicif.; sharp, cutting pains
anywhere, Bry.; a twisting, boring pain in the bowels around
the navel, Colocynthis. Secale, Canthar., Cal. carb., Cubebs,
Sulph., Rhus, Puls., etc., should also be studied, as they are
sometimes indicated in these cases.
SPONGE TENTS.-The need for the use of sponge tents may
arise in cases of ante-flexion as in retro-flexion, to dilate the
strictured uterine canal, and relieve dysmenorrhoea. They or
bougies may be used to establish the canal of proper size.
Rest, proper diet, and good air, bathing, etc., are never
to be forgotten.
THE SPECULUM.-This instrument is not needed either in
the diagnosis or treatment of these displacements.
PESSARIES.-Pessaries have been the bane of the
pro-
fession, and the sooner the whole batch of hard pessaries are
destroyed the better for our own reputation and the comfort
of our patients. How many ulcerations, fistulæ, and inflam)-
mations they have produced the judgment day can only
reveal. They are to be placed with caustics, venesection, the
LATERAL DISPLACEMENTS.
603
actual cautery, indiscriminate incisions of the cervix, and the
like, and be condemned together. The cases benefited, do
not equal those injured by them.
WARM VAGINAL INJECTIONS.-Injections of warm water
given in the way of a douche, are often beneficial in those
cases where there is a supersensitive condition of the pelvic
viscera. They may be used once or twice a day for a week
or two if necessary. Astringents and medicated washes are not
needed, and often do harm. The warm hip bath, used with
judgment and moderation, is often of service.
LATERAL DISPLACEMENTS.
Lateral displacements, existing uncomplicated with other
disease, are seldom found. They can scarcely occur, except
when there is disease of one of the broad ligaments, adhe-
sions after cellulitis, a tumor in the side of the fundus, or
disease of the ovary. As displacements they deserve no
more than a passing notice. The difficulty which causes.
them, being of so much greater importance, needs the special
treatment. When, however, we find a case of lateral dis-
placement, we should consider the causes producing it.
Diagnosis.
Physical examination is always requisite to diagnose a
case of lateral displacement. As the fundus would not press
upon any important organ or viscera in this displacement the
symptoms are not as marked as in anterior or posterior dis-
placements; still the difficulty which causes the displacements
may give rise to marked symptoms peculiar to uterine dis-
ease. By making a digital examination per vaginam we
find the os directed towards one side of the pelvis, and
by introducing a sound into the cervical canal up to the
fundus, we find it inclining towards the opposite side. This
determines the existence of lateral displacement, but much
more careful examination is necessary to determine the
604
EATON ON DISEASES OF WOMEN.
"
causes of the displacement. It is unnecessary to go over
them all here; search should be made in the diagnosis of
ovarian tumors, fibroma of the uterus, pelvic cellulitis, hæmat-
ocele, etc., for the symptoms which indicate the difficulties
named.
Etiology.
The existence of disease of one of the broad ligaments
may draw the uterus to one side. The wearing of badly
adjusted pessaries, thickening of the walls of one side of the
uterus from inflammation, or the development of a tumor
in the walls of one side of the organ may cause this dis-
placement.
To these causes may be added faulty nutrition and con-
genital malformation. The development of a small tumor of
the ovary, or a fibroma in the side of the uterine walls, would
drag the fundus towards the affected side, while the large
tumor in these localities would press the fundus to the oppo-
site side of the pelvis. Adhesions formed after cellulitis will
also tend to cause a lateral displacement of the uterus.
Treatment.
No
The treatment of lateral displacements must mainly con-
sist in the removal of the causes which produce them.
special treatment as displacements is required-the main ob-
ject of calling attention to them being to recognize the fact
of their possible existence, and suggest what they may indi-
cate as regards other ailments, thereby aiding in the diagnosis
of the prime and main difficulty. Attempts to replace and
retain in situ a lateral displacement without removing the
cause would simply be lost time, and would expose the
ignorance of the physician, as well as possibly be injurious
to the patient. For if we carefully note the causes we will
see that most of them are beyond our control; and the
others require treatment peculiar to themselves.
PLATE XXIII.

PROLAPSE OF THE UTERUS AGAINST THE PERINEUM.
PROLAPSUS UTERI AND PROCIDENTIA.
605
CHAPTER LII.
PROLAPSUS UTERI AND PROCIDENTIA.
THESE terms are used to designate downward displacement
of the uterus, prolapse being applied to the downward dis-
placement of the womb while it is still within the pelvis
(see Plates XXIII and XXIV), and procidentia when the
organ is so much displaced as to appear external to the os
vaginam. (See Plates XXV and XXVI.)
Prolapse may exist in various stages, from the slight
downward displacement to the extent of resting against the
perineum.
Procidentia is called partial when a small portion of the
cervix appears in view between the labia; and complete
when the whole organ is external to the os vaginam (Plate
XXVII).
To whatever extent the displacement exists the bladder,
ovaries, Fallopian tubes, and small intestines are also dis-
placed downwards in similar proportion; and I may say the
vaginal walls, and in some instances the rectum and lower
portion of the colon also, are displaced.
The sufferings which women endure from prolapsus uteri
and procidentia are very great, and the effect upon the gen-
eral health is sometimes disastrous. At other times we meet
with cases where the system seems to become tolerant of the
displacement, and very little effect is produced upon the
general health of the patient. I have seen women who had
been about their work for years with the uterus dangling
between the limbs, or retained in the vagina with a Ț band-
age, and complaining very little of the displacement. Many
women suffer from partial prolapse when their difficulty is
606
EATON ON DISEASES OF WOMEN.
not discovered, even after their physician has made a vaginal
examination (the patient being in the reclining posture).
The patient should stand during the examination, and the
physician be well experienced, or error of diagnosis may
result.
Etiology and Pathology.
Upon this topic I must differ in a measure from all who
have written on this subject, so far as I am aware. I do
this with some reluctance, although I believe I am right, for
I well know the slowness with which the profession adopts a
new idea in pathology or etiology.
Before offering my own ideas I will quote from the most
recent writers upon the subject. Dr. Barnes* says: "The
leading fact in the history of prolapse is that of imperfect
involution after labor. If this great fact be kept steadily in
mind, and the lessons in practice which it dictates be carried
out, many cases of prolapse will be prevented altogether, and
many more will be arrested in their early and curable stages."
Dr. Emmett says: "The immediate causes of prolapse
are threefold-either some growth above the uterus crowds
it downward, or there is an increase of weight in the uterus
itself, or there is a want of proper support below. The first
step in the process is usually to be traced directly to the
absence of support for the vaginal walls at the outlet of the
passage, from which a further prolapse is soon induced by
the increase in weight of the organ, resulting from its mal-
position."
"To whatever cause the increase in size and weight of the
uterus may be due, the organ will settle into the pelvis just
in proportion to the additional burden" (evidently meaning
the weight of the uterus).
Now, that prolapse is caused almost entirely by sub-invo-
lution of the uterus after labor is disproven, from the fact
* Barnes's "Diseases of Women," page 541.
† Emmet on "Diseases of Women," p. 366.
,
PLATE XXIV.

PROLAPSE OF THE UTERUS.
Um
......
PROLAPSUS UTERI AND PROCIDENTIA.
607
that very many women who have never been pregnant suffer
from this displacement. This is particularly the case with
girls and young women who are employed as clerks in stores.
or as teachers, or in any employment where they stand for
hours at a time. Domestics do not suffer as much, for the
reason that they are moving about and change their position
often; they walk, sit, or stoop over, at short intervals, and the
weight of the abdominal viscera does not press down into
the pelvis so directly and continuously as when standing
erect and nearly still. These women do not as a rule enter
a hospital, and it may be due to the fact that married
women among the poorest class more frequently are found
in hospitals that the gentlemen quoted have arrived at the
conclusions which they have.
Dr. Emmet's suggestion of want of support at the vaginal
orifice being a cause of prolapse of the uterus, would inti-
mate that which we find he afterwards teaches, that lacera-
tions of the perineum are one of the most common causes of
prolapse; in fact, he says (page 367), "that in practice we
will have to deal with childbirth as the most common of all
causes in producing procidentia, and in all these cases the
perineum will be found extensively lacerated."
It is true that, in many cases in which there is procidentia,
there is a ruptured perineum; but I deny that the ruptured
perineum is the main cause of the procidentia. I am of the
opinion that other and more philosophical reasons can be
assigned.
The floor of the pelvis (the perineum) when intact would
in a measure resist the further descent of the uterus when it
had become prolapsed enough so that the os rested upon it
(see Plate XXIII). The perineum then conjoined with a
contracted os vaginam (which would indicate a long peri-
neum) would offer some considerable resistance to complete
procidentia. So would a T bandage if well applied; but the
absence of a T bandage would hardly be given as a cause of
608
EATON ON DISEASES OF WOMEN.
procidentia. Normally the perineum is no more a support of
the uterus than is a T bandage. The uterus in its natural
position is about four inches above the perineum, at the top
of the vaginal cavity; the vaginal walls are loose and flabby,
distensible with the slightest force. If the vaginal walls
stood up like pieces of paste-board, and rested upon the peri-
neum, the taking away of their support might allow of the
prolapse of whatever rested upon them; but such is not
their nature. The vagina is retained in place by means of its
attachment to the cervix uteri above, and to the cellular tis-
sue on its sides, which cellular tissue is attached to the
rectum, bladder and walls of the pelvis. Separate it from the
attachments I have named, and it will drop down at once to
the vaginal outlet (when the subject is placed erect).
In so far as the attachment of the vagina to the cellular
tissue and uterus is firm and normal, it holds the vagina in
situ, if there is no abnormal weight in or upon it. But, we
think, the uterus is sustained mainly by the folds of perito-
næum constituting the broad ligaments, the cellular tissue
surrounding it and the vagina, and by atmospheric pressure
coming in through the vagina.
Heavy lifting, tight lacing, forcing the intestines down
upon the uterus by straining in labor or at stool, and stretch-
ing and weakening the attachments of the intestines serve to
produce prolapse directly.
The conditions present after confinement are enlargement
of the uterus, it is true; sometimes a condition of sub-involu-
tion is present for a long time, but it does not necessarily
produce prolapse or procidentia, as I have seen hundreds of
cases where there was sub-involution of the uterus which had
been present for years, and complicated with endo-metritis
to the extent of causing much suffering, and still there was
little or no prolapse at all.
These cases showed an enlargement of the uterus to the
extent of measuring from three and a half to four inches in
PLATE XXV.

PARTIAL PROCIDENTIA UTERI.
PLATE XXVI.
}

PROCIDENTIA, WITH ELONGATION OF THE CERVIX UTERI
PROLAPSUS UTERI AND PROCIDENTIA.
609
the uterine cavity, as indicated by the uterine sound. Why
did they not have prolapse? They have weight enough in
the uterus and often a lacerated perineum. I answer, they
did not have prolapse, because their intestinal supports
were firm and normal, and the broad ligaments were not
relaxed, the cellular tissue around the vagina was normal,
and the uterus had no superincumbent unnatural weight to
support.
Every woman is more liable after confinement than be-
fore to have prolapse, it is true; but why? Not because of
the sub-involution of the uterus, for very few women have a
complete and perfect involution of the uterus in the ten days
they commonly maintain the recumbent position, and if en-
largement of the uterus was the cause of prolapse, all
should have it.
Again, in the growth of uterine polypi and intra-mural
fibrous tumors of the uterus, do we find the uterus pro-
lapsed? Seldom, if ever. Why is this? The weight of the
organ is certainly as great, or greater, than in most cases of
sub-involution. I have discussed this point at some length
under Displacements (in general), but I deem the subject
of sufficient importance to demand attention in this connec-
tion also.
In gestation, during the last months, the intestines are
crowded upwards by the large size of the gravid uterus; their
attachments become weakened and stretched, the broad liga-
ments of the uterus also relax. Now, after the expulsion
of the contents of the uterus in labor, the intestines will
press heavily upon the uterus, on account of the relaxed
condition of the mesentery. If the erect posture should be
at once taken, the broad ligaments being relaxed, they offer
no resistance, and downwards the uterus is pressed, dragging
with it the upper portion of the vagina; and if the uterus
retroverts in its downward way, the cervix may emerge from
the vagina, and if the pressure is sufficient the procidentia
39
610
EATON ON DISEases of women.
may become complete, for the vagina is always dilatable if
not already relaxed, and the uterus may become completely
expelled from the vagina, although there is no laceration of
the perineum.
If there was no perineum, and the patient did not wear
a T bandage, of course, it would come out a little easier than
if they were there to offer resistance. Hence, we have to ac-
knowledge that the laceration of the perineum in small part
allows of complete procidentia, but we do not concede that
it is in any way concerned in causing or allowing of pro-
lapse. Sub-involution does not in itself and alone cause
prolapse, we think; but accompanying some cases is a con-
dition of the broad ligaments and abdominal organs caused
from inflammation (which often is the cause also of the sub-
involution), which tends to produce a downward displace-
ment. The sub-involuted condition may co-exist with pro-
lapse, but I deny its being the principal cause of it.
These
In these cases where lacerations occur, there have usually
been present the most intense expulsive pains.
severe bearing down efforts tend to displace all the abdom-
inal viscera downwards in any case of labor, and where they
are strong enough to cause a laceration of the perineum, or
to exhaust the patient, so that forceps have to be used, the
downward displacement of the intestines must be consider-
able, on account of the straining and the atonic condition
produced by the general exhaustion incident to labor. Strain-
ing at stool from constipation tends to produce prolapse,
which may come on gradually, forcing down the intestines
upon the uterus and weakening the broad ligaments.
The straining from efforts of the uterus and voluntary
muscles of the abdomen to expel a polypus from the uterus
may also in the same way cause prolapse. Tight lacing of
the chest and upper part of the abdomen tends to force the
abdominal organs downwards upon the uterus, and produce
prolapse. Dr. Emmet says, page 368: "In early life, even
PLATE XXVII.

13:00 4
COMPLETE PROCIDENTIA UTERI.
PROLAPSUS UTERI AND PROCIDENTIA.
611
with extensive lacerations of the perineum, the formation of
a procidentia is not the rule, unless the woman is exposed to
the risk by accidents, or from the character of her occupa-
tion." He does not explain why this may be in early life
and not when older.
To my mind the explanation is to be found in the fact
that in advanced years the muscular tissues-in fact, all the
tissues are more relaxed, and do not so readily regain their
normal condition after delivery, as when younger. Hence,
the fact which he gives regarding the immunity of young
women from procidentia, even though suffering from lacera-
tions of the perineum, is the best of argument in favor of
the position which I hold, that laceration of the perineum is
not the principal cause of procidentia, though Dr. Emmet
teaches, in another place, that it is, as I have quoted him.
(Page 367, Emmet's "Prin. and Prac. Gynecology.")
In the descent of the uterus the vagina becomes partially
inverted, and in complete procidentia it is completely so, and
must necessarily either drag down into its inverted cavity
the bladder and rectum, or must become torn loose from its
attachment to the cellular tissue. It is usual that the blad-
der is drawn down partially, and the course of the urethra
is changed to a downward direction instead of upward. The
small intestines are often found in the sac formed by the
inverted vagina (see Plate XXVII). Their agency in caus-
ing the displacement seems not to have occurred to the
writers who have mentioned the fact of their presence down
in this sac ten or twelve inches below their normal position.
Calculi have sometimes formed in the bladder while thus
prolapsed, and could be rattled together with the hand (Dr.
G. Raper in Barnes's "Diseases of Women," page 545).
In this condition of the bladder there is a great tendency
to cystitis, owing to the difficulty of voiding the urine, which
causes a retention of stale urine, and this tends to produce
cystic inflammation.
612
EATON ON DISEASES OF WOMEN.
At first it might be thought that very fleshy women
would be more liable to prolapse than the spare built. Such
does not appear to be the case in my experience, and is
explained, I think, from the fact that most of the adipose
is deposited exterior to the muscles, and although producing
a pendulous abdomen does not cause greater pressure to be
exerted upon the uterus than in those not fleshy, unless
they should attempt to lace themselves down to a small
size, in which case there would be a great tendency to pro-
duce some form of displacement of the uterus. Fleshy
women have usually good assimilative power and good diges-
tion, and are well nourished, while in the slender, spare built.
woman this is often not the case; hence, the fleshy woman
is not on that account more liable to prolapse.
Diagnosis.
In some women the uterus is situated abnormally low in
the pelvis, and this condition appears to be congenital, as its
deviation from the ordinary position produces no suffering or
inconvenience. On careful examination, however, some of
these cases will be found to be affected with elongation
of the cervix, which gives the appearance on a careless ex-
amination of a depressed condition of the entire organ. The
history of these cases will usually show a previous cervicitis,
which may have subsided so that little or no pain is experi-
enced. If married, this condition is likely to produce sterility;
but the consideration of this subject has been mentioned in
connection with sterility and elongation and hypertrophy of the
cervix. Most patients afflicted with prolapse suffer from bear-
ing-down pain, a sense of weight in the pelvis, pain in the small
of the back, frequent desire to micturate, etc. The severity
of these symptoms depends much upon the suddenness of the
displacement. When considerable prolapse comes on sud-
denly these symptoms are more acute than when the dis-
placement has come on gradually.
1
PROLAPSUS UTERI AND PROCIDENTIA.
613
Sympathetic Symptoms.
Often in this displacement we have sympathetic symp-
toms affecting the stomach, producing nausea (especially on
rising), dyspepsia, gastrodynia, heartburn, etc. It also causes
a variety of symptoms in the brain and spinal cord. Very
frequently there is pain in the back of the head and neck;
sometimes burning heat on the top of the head, dimness of
vision, pain and tenderness over the entire spinal column,
etc. Sometimes we have hysterical symptoms, a changeable
mood, crying and laughing in rapid succession, hysterical or
imaginary pains in various parts of the body, and sometimes
a condition of hyperesthesia of a part of the body, or some-
times of the whole body. Hysterical spasms often supervene.
These symptoms are usually aggravated or produced at or
about the menstrual period. In other cases, instead of
hyperesthesia there is a loss of sensibility in a part of the
body, sometimes affecting one side of the body and not the
other; sometimes there is a loss of both sensibility and
motion in one limb or in one-half of the body. In still
other cases there is a spasmodic condition of the oesophagus.
making it almost or quite impossible to swallow. Palpita-
tion of the heart, dizziness, fainting spells, are also indica-
tive of this displacement. There is usually considerable pain
and tenderness in one or both iliac regions, caused from the
inflammation which is often awakened in these cases from
cold, as well as the irritation caused by the straining of the
folds of the peritoneum and the laceration of the cellular or
connective tissue, which often takes place.
Among the symptoms sometimes manifested by nervous
women affected with prolapsus, might be enumerated nearly
or quite all the hysterical manifestations which are ever wit-
nessed. These are not, however, peculiar to prolapse of the
uterus, but are sometimes caused from other displacements. as
614
EATON ON DISEASES OF WOMEN.
well as any form of pelvic inflammation or spinal irritation.
The only positive diagnosis is to be made in these cases
by physical examination. First, a digital examination per
vaginam is to be made while the patient is standing, if conve-
nient. This examination reveals the os depressed in the pel-
vis in some measure. (See Plate XXIV.) It may be but
slightly prolapsed, or it may be found resting upon the per-
ineum. (See Plate XXIII.) Or, in case of partial proci-
dentia, the cervix is found pressing out between the labia,
and if complete the whole organ is found external to the
body. (See Plate XXVII.)
Differential Diagnosis.
The diseases and conditions which might lead to an error
in diagnosis are a uterine fibrous pedunculated polypus, which
has been expelled from the uterus, and is lying in the vagina,
or is pressed out external to the vulva. The cervix, in com-
plete procidentia, and in some cases of prolapse, is inflamed
and enlarged so as to be out of all proportion to its normal
size, and hence more care is necessary in its diagnosis. The
distinguishing diagnostic point is the presence of the os
uteri in the protruding or prolapsed mass. We must not
be misled by a dent or fissure, and conclude it is the os
till we make sure by the introduction of a probe or the
uterine sound, that the cervical canal is there within the mass,
as the polypus might have the fissure or dent in its depend-
ent portion simulating the os quite perfectly. If the case
was one of complete procidentia we could not pass the finger
up by its side into the vagina, as the vagina is inverted and
covers the protruding mass in its upper portion; but if the
mass was a polypus with a long neck attached to the uterus,
we could freely pass the finger up into the vagina all around
the pedicle, and discover the os surrounding it as it entered
the cervical canal.
PROLAPSUS UTERI AND PROCIDENTIA.
615
Diagnosis from Cystocele and Rectocele.
These conditions may cause the patient to imagine she
has procidentia, but it should not take the physician long to
make out the correct diagnosis. The soft, fluctuating feel of
these conditions, the absence of the os uteri, and finally
passing the finger into the vagina and finding the os and
cervix in position, settle the question.
The PARTIALLY DELIVERED FŒTUS.-The partially delivered
foetus with a breech presentation may simulate prolapse. In
both cases there may be backache and bearing down pains.
But in prolapse there is usually no hemorrhage, while in a
miscarriage there is. By passing the finger up around the
mass in the vagina, to feel the anterior and posterior cul-de-
sac of the vagina, we discover the os surrounding the mass,
and by a little effort we dislodge it and bring it away.
THE PARTIALLY DELIVERED PLACENTA.-This may slightly
resemble procidentia, in a case where we are not informed'
of a delivery having occurred. The placenta feels spongy,
quite in contrast to the firm, rounded feel of the uterus.
little care will prevent an error of diagnosis.
Diagnosis from Inversion of the Uterus.
A
The condition of chronic complete inversion, perhaps,
simulates complete procidentia more perfectly than any other
condition (see chapter on Inversion as to differential diag-
nosis).
Treatment.
Regarding treatment, I differ somewhat with most authors
on diseases of women, Prof. Guernsey and Dr. Eggert
teaching that remedies are alone the means of cure, and most
other writers placing the greatest importance upon pessaries,
narrowing the vagina by operation, restoring a lacerated peri-
neum, and astringent vaginal washes, etc. I should, perhaps,
except Prof. Ludlam. In his work giving a record of many
616
EATON ON DISEASES OF WOMEN.
interesting cases, he incidentally mentions prolapse, and gives
some remedies indicated, and intimates that other treatment
is necessary, the description of which he seems to have in-
advertently omitted. He mentions postural treatment in
prolapse complicated with erosions of the cervix, with which
I fully accord.
Those physicians who believe in the cause of prolapse
being want of tonicity in the vagina, and the sub-involuted
condition of the uterus, and that procidentia is mainly due to
a lacerated perineum, naturally attempt to cure the difficulty
with astringent washes in the vagina, by pessaries to sup-
port the uterus placed in the vagina, and in operations to
lessen the size of the vagina, and cure the laceration of the
perineum.
Of the success of this plan we may judge from Dr.
Emmet's own words, and as he is a representative man of the
old school, with the sanction of the entire allopathic profession,
I believe we may well take his words as representing the
school to which he belongs. He says, after describing the
operation: “This plan of operating disposes, most effectually,
of all excess of tissue, and when union has been obtained
the support is perfect. But with all its advantages one
difficulty remains which I have never been able to overcome.
In consequence of the traction exerted in opposite directions
the three flaps brought together almost always separate to
some extent in the angle A, after the sutures have been re-
moved, and this necessitates another operation."
With this language he closes the discussion of the treat-
ment of "procidentia and prolapse," after having devoted ten
pages to the description of the operation required. This is
not very encouraging. Still in hospital practice these cases
afford interest to a class of students who are ever clamorous
to see operations. Dr. Emmet has omitted to give us a table,
showing the per cent cured under his care, although his
* Emmet's Diseases of Women, page 283.
PROLAPSUS UTERI AND PROCIDENTIA.
617
tables are elaborate in showing how many commenced to
menstruate at various ages. The age at marriage, average
number of children each had been delivered of, the kind of
labor each had suffered, etc., etc., etc. (I am sorry he omit-
ted the number of cases cured.)
He has, however, told us, on page 371, of an eccentric
friend of his who claimed to cure every case among the
negroes where he practiced, in ten days, by swinging them
up in the knee-elbow position, and filling the vagina with a
strong decoction of oak bark. Dr. Emmet says, the princi-
ple of treatment was correct, and he has it from others that
the gentleman's claim to success was well founded. The treat-
ment took off the weight of the abdominal viscera, replaced
the uterus by gravity and atmospheric pressure, and the in-
testinal and uterine supports regained their normal strength.
No supports in the way of pessaries or operations were used,
and still, as Dr. Emmet acknowledges, his friend had most
excellent success.
My wonder is that Dr. Emmet was not led to use the
same principle of treatment, which he acknowledges is cor-
reet, and which I believe to be the only true one. He does,
it is true, speak highly of the advantages of position and at-
mospheric pressure, on page 129 of his work, while writing
upon the general principles of the treatment of displace-
ments; but in the treatment of special displacements he
omits the recommendation for this plan of treatment, and
one would infer from reading his remarks upon the treat-
ment of prolapse and procidentia, that the main thing was
to support the uterus with a pessary, or sew up the vagina
after cutting out a piece of its membrane.
OBJECTIONS TO ELYTRORRHAPHY, or, taking out a piece of the
vaginal membrane. The first objection is, that it is unneces-
sary. The second, that it is liable to fail in most instances,
as Prof. Emmet has acknowledged. The third objection is,
*Emmet, Diseases of Women, p. 383.
618
EATON ON DISEASES OF WOMEN.
that should pregnancy subsequently ensue, the narrowing of
the vagina by the operation might interfere materially with
the delivery of the child at full term, either preventing the
delivery, or causing a laceration of the vagina to occur in
its expulsion. In the very aged, or in those who have
passed the climacteric period, this last objection is, of course,
invalid; but the first two would deter me from the operation.
There are other means of affording relief, if not a cure, in
these older cases, of which I will speak hereafter.
The first and most important point in the treatment of
prolapse, in my judgment, is to take off from the uterus all
weight that may be pressing upon it. The wearing of cor-
sets or clothing suspended from the waist must be forbidden.
The weight of the intestines pressing down upon the pro-
lapsed uterus must be removed by some means; and just
here much ingenuity is required to adapt means to secure
this end, in the variety of patients who come under our
care. The knee-chest position, as practiced by Dr. Emmet's
friend (previously mentioned), accomplishes the object; still
we can not, in general practice, swing our patients up, as
this gentleman did his negress patients (though I am some-
times tempted to do it). The reason of his great and rapid
success probably lies in the fact that his cases were com-
paratively recent displacements in women of strong consti-
tution and firm muscular development, rather young in years,
and, consequently, the tonicity of the intestinal supports was
soon restored, when every particle of strain and weight was
taken from them.
Causing our patient to lie upon the side with the hips
elevated for several weeks will accomplish about the same
results. In those cases where their employment or circum-
stances make it necessary for them to be up and at work,
some form of abdominal support is necessary. I prefer the
Improved London Supporter for this purpose, giving attention
to the fit of the instrument, and making sure that it acts as
PROLAPSUS UTERI AND PROCIDENTIA.
619
an abdominal supporter, and not as an abdominal compressor.
Daily cause the patient to assume the position on the side,
with the hips elevated, for an hour or so, and, separating the
limbs, press the uterus upwards with the fingers; then in-
sert into the vagina a common, round vaginal speculum of
suitable size to be readily retained. This allows of the free
introduction of atmospheric air, and from its pressure it re-
lieves the engorgement of the capillaries of the vagina and
cervix, and presses the organ into position. Now, before the
patient changes her position, apply the Improved London Sup-
porter (see cut in Plate XII), so that when the patient as-
sumes the sitting or standing posture the abdominal organs
will be held up away from the uterus.
Use warm water vaginal injections daily, and such other
treatment as the complications demand, with remedies used
according to their indications, and the recent case of pro-
lapse or procidentia will be, as a rule, speedily cured.
The chronic cases which have existed for years may re-
quire that some force be used by the physician to break
loose attachments which often are found to have formed in
the cellular tissues, binding the organ down in its unnatural
position. In some cases these adhesions are so strong as to
make it impossible to lift up the uterus by any means, and
such attempts have to be abandoned. In other cases we
may cause these attachments to gradually give way by the
use, in the vagina, of the inflatable gum-elastic bag, which
we may insert after pressing up the uterus as high as the
attachments will allow, and then inserting the bag and in-
flating it as fully as possible with the tube, which is left ex-
ternal to the body. The air in the bag is retained with a
stop-cock, or by means of a string tied tightly around the
tube. This exerts a steady, but soft and gentle, pressure
upon the uterus, carrying it upwards as high as the attach-
ments will allow, and frequently causes them to give or re-
lax and allow the uterus to be normally located. This means
620
EATON ON DISEASES OF WOMEN.
is to be used with the patient in the knee-elbow or side po-
sition, and with the abdomen supported if she rise, as in the
recent case. In some cases the physician will have to re-
move and reinflate the rubber bag every three days; in
others, the patients can do it themselves.
In instances of lacerated perineum complicating the case,
the perineal bond and compress may be needed to retain the
inflated bag within the vagina and exert sufficient pressue to
avail any thing in the removal of the attachments. Ther
length of time which it is advisable to use this treatment to
restore the uterus when partially attached in its abnormal
position varies much; usually, however, not more than two
or three weeks, and sometimes only that many days; but
the use of the abdominal supporter should be continued for
several months, especially if the patient has to go about or
work much.
Dietetic and hygienic measures must not be overlooked.
Attention to food, rest, sleep, exercise, clothing, bathing, etc.,
is always necessary. The bowels must be kept regular with
enemæ of soap and water, if inclined to constipation, as
straining at stool is particularly to be avoided in all cases
of displacements, and especially in prolapse.
Treatment of Complete Procidentia.
In cases of complete procidentia which have become.
chronic, there are sometimes serious obstacles to the return
of the mass even within the vagina. Sometimes the uterus
and vagina covering it becomes inflamed, swollen, and œde-
matous. In this case the mass should be wrapped in a cloth
well saturated with equal parts of Glycerine and Tr. Hydras-
tis; over this we may wrap a cloth wrung out of warm water,
and over that again apply a dry flannel. If the oedema is not
relieved in a few days, we may puncture the most swollen
portion of the mass with a good-sized surgeon's needle in sev-
eral places, and allow the serum and blood to drain away,
i.
PROLAPSUS UTERI AND PROCIDENTIA.
621
.
still continuing the local application just mentioned till the
mass is much lessened in size, when the attempt at replace-
ment should be made, first placing the patient in the knee-
chest position or on the side, with the hips elevated and the
body low.
After succeeding in replacing the mass within the body
we should wait a day or two, keeping the patient in the side
position, with the hips elevated, so as to allow the force of
gravity to do all in its power to restore to position, not only
the uterus, but the displaced intestines as well.
We may
then make further attempts to lift the uterus into its normal
situation, having the patient placed in one of the positions
mentioned. This can be readily accomplished in most cases
with two fingers passed up into the vagina, after which the case
is to be treated as directed for the recent case of prolapse,
only bearing in mind that a longer time will be required in
the treatment than is usual in the recent case, and that we
are liable to be troubled with occasional relapses from the
imprudence or carelessness of the patient.
*
Cases sometimes occur where the bowels have formed
adhesions in the pouch formed in the pelvis in the descent
of the uterus, bladder, and ovaries, on account of inflamma-
tory action; and it may, hence, be impossible to replace these
organs. Dr. Barnes says: "The extreme pain which at-
tends the attempt to return the procident mass into the pelvis
is often due to some degree of inflammation having been set
up in the peritonæum lining, the pouch into which the intes-
tines descend, at the upper and back part of the womb, or
of the peritoneal investment of the intestines themselves;
and death may in these circumstances take place, with many
symptoms of the same kind as attend upon fatal strangulated
hernia or ileus." He further says: "Another cause of the
bulk of the tumor, and of the difficulty in replacing it, arises
from the presence of the intestines in the sac, which seldom
*Barnes's "Diseases of Women," p. 568.
622
EATON ON DISEASES OF WOMEN.
reside there long without inflammation of their peritoneal
coat being set up, not of so acute a character as to produce
formidable symptoms, but matting their different coils to-
gether, and tying them firmly to the interior of the sac."
The only treatment which can be given these cases, where
adhesions have formed, is palliative in character, if complete
procidentia is present. This palliative treatment consists of
holding up the protruding mass in a sling attached to a band
around the hips, drawing off the urine with a catheter, if
necessary, and treating any inflammation which may arise
with those remedies most clearly indicated.
RESTORING THE PERINEUM.-In my opinion an operation to
restore the perineum is never required in the treatment of
procidentia. When the laceration includes the sphincter ani
it is necessary to operate sufficiently to enable the patient
to retain the feces; but for the purpose of preventing the
return of procidentia it is valueless, or nearly so, unless we
also cause such a constriction of the vagina as to make a
descent of the uterus physically impossible.
In this case
the natural delivery of a child is impossible, and in some
instances copulation even is out of the question.
Dr. Barnes,* of London, says of the operation to restore
the perineum in these cases: "As we have seen, the poste-
rior wall of the vagina and the perineum form a most efficient
support for the anterior wall. Much benefit might, therefore,
reasonably be expected from making good this part. Mr.
Baker Brown was one of the earliest and most earnest advo-
cates of this plan. A considerable number of operations of
this class have been performed by him and others, and with
varying degrees of success. But then there are clinical ob-
servations in abundance to prove that it is based upon im-
perfect appreciation of the cause of the prolapsus. In many
of the cases, notwithstanding the narrowing of the posterior
wall of the vagina and the union of the labia, much anterior
Barnes's "Diseases of Women."
PROLAPSUS UTERI AND PROCIDENTIA.
623
to the normal fourchette, the prolapse after a time returned.
The true factors of the prolapsus remaining untouched, grad-
ually the uterus made its way down again, and, distending,
the new perineal floor appeared outside the vulva. Nor is
the relief often permanent, unless the vulva be almost com-
pletely occluded. It has been seen that the small vulva and
perfect hymen of the virgin are not an absolute safeguard
against prolapsus. The narrowing of the vulva simply forms
a shelf to receive the falling uterus."
PERINEORRHAPHY.-Perineorrhaphy is a name given by
Prof. Thomas to an operation for restoring the perineal
body. The idea is to make by this operation a firmer and
thicker perineum.
The operation consists in dissecting out a piece of vaginal
membrane from the interior of the perineum. It may vary
in size, according to the case, from two to three inches in
length, and from one to two inches in width. And then
place sutures so as to draw together the opposite sides of the
vagina, thereby narrowing its capacity at its inferior extrem-
ity. The operation is not difficult; but still we do not rec-
ommend it, for the reason that we do not find need for it,
and believe there are easier and better ways of treating
prolapsus of the uterus.
ELYTRORRHAPHY.-Elytrorrhaphy is an operation for nar-
rowing the vagina in its upper portion, which is about as
useless as perineorrhaphy, though much more difficult. In
the first quarter of the nineteenth century the operation
was performed in England and Germany. In 1858 Prof.
Sims revived the operation, which had for many years
fallen into disuse. The late Prof. A. G. Beebe reported,
about five or six years since, to the Illinois State Homoeo-
pathic Medical Association, several successful operations per-
formed by himself.
*Thomas's "Diseases of Women," p. 349.
†Sims's "Uterine Surg.," Eng. ed., p. 309.
624
EATON ON DISEASES OF WOMEN.
The only cases in which we think the operation of ely-
trorrhaphy is allowable at all are those cases of quite old
women who are troubled with procidentia uteri, and who, for
some reason, prefer to be operated upon to having the trouble
of using other suitable treatment.
The operation, to be of any use, must remove a large
piece of the vaginal membrane so as to effectually narrow
the canal to a very small size. In performing the operation
we should remove a diamond-shaped piece of vaginal mem-
brane, the longest diameter of which is lengthwise the vagina,
for otherwise a pouch might be formed, in which would accu-
mulate secretions which would become irritating by their long
retention. There is liability to great hemorrhage from the
large extent of surface required to be dissected off, and this
class of patients are, as a rule, unprepared to stand the loss
of blood, the effects of the anaesthetic required, and the
operation.
I will not enter into a minute description of the steps in
the operation. The student understands that the patient.
must be placed upon her side or back on the operating table,
and an anesthetic administered; that the. vagina must be
dilated with retractors held by assistants. He knows that
a tenaculum will hook up the vaginal membrane, and that a
scalpel will cut it, and that if he has skill enough he may dis-
sect out a large piece of vaginal membrane and then stitch the
opposite sides of the denuded space together with silver wire,
as he would do in a case of vesico-vaginal or recto-vaginal
fistula; that the stiches may well remain about the same time.
as when used in the treatment of fistula. His judgment
should teach him that for at least two weeks the patient
should remain in a horizontal position, etc., etc. So, if he
ever feels blood-thirsty, and he has a patient wishing to be
operated upon, he may go ahead and perform the operation
of elytrorrhaphy.
There are authorities enough who justify and recommend
PROLAPSUS UTERI AND PROCIDENTIA.
625
the operation. We, however, give the advice to use the
homoeopathically indicated remedies in prolapsus, and conjoin
rational support to the abdominal viscera, supporting the
uterus even (in cases of very old women) with the T ban-
dage, a Babcock supporter, or the inflatable pessary, and al-
low the old ladies to live their few remaining days with all
their vaginal membrane intact.
Remedies.
Great good is accomplished with remedies, especially when
used in connection with the postural treatment in recent cases,
and with young women. They are useful in any case, but
strikingly so in some of the class just mentioned.
The remedies useful in prolapsus are not always used for
their direct effect upon the uterus or its appendages, nor
even upon the abdominal organs or vagina, for the reason
that the sympathetic affections which are produced by pro-
lapsus uteri are so numerous and varied that it is sometimes
necessary to meet these symptoms with indicated remedies.
We can not, therefore, expect to mention every remedy
which might be useful in some particular isolated case, but
will record those most frequently indicated; for, should we
attempt to recount all the remedies which might possibly be
of use, especially for the nervous symptoms and those of
hysterical nature, we would have to make up quite a materia
medica.
LOCAL REMEDIES.-These we mostly discard, although in
some cases the complications in these patients make a resort
to them advisable.
In case we have metritis, endo-metritis, leucorrhoea, cystitis,
erosions of the cervix, etc., some local applications to the
uterus direct are of great benefit; but as we have discussed
them under their appropriate chapters, we will not repeat
them here, further than to mention the almost universal in-
dication in these cases for the use of warm sitz baths, or
40
626
EATON ON DISEASES OF WOMEN.
warm vaginal injections of pure water. These may be used
daily in almost any case of prolapse or complete procidentia,
with great comfort and benefit.
The remedies most frequently indicated internally are,
Nux, Aconite, Bell., Sepia, Cantharides, Secale, Puls., Lycopod.,
Colocynth., Aloes, Plumb., Arnica, Hyosc., Cimicif., Calc. carb.,
Can. ind., Dig., Ignat., Bry., China, Ars., Iris vers., Lilium
tig., Sulph., Phos., Sabina, Calc., Phos, Aurum, Petroleum.
Special Indications.
Aconite.-Tenderness of the cervix uteri; general con-
gestive and feverish condition; tenderness in any part;
suited to timid ladies; despondency, indicated especially in
plethoric women; acute catarrhal conditions; great restless-
ness; loss of sleep; palpitation of the heart, etc., etc.
Arsenicum Alb.-Prolapsus, with erosions of the cer-
vix; corroding leucorrhoea; great thirst; alternately feeling
heat and cold; hot, but shivering; burning hands and feet;
nausea; diarrhoea of a cadaverous odor; burning sensation
in abdomen; great prostration of strength, with irritation of
the mucous membranes, characterize this remedy.
Aurum. Heaviness in abdomen, and coldness of hands
and feet.
Belladonna.—Prolapsus, with pressure as though all
the abdominal organs would be pressed down through the
vagina; spasmodic pain in the uterus; inflammation of the
uterus, with cerebral congestion; dullness of intellect; com-
plete procidentia, with erysipelatous condition of the pro-
truding mass; spasmodic cough; difficulty of swallowing,
from spasmodic closure of the oesophagus; takes cold easily;
bathed in perspiration; right side most affected; paralysis of
one side of the face; sore throat; tonsils red and swollen;
spasmodic twitching of some of the voluntary muscles; dila-
tation of the pupil; painful micturition.
Bryonia. In prolapsus, with darting, piercing pains;
PROLAPSUS UTERI AND PROCIDENTIA.
627
constipation; great nausea; nausea and pain, aggravated by
motion. (Consult Coperthwaite's Mat. Med.)
Calc. Carb.— Prolapsus with leucorrhoea; light com-
plexioned women of scrofulous tendency most benefited;
distressing bearing down pain, with inflammation of the
vulva; menses profuse and frequent; great emaciation with
bloated abdomen; excessive adipose development.
Cannabis Indica.-Prolapsus, with jerking in the abdo-
men; profuse leucorrhoea; catarrh of the vagina, etc.
Cantharides.-Prolapsus with sterility; loss of sexual
desire; pain at the base of the brain; constant desire to
urinate; spasmodic condition of the larynx, with mucous
stools; excessive sexual desire.
China. Prolapsus after miscarriage, with great loss of
blood. (For other indications, consult Burt's or Allen's Ma-
teria Medica.)
Colocynthis.—Prolapse with sharp cutting pains in the
abdomen, especially around the navel; violent sciatic pain,
with thick viscid urine.
Conium.-Prolapsus, with induration of the cervix; ex-
cess or want of feeling, accompanied with sterility.
Digitalis.—Prolapsus, with palpitation of the heart; diffi-
culty of breathing; motion produces faintness; smell of food
excites nausea.
Ignatia. In prolapsus, with piles; pains shooting deep
into the rectum; throbbing pain in occiput; hysterical
symptoms.
Iris Versicolor.-Prolapsus, with burning distress in the
stomach; watery, burning diarrhoea; very useful in cases
afflicted with sick headache.
Kali Phos.-Prolapsus, with rheumatic pains; sufferings
from great grief; diarrhoea; leucorrhoea; takes cold easily.
Lilium Tigrinum.-Prolapsus, with intense bearing
down pains, with depression of spirits (a very useful remedy).
Lycopodium.-Prolapsus with constipation; straining at
1
1
628
EATON ON DISEASES OF WOMEN.
stool; dryness of the vagina; sharp pains in the labia;
flatulence; severe pain in the back; red sand in urine; ten-
dency to hepatic disease.
Nux Vomica.-Pain in the back and head; bearing
down pains in abdomen; constipation; indigestion; fetid
leucorrhoea; irregular menstruation; too profuse menstrua-
tion; bad dreams; debility; trembling of the limbs; loss of
appetite; cases complicated with piles or fissure of the anus ;
hemorrhage from the bowels; incontinence of urine and
bloody urine; paraplegia, and effects following spinal irri-
tation.
Petroleum.—Prolapsus, with troublesome diarrhoea; irri-
table temper; very useful in chronic inflammation of cervix;
gastralgia; burning of palms of hands and soles of feet.
Phosphorus.—Prolapsus, with weakness; excessive, or
lack of, sexual passion; corrosive leucorrhoea; great debility;
constipation; cold extremities; nervous exhaustion.
Pulsatilla.—Prolapsus with scanty menstruation; sour
stomach; menstrual blood thick and dark; tendency to faint-
ing spells; indigestion; thick white albuminous leucorrhoea.
Sabina. Prolapsus, with quivering sensation in abdo-
men; copious leucorrhoea; prolapsus, with threatened abor-
tion; excessive plethora.
Secale. Prolapsus with severe bearing down pain; fear
of death; melancholy, accompanied with passive hemorrhages
from the uterus or rectum.
Sepia.-Prolapsus, with painful pressure in the vagina;
burning, stitching pains in the neck of the uterus; complete
procidentia; profuse leucorrhoea; troublesome itching of the
vulva; very sensitive to cold air; sad, dejected mood,
with fetid urine depositing a clay-colored or reddish sedi-
ment, which adheres to the vessel as if burnt on; dyspar-
eunia or vaginismus; bad smelling leucorrhoea; nausea in
the morning; spasmodic dry cough, etc.
LACERATION OF THE VAGINA.
629
CHAPTER LIII.
LACERATION OF THE VAGINA-LACERATION OF THE PERIN-
EUM-ULCERATION (TUBERCULOUS, CANCEROUS, AND SYPH-
ILITIC).
LACERATION of the vagina occurs most frequently as a
result of labor where the vagina is not well relaxed and the
uterine contractions are very strong. Laceration of the
perineum is frequently complicated with laceration of the
vagina when it is produced from this cause, or violent
traction in delivery with forceps, or by pedalic version.
Laceration of the vagina may occur from other causes, as
the breaking in the vagina of a glass vaginal syringe, or by
being hooked by an animal, or falling upon something stiff
and sharp. Dr. James reports a case where a woman was
impaled upon the prong of a hay fork, which passed between
the cervix uteri and the rectum, penetrating the abdomen
as far as the ribs. (The lady recovered.) Gotthardt re-
ports a case of spontaneous rupture of the vagina from a fall.
Lacerations from traumatic causes usually implicate the
bladder, uterus, rectum, or peritoneal cavity, causing some
form of vaginal fistula.
Ulceration of the vagina is due in many instances to the
long continued pressure of the head of the child in the pelvis
during confinement, and it may result from the wearing of
hard pessaries. The various fistula of the vagina are liable
to result from these ulcerations.
Syphilitic and tuberculous ulcerations are not likely, to
cause fistula, being mainly confined to the mucous membrane
of the vagina, and occurring, in connection with other man-
*Boston Gyn. Jour., Vol. 3, p. 175.
† Weiner Med. Woch., 1869, No. 94.
630
EATON ON DISEASES OF WOMEN.
ifestations of these diseases, in other parts or organs of the
body.
Cancerous ulceration of the vagina is usually the result
of its extension from the cervix uteri, and may destroy all
the adjacent organs.
The cancerous cachexia is observed in
these cases, characterized by the yellowish brown, sallow,
wrinkled condition of the skin all over the body.
Treatment.
In case of lacerations of the vagina, which affect the
vaginal membrane only, injections into the vagina of warmı
water, to which a little of the Tr. of Calendula is added, is
all the treatment required. In cases where the peritoneal
cavity is penetrated the exclusion of atmospheric air to as
great an extent as possible should be attempted, by wearing
oiled silk over the external genitalia, held in position with a
compress of cloth and a T bandage, after stitching the lacera-
tion together with silver wire interrupted sutures, and keeping
the patient lying on her side with the hips elevated.
When the bladder or rectum or perineum are implicated,
they are to be treated as directed under the heads of lacer-
ated perineum, vesico-, and recto-vaginal fistulæ.
Syphilitic ulceration, as well as the tuberculous and can-
cerous require the same treatment as when occurring in other
localities.
FISSURES OF THE VAGINA.
Fissures of the vagina may exist around the os vaginam,
as a result of violent coitus, the use of a speculum of too large
a size, or may be the result of slight lacerations in confinement.
Ordinarily they heal readily, but, in some cases, owing to the
want of plasticity of the blood, or on account of frequent in-
jury, they become chronic, and show no disposition to heal.
In such cases the sharp-pointed stick of Argentum nit., ap-
plied to the base of the fissure once in three days, and smear-
ing the parts with Basilicon Ointment, is the way to effect a
LACERATION OF THE PERINEUM.
631
healing rapidly. The general condition of the system must
not be overlooked, and remedies which are homoeopathically
indicated by the symptoms should be given. The parts may
be bathed with tepid water frequently, though gently. Sexual
congress must be strictly prohibited till the fissures are well.
LACERATION OF THE PERINEUM.
Laceration of the perineum takes place in cases of rapid
deliveries, where the vagina is not well relaxed, and from
undue traction upon the head of the child in delivery by
forceps, or in pedalic version where the head of the child is
large, and the vagina not completely relaxed; and from the
unrelaxed condition of the vagina in natural delivery, where
the head of the child distends the perineum for a long time,
cutting off the circulation of the blood from the distended
tissues. Slight lacerations quite frequently occur, and heal
without special treatment.
The lacerations of the perineum occur in various degrees.
from the very slight to complete laceration of the perineum,
implicating the rectum and dividing the sphincter ani. This
throws the vaginal and rectal outlets into one common pass-
age. In these extensive lacerations, the vaginal wall is lacer-
ated from one to three inches. The feces and flatus from
the bowel can not be retained, and pass away involuntarily
and unconsciously.
Laceration of the perineum occurs as a result of external
violence occasionally. This accident may happen in this
way to young girls or old women as well as the middle aged.
Laceration of the perineum most frequently occurs in
women who are being delivered of their first child, and if the
lady is middle aged, the delivery of her first child is more
hazardous in this respect than when younger in years.
Of
course, lacerations do sometimes occur in women who are
quite young, and have had several children previously. This
may result from their previously having had a slight lacera-
632
EATON ON DISEASES OF WOMEN.
tion, which, in the healing, left a cicatrix which would not give
or relax, and hence results an extensive laceration. Possibly
the midwife is to blame, in some cases, for allowing labor to
progress rapidly while the tissues are rigid about the vag-
inal outlet.
Inattention to giving the head of the child proper support
while passing the perineum may cause a laceration, even in
those cases where there is a good degree of relaxation of the
perineal and vaginal tissues.
Diagnosis.
After a laceration of the perineum the patient complains
of a smarting, burning pain in the parts, even if the lacer-
ation be slight. When it is extensive, the pain and smart-
ing is usually severe. These complaints made by the patient.
should indicate to the medical attendant the necessity of
physical examination. By passing the finger into the vagina
and moving it from side to side over its posterior surface,
the laceration is readily detected in the solution of contin-
uity of the vaginal membrane. We then withdraw the fin-
ger and place it upon the anus, and passing it forwards de-
tect the extent of the laceration. There is no call for ocular
inspection of the perineum, to make out the diagnosis. I
am aware that Dr. T. G. Comstock, of St. Louis, recom-
mends ocular examination of every case of confinement, to
see if a laceration of the perineum exists. This may be
done in a hospital, but I think would not be considered just
the thing to do in private practice.
Dr. Emmett claims that "a laceration of the perineum
is sometimes accompanied by a general irritability, which can
not be traced to any other cause, and is only relieved when
the perineum is restored. I have known several instances in
which the existence of scars in the perineum had so much
* U. S. Med. Investigator, July 1, 1880, p. 39.
† Emmet's Prin. and Prac. Gynecology.
LACERATION OF THE PERINEUM.
633
effect upon the nervous system as to entirely change the dis-
position of the woman, and yet they were not conscious of
any local difficulty."
Now, it has not been our experience that such results
follow slight lacerations or even scars of the perineum; still
we give the student the suggestion from Dr. Emmet. The
perineal body has not by its anatomy any peculiarity which
would make a laceration of it any more likely to cause ner-
vous symptoms, than would result from scars or lacerations.
anywhere else, and we do not think that experience shows
that they do. We do not think that slight lacerations of
the perineum interfere with involution of the uterus after
confinement, as is claimed by some; neither do they materially
aid in causing prolapsus uteri; but they do cause sterility by
allowing of the discharge of the semen from the vagina be-
fore it is drawn up into the uterus. They are not desirable,
as they interfere with sexual congress by preventing the con-
traction of the sphincter vaginæ, thereby tending to prevent
the sexual orgasm in both sexes.
Treatment.
In recent slight cases the treatment consists in putting
the parts in apposition, by placing the patient upon her side
and tying the knees together to prevent their getting sepa-
rated, and thereby cause the breaking loose of any feeble
attachments which may form. The bowels should be con-
stipated, in extensive lacerations, for eight or ten days, by
giving Opium in Mother Tr. about ten drops every eight hours.
Evacuate the bladder with the catheter twice a day, or leave
a self-retaining catheter in the bladder. (See Plate XIII.)
If the laceration is so extensive as to implicate the anus in
the rent, the taking of three or four deep sutures, at once, is
advisable. The interrupted suture may be used, or the quill
suture is applicable, if preferred, as we will describe in the
operation necessary in old cases of laceration.
634
EATON ON DISEASES OF WOMEN.
When the laceration is small in extent, there is no need
to constipate the bowels or use sutures. They may move
aided by warm water enemæ, every two or three days. The
limbs must be kept tied together, and gentle, bland nourish-
ment, only, must be allowed. Tepid water, to which a little.
Tr. Calendula is added, may daily be very gently thrown into
the vagina, always keeping the patient on her side. This is
for the purpose of preventing the discharges from the uterus
from getting into the laceration, and preventing union, which
would be likely to result if the patient was upon her back.
Many cases even of extensive laceration will heal promptly
if the foregoing directions are strictly followed; still I would
place sutures in extensive lacerations, thereby preventing the
possibility of a tedious and sometimes troublesome operation
afterwards, as well as having the advantage of giving much
comfort to the patient in the possession of health and avoid-
ing the dread of an operation afterwards. Another advan-
tage of prompt and efficient treatment consists in the saving
of tissue which is necessarily lost in operating upon old lac-
erations, in order to freshen the edges of the tear and enable
union to take place. Again, the inherent resources of nature
which supply the plastic material to restore solutions of con-
tinuity, either in the bony, fleshy, or mucous tissues of the
body, seem to be more active directly after the injury is re-
ceived than at any subsequent period.
The case of chronic laceration of the perineum must be
made to simulate the recent case, by freshening the edges of
the rent in the vaginal, muscular, and cutaneous tissues,
which have become covered by a sort of mucous membrane.
We have made a drawing (Fig. 61), to represent the tissues
which are lacerated and the position of the sutures to be
taken where the laceration includes the recto-vaginal septum.
OPERATION. First the patient should be in as good a condi-
tion as possible. If the general health is in bad condition, we
are not likely to obtain union of the edges of the laceration.
LACERATION OF THE PERINEUM.
635
The bowels should be freely moved previous to the operation.
The lady should lie upon a conveniently high operating
table, upon her back, being suitably clothed in woolen drawers
and stockings, with the knees flexed upon the abdomen, and
well separated by an assistant upon each side, who should
also each hold a vaginal retractor to separate the lateral

1000
་,,་
2.
-
FIG. No. 61.-LACERATION OF THE PERINEUM.
walls of the vagina from each other, and bring the entire
laceration into view, after the patient has been given an
anæsthetic.
We next proceed to denude the lacerated surfaces of the
mucous membrane developed over them. If the laceration
implicates the recto-vaginal septum, we make two operations,
636
EATON ON DISEASES OF WOMEN.
the first to cause a healing and closing of the recto-vaginal
septum, and afterwards of the rupture of the perineum;
although instances might occur where it would be advisable
to perform the whole operation at once.
In case we are to make two operations, we only denude
the tissues which are to be approximated to form the recto-
vaginal septum. Commence at the lowest portion of these
tissues to be united, and seize the mucous membrane with a
tenaculum, and incise its lower portion with scissors or small
scalpel; then proceed to lift up and dissect off as rapidly as

GĦDEMANN
FIG. No. 62.-BOZEMAN'S STRAIGHT SCALPEL.
possible, either with scissors or scalpel, all the surface we
wish to bring in contact with the opposite side.
(Both op-
posed surfaces must, of course, be denuded.)
We then insert the silver wire interrupted sutures, the
same as in recto-vaginal fistula (after arresting any hemor-
rhage we may have caused), placing the uppermost suture
first. Here my wire holder and twister will be found very
convenient in fastening the sutures (see chapter on Instru-
ments, Plate VI). Place as many sutures as are necessary
to restore the recto-vaginal septum by placing them one-
third of an inch apart, the number required varying accord-
ing to the extent of the laceration.
In case we see fit to perform the whole operation at
once, the entire surface, triangular in shape, as represented
in the cut No. 61, must be freshened, and after placing the
sutures to restore the recto-vaginal septum, as I have just
described, we turn the patient upon her side, letting the
knees come together, having the uppermost buttock lifted up
by an assistant, to be out of the way. We may now take
from three to five deep sutures in the perineum, placing the
first just at the margin of the anus and the others at inter-
LACERATION OF THE PERINEUM.
637
vals of a half inch anterior to it, using Peaslee's improved
perineum needles, or strong curved surgeon's needles. We
place these sutures deeply enough to include the vaginal
membrane, having the last one anteriorly placed so far for-
ward as to draw together some little of the tissue not fresh-
ened. This will be found in practice a useful suggestion,
causing the restoration of a more complete and symmetrical
fourchette than can otherwise be accomplished.
To insert a quill suture we must have a needle which has
its eye about one-half inch back from the point, and is made
somewhat semi-circular-it should be at least three inches in
length, and fastened into a straight handle. (See Penslee's
improved perineum needles, Plate VI, chapter on Instruments.)
The needle is threaded with silver wire, and inserted deeply,
from side to side, carrying the point of the needle through the
cutaneous surface of the opposite side to the one through
which it is first inserted, far enough to enable us to pass a
tenaculum through the loop of wire carried by the needle.
We now make a little traction upon the tenaculum, so as to
draw a little of the loop through the tissues, and holding it
firmly, withdraw the needle by the side of the wire. We
now insert a piece of No. 6 bougie through the loop of wire,
and make slight traction upon the ends of the wires, suf-
ficient to tighten the loop over the bougie.
We now
thread the needle with another piece of wire, or use another
needle already threaded, and insert another suture in the
same way, placing the first suture in the margin of the
anus if it is implicated, or near it in case it is not torn,
using a sufficient number of sutures to bring the laceration
well together, placing them about one-half an inch apart and
slipping the piece of bougie through each successive loop as
it is inserted.
In placing these the patient may most conveniently lie
upon her back, with the limbs well drawn up, as required for
freshening the edges of the laceration, and, after the sutures
638
EATON ON DISEASES OF WOMEN.
are placed, we turn the patient on her side, tighten up the
ligatures so as to evenly approximate the lacerated surfaces,
by taking the two wires of each suture and twisting them
together over a piece of bougie like the one placed through
the loops of the sutures upon the opposite side. (See Fig.
No. 63.)
After these sutures are placed and tightened around the
piece of bougie or quill, as was formerly used, superficial
stitches between the
deep ones may be taken
just to include the cu-
taneous tissue, approx-
imating it more evenly;
and these may be re-
moved in about four
days. The ends of
the sutures should be
wrapped together in a
piece of soft cloth, to
prevent their irritating
the thighs.

FIG. No. 63.-QUILL SUTURE ADJUSTED IN CASES OF
LACERATED PERINEUM.
AFTER TREATMENT.-
As soon as the opera-
tion is completed the
patient may be re-
moved to her bed, first
tying the knees to-
gether. After the pa-
tient has recovered
from the anaesthetic,
ten drops of Tr. Opi
may be given and repeated every eight or ten hours for two
or three days, when the dose may be reduced to five drops
Beef tea, soup,
if the bowels show no disposition to move.
milk, etc., should constitute the diet for ten
days or two
LACERATION of the perineum.
639
weeks. The urine should be drawn off with a self-retaining
catheter. No vaginal washes are required, nor should they
be allowed. In the recent case, following confinement, we
recommend them to wash away the discharges from the uterus
which follow ordinary delivery; but in the old case, we have
no need of them, and when they are needed in the recent
case, they should be used while the patient is on her side
inclining towards the face.
TIME FOR THE OPERATION.-The time to be selected for an
operation for the restoration of the perineum is within a few
days after the menstrual flow (if the menses have come on
since confinement), in order to get the parts healed before
the next period.
CAUTIONS.-In placing the sutures do not draw them too
tightly. There is more liability to make a mistake in this
direction than in any other. When the sutures are drawn too
tightly the normal circulation is arrested, and sloughing re-
sults, making not only a failure of the operation, but making
any subsequent operation extremely difficult or impossible,
owing to the loss of tissue from the sloughing.
Do not be induced to allow the patient to pass her urine
for ten days without the use of the catheter, on account
of the danger of its getting into the laceration and pro-
ducing irritation. It is better that it be not allowed to
dribble in the least down upon the freshened lacerated
tissues.
If the anus or recto-vaginal septum is included in the
laceration do not allow the bowels to move for at least eight
days. When it is not involved they may move regularly.
Reason and experience teach us that the passage of feces
through the rectum and anus will tend very materially to
disturb the healing process by breaking loose feeble attach-
ments in the parts.
Do not make frequent examinations of the tissues to see
how they are getting along. Perform the operation properly,
七
​640
ΕΑΤΟΝ ΟΝ DISEASES OF WOMEN.
and then let the parts alone for about ten days. In the
very young, robust patient, the sutures may be removed on
the tenth or twelfth day; but with those not very strong the
stitches better be allowed to remain fourteen or sixteen days.
The bowels may, however, be moved on the eighth day,
as a rule.
DRESSINGS AND LOCAL APPLICATIONS.-Regarding these, we
say, none are required. Cases do better without than with
them.
REMOVAL OF THE SUTURES.-The patient may lie upon her
right side, with her thighs well flexed. We now pass the
index finger of the left hand into the vagina, and feel for the
highest suture. Having found it, we slip Cutler's suture
forceps and cutter alongside the finger, and introduce the
probe point of the long blade under it, and then open the
blades a little, and pass the forceps in about a half inch
further, taking care that the forceps are a little to the right
of the twist of the suture. Now press the forceps together,
and we sever the wire and hold the suture firmly; gently
lift the forceps, and remove the suture. Remove the next
below in the same manner, till all are removed.
We next proceed to cut the loops of the sutures in the
perineum, if we have used the quill suture; and after remov-
ing the piece of bougie straighten out the wire which has
been curved around it. We then make gentle traction upon
the opposite ends of the sutures, sufficiently to allow us to
remove the other piece of bougie. Now seize the twisted end
of the sutures, one at a time, commencing with the one at
the margin of the anus, and withdraw them, making counter
pressure against the perineum at their point of insertion as
each is withdrawn. We may now gently apply a pad of lint
against the perineum, and support it with a T bandage. For
a week longer the patient should keep the knees together
religiously, and the T bandage and gentle compress may well
be used for several weeks. The movements of the bowels
LACERATION OF THE PERINEUM.
641
may be assisted by injections of warm water and soap for
several weeks.
WHEN SHALL WE PLACE SUTURES IN THE RECENT LACERATION
OF THE PERINEUM?—I would say as a rule, when the lacera-
tion is extensive, place silver wire sutures in the parts at
once-i. e., within a day or so. No freshening of the edges.
of the wound is then needed. Those lacerations which are
slight may be expected to unite without using sutures, if we
keep the limbs together, and use the precautions already
mentioned. In the recent case the sutures need not remain
more than eight or nine days.
Remedies.
Remedies are sometimes not needed at all; in some in-
stances, however, symptoms arise which demand their use, and
they should be given as homoeopathically indicated. Arnica,
Hamamelis, Aconite, Bell., Ars., Nux, or Cal. will be most
frequently demanded. Opium, given to constipate the bow-
els during the first eight days after the operation, we recom-
mend, not as a remedy in the doses suggested, but rather to
induce an abnormal condition. We give it in Tr., not to
relieve pain or cure disease, but to restrain the normal peris-
taltic action of the bowels. If the patient has some idiosyn-
crasy regarding food, so that she knows of some food which
will, in her case, cause an arrest of action of the bowels, let
her have it instead of Opium by all means.
Aconite is indicated if inflammatory fever is manifested.
Arnica will ordinarily relieve any pain complained of in
these cases.
Nux or Ars. may relieve nervous symptoms, according to
their pathogenesis, as laid down in works upon materia medica.
41
642
EATON ON DISEASES OF WOMEN.
CHAPTER LIV.
EXTRA-UTERINE GESTATION.
THE development of a foetus in the Fallopian tube or
abdominal cavity is termed extra-uterine gestation or preg-
nancy. The lodgment and impregnation of an ovum in the
tube is one of those freaks of nature about which we may
theorize to our heart's content, and know as little afterwards
as at first. The fact, however, is presented, that gestation
does commence in the tube in some instances.
That it never
goes on to completion there is just as true. The distension
of the tube by the foetus generally causes a rupture of its
coats about the third month. Barnes claims that this rupture
of the tube is not necessarily fatal, and that an abdominal
gestation is sometimes the result. Other authors are agreed,
so far as I have noticed, that the rupture of the Fallopian
tube is fatal. Few can say they have ever seen it otherwise.
Abdominal gestation may, however, become attached to
any part of the peritoneal cavity, and go on to the full
development of the child. The interest in this class of cases
is found in the methods of nature and art adopted in its deliv-
ery, and also in the fact that it may remain in the abdomen
for years, without producing any perceptible effect upon the
mother. One case is recorded where the child remained in
the abdomen fifty-six years. Campbell collected reports
of eighty-five cases of abdominal gestations, varying in time
from four to fifty years. (This does not look as if there
was any very great necessity for operative interference.)
In some cases uterine pregnancy commences and goes on
to completion, while abdominal pregnancy exists in the same
woman.
* Barnes's "Diseases of Women," p. 322.
† Ibid., p. 322.
EXTRA - UTERINE GESTATION.
643
Generally the death of the child takes place, it is said,
at about the time of the completion of full term, if not then
delivered. This I have some reason to doubt, from having
seen one in Rush Medical College Museum, which had been
removed, by abdominal section, three and one-half years from
the time of conception, which had an appearance of much
greater age than nine months. I could not learn the history
of the case, however.
Interstitial, or intra-mural, gestation, as it is sometimes
called, consists of the development of a foetus at the uterine
extremity of the Fallopian tube, which makes for itself a de-
pression in the muscular fibers of the uterus around the tube.
This form of abnormal gestation is about as fatal as the reg-
ular tubal variety, sometimes producing sudden death from
rupture of the tube or the outer coats of the uterus, or being
fatal from ulcerative action implicating the rectum or perito-
næum. In these cases gestation sometimes goes on to full
term; but more frequently the foetus dies sooner, and may
remain undecomposed for a time, when it disintegrates, and
is discharged piecemeal by the uterus, vagina, or rectum, or
through fistulous openings in the abdominal walls.
Diagnosis.
In all varieties of extra-uterine gestation the symptoms
are more or less obscure for a few months after impregnation.
The uterus, of course, enlarges little, or none at all; and still
there is present, in most cases, partial or complete arrest of the
catamenia, together with some nausea; enlargement of the
papillæ around the nipples; some darkening of the skin in
this locality; enlargement of the breasts, etc. In tubal and
intra-mural pregnancy there is considerable pain and soreness
in one iliac region. At times some enlargement may be felt
here; at other times the tube may be felt enlarged by rectal
explorations; still, similar symptoms sometimes arise from ova-
ritis or salpingitis, with amenorrhoea, and from other diseases
644
EATON ON DISEASES OF WOMEN.
of the uterus and its appendages. In the case of abdominal
gestation the symptoms are still more perplexing for a time,
as for several months, and in some instances during the entire
history of the case, menstruation goes on uninterruptedly.
After three or four months, however, we may detect the pul-
sations of the foetal heart, and this fact, taken in connection
with the normal size of the uterus when unimpregnated, to-
gether with the absence of the severe pain experienced from
intra-mural pregnancy, and from the patient's health being
very little affected, will determine the diagnosis in favor of
abdominal pregnancy.
Prognosis and Treatment.
But little can be done in these cases in the way of treat-
ment. They are noted here for the general information of the
student, and particularly to aid him in making a diagnosis of
other ailments. The patient is likely to die in about three
months after the commencement of tubal, and in from three to
six months' duration of interstitial gestation. Kussmaul
collected thirteen cases of tubal pregnancies, all of whom
died before the sixth month. Rosenmüller reports one case.
where the sac burst at five months from interstitial impreg-
uation.
In abdominal gestation it is best to advise caution
about becoming again pregnant, as this event (when the full
term is accomplished in the uterus), and labor sets in, is very
liable to destroy the patient by inducing a rupture of the sac
in the abdomen, thereby causing a necessity for Caesarian
section, for the removal of the foetus in the abdomen, which
in the delicate condition of the patient is liable to prove fatal,
as it is sure to do if the foetus is left in the abdominal cavity
after the amniotic sac has been ruptured.
Our hands are quite completely tied in these cases of ab-
dominal gestations, where there is no special urgency, from
# Monatsschrift für Geburtskunde, 1862.
EXTRA - UTERINE GESTATION.
645
!
the experience, which I have mentioned, of the long life
enjoyed by some women, though carrying an abdominal preg-
nancy. Symptoms may be met with appropriate, clearly in-
dicated, homoeopathic remedies; and exercising great care
that the sac be not ruptured, is giving our patient the best
chance for life.
In case the sac becomes inflamed for any reason, adhesions
may form between it and the abdominal walls, and a sinus
may form externally through these tissues. In this case it is
proper to enlarge the opening, and extract the fœtus; inject
the sac with a diluted Solution of Iodine, after ligating the
funis near its placental attachment with catgut ligature, and
removing the cord, leaving the placenta in the abdomen.
Then compress the abdomen with bandages to bring the
walls of the sac in contact, and promote union, leaving the
external opening clear, to allow of the discharge of matter till
the sac is healed. A similar procedure is advisable when the
abscess in the sac points in the vagina. When the ulceration
points into the uterus, in intra-mural gestation, we may en-
large the os uteri by the use of sponge tents till we can
extract the foetus in pieces through it, using the vulsellum
forceps to extract such parts as we are able to reach. This
treatment may sometimes avail, especially if there is a large
laceration of the internal wall of the sac.
646
EATON ON DISEASES OF WOMEN.
CHAPTER LV.
STRANGURY, DYSURIA, ISCHURIA, RETENTION OF URINE, SUP-
PRESSION OF URINE, ENURESIS, ETC.
STRANGURY, Dysuria, Ischuria, etc., are terms used to sig-
nify a complete or partial retention of urine in the bladder and
painful evacuation of it; while suppression of urine indicates
the failure of its secretion in the kidneys. These affections.
are found in the male as well as the female; but there are
certain causes which operate only in the female to produce
this condition, and it is these only which we purpose to dis-
cuss here.
Etiology.
Displacements of the uterus, which cause the organ to
press the urethra tightly against the pubis, as in retro-version,
ante-version with some degree of prolapse, ante-flexion, etc.,
cause painful micturition. These displacements not only
cause strangury from pressure, but from the irritation of the
urethra caused from the pressure. After confinement wo-
men are often troubled with retention, which in some instances
results from irritation produced by the pressure of the child's
head against the urethra for a long time, in its passage
through the pelvis; and sometimes from a semi-paralyzed
condition of the muscular fibers of the bladder, rendering it
incapable of contraction. This is increased by over disten-
sion, liable to result from a neglect to have it evacuated in
due time. Suppression of urine results from want of healthy
action in the kidneys, or from obstruction in the ureters;
but I can not discuss these conditions here.
DYSURIA, AND SUPPRESSION OF URINE.
647
Diagnosis.
The physician is sometimes misled by the patient's state-
ment that she passes water very often. The distended con-
dition of the bladder causes a desire to frequently urinate,
as does also the pressure of the displaced uterus against the
urethra; but the frequent passing of a few drops of urine,
instead of being evidence that the bladder is empty, is very
conclusive evidence that it is full or inflamed. Let the
student be impressed with this point in diagnosis, as the
patient is very liable to view the case as excessive rather than
diminished flow of urine. These symptoms may be present
when there is no large amount of urine in the bladder, from
the constant irritation of the urethra, by a displaced uterus,
or improper adjustment of a vaginal pessary; and hence the
introduction of the catheter is demanded to clearly settle the
diagnosis. The distended bladder may usually be felt above
the pubis in the hypogastric region; but enlargement here
may be due to ascites, tympanites, an enlarged uterus, uterine
or ovarian tumors, etc.; hence this symptom is not conclu-
sive of retention of urine in the bladder.
The sufferings of the patient from ischuria are sometimes
very intense. The patient will make frequent and long pro-
tracted attempts to urinate, and strain with her utmost
power, and still get no relief from the discharge of the few
drops of urine she is able to force away. After confinement
the pain is not so great, usually, owing to a degree of in-
sensibility of the parts; still its retention must not be over-
looked. If urine is not passed freely, the catheter should be
used to make sure the bladder does not become over dis-
tended.
Prognosis.
Death is the prognosis if the patient gets no relief from
retention. But with some skill in the diagnosis as well as in
the treatment (so that there is not too great a loss of time)
648
EATON ON DISEASES OF WOMEN.
we may hope to be successful in the treatment. In ischuria
not dependent upon chronic cystitis we may hope to cure
speedily. (See chapter on Cystitis for treatment of dysuria
caused by this disease.)
Treatment.
The first point in treatment is to promptly evacuate the
bladder with the catheter. Secondly, replace the uterus if it
be displaced, or remove an offending vaginal pessary if one
is there. Cantharides 6 is usually the indicated remedy.
Sometimes Aconite, Bell., Can. ind., Cub., etc., are the indi-
cated remedies.
X
There is very little use to depend upon remedies alone,
when the cause is left to act. First remove the cause, and
then remedies may cure the symptoms. Most cases are
cured promptly with homoeopathic remedies (after the cause
has been removed). The cure may not be instantaneous,
however; hence, for a few days it may be necessary to
artificially evacuate the bladder with the catheter twice a
day. Here Nux vom. 2x or 3* is the remedy most frequently
indicated. If there has been great loss of blood during de-
livery or subsequent to it, China 3x is indicated. I do not
mean “give one dose and wait four weeks for it to act," but I
mean to repeat it every three or four hours. Canthar., Puls.,
Merc., Helleb., Dulc., or Ars. alb., may sometimes be indicated.
(See Materia Medica for special indications.)
ENURESIS.
Enuresis, or want of power to restrain the flow of urine,
is quite the opposite to dysuria, or strangury. In this com-
plaint the urine passes involuntarily, not only during sleep,
but while the patient is awake, in some cases. Here, as in
dysuria, I intend simply to consider some causes of the com-
plaint which are peculiar to women; the main ones of which
are, pressure upon the bladder from the gravid uterus, when
ENURESIS.
649
approaching full term, and pressure from the enlarged uterus
resulting from tumors of the organ or from tumors of the
ovaries. From these causes the muscular fibers at the base
of the bladder seem to have lost their tonicity, and hence
results the inability to retain the urine. Want of room for
the bladder to become distended, on account of these causes,
is also an element in the case. Catarrh of the vulva, vagina,
or urethra sometimes causes this condition in girls.
Treatment.
The indication is clear to remove the pressure from the
bladder as much as possible. This is many times very suc-
cessfully accomplished with the abdominal supporter. The
reclining position, in some cases, relieves temporarily in some
measure. Together with these measures the following reme-
dies may be studied and prescribed according to their homoe-
opathic indications: Caust., Rhus, Nux, Bell., Sulph., Sepia,
Acon., Bry., Hyosc., Canth., etc.
650
EATON ON DISEASES OF WOMEN.
CHAPTER LVI.
GONORRHEA IN WOMEN.
It seems, from the earliest accounts which have been re-
corded, that gonorrhoea has always existed among all nations.
Moses speaks of it in the Bible* as "a running issue out of
the flesh." Hippocrates, Herodotus, Celsus, and Cicero speak
of the disease. It is treated of especially in works upon
venereal diseases; but it seems to me advisable to mention
it here, as the peace of families may at times depend upon
the physician's correct understanding of it. Many physi-
cians even to-day believe that gonorrhoea arises only from
infection, which is a serious error, and liable to cause blame to
rest upon the innocent.
Etiology.
Gonorrhoea may arise from infection; that is, from connec-
tion with a man affected with the disease, or from the appli-
cation of the gonorrhoeal matter to the mucous membrane of
the labia or vagina with the finger or otherwise. It may also
develop from a cold, causing inflammation in the vagina and
urethra, which is followed by a discharge of matter which will
produce the disease in the male... Excessive coitus, want of
cleanliness, etc., may also develop the disease. Women may
also disease a man, who are themselves free from any symp-
tom of the disease, and who have never before had any sexual
intercourse. This is asserted by Diday. Fournier, from
his investigations coincides with these views. Out of three
hundred and eighty-seven cases of gonorrhoea in men, he
*Leviticus, chapter XV.
† Bumstead on Venereal Diseases, page 50. † Ibid.
GONORRHEA IN WOMEN.
651
found that it had been contracted from the following classes
of women:
From women of the town…..
Clandestine prostitutes..
Kept women, actresses, etc
Working girls......
Domestics..
Married women
..
12
44
•
138
126
•
41
26
387
Excessive acidity of the vaginal secretions may cause
the disease in a man, or at least produce a condition which
can not be clearly diagnosed from the disease arising from
contact with an undoubted case of purulent gonorrhoeal mat-
ter in the woman of the town. Sexual intercourse during,
just before, or just after the menstrual period, may disease
the husband; and still we can not say the wife has gonorrhoea
in these instances. We would be doing her gross injustice
in the eyes of the people by such an assertion.
We must pay respect to the popular opinion, which is
well settled, that gonorrhoea only arises from an impure con-
nection. We are obliged, therefore, to diagnose the case
as leucorrhoea, and explain that gonorrhoea may be con-
tracted by the husband from connection with his wife while
suffering from some varieties of leucorrhoea (or whites), or
at the menstrual period, and in some instances from the
acrid secretions of the uterus and vagina, when nothing ab-
normal can be discovered in the female genital organs by
physical examination. Dr. Bumstead fully agrees with
these views, and says "he is convinced by extended obser-
vation that gonorrhoea originating in this mode is of very
frequent occurrence."
In the female the
lent than in the male.
Symptoms.
symptoms of gonorrhoea are less vio-
Inflammation, heat, swelling, itching,
Bumstead on
<<
Venereal Diseases," p. 46.
652
EATON ON DISEASES OF WOMEN.
burning, etc., in the labia, vagina and urethra, with painful
micturition, and a discharge of purulent matter, are the symp-
toms produced by the disease when contracted from infec-
tion. When contracted from want of cleanliness, there is less
discomfort in every way; but the discharge is sometimes large,
at other times small in amount. The attack comes on gradu-
ally from this cause, while in the case arising from infection,
the symptoms come on in about five days after exposure,
and are of an active character, causing sometimes so much
swelling of the labia as to make walking almost impossible.
Swelling of the inguinal glands often accompanies this form
of the disease. Abscess of these glands is liable to occur, but
no constitutional blood taint is likely ever to be manifested.
In some cases the labia are mainly affected, in others the
vagina, and in some the vagina and urethra, while in others
the urethra, vagina, and labia are all simultaneously affected.
The gonorrhoeal discharge is thick, whitish, and slightly puru-
lent, sometimes streaked with blood; but it has no character-
istic qualities, either chemical or otherwise, excepting its
infectious properties, which characterize it from leucorrhoea.
Treatment.
Where the urethra is mainly affected, causing much pain
in this canal during micturition, Can. ind., Aconite, Cubebs,
Canthar., Merc., Sepia, or Ars. will usually give prompt re-
lief, if used according to their homoeopathic indications.
Where the labia and vagina are affected, without the urethra
being implicated, bathing the parts with a Solution of Kali
chlo. every four hours, previously washing away the dis-
charge with warm water and castile soap, is often all the
treatment required. In some obstinate cases, the vagina and
labia should be well and frequently coated with Vaseline, and
the vagina should be swabbed out with Zinci sulph., 10 grs.
to the oz. Using a speculum, and putting the vaginal walls
upon the stretch, we saturate a soft sponge with the wash,
GONORRHEA IN WOMEN.
653
and bathe the vaginal membrane freely, repeating this treat-
ment every day for a week or so, when we will usually find
the discharge has ceased, it having previously been kept up
from the folds of vaginal membrane concealing surfaces
which were affected, and still not reached until we dis-
tended the vagina with the speculum. The warm sitz bath
is a useful adjuvant in the treatment of these cases.
Enlargement of the inguinal glands, called bubo, should
be treated with warm compresses of cloths wrung out of
warm water, or warm hop water, or we may add Tr. of Ar-
nica to the water. Diluted Spts. of Camph. may be bathed
over the swelling three times a day. If a few days' treat-
ment of this kind fails to cause resolution, in connection
with the internal use of the indicated remedy, we may poul-
tice with ground flaxseed meal, or pulv. slippery elm, apply-
ing the poultices warm, and renewing them every six hours.
If pus forms, the abscess should be lanced freely, the matter
evacuated, and poultices continued. Aconite, Sepia, Sulph.,
Merc., Iod., Ars., etc., are usually the indicated remedies.
(See Materia Medica.)
Those cases about which we are in doubt as to the real
nature of the disease, though manifesting symptoms giving a
suspicion of gonorrhoea, we had better name to the patient
and friends as leucorrhoea, or vaginitis (if you like), and then
proceed to treat the case for gonorrhoea. Of course, where
the history of the case and the violence of the symptoms
clearly indicate it to be gonorrhoea, and there is no need of
concealment, the physician should, of course, frankly state
the nature of the disease. In either condition of affairs
sexual congress should be strictly forbidden, and the patient
should be warned to use care nor to get the matter carelessly
upon other mucous surfaces, especially in the eye.
GONORRHOEA IN YOUNG GIRLS.-When quite young girls be-
come diseased in this way (through the intent of some angry,
low-lived servant girl, in order to spite the family for some
654
EATON ON DISEASES OF WOMEN.
fancied indignity or insult), or from any other cause, the wash
of Kali chlo. should be injected into the vagina with a small
tubed syringe, and the external genitalia should be freely
bathed with the same three times daily. Vaseline may also
be applied to the mucous surfaces of the labia; and when
the urethra is affected the same internal remedies should be
used, as mentioned in connection with the treatment of
gonorrhoea in women.
•
SYPHILIS IN WOMEN.
655
CHAPTER LVII.
SYPHILIS IN WOMEN.
SYPHILIS has only been known (so far as we can trace its
history) about four hundred and eighty-five years. In the
latter part of the fifteenth century, about the year 1495, it is
described as being prevalent in France, Italy, and Germany,
since which time the world has not ceased to suffer from its
effects, until at the present time we have hard work to follow
it in all its contaminating effects in the blood of nearly the
entire race.
The immediate effects of primary syphilis are not so ap-
parent now as in its past history, but its remote effects are
around us on every hand.
We do not intend to make more
than a very few suggestions regarding syphilis, which appear
to us to be of special interest to the student, leaving him to
study the disease more in detail from special works on "Vene-
real Diseases."
Etiology.
Syphilis is contracted from infection and through hered-
itary descent. In its primary form it is communicable by
means of copulation, or from the application of the syphilitic
virus to any irritated mucous or cutaneous surface, where it
develops as a chancre or chancroid.
A person having secondary syphilis, as it is called (mucous
patches in the mouth, throat, etc.), may communicate the dis-
ease to another by kissing; and the disease develops in such
person as a primary sore at the point where the virus entered
the system. Tertiary symptoms are communicated only
through the semen or ovum. Tertiary syphilis may develop
from the semen in a child begotten of a father so affected,
656
EATON ON DISEASES OF WOMEN.
and the mother may become affected with the disease in its
tertiary form, in this manner, so far as the cutaneous symp-
toms are concerned.
I am sure I have seen the primary form developed from
the virus rubbed off from the seat of a water-closet.
I was
formerly skeptical about this method of infection, but am now
fully convinced such may be the fact. I will give one case
in illustration.
A young man came to me with a well developed Hun-
terian chancre upon the dorsum of the penis, about three
inches from the glans. He had previously been a patient
of mine with other diseases, gonorrhoea among the number,
and I am confident he would tell me the truth, as he was no
ways backward about telling of his liasons. He declared that
he had had no sexual intercourse for more than two months,
that the sore commenced about a week before I saw him, and
that a domestic where he lived, he had reason to believe, had
the disease. He could not credit my diagnosis that it was
a chancre, and he neglected treating himself properly till
finally convinced by his inability to cure himself, when he
again came to me. I then treated him as well as I could.
He thought himself cured, and married. His first child was
still-born, and covered with syphilitic eruptions. His wife
now manifested the disease clearly in its tertiary form. (She
had never had primary syphilis.)
This case convinced me that the disease in a primary
form could be contracted without copulation. Since that
time, which was some sixteen years ago, I have seen a num-
ber of cases, both in the male and female, which have proven
more strongly this idea to be correct.
The virus will not, however, be readily absorbed by any
surface which is perfectly intact. Some irritation of the
mucous or cutaneous surfaces is necessary for its absorption,
unless it be allowed to remain in contact with the skin or
mucous membrane for a considerable length of time.
SYPHILIS IN WOMEN.
657
A syphilitic child may communicate the disease in its
secondary form to a healthy wet nurse through nursing, and
the diseased wet nurse may communicate the disease to the
healthy child she may be employed to nourish.
Symptoms and Diagnosis.
The syphilitic symptoms are not so marked or violent as
are those of gonorrhoea. The period of incubation for the
chancroid sore is about eight to ten days, while the Hun-
terian chancre will not be found under about eighteen days
after exposure.
The first symptom in the case is the appearance of a
little pimple, slightly elevated, upon the inner surface of one
labia, or at the juncture of the labia minora with the labia
majora. This pimple slowly suppurates, and in about three
days becomes an open sore, not, however, very painful. A
hard margin and base is now observed, and the ulcer grad-
ually enlarges. This is the Hunterian variety of chancre, and
is usually single, though occasionally multiple. The chancroid
is manifested in multiple sores, which spread and multiply
rapidly, but do not ulcerate so deeply, and have a soft margin
and base.
From these ulcerated surfaces a considerable quantity of
matter is discharged. The sores are situated upon the inter-
nal surface of the labia, and sometimes within the vagina,
and even upon the cervix uteri. We can not, therefore, de-
cide that the patient has not syphilis because we find no
chancres upon the internal surface of the labia or around the
margin of the os vaginam. We must thoroughly examine the
cervix uteri and vagina, by the aid of a speculum, in all sus-
pected cases before giving a positive diagnosis.
Buboes, or enlargement of the inguinal glands, occur in
connection with syphilis more frequently than in cases of
gonorrhoea.
The above are considered ordinary primary symptoms.
42
658
EATON ON DISEASES OF WOMEN.
The location of the chancre may, however, vary.
The pres-
ence of a chancre in some place is necessary, however, to the
diagnosis of a case of primary syphilis.
Secondary syphilis is the secondary manifestation of the
disease, after the cure of, or in connection with, the primary
ones. It is manifested by mucous patches, and eruptions on
the skin, which are usually shiny and yellow. Condylomata,
which consist of ear-like growths about the external gen-
italia, upon the mucous and cutaneous surfaces, etc., are an-
other form of development of secondary syphilis.
Tertiary syphilis affects the osseous structure, especially
the tibia and nasal bones, as well as causes various forms of
eruptions on the cutaneous surface. (See works on Venereal
Diseases.) Secondary symptoms are seldom manifested after
the chancroid or soft chancre; but no patient is safe from
them after having had the Hunterian variety.
Treatment.
We
The treatment of syphilis in women does not materially
differ from the treatment of this disease in the male.
have mentioned the disease here mainly to call attention to
its transmissibility through nursing and the spermatozoa in
impregnation, and to suggest the necessity for thorough
exploration in suspected cases that chancres be not over-
looked. The treatment of primary syphilis has usually been
more heroic than wise, both in the male and female.
Our treatment consists in first giving Merc. sol. 3, a 3
gr.
powder, every three hours, and bathing the chancre with a
weak solution of carbolic acid. After three days change the
local application to Vaseline in case of chancroid, and give
Merc. sol. and Ars. alb. in alternation every three hours,
which is usually all the treatment required. In some in-
stances I have used Basilicon ointment, instead of Vaseline,
with the happiest effect.
In the case of the Hunterian chancre, after using the
SYPHILIS IN WOMEN.
659
treatment suggested for three or four days, it is best to make
one application of fuming, Acid nit. with a glass rod, taking
care that it touch the entire margin and base of the chancre
sufficiently to cause a free slough of the indurated tissues;
then dress with Vaseline. In case the single application of
Acid nit. does not produce a slough, another application
should be made. We prefer that Merc. be taken three days
before we attempt to cause the slough, in order that the
healing after the slough may be more prompt. After the
slough has separated we have a simple sore to deal with,
which will readily heal if the syphilitic poison has been
neutralized by remedies as suggested.
In cases which manifest secondary symptoms, as the
mucous patches in the mouth, condylomata, pustules of the
skin, or the yellow shiny spots upon the skin. Kali iod.,
Merc. cor., Ars., Acid nit., Thuja, etc., are the remedies ordi-
narily indicated.
Tertiary symptoms are to be treated quite similarly to
the secondary, Thuja being the most prominent remedy.
Silicia, Cal. carb., etc., I would add to the list of remedies
in treating this form of syphilis.
Buboes in syphilis are to be treated the same as when
occurring in cases of gonorrhoea, to which the student is re-
ferred in order to save repetition here.
The mucous patches and condylomata require no local
treatment, save that which conduces to cleanliness. The
remedies suggested for the secondary form of syphilis are
adequate to cure them. Frequent bathing of them with
tepid water and castile soap, when the patches are around
the anus or vulva, and washing the mouth with a weak solu-
tion of salt or Potass. chlo., is well enough, when the lips,
cheeks, throat, or gums are affected.
660
EATON ON DISEASES OF WOMEN.
CHAPTER LVIII.
DISEASES AND DIFFICULTIES OF PREGNANCY.
THE development of the foetus in the uterus produces in
some women considerable disturbance of the general system,
as well as particular affections of special organs and func-
tions. The uterus, when affected with inflammation or dis-
ease, produces through the sympathetic nervous system
many symptoms in remote parts of the body, which have
been treated of under the head of "sympathetic affections."
The pregnant state, being one physiological in its char-
acter, it would seem, should produce no serious effects on the
female system. We would naturally expect that this process
might go on to completion of term without any interference
with the general health, as we see among the animal creation.
This is observed in some cases in the human female, notably
among those savage or half-civilized races who live in the
open air, perform much physical labor, and live upon the
plainest diet, and in all things allow nature's inclinations and
appetites full sway, almost like the beasts of the field. But
as we rise in the scale of civilization we find that the women
suffer more in the process of gestation and labor.
The want of physical exercise and pure air in sufficient
quantity to develop and maintain the full normal amount of
nerve and muscular strength tends to the production of ail-
ments which, under circumstances of conformity to nature's
laws, might be avoided. The tight lacing of the body of
ladies in civilized and cultivated society, with the late hours
spent in the heated and ill-ventilated ball-room, the insuffi-
cient clothing worn, and the nervous exhaustion consequent
upon the rounds of dissipation engaged in by many, tend to
DISEASES AND DIFFICULTIES OF PREGNANCY.
661
unfit woman for her high function in propagating the race;
thus entailing upon her offspring debility and disease, and
causing herself untold agony in the process, that should be as
free from pain and disturbance as it is natural in itself.
But we have to take the world as it is, and the people
likewise; and as it is probable that we will have more pa-
tients among the civilized races than the savage, we will
probably have to contend with ailments innumerable accom-
panying the pregnant condition, for we can not expect to
effect a reform in women's habits, dress, and diet in our natural
lifetime, though it is to be hoped that the world will some-
time pay more attention to the health of women than it does
to-day, not by a return to barbarism and laying upon women
grievous, severe physical labor, greater than she can well
bear, and which is inconsistent with any mental growth, nor
by set rules of living, bathing, and diet (for what is good for
one may not be for another), but in the avoidance of excesses,
by greater freedom from conventionalities, by plainer living,
by conforming to the necessary laws of development and
growth in girlhood, stopping the demand of society that
young girls shall be expected to dress, act, and live like
ladies, etc.
Various Symptoms.
One of the first symptoms of disturbance in the system
during gestation is nausea-sometimes this is severe, and
causes the rejection of nearly the entire ingesta. (See Vom-
iting in Pregnancy.)
Coincident with nausea we have the frequent desire to
pass urine caused by the pressure of the enlarged womb
irritating the urethra as it passes posterior to the pubis.
Again we have constipation, resulting from the pressure of
the uterus against the rectum. Sometimes diarrhea sets in.
indicating an inflamed condition of the rectum, produced by
the irritation of the enlarged uterus.
Along with these symptoms we have frequently headache,
662
EATON ON DISEASES OF WOMEN.
toothache, and neuralgia in various parts of the body, with
a fretful disposition, various abnormal cravings for indigest-
ible substances, such as slate pencils, lime, pieces of wood,
etc., etc., ad infinitum.
As time rolls on the uterus still increases in size. It
presses upon the bowels, liver, stomach, etc., and we have
derangement of digestion, the sour stomach, gastralgia, heart-
burn, pruritus vulva, and a miserable condition generally.
Very little consideration is often exercised towards patients
in this condition, the treatment shown them being calcu-
lated to irritate and anger them, and the effect is manifested
in the bad temper of the child when born.
Albuminuria is a frequent condition of pregnancy, and
was formerly supposed to result from disease of the kidney,
the exact nature of which was in dispute; but it is now
conceded that albumen is frequently in the urine of pregnant
women in the later months of pregnancy, and is caused by
the pressure of the gravid uterus upon the renal vessels,
and that as soon as the pressure is removed by the delivery
of the child the albumen will generally cease to be found in
the urine.
Uræmia, caused from the same pressure, sometimes re-
sults, and it is mainly from this cause that we have convul-
sions in these cases, though, of course, the irritable condition
of the general nervous system tends to produce convulsions,
and may exist without the uræmia being present; still, as I
said before, this I believe to be the most frequent cause of
convulsions occurring in the pregnant woman.
Cramps in the thighs and calves of the legs, varicose
veins of the limbs, ædematous swelling of the lower limbs,
and sometimes general anasarca, jaundice, hemorrhoids, etc.,
are sometimes produced by the pressure of the enlarged
womb upon the nerves and blood-vessels in the pelvis and
abdomen. Palpitation of the heart from reflex nerve action,
as well as general fever, sometimes result.
DISEASES AND DIFFICULTIES OF PREGNANCY.
663
Displacements of the uterus are common in the early
months of gestation, notably prolapse. This is owing to its
increased size and weight causing it to settle down in the
pelvis; and in our opinion the organ thus prolapsed produces,
not only the symptoms heretofore noted as the result of
pressure, but also, through the sympathetic nerve ganglia,
causes the nausea on first rising in the morning. If this
theory be correct we have a hint of the means of relief,
which, so far as I have tried them, have been successful. I
refer to restoring and maintaining the position of the uterus
in situ.
Retro-version of the uterus sometimes takes place during
the first two or three months of gestation, and is generally
the result of jumping out of bed, or from a carriage, or in
some way receiving a severe jolt. In this case the symptoms
of misplacement are well marked, come on suddenly and
violently, and unless soon relieved will result in the death
of mother or child or both. Therefore, when called to a case
where symptoms of displacement are manifest, with the as-
surance of pregnancy being present, no time should be lost
in making a physical examination. If retro-version is present
the introduction of the finger into the vagina will generally
reveal the presence in the vagina of a large globular body,
consisting of the body of the uterus; and by passing the
finger high up on the anterior wall of the vagina we discover
the os uteri. Replacement of the organ is, of course, at
once indicated. This is the only efficient method of obtain-
ing relief from the distress experienced in these cases where
retro-version is present.
Syncope is often a resultant symptom of this condition.
The student will also bear in mind that hemorrhage from the
uterus may result in the pregnant woman from partial sep-
aration of the placental attachment, or in placenta previa,
and be in readiness to use those prompt measures for its
suppression which are often absolutely necessary to the saving
664
EATON ON DISEASES OF WOMEN.
of life. I will only notice pruritus vulvæ and leucorrhoea as
sometimes annoying the patient, resulting from a cervical
inflammation, generally combined with some vaginitis, the
leucorrhoea being dependent upon this irritation, and its acrid
character causing the itching of the labia and vagina. This
affection is often concealed from the physician by the patient
through feelings of modesty, and she sometimes injures her-
self in her efforts to relieve the itching. Swelling and in-
flammation of the mammary glands in some instances have
their predisposing cause in the pregnant state.
Treatment.
Although the recital of the many ailments of the pregnant
state seems formidable we may hope to relieve many of
them-though it is sometimes impossible to relieve them all;
and we will have need of using constant vigilance, and in some
instances continuous treatment, to obtain satisfactory relief
(if relief may be considered satisfactory that requires con-
stant application of treatment).
The size of the uterus,
which does so much to produce these derangements, can not,
of course, be modified; neither can the supersensitive nerv-
ous system be restored in many cases.
It is quite common that the womb is morbidly sensitive
during the early months of gestation. This may be due in
part to the displaced condition of the organ, owing to its in-
crease of size and weight, and in part to the irritability of
the organ, consequent upon the growth of its substance, ne-
cessitated by nature, in order that it may contain and nourish
the foetus.
These considerations furnish to my mind reasons sufficient
to cause me to believe that it is best to rely in part upon an
attempt to relieve the uterus as much as possible from all
pressure from the superincumbent weight of the abdominal
organs, and in restoring and maintaining it in its normal posi-
tion in the pelvis, instead of depending upon remedies alone
5.
:
DISEASES AND DIFFICULTIES OF PREGNANCY.
665
for the relief of the symptoms resulting from the condition
of the organ in the earlier months of pregnancy.
This is obtained by rest in the reclining posture, with
the occasional lifting up of the uterus by digital taxis. Lying
with the hips a little elevated, with the limbs separated, is
the best position. This favors the ingress of air into the
vagina, and relieves the uterus from pressure from the weight
of the bowels. When this position can be maintained for a
period of some weeks we will have little trouble with the
case as a rule; but as it is very unusual that a patient is
willing to submit to this confinement, and as we have the
injurious effect of want of exercise to contend with, if we
allow it, we are driven to other expedients to accomplish the
same ends.
I have found that the use of an elastic abdominal sup-
porter accomplished the purpose in many cases (see Plate
XII); some, however, requiring that the recumbent posture
be taken for an hour or two after dinner, and applying the
supporter before rising. We should be careful that it is of
the right size, and is applied so as to lift the abdomen and
not compress it. It is necessary that the band be a little
tight in the lower part of the abdomen and loose above, so
that the abdominal regions be supported by it. I have had
made by Max Wocher & Son, of Cincinnati, a modification
of the London supporter (see chapter on Instruments), which
acts efficiently for this purpose, bringing the pressure just
above the pubis, instead of two or three inches above, as it
does with the old London supporter.
Some cases that are obstinate, where the patient is obliged
to perform much labor while standing, may be benefited by
the use of the soft gum elastic pessary, taking care to use a
size that does not distend the walls of the vagina too much,
using it for two or three days and then omitting it for a week
or more; but unless the physician is in active gynecological
practice, and has the time and patience to properly adjust
666
EATON ON DISEASES OF WOMEN.
and take care of the instrument, it is better to use simply
the abdominal support; and this requires some little attention,
as we may see that compression of the abdomen would do an
injury, by forcing the uterus lower in the pelvis.
But I may say, once for all, that unless the physician
has tact and skill enough to apply treatment in such a way
as to obtain the desired result (when it is clearly attainable
with proper skill and care), he had better pass all cases of gynæ-
cology, as well as his other practice, over to some one else;
as it is true, not only in these cases but in all others, the
ignorant, careless use of sounds, speculums, pessaries, sup-
porters, washes, tents, etc., as well as remedies, can only do
an injury.
The remedies to be given in case of neuralgia, toothache,
constipation, gastralgia, enuresis, palpitation, etc., are the
same as though the cause was something else. In the albu-
minuric and uremic condition it is probable Merc. cor. has
more efficiency than any other remedy; but there are some
cases that will not be relieved till delivery is accomplished.
Some cases immediately recover on the event of confinement,
while others, only recover after weeks of treatment; and
some, I am sorry to say, never.
Dr. Goubeyre states that of sixty-five pregnant women
attacked with albuminuria, twenty-seven died, thirty-three
were restored to health, while five remained albuminuric.
He also states that out of one hundred and fifty-nine affected
with albuminuria, ninety-four had convulsions.
This condition is more common in the primipara than in
those who have borne children, as in the primipara the abdom-
inal walls are more resisting, and consequently greater press-
ure is exerted on the renal vessels by the gravid uterus.
Blatt discovered albumen in thirty out of ninety-nine cases
of primipara, while in the multipara only eleven cases in one
hundred and six were observed, as recorded by Bedford.
* Mémoires de l'Académie Imperiale de Médicine. Tome xx.
1
DISEASES AND DIFFICULTIES OF PREGNANCY.
667
:
Convulsions occurring during gestation are usually due to
the presence of uræmia, as has been stated. The treatment
should be first directed to the relief of the spasm; and,
secondly, to prevent a recurrence of the paroxysm. For
the relief of the convulsion a few pellets of Bell. 3, may
be put in the mouth, or a few drops of the dilution of Bell.
3*, Nux, or Verat. alb. may be given, and the feet wrapped
in warm wet cloths; or, if convenient, the full warm bath
may be given or warmth to the spinal column by means of
warm compresses may be used, and in case of failure to obtain
prompt relief by these measures Chloroform or Sulph. Ether
may be given by inhalation, till the convulsion ceases; after
which we should ascertain if it be a retro-version that has
produced the spasm, or if it be from albuminuria.
If albumen be found in the urine we will generally find
relief from the use of Merc. cor. 3*. In some severe and
extreme cases, where convulsions continue in spite of every
remedy, we may be obliged to produce a premature delivery
of the child to save the mother. This procedure better be
only done after consultation with two or more physicians.
We generally have time in these cases to obtain counsel, and
we should always insist upon having it in this class of cases
before proceeding to bring on premature delivery. Of course,
the child is viable at seven months, and we may hope to save
its life in many instances; but from the fact that we may
have not only a loss of the child, but the mother as well, we
had better be fortified with advice from other physicians of
high standing. We have in these cases not only the danger
of an ordinary delivery, but the added danger from the use
of the means to promote the delivery, and also the irritable
and depressed condition of the nervous system, consequent
upon the convulsions, as well as general derangement of the
system from the causes which led to them. Fortunately
spasms seldom occur previous to the viability of the child;
668
EATON ON DISEASES OF WOMEN.
still its death may result from the convulsions, if they con-
tinue for a considerable time.
Vomiting may, in some rare instances, be so persistent as
to endanger the mother's life, and a resort to abortion be
advisable. (See Vomiting in Pregnancy.) Occasionally the
slight nausea and occasional rejection of a meal may be a
conservator of health, acting to prevent undue plethora, as
after conception and the consequent suppression of menstrua-
tion, the system has in some instances, a tendency to undue
plethora; hence Nux or Ipecac may be the remedies demanded
to rectify the trouble. If we bear in mind that in pregnancy
one lady may suffer from anæmia and another from hyper-
æmia, we may understand why the vomiting that is so inju-
rious to one may conserve health in another.
We may also observe that the jaundice and sundry other
disturbances and ailments are caused by the pressure of the
uterus, and we will be led to rectify the trouble without a
resort to medicine in some cases. The uterus rises the
highest in the abdomen at about the completion of eight and
one-half months of gestation, and owing to some cause the
uterus may be deflected to the right side, and press so hard
upon the liver as to interrupt its action, or more generally,
probably upon the ductus communis choledochus, and prevent
the discharge of the bile into the duodenum, hence giving
rise to jaundice. By directing the patient to lie upon the
left side and lean towards the left while sitting, seeing to it
that the clothing is sufficiently loose, we may soon discover
amelioration of the symptoms, and erelong their complete
subsidence.
While speaking of looseness of clothing I will suggest that
by attention to this matter in cases of renal difficulties, with
or without dropsical swelling of the limbs, we may do much
to relieve the trouble. Here we have annoyance to contend
with, in the desire of women to look small and keep people
DISEASES AND DIFFICULTIES OF PREGNANCY.
669
from knowing their condition. This desire is so strong in
some women that they actually lace themselves to keep their
size to suit them; hence I am often astonished that they
have in these cases even the ability to live, and we are
placed on our guard, in the management of these cases, by
keeping in mind how the ailments of the pregnant state are
occasioned.
In the treatment of the cases of nausea and vomiting
occurring only at night, I would first ascertain if it were not
due to retro-version (which I would rectify if it existed),
and I would positively interdict sexual congress. By com-
pliance with this direction our patient may expect relief. And
while on this subject it may not be amiss to intimate that I
am of opinion that if sexual connection was not in the least
indulged in during pregnancy, we would have much less of
suffering during this period.
The attempt to relieve these inveterate nauseas by giving
a glass of cold water, warm tea or coffee, or a bite of cracker
before rising is all well. Acid cit., Acid nit., Puls., Cal.
carb., Ars., etc., have been found often useful in the acidity
of the stomach that is often so annoying. Failing by these
remedies it may be best to use a chemical treatment, or food if
you please, and feed the patient on a little Soda or Magnesia.
If Nux, Bry., Sulph., etc., do not relieve the constipa-
tion when given as indicated, enema of tepid soap water are
to be used as adjuncts.
Canthar., Bell., Can. ind., give much relief to irritations
in the urethra and bladder, given according to their homoo-
pathic indications.
Diet. Some attention to diet and exercise are important
in the treatment of these ailments of the pregnant state.
The diet should be nutritious, unstimulating, and digestible.
The exercise should be moderate and in the open air.
Riding in a carriage is better than confinement indoors; but
walking exercise is much better if it can be taken.
670
EATON ON DISEASES OF WOMEN.
Great gentleness should be shown the pregnant woman.
We can not be too considerate of her feelings nor too in-
dulgent in our ministrations for her comfort, for her own
good and that of her offspring as well.
Pruritus and leucorrhoea, which are often combined in the
same case, are troublesome, although only remotely injurious,
and merit the attention of the physician, on account of the
nervous exhaustion that the intolerable itching produces
after a time. The leucorrhoea sometimes is of a bland char-
acter and gives little trouble, except that it is disagreeable
to the patient in the soiling of the clothing; at other times it
is acrid in character, denuding the mucous membrane of
the vagina of its epithelium, causing intense smarting, burn-
ing pain. Sometimes apthous ulcers are formed on the mu-
cous surface of the labia, and require applications of Vaseline.
Frequent use of the vaginal injection of tepid water is of
benefit in some cases. I have found the insertion into the
vagina of a wad of cotton high up in the vagina, saturated
with equal parts of Glycerine and Hydrastis, or Glycerine and
Tr. Aconite, or Calendula (recollecting to attach a thread or
string to the cotton to facilitate its removal, and changing
the application every twelve hours), is a very useful treat-
ment. Aconite, Sepia, Bry., Puls., and Sulph. are useful rem-
edies in this class of cases.
There is a form of pruritus without the leucorrhoeal dis-
charge, where the sensation is that of burning, sometimes
giving the sensation of the crawling of pediculi. This
variety is mostly confined to the cutaneous surface of the
labia and the mucous membrane covering the clitoris. Both
varieties of pruritus may result from disease of the uterus,
as well as pregnancy; but I think we have them more fre-
quently in pregnancy than otherwise. This variety last
mentioned is evidently abnormal nerve sensation or sensi-
bility, which is peculiar to some women, or to women at par-
ticular times. Camph., Apis, or Ars., are probably the best
DISEASES AND DIFFICULTIES OF PREGNANCY.
671
remedies in these cases. If abnormal sensitiveness of the os
uteri be observed, one or two applications of Bell. ointment
may be made to it, and the labia may be bathed three or
four times a day with a wash of one part of Glycerine to
three of water. Attention must also be given to the general
health and diet of the patient.
In all these ailments we do well to see to it that our
patient does not get excessively fatigued, but takes frequent
rest in the horizontal position during the day.
In cases of inflammation of the breast, where there is a
secretion of milk, it must be artificially drawn two or three
times a day in some cases; in others, once a day is sufficient.
Bell. is the chief internal remedy indicated, and it may also
be applied locally to the inflamed part.
672
EATON ON DISEASES OF WOMEN.
CHAPTER LIX.
VOMITING IN PREGNANCY.
VOMITING in pregnancy is sometimes exceedingly annoying
to the patient, her friends, and her physician. Ordinarily it
occurs only upon rising in the morning, or after breakfast;
but in some instances the nausea comes on worse in the after
part of the day, and sometimes is continuous, apparently
causing the rejection of all the food and drink taken into
the stomach. In these extreme cases the gravity of the
symptoms becomes alarming, and the life of both mother and
child is endangered.
Authors upon diseases of women have either ignored this
subject, or treated it as of little moment. Works
Works upon ob-
stetrics are almost as silent, and college professors also
have usually slighted the subject. Hence, the young practi-
tioners are left without sufficient guidance in this complaint,
most of them having from their readings been impressed
with the idea that vomiting was rather physiological than
pathological.
They
These young men find upon engaging in active practice.
that cases of vomiting in pregnancy come to them for relief.
The question arises, In what can relief be found?
then naturally ask themselves, Why this manifestation?
What are the conditions producing it? Why do some escape
and others suffer? They naturally consult books, and find
either no mention made of the complaint or only an unsatis-
factory allusion.
These considerations have prompted me to include this
subject in this work, although it more properly belongs to
the department of obstetrics.
VOMITING IN PREGNANCY.
673
Etiology.
Just here we venture upon contested ground. Although
the contest has not been sharp or decisive, it has torn up the
soil enough to perhaps enable us to get at some light upon
the subject. As gestation is established the uterus enlarges,
and, of course, becomes heavier than in its unimpregnated
state. (And it is well known that it settles down in the
pelvis during the first three months of pregnancy below its
normal position.) This may account for the nausea produced
by rising from the recumbent position while the stomach is
empty through the sympathetic nervous irritation caused by
the downward displacement just mentioned. In some cases
this nervous irritation is caused by the enlargement of the
womb alone; in some cases, due to a sub-acute inflammation
of the organ; sometimes to irritation of the uterus from cop-
ulation after pregnancy has occurred. The general nervous
irritability of the patient may predispose to this condition.
It is, however, none the less a pathological or diseased con-
dition which manifests this symptom.
We think it time that the profession was outspoken on
this point. It may cast reflections upon the method adopted
by fashionable society, and even by civilized nations, in the
rearing of children, and apply with special force upon those
of the present generation; but let it fall where it may, it is
time the people understood that they can not ignore the laws
of their physical being, and still have health and an easy
procreation, devoid of annoyance and danger, like the an-
imal creation. We must remember that we have an ani-
mal frame, requiring, not only healthy food, but pure air and
plenty of physical exercise. Our daughters are reared to-day
with a scant supply of all these, and have inherited none too
good a constitution from their parents. Let us, then, place
the blame where it belongs, and not by intimation censure
our Creator for making women so as to suffer these things.
43
674
EATON ON DISEASES OF WOMEN.
Diagnosis.
In diagnosis the absence of menstruation in the married
woman, previously regular, together with other symptoms,
will indicate that the nausea is due to pregnancy, or rather
the condition produced by pregnancy. The history of the
case should show an absence of gastric disturbance previous
to the arrest of menstruation. In these cases the smell of
food is often as nauseating as its taste. A somewhat similar
train of symptoms may arise from uterine disease or displace-
ment, independently of pregnancy; hence, we must be some-
what careful in noting the history of the case, as well as all
the symptoms present indicating pregnancy, in order to make
a correct diagnosis. Most cases are clear, but 't is well to be
on our guard against error in the exceptional ones which
sometimes come before us.
Treatment.
The suggestions which I have made regarding the etiology
suggest the treatment. In some cases we should proceed as
though the patient was suffering from displacement of the
uterus. Rest in the recumbent posture is one means of
allaying the irritation. Sometimes the abdominal supporter,
by taking off the weight of the intestines from the uterus,
and relaxing the strain upon the broad ligaments, relieves the
symptoms. Conjoined with these measures the use of the
inflatable pessary in the vagina by lifting up the uterus re-
lieves the trouble. Bathing the abdomen and spine with
Chloroform wash is often of service. The tepid sitz bath,
used daily for fifteen minutes, is of some service in those
cases where there is much tenderness of the uterus.
Internal Remedies.
Oxalate of Cerium, Puls., Ars., Ipecac, Cal. carb., Acon.,
Nux, Sepia, etc., sometimes give some relief, if indicated by
1
VOMITING IN PREGNANCY.
675
the symptoms other than the vomiting, as well as this one in
particular. Bell., Hyos., Ignat., Gelsem., Secale cor., or Arnica are
sometimes of benefit when there are nervous symptoms which
strongly indicate their use homoeopathically. We should be
sure in obstinate cases that there is not retro-version or retro-
flexion of the uterus causing the nausea. This can be best
detected, if the case be one of retro-flexion in the gravid
uterus, by means of rectal examination. The uterine sound
must not be introduced for the purpose of diagnosis or treat-
ment in the suspected case of pregnancy, as being too likely
to produce an abortion. Taking a little food or a drink of tea
or coffee before rising has been found, by some, a relief to
the nausea, though not curative.
The remedies and treatment I have suggested will, in the
majority of cases, give relief, and in many a complete cure is
effected with them. There are however, I regret to say,
some few cases where all these means fail, and the serious
question arises, What is to be done? Sometimes the vomit-
ing is so constant that the patient is in imminent danger of
dissolution from actual starvation. In these extreme cases
rectal injections of beef tea may be tried. The patient con-
tinuing to go down in spite of these injections the question
arises, Shall we resort to abortion to save the patient's life?
Obviously, before this is done, a consultation should be held
(as in case of convulsions) with at least two medical gentle-
men of good standing, and their concurrence in the necessity
of the procedure should be obtained before making any
attempts to evacuate the uterus.
Dr. W. W. Potter, of New York, reports a case, with
comments upon the arguments pro and con regarding the
operation, which I will quote. He says:
"There is, perhaps, no malady which puts to a severer
test the resources of the obstetric practitioner than extreme
cases of nausea and vomiting dependent, etiologically speak-
* Amer. Jour. of Obstet., January, 1880, page $5.
676
EATON ON DISEASES OF WOMEN.
ing, upon the gravid uterus. It is, therefore, fortunate that
we only now and then meet with a case of that sort, demand-
ing the extremest expedient for its relief known to the
obstetric art; namely, the artificial induction of abortion.
Since but very few of these extreme cases can fall within the
observation of any one physician, I shall assume that a de-
tailed history of one which lately came under my ministra-
tions will not be devoid of interest.
"March 26, 1879, was called seventeen miles to see Mrs.
J. L. T., aged twenty-three years, and who had been married
a little more than five months. I found her about ten weeks
advanced in pregnancy, and also suffering from chronic bron-
chial catarrh. She was greatly emaciated; vomited all food,
and even water was at once rejected, the nausea being per-
sistent and constant. Pulse 80, and feeble; temperature
99° F. She also complained of neuralgic pains in the right
chest wall. Examination, per vaginam, revealed a gravid
uterus, and the speculum further disclosed chronic endo-
cervicitis with granular erosion of the os and lower segment
of the uterus, accompanied by the characteristic discharge
incident to the pathological condition described.
"Clearing away the thick, tenacious mucus clinging to the
parts, I applied Tr. of Iodine to the os and cervical canal,
after which a pledget of cotton wool, which held about one
drachm of the following mixture, namely:
Chloral hydratis.
Acidi carbolici....
Fl. ext. opii...
Glycerine.
5
3 ij.
gr. x.
•
aa 3 ij. M.
was packed snugly around the os, and held in place by other
dry cotton pledgets.
66
"I advised that the stomach be entirely abandoned for
the purposes of nutrition, and that rectal alimentation be sub-
stituted; and further suggested the use of a Kreosote mix-
ture per orem, to be used cautiously, and to be discontinued
VOMITING IN PREGNANCY.
677
if it should not be well retained. It is proper to add that
this was intended to be a consultation visit, but the physician
who had already attended Mrs. T. for four or five weeks did
not arrive until just as I was taking my leave, when I sub-
mitted my plans to him, and secured his cordial assent.
66
April 2d.-Saw Mrs. T. again to-day, one week after my
first visit; found her suffering considerably from neuralgic
pains in the right thoracic wall; stomach less irritable, though
all food given per orem is still rejected, this having occa-
sionally been tried, notwithstanding my injunctions to the
contrary. I renewed the applications to the os and cervix
uteri in the same manner as on the former occasion; gave
one-sixth grain of Morphia hypodermically for the relief of
the thoracic pain; advised lime water and milk in small doses,
and continued the Kreosote mixture, as the patient fancied it
had been of some benefit.
"The emaciation had increased since my last visit, and
anemia was now extreme. The nutritive enemata, consisting
of beef essence, milk, brandy, and laudanum, had been toler-
ably well retained, and I therefore advised their continuance.
as a chief dependence for nutrition.
66
April 13th.-Was summoned by telegraph late at even-
ing (Sunday), to visit Mrs. T.; arrived at ten o'clock P. M.,
and found Dr. Barross, of Attica, in consultation with Dr.
Young, the attending physician. Her stomach
Her stomach was now
rejecting every thing; nausea and retching constant; emacia-
tion and anemia progressing. She was sleepless; tempera-
ture 100° F.; pulse 110 and feeble, with the vitality greatly
depressed. Her mother stated that the patient had had
three convulsions during the day, which so alarmed the
friends that they had associated Dr. Barross (who resided
eleven miles nearer the patient than myself) with Dr. Young,
pending my arrival.
"I presented to these gentlemen the propriety of the
artificial induction of abortion in the case; but they were
678
EATON ON DISEASES OF WOMEN.
both minded otherwise, fearing fatality as a result, and which
now seemed inevitable to them under any plan. I, there-
fore, advised Chloral hydrate and the Potassium bromide (thirty
grains of each) in emulsion with yolk of egg and milk per
rectum, to be administered at once. This was done about
eleven o'clock P. M., and it brought about a comfortable.
night's sleep.
66
April 14th.-Next morning our patient seemed in a more
encouraging condition; her pulse was slightly stronger, and
there had been neither nausea nor retching since midnight.
Advised continuance of the Chloral and the Potassium salt
per rectum, from two to four times a day; also beef essence,
milk, and brandy in the same manner. Per orem, small
quantities of iced lime water and milk, if retained.
"April 18th.-Was again summoned by telegraph; found
patient suffering from repeated nausea and vomiting; greatly
prostrated; pulse 116; temperature 100.05° F.; emaciation
increasing, and bronchial symptoms more aggravated.
66
The rectum had now become so irritated that medica-
tion and alimentation by that method had to be suspended;
therefore, I now determined that the induction of abortion
should be no longer delayed, particularly as it seemed to
offer the only chance of saving life, even though, apparently,
never so slight a one. Accordingly, with the concurrence of
the attending physician, I dilated the os with the finger, the
patient being in the Sims' position, and passed into the
uterus a piece of carbolized catgut about twelve inches long,
doubled upon itself, retaining it by pledgets of raw cotton,
neatly and snugly packed around the os. I administered
morphia hypodermically, and left the patient under the close
surveillance of Dr. Young.
"April 24th.-Visited the patient again by appointment,
when I learned that at five o'clock P.M., on the 22d, a three
and one-half months foetus (it was saved for my inspection)
had been thrown off, and that the placenta followed soon
VOMITING IN PREGNANCY.
679
after, all without hemorrhage or anything worthy the name.
All her symptoms now seemed better; she was cheerful, and
took nourishment per orem, cautiously administered, brandy
and cream, etc.; temperature 99.05° F.; pulse 88, and no
nausea nor vomiting. Gave her iced champagne, which she
enjoyed.
April 27th.-Saw Mrs. T. again by appointment; there
had been no return of nausea; bronchial symptoms much
improved; strength slowly increasing, and food is taken with
relish. Continued nourishment per orem, with champagne
and Mensman's beef tonic.
"Sept. 6th.-Mrs. T. visited me. She was at this time
quite strong and well, and about to undertake housekeeping.
"At the risk of being wearisome, I have been somewhat
diffuse in the relation of this case, while at the same time I
have abridged many of its details. It is proper, however,
that I make further mention of one or two special features of
the case.
"I. Let it be noticed that there was inter-current catar-
rhal bronchitis, complicating the excessive nausea and vomit-
ing of pregnancy, which in no small degree embarrassed its
therapeutical management, since the remedies necessary to
control the bronchial symptoms could not be retained by the
stomach. The bronchial catarrh had, up to the time of my
first visit, been the sole source of anxiety on the part of the
friends of the patient, and thus far had entirely absorbed the
offices of her physician. Neither had yet suspected preg-
nancy, believing that the suspension of the menstrual func-
tion was due to the general debility and anemia growing
out of the bronchial disease. Now that the uterus was pro-
nounced gravid, an additional and greater source of danger
was discovered, and anxiety on all hands became extreme.
"II. The second point of special interest to which I
would refer, before dismissing the case altogether, is the ex-
tensive superficial ulceration of the lower segment of the
680
EATON ON DISEASES OF WOMEN.
uterus, attended, as it was, by the profuse egg-like discharge
which is so often found present in similar conditions. I fan-
cied that I had discovered in this the true source of all the
difficulty, and that I had but to remove it, when the nausea
and vomiting would depart. In her very feeble state, how-
ever, I found it exceedingly difficult to make the necessary
local applications; and becoming convinced, also, that the
ulceration was no longer tractable to the use of mere topical
remedies, I determined to abandon them altogether; more-
over, rectal alimentation and medication having failed to
arrest the progress of the malady, the direful alternative of
putting an end to the pregnancy was forced upon me.
"I will now offer some remarks germane to the whole
subject of excessive vomiting and inanition of pregnancy,
the case reported having furnished an appropriate text
therefor.
"First, let us briefly examine the subject with reference.
to the etiology of this vomiting; and, be it understood that
we are speaking generally, dealing only with cases where
this symptom of the gravid state is so severe and persistent
as to threaten the life of the patient, since, in the main, the
ordinary vomiting in pregnancy may be regarded as a useful
and not an abnormal symptom.
•
"A few obstetricians strongly advocate the theory that
some displacement of the gravid uterus is, in almost every
instance a cause of vomiting, and notably among their num-
ber we find the name of Dr. Grailly Hewitt; others refer
the condition to granular inflammation of the os, cervix uteri,
cervical canal, or os internum; others, again, believe that the
symptom is due to the stretching of the uterine fibres;
while still others regard it as a reflex phenomenon due to
the gravid state, a condition which has been so happily
termed by Dr. Geo. J. Engelmann, of St. Louis, as a hystero-
neurosis of pregnancy. Let me quote his own words. 'I
will,' remarks Dr. E., 'merely recall the various gastric symp-
VOMITING IN PREGNANCY.
681
the
toms which occasionally accompany pregnancy;
uterus after conception, as previous to the menstrual flow, is in
a more active sensitive condition; it is congested and en-
larged, and the nausea, the vomiting, and epigastric distension
occasionally found during pregnancy, may also be classed
among the hystero-neuroses, as we know that in some cases
these symptoms may be relieved by dilatation of the cervical
canal, and always by the discharge of the ovum, whether at
term or sooner, thus proving their dependence upon the
uterine condition.'*
"Prof. Samuel C. Busey, M. D., of Washington, D. C., in
a paper lately published,† 'On the Potassium Bromide and
Suspension of the Action of the Stomach in the Uncontroll-
able Vomiting of Pregnancy,' has interpolated some remarks
upon the etiology of the disease, which are so germane to
the proposition which I have just advanced, and, withal, so
concisely stated, that I shall take the liberty of quoting them
here. The nausea and vomiting of pregnancy,' says Dr.
Busey, are undoubtedly, in a vast majority of cases, reflex
phenomena, but it is not improbable that occasional excep-
tions occur, and in a large proportion of, if not in all, the
cases when these stomachic disturbances become serious, and
for a time uncontrollable, catarrhal conditions of the gastric
mucous membrane are superadded. The clinical history of
cases of acute gastric catarrh, and of cases of protracted and
uncontrollable vomiting of pregnancy, are very analogous.
Anorexia or a vitiated appetite, nausea, vomiting, thirst,
epigastric oppression or pain, a saburral condition of the
tongue, eructations of a glairy mucus, and despondency, are
common to both affections. In fact, there is not a symptom,
except such as may relate to the reproductive organs, belong-
ing to either which may not be present in the other. The
most frequent cause of catarrh of the stomach is indigestion,
*Trans. Am. Gynecological Society, Vol. II, p. 518.
† Am. Jour. Med. Sciences, January, 1879, p. 112.
682
EATON ON DISEASES OF WOMEN.
due either to an indiscreet diet or to derangement of the
digestive process. Impoverishment of the blood disqualifies
the gastric fluids, and the inanition of pregnancy, so fre-
quently the precursor of the more serious stomachic dis-
turbances, may thus become a potential factor in their
causation.'
"I have by no means exhausted the list of causes which
have been enumerated by different writers upon this subject,
but enough have been mentioned to illustrate the fact that,
as they are various and variable, so, too, will the treatment
recommended vary in method and application.
"As we are dealing only with extreme cases, where life
is placed in great jeopardy from the prolonged and constant
nausea and inanition of pregnancy, so, in the consideration of
treatment, shall we, likewise, confine our remarks to the
extreme measures requisite for its relief.
"These will be discussed under three general heads, viz.:
"I. Stomachal rest.
66
"II. Rectal alimentation and medication.
“III. The artificial induction of abortion.
"I. The first indication of treatment, then, in these ex-
treme cases, speaking generally, is absolute and complete rest.
for the stomach; not only must all food be positively inhib-
ited, but so also must all drinks, in large or small quantities,
be excluded per orem. So necessary to success is stomachal
rest, I am convinced, after considerable observation, that
there must be a positive prohibition of all alimentation by
the stomach; and that under no circumstances must we allow
the cravings of the patient or the entreaties of her friends
to persuade us to relax this stern and apparently cruel man-
date. To relieve thirst, dryness of the mouth, and the
parched condition of the lips small chips of ice may be
allowed per orem, but nothing else.
6
"Cases occur,' remarks Dr. Busey,* in which the stom-
“*Op. cit., pp. 114, 115."
VOMITING IN PREGNANCY.
683
Oc-
ach will not tolerate any thing, either liquid or solid.
casionally, when some simple article of food is for a time
retained, it simply accumulates, and is finally expelled undi-
gested. Digestion seems to be suspended, or so disturbed
that stomachal alimentation is impossible.'
"This is undoubtedly the experience of every one who
has had much to do with this malady. Why, then, should
we torture the already disturbed, irritated, and rebellious
stomach by the introduction of even the blandest aliments?
Better far to wait until rest and time have sufficiently
repaired these disturbances to warrant the gradual resump-
tion of stomachal alimentation, and to inspire the belief that
the assimilative process may also be restored.
66
"By the same inexorable rule that we prohibit the inges-
tion of food would we also deny the introduction of medicines
per orem, for the self-same reasons which govern in the one
case apply with equally cogent force in the other.
"II. Of rectal alimentation and medication.
"The same dire necessity which compels us to abandon
the stomach for purposes of nutrition and medication forces
us to adopt the rectum for like uses; and fortunate it is that
nature has so wisely provided such a valuable and efficient
substitute, enabling us thereby to sustain life for even a
lengthened period, should such a necessity arise.
"It is a well known fact that in many stomachic, eso-
phageal, and pharyngeal disorders rectal alimentation has
been employed with more or less success, oftentimes, indeed,
it being the only method of sustaining nutrition for weeks,
months, and even years. I shall not attempt to enter into a
historical review, nor to discuss in extenso the rationale of the
rectal method of alimentation, but shall simply submit a few
remarks in regard to its applicability and usefulness in the
nausea and inanition of pregnancy.
"The most valuable recent contribution to the literature
of this subject is a paper by Dr. Henry F. Campbell, of
684
EATON ON DISEASES OF WOMEN.
Augusta, Ga., submitted to the American Gynæcological
Society at its annual meeting in 1878, from which many
of the thoughts here suggested have been formulated.
"If it is important-nay, absolutely necessary—that the
stomach shall have rest in gravid nausea,' it is equally im-
portant that nutritive elements shall be furnished in some
artificial manner in sufficient quantities to maintain the vital
standard to such a degree that there shall at least be no loss.
by the prohibition of stomachal alimentation. It has been
demonstrated over and over again that this was possible; but
just how the rectal food was prepared for, and finally intro-
duced into, the blood has been a matter of controversy,
conjecture, and doubt, until Dr. Campbell cut the Gordian
knot' by his ingenious and, to my mind, conclusive explana-
tion of the modus operandi by the method which he has so
simply and aptly termed 'intestinal inhaustion.'†
6
"If the rectum or colon were alone depended upon to
absorb or convey to the blood the nutritive enemata very
little or no good could come from their use, since both of
those organs are devoid of the digestive juices so necessary
to the preparation of all aliments for their absorption into
and admixture with the blood. It is highly probable, how-
ever, that when food is properly placed in the rectum there
is a reversion of the ordinary and normal peristaltic action of
the intestinal tube, which carries it upward until the small
intestine is reached, where those digestive juices are found
which prepare the food for chylous absorption in the same
manner as though the aliments came by way of the stomach
instead of the rectum. Nay, more; is it not likely that food
which finally reaches the blood up through a healthy avenue
is better fitted for the nutrition of the body than when sent
downwards through a stomach irritated and disturbed, with
its secretions chemically at fault, and its functions rendered
morbid by the hystero-neuroses of pregnancy?
"*Gynæcological Trans., Vol. III, p. 268."
"Op. cit., p. 282."
.
VOMITING IN PREGNANCY.
685
"Let us interrogate Dr. Campbell in this connection with
reference to the manner in which rectal alimentation is made
to serve the purposes of nutrition in these cases. 'I have
already,' says Dr. Campbell, 'defined the method by which
I account for the digestion, absorption, and assimilation of
food when placed in the rectum. It is this, differing from
all others with which I am acquainted, that digestion in
either rectum or colon is not at all contemplated-neither
by direct absorption on the part of the walls or vessels of
these cavities; nor by the means of artificial digestive prin-
ciples added to the food after the manner of Leube; nor by
the glands of the large intestine vicariously secreting the
digestive fluids of the small intestine; nor, lastly, by the
alimentary mass in the large intestine exciting the secretions
of the stomach and small intestine, and then attracting, or in
some way acquiring, them, in order that rectal digestion may
take place.
666
My proposition is distinctly the reverse of this last,
and asserts that instead of the digestive principles descend-
ing to the food to digest it the food ascends to these fluids
in the small intestine, and that it is there digested and pre-
pared for absorption by the proper organs in precisely the
same manner as after buccal ingestion.**
"I am at this moment feeding four patients per rectum
for various maladies (one being for gravid nausea and inani-
tion); and I should be glad to introduce notes of these cases
in this paper, but I forbear lest I wax wearisome with many
details. It is sufficient to say that they all tolerate the
method well, and are improving under it. I have interro-
gated each patient carefully, after having instructed them to
make particular observation as to recto-staltic action, and
they all assert that they can feel the food going upwards
into the intestines' a little time after its introduction.
"Dr. Nathan Bozeman, of New York, in a recent, most
"*Op. cit., p. 285."
686
EATON ON DISEASES OF WOMEN.
valuable contribution to the literature of ovariotomy,* has
demonstrated the superiority of both rectal medication and
alimentation, even before as well as after the operation.
"Dr. M'Clintock read a paper on the subject before the
Obstetrical Society of Dublin, March 12th, 1873,† in which
he gave the report of a case which was reduced to the very
last degree of prostration and weakness when the abortion
was provoked, insomuch that the preservation of her life
seemed scarcely possible; nevertheless, she made a good
recovery and again became pregnant.
"Dr. M'C. also gives in his paper a table of thirty-six
cases where abortion had been artificially produced to rescue
the patients from the fatal effects of their persistent and
excessive vomiting. In twenty-seven of these cases the
nausea and vomiting was completely arrested and the patients
perfectly recovered; in the remaining nine cases, while the
vomiting was stopped, ultimate recovery did not take place.
The result in these nine instances the author thinks due, in
part, to the fact that the operation had been too long de-
layed; and in part to the fact that concurrent disease in
some form had complicated the cases so as to put recovery
out of the question under any plan.
"Dr. M'Clintock also cited fifty cases, from various
authentic sources, where death had actually taken place in
consequence of the persistence and uncontrollable severity
of the pregnant sickness.
"It now and then happens in those cases, that nature
herself comes to her own relief and turns out the offending
uterine contents, thus clearly indicating the correctness of
this line of practice in exceptional instances. This occurred,
indeed, in the very case which Dr. Campbell makes the
basis of the valuable paper to which I have frequently made
reference in this rambling communication.
"See New York Med. Record, July and August, 1879."
"Irish Hospital Gazette, May 1, 1873."
VOMITING IN PREGNANCY.
687
"I will conclude by formulating some of the principles
which we seek to enforce :
"I. That in extreme cases of gravid nausea the stomach
often becomes so disturbed in its functions as to render the
digestion of food harmful, nay, even impossible. Hence
arises a degree of exhaustion and inanition which may result
in death.
"II. That stomachal rest, which oftentimes must be
absolute as far as a positive prohibition of all buccal inges-
tion can make it so, must be strictly enjoined; moreover,
this may be, and often is, a condition precedent to thera-
peutical success in the management of cases where life is
threatened.
"III. That rectal feeding and medication become alike
important factors in securing the necessary rest for the
stomach, and indispensable ones in maintaining and improv-
ing the nutrition of the body.
"IV. That the maintenance of nutrition by means of
rectal feeding is accomplished by a 'reversal of normal pe-
ristaltic action' in the intestinal tube-the 'retrostalsis' or
'intestinal inhaustion' of Campbell; and, further, that to Dr.
Campbell belongs the credit of first bringing to the notice of
the profession this newly-discovered function of the aliment-
ary canal, whereby the true rationale of rectal alimentation
seems fully explained.
6
"V. That by the careful and systematic' employment of
feeding and medication through the rectum, the necessity for
the artificial induction of abortion for the relief of gravid
nausea may be reduced to a minimum.
"VI. And, finally, that in cases which have resisted the
employment of all milder expedients, and life still seems
threatened, the induction of abortion for the relief of the
excessive, obstinate, and uncontrollable vomiting of preg
nancy becomes an alternative measure, justifiable alike by
medicine and morals.”
688
EATON ON DISEASES OF WOMEN.
}
CHAPTER LX.
•
PUERPERAL MANIA.
MENTAL derangements are but imperfectly understood.
We note some of the phenomena of the mind, but of the
workings of the brain, nerve currents, thoughts, emotions,
etc., we are about as ignorant as was Aristotle or Hippo-
crates. To draw a line clearly defined between sanity and
insanity is to-day an impossibility. There is such a variety
in the mental peculiarities of those considered sane, so many
idiosyncrasies among those whose entire sanity is sometimes
doubted (and as often defended), that we can in no manner
clearly define the boundary line between sanity and insanity.
Still we may be able to clearly distinguish the difference
in the two realms of mentality when fully within their
borders, figuratively speaking.
If any one thinks he understands mental derangements,
let him try to explain the conditions and symptoms which
indicate them, and he will soon find how careful he must be
in his language not to include in the description of mania
some symptoms often manifested by those considered sane.
Many books have been written and much said upon the sub-
ject, but all have left the matter with their thoughts so
shrouded in the profusion of verbiage that they are not easily
discerned. This is a charitable view to take of the matter.
Here is a wide field for discovery, and I hope that some one
will soon be able to give us clearer views of the operations
of the mind, both in health and disease.
We
So far as I can learn there is now no standard by which
we can positively judge of mild aberrations of mind.
can not say one is insane on account of peculiarities of judg-
2
PUERPERAL MANIA.
689
ment, unless these peculiarities have come on suddenly to one
previously free from them. For some people are very pecul-
iar all through life, and should we judge them, in comparison
with the mass of mankind, we would say they were of un-
sound mind. They do things which mankind do not approve
of, seemingly with the sanction of their own judgment and
conscience, and have a distinct recollection of what they have
done. This is strikingly exemplified in cases of religious
bigotry and zeal, even carried to the extent of murdering
their own children and their fellow-men in the service, and
to please a GOD of love, mercy, and tenderness. To the world
at large, these acts look like evidences of insanity; still, the
whole sect to which they belong may approve and applaud.
If a certain act is performed, and the person performing
it has no recollection of it, the act is like that of the som-
nambulist, and he is not responsible. But the trouble arises
in this case to make it clear that the act was committed while
unconscious. Again, simple forgetfulness will not indicate
insanity (would that it did, especially to affect those who
forget to do as they agree).
But it is of puerperal mania I would speak. We find
that there are certain reflex influences from the uterus affect-
ing the brain in some cases. This is first manifested at
puberty, the girl's whole mentality seeming to change after
the catamenia is established. Again, in disease and displace-
ment of the uterus, pain in the head is of almost constant
occurrence. It is, therefore, found to be, as might be ex-
pected, that the processes of gestation and delivery affect
the brain, and, in some instances, produce aberration of the
mind.
Hence we find the puerperal woman manifesting symptoms.
entirely at variance with the ordinary character of the pa-
tient. Sometimes in one way, sometimes in another. In
some cases consisting of ravings, disjointed mutterings, etc.;
in others, obscenity and vulgarity; while others are indifferent
44
690
EATON ON DISEASES OF WOMEN.
to their offspring, and even have aversion to them, to the
extent of taking their lives, in some instances. These mani-
festations coming on in connection with gestation, following
after, or occurring at, the period of confinement, are termed
puerperal mania.
There is nothing very peculiar in the disease from other
cases of insanity in women, except in regard to its causation,
it being dependent upon a want of equilibrium in the ner-
vous system, over-excited and depressed by the irritation of
the uterus, affecting especially the nerves, and occurring
either during or shortly following gestation.
Diagnosis.
The disease is easily diagnosed. The derangement of
mind is not to be confounded with the delirium of puerperal
peritonitis. The cases to which the term puerperal mania is
properly applied are those where there is no special disease
of the system manifested which has brain symptoms in con-
nection with it, although the continuation of hallucinations
of the brain after the disease which had appeared to cause
them had subsided, for some time, would correctly receive
the term puerperal mania, if occurring immediately subse-
quent to delivery.
Treatment.
Hyoscyamus, Gelsem., Bell., Ignatia, Glonoine, Phytolac. dec.,
Verat., Puls., China, Ars. alb., etc., may be indicated. Each
case must be studied, and the homoeopathic remedy selected.
Much depends upon the temperament, constitution, and sta-
tion in life of the patient, her domestic happiness or unhap-
piness, her inherited diathesis, etc., etc.
One of the first things to be done is to make such
arrangements for her care as to prevent her doing injury to
The physician should be very careful on this
point, as we know how liable these patients are to commit
extreme acts; and her friends are not likely to appreciate
any one.
!
PUERPERAL MANIA.
691
the danger; they, having known her as full of gentleness,
tenderness, and love, can not think she would do any vio-
lence. The patient should be in a temperature which is
moderately cool, but she must be well protected with cloth-
ing. Her general health may be such as to admit of her
taking exercise; if so, she may ride or walk in pleasant
weather. Close confinement is not desirable, except when
absolutely necessary, owing to her general health, her vio-
lence, or liability to make immodest exposure of herself.
The nourishment should be governed by the condition of
the patient. If hyperamic, let her live on light diet-veg-
etables, fruits, etc. If anæmic, give meats, soups, and as
generous a diet as she can digest. Frequent bathing, with
frictions to the entire cutaneous surface, is of great utility.
Indications for Remedies.
Ars. Alb., great weakness, with nausea; alternations of
heat and cold; aching of the limbs; diarrhoea accompanying
the cerebral symptoms.
Bell. has the flushed face; rush of blood to the head, etc.
China, after excessive hemorrhages; atonic and anæmic
condition.
Gelsem., for violent raving; sees demons; fright; de-
spondency.
Glonoine, stupidity; muttering delirium; congestion.
Hyos. is indicated in a disposition to weep, and with
a tendency to be immodest.
Ignatia, in nervous tremors; restlessness; exhaustion.
Phytolac., in scrofulous patients; lymphatic temper-
ament.
Puls., when the disease is accompanied with loss of ap-
petite, and pain in the back of the head.
Verat. Alb., violent disposition; cold sweat upon the
forehead; passive congestion of the brain.
692
EATON ON DISEASES OF WOMEN.
CHAPTER LXI.
DISEASED AND DEFORMED NIPPLES— MILK FEVER — ABSCESS
OF THE BREAST TUMORS OF THE BREAST, CANCER, AND
AMPUTATION OF THE BREAST.
EXCORIATED NIPPLES-FISSURES OF THE NIPPLES.
THESE affections, though not dangerous, are extremely
painful to the patient, and merit the earnest attention of the
physician, as one important duty of his is to relieve the suf
ferings of his patients.
These affections occur, of course, during lactation. The
child is sometimes allowed to nurse almost continuously on
account of fretfulness and colic. (which, by the way, is an
efficient means of making the colic and fretfulness worse).
The nipple becomes denuded of its epithelium, or becomes
cracked, and then every effort of the child to nurse becomes
very painful. The mother is placed in an agony of pain
each time she gives the child the breast.
If only one nipple is affected she is inclined to let the
child nurse the other entirely, and leave the affected nipple
alone, which tends to produce an over-fullness of milk, and
develop mammitis or mammary abscess.
There is perhaps
no affection of women which causes more dread and agony
than excoriated and fissured nipples.
Treatment.
Arnica, internally and externally, is an excellent remedy.
Basilicon ointment, pressed down into the fissure, after wiping
the parts dry from all the secretions of the child's mouth
after nursing, is the most efficient remedy I know. Calendula,
Borax, Alum, and Collodion are used by some. I have used
them all, but none equal Basilicon ointment in my experience.
RETRACTED NIPPLES.
693
It is of great importance to have the child nursed as
seldom as possible in these cases, (i.e.) not oftener than
three hours, using one breast one time and the next time
the other. This gives six hours for the healing process to
go on.
We will often obtain better results by using Kent's
nipple shield when the child nurses, which will help to pre-
vent tearing open the laceration, and allows of the formation
of new epithelium.
The Basilicon ointment is as harmless to the child as any-
thing which can be used upon the nipples; and, besides, is
the most efficient. It is composed of Olive Oil four parts,
Pitch, Wax and Resin, each one part. It is stimulating, and
it is in accord with homoeopathy to apply an irritant to cure
an irritation, though it be applied externally instead of in-
ternally.
RETRACTED NIPPLES.
This affection, which is sometimes due to abnormal de-
velopment, or to the contraction of a cicatrix following an
abscess of the breast which has opened, or has been lanced
near the nipple, is also due to the pernicious fashion of the
ladies of this day in using pads to simulate breasts, or to
make the appearance of a large development of the mamma;
and in the case of large development of the breast, the use
of corsets to compress them, the ladies seemingly unwilling.
in either instance, to allow nature to have her way at all.
The result has been retracted nipples in many, and generally
an imperfect development of the breast in the majority of
American women. Retracted nipple tends to the develop-
ment of mammary abscess, by preventing the free evacuation
of the milk tubes, and is productive of much trouble and
suffering.
Treatment.
The retraction caused from a cicatrix, and, in most cases,
those of abnormal development, can not be remedied, and we
694
EATON ON DISEASES OF WOMEN.
have to content ourselves with drying up the milk in the
breast so affected. This can usually be accomplished with
alternate bathing of the breast with Camph. and Bell. every
two hours. Those cases caused by pressure can many times
be relieved by the frequent use of the breast pump. Kent's
metallic nipple shield and cartouch teat is the best invention
for use in these cases. It is very simple, free from rubber
tubing, is easily cleansed, adheres firmly to the breast with-
out causing constriction of the nipple or of the lactiferous
ducts.
MILK FEVER.
THE term milk fever is applied to a slight fever which
usually affects the parturient woman on the third day after
delivery; sometimes, however, coming on a little earlier. It
is connected with the activity about to be established in the
mammary glands, causing the secretion of milk in them.
When moderate, we can but consider the increased activity
of the circulation at this time only as a physiological
condition. The student needs to note this, as otherwise he
might be unnecessarily alarmed at the symptoms manifested
at this time.
Sometimes there is a slight chill experienced by the
patient on the second or third day. This usually lasts but a
few moments, and is followed by heat, flushed face, increased
rapidity of the pulse, dry skin, etc. This fever may last
several hours (usually from four to six); but sometimes it
continues all day. The development of the milk in the
breast is usually followed by a cessation of the feverish
symptoms, and they do not return.
The secretion in the breast previous to the development
of milk is termed colostrum. It is a watery fluid, slightly
milky in appearance. When nursed by the child it seems to
affect the bowels and cause them to act. In exceptional
cases, milk is secreted in the breasts for months before
confinement.
MILK FEVER.
695
Etiology.
The causes of this fever seem to be, the congestion in
the breasts, preceding the secretion of milk, and the sympa-
thetic nervous excitation induced by this condition.
Diagnosis.
A little care needs to be exercised in the diagnosis, as it
is possible that "Puerperal peritonitis" might come on at this
period; or the patient might be suffering from some other
condition which produces fever, and we might be at fault in
passing the whole matter by as of little moment. Es-
pecially should we be careful in the diagnosis, when the
fever is very high, or the chilly sensations return; and, also,
when we find tenderness and distension of the abdomen, or
very great tumefaction or tenderness of the breasts.
An overloaded stomach, incipient pneumonia, etc., may
cause the high fever at this time; and we need to recognize
these conditions if present, and treat the case accordingly.
Treatment.
Generally speaking, milk fever needs no treatment. After
confinement the child should nurse from the breasts twice a
day the colostrum found there; and the patient's diet should
be very bland, consisting of gruel or toast, with a little warm
milk, etc. No meats or soups should be allowed before the
fourth or fifth day. Cold should be carefully avoided.
or 30, may be given with good effect,
few doses of Bell., 6
and is usually the only remedy indicated.
A
MILK ABSCESS, MAMMITIS, MASTITIS, OR WEED; SOMETIMES TERMED
EPHEMERA, GALACTOCELE, ABSCESS OF THE BREAST, MAMMARY
ABSCESS, BROKEN BREAST, ETC.
The terms ephemera, galactocele. or weed are applied to
an attack of inflammation of the breasts, which subsides in
696
EATON ON DISEASES OF WOMEN.
TON
a day or two without suppuration; while the terms mam-
mary abscess, abscess of the breast, and mammitis are ap-
plied to those cases of inflammation of the mammary gland
which progress for some days, and tend to the development
of pus.
Symptoms.
The attack of mammary abscess is ushered in with a chill
much like an ordinary intermittent, followed by fever, and
generally ending in perspiration. The breasts are swollen,
tender, and very hard, especially in some particular part. At
first this hardness and tumefaction is confined to a small space
in many cases, but gradually, and sometimes rapidly, extends
and enlarges, so as to embrace the half, and sometimes the en-
tire, breast. Intense pain in the head, forehead, and eyebrows
is complained of; the face is flushed; mouth and tongue
dry; pulse hard and rapid. The secretions of the kidneys,
liver, etc., as well as the mammary glands, are suppressed.
There is sometimes delirium; at other times, great despond-
ency and fear of death.
If the inflammation goes on for several days softening is
observed, which gives indication of the formation of pus. This
is also signalized by the occurrence of a chill. In a week
or so, if not artificially evacuated, the pus finds its way to
the surface by ulcerative action, and breaks through the skin
in one or several places. This has given rise to the term
"broken breast." During this time the pus is finding its
way to the surface the intensity of the pain in the part is
very great.
These attacks of inflammation of the breast are not.
peculiar to the period immediately following delivery, but
may occur at any period during lactation, the most usual
Some-
time, however, being during the first few months.
times, 't is true, they occur during the first week after de-
livery, and a little care is necessary then to discriminate
between the attack of milk fever, puerperal peritonitis, and
ABSCESS OF THE BREAST.
697
inflammation of the breast. The use of ordinary skill and
care will, however, make the correct diagnosis easy.
Etiology.
Cold is the most frequent cause of these conditions of
the breast, the cold in the breast causing an arrest of the
lacteal secretion, or its retention in the lactiferous glands,
from obstruction in the tubuli lactiferi, causes inflammation,
enlargement, and tenderness of the breast, as just enumerated.
Treatment.
Bell. internally, and locally applied externally to the
breast, is the remedy to abort the disease, keeping the
breast warm, and applying warmth to the extremities. If
in spite of this treatment the disease goes on to suppuration,
poultices of flax-seed meal or slippery-elm, applied warm and
continuously, are useful in softening the hardness and help-
ing to invite the ulceration towards the surface. When the
fluctuation is very distinct it is best to lance the abscess,
and thoroughly evacuate all the pus, and then apply com-
pression in such a way as to cause all the matter to freely
pass out and cause adhesions of the walls of the sac. This
can sometimes best be done with long strips of adhesive
plaster; at other times with bandages, always taking care to
leave an opening for the free exit of all pus that may be
formed. Merc. iod., Hepar sulph., or Ars. iodid. are very gen-
erally indicated in the suppurative stage; and afterwards we
must prescribe remedies according to the particular condition
of each case.
MALIGNANT AND NON-MALIGNANT TUMORS OF THE BREASTS, Indu-
RATION, GANGRENE, HYPERTROPHY, ETC.
Various tumors develop in the breast, of both malignant
and non-malignant varieties.
Gangrene of the breast is seldom seen, and only occurs in
698
EATON ON DISEASES OF WOMEN.
women of broken down constitution, and usually in those
only who are also affected with scrofulous or syphilitic dis-
ease, entailing an impoverished condition of the blood. Gan-
grene has been known to be occasioned by the protracted use
of Ergot by women of middle age.
Hypertrophy of the breast may affect the entire gland or
only a part. It consists of simple enlargement of the normal
structures of the gland. It is chiefly troublesome on account
of its increased weight, and the patient may demand its
amputation for this reason.
NON-MALIGNANT OR BENIGN TUMORS OF THE BREAST.
These are lacteal, sero-cystic, hydatid, and adenoid.
The lacteal tumor of the breast results from an obstruc-
tion in the lactiferous ducts, and we have treated of it under
the head of abscess of the breast, though strictly a milk
tumor is not an abscess (as it contains milk instead of pus).
The quantity of milk sometimes contained in a lacteal tumor
is astounding. Dr. W. Parker reports a case where three
quarts of fluid were evacuated at one time from one of these
tumors. The swelling in these cases commences usually
within three weeks after delivery, and very soon shows fluc-
tuation. There is little tenderness or inflammation in the
breast, but the sub-cutaneous veins are enlarged and dis-
tended. Sometimes the milk is partially absorbed and car-
ried into the circulation, leaving a residue of thick creamy
or cheesy matter. This becomes encysted, and may remain
for a long time as an indurated tumor, without giving any
trouble to the patient.
Treatment.
Where the milk tumor is of considerable size and on the
increase, it should be evacuated with a trocar, and then
injected with a Solution of Iodine, about 5 grs. of Iodine and
15 grs. Potass. iodide to the 3 of water. After being injected,
*Gross' Surgery, Vol. II, page 911.
TUMORS OF THE BREAST.
699
and the injected fluid has passed away, we should compress
the breast with adhesive plaster or bandages carried over the
shoulder and around the body, so as to bring the walls of the
abscess in contact to promote their adhesion. Small tumors
of this kind may be left to themselves, or we may give
Bell., Merc. iodid., etc., internally, and apply Iodine or Camph.
externally to promote their absorption.
ADENOID TUMORS, INDURATIONS, ETC.-This form of tumor
occurs in the young unimpregnated woman, either in the
married or single. It produces no constitutional effect. It
is a hard, indurated, irregular tumor, varying in size from the
very small tumor not larger than a hazelnut to the size of a
child's head. When removed by operation it creaks under
the knife. The tumor is inclosed in a capsule of condensed
cellular tissue, and is composed of a pale grayish, blue, or
brownish homogeneous substance. Bluish veins are seen over
its surface, but it occasions little or no pain or inconvenience,
except from its weight, in case it is of large size.
Treatment.
Adenoid tumors require no treatment unless they attain
large size, when their extirpation is advisable. Local appli-
cations and internal medication are of no avail in this form
of tumor.
SERO-CYSTIC TUMORS OF THE BREAST.-Sero-cystic tumors of
the breast occur in women usually between the twentieth and
fortieth years of their ages. They often attain great size.
They do not produce constitutional symptoms, and there is no
sympathetic enlargement of the axillary glands, as in malig-
nant disease of the breast. They are not painful, except from
their weight. Extirpation is their treatment, which is effect-
ual. They do not return.
HYDATID TUMORS OF THE BREAST.-These are very rare,
and it is scarcely necessary to more than mention their possi-
ble occurrence and say that extirpation is the treatment
700
EATON ON DISEASES OF WOMEN.
required. It is usually impossible to diagnose them till after
removal or by examination of their contents after making an
incision into them, when they are found to consist of inna-
merable minute cysts. They do not cause enlargement of the
axillary glands, cause pain at night, or produce constitutional
disturbance. After thorough excision they do not return.
*
FATTY TUMORS OF THE BREAST.-Fatty tumors of the
breast are exceedingly uncommon. Gross relates but one
case, and that one from Brodie. This was situated back of
the gland and pushed it forwards. The only remedy is
extirpation. Dr. Gross says: "I would suggest the Bantam
system of diet in such a case. Allow the patient no cream,
butter, sugar, milk, or fat meat, or starch; but let her eat
lean meat, fish, all vegetables, except potatoes and beets, and
all kinds of fruit. Allow acidulated drinks." This plan of
diet is calculated to rapidly reduce the adipose tissue in any
case; and we believe it might be found to have a salutary
effect upon fatty tumors of the breast, though we have never
tested it in such a case.
CANCERS OR MALIGNANT TUMORS OF THE BREAST.
The most common malignant tumors of the breast are
the scirrhus (or hard cancer) and encephaloid. Melanosis
and colloid are occasionally found.
Scirrhus of the breast sometimes occurs after the climact-
eric period is passed. It has been known to develop in
women from seventy to eighty years of age. Isolated cases
are reported where it has affected young girls, even as
young as twelve years. I removed one breast for scirrhus
in a lady but twenty-four years of age. Such instances are,
however, extremely rare. Spinsters are liable to the dis-
ease as well as the married. The left breast is affected
more frequently than the right.
*Gross' Surgery, Vol. II., p. 914.
CANCER OF THE BREAST.
701
Symptoms.
The patient usually complains of sharp lancinating pains,
occurring mostly at night, in one breast. On examination,
there is found an indurated tumor of small size, uneven,
and nodulated. The axillary glands of the corresponding
side are found enlarged and tender, and the patient exhib-
its the sallow, tawny complexion characteristic of the can-
cerous cachexia. The disease progresses very slowly; by
degrees the nipple is found to be more and more re-
tracted, the tumor enlarges, and blue veins are seen over its
surface.
In some instances, scirrhus commences in the integument
of the breast, or the underlying cellulo-adipose tissue. In
the former case, it is of very small size, bluish in color,
round and movable. When situated in the cellular tissue it
is felt deep-seated, though movable, generally oblong and
nodulated; after several months it approaches the surface,
the tumor becomes fixed, the nipple retracts, the skin over
it becomes bluish, and sloughing commences, and a foul,
irritable fungous opening is established. This results from
all forms of scirrhus sooner or later.
ENCEPHALOID OR SOFT CANCER.The soft or encephaloid
cancer of the breast is much more uncommon than the
scirrhous, or hard cancer, just described.
This form of cancer
develops rapidly in comparison with the hard variety, often
in a few months attaining the size of a child's head. The
tumor commences deep in the substance of the breast, and
soon ulcerates, and throws out a sort of fungous growth.
The pain is comparatively slight in encephaloid, compared
with scirrhus. The constitutional disturbance is. however,
marked, and the cancerous cachexia is unmistakable. Death
generally brings relief in from six to ten months from the
time ulceration commences.
Colloid, alveolar or gelatiniform, cancer in the breast is
702
EATON ON Diseases of WOMEN.
1
seldom met with. It is of slow development, is of a grayish
color, dense, firm, glistening.
Melanosis of the breast occurs sometimes in connection
with scirrhous cancer. It consists of an infiltration into the
cellular tissue of material of a dark, sooty color, which
hardens into nodules. These deposits have a tendency to
suppuration, and usually return after removal.
Treatment.
In all varieties of tumors of the breast (except the fatty)
a generous, unstimulating diet is to be given. Hygienic meas-
ures are to be rigidly enforced. In the non-malignant varie-
ties of these tumors we may expect a cure, either with
medicine or by surgical operation. In simple hypertrophy
Iodine in the 4x dilution (or ten-thousandth potency) is an
efficient remedy; or we may sometimes find that Ars. iodid.
is more clearly indicated. These remedies, as well as Phy-
tolac. dec., may reduce the size of either variety of the non-
malignant tumors of the breast.
In the cancerous, or malignant tumors we can not expect
a cure with either remedies or by surgical means. Remedies
must be used according to the homoeopathic indications in
each case. Among the remedies most frequently indicated
we will find Ars., Apis, Conium, Macrotis, China, Nux, Bry.,
Sulph., etc.
AMPUTATION OF THE BREAST, OR EXSECTION OF THE TUMOR.—
In the malignant tumors of the breast it is of but little use
to operate, for at best the disease is sure to return in a few
Removal of the growths with caustic paste is also
years.
just as unsatisfactory. The removal of the whole or a part
of the breast in cases of large, hard, non-malignant tumors
of this gland is often advisable.
OPERATION.—The patient is to be placed under the influ-
ence of an anæsthetic, and then placed upon the operating
table. The incisions should be made in the skin of an ellip-
AMPUTATION OF THE BREAST.
703
4
tical shape, so that when the tumor is removed the integument
may be brought together, and have no redundancy.
The first incision should be in the direction of the fibers
of pectoralis major muscle, if possible (sometimes, owing to
the position and shape of the tumor, this rule must be ig-

SON-JEL.
B
STOHLMANN. PFARRE & Co
HOLT:SE:
A
FIG. No. 64.-OPERATING TABLE.
nored), and should encircle the lower part of the tumor, and
should include the skin and cellular tissue. The tumor
should now be held up by an assistant while we dissect off
the lower flap of integument from the tumor.
After this is done, we make a similar incision upon the
upper side of the tumor, and dissect back the flap as before.
We now grasp the tumor with the left hand, and dissect it
out with the right, peeling it out as much as possible, using
the fingers, or the handle of a scalpel, for this purpose, and
incising such tissues as we find we can not lacerate. An
704
EATON ON DISEASES OF WOMEN.
assistant should seize any artery we may divide with the
artery forceps, and use torsion if it be small, or let another
assistant ligate it, if it be of considerable size. After the
removal of the tumor, and we have ascertained that all ooz-
ing of blood has been arrested, we may lay the flaps together;
apply a compress of soft cloth wet with warm water and
Arnica; gently apply a bandage, and allow the patient to
revive. Remove her to her bed, and give Arnica 6 every
half hour, unless she sleeps; if so, let her alone, only apply-
ing sufficient covering to maintain the warmth of the body.
X
After six or eight hours we remove the bandages and
compress, and ascertain if there is any hemorrhage, and after
giving a little Chloroform we proceed to fix the flaps in posi-
tion with interrupted silver wire suture, bringing the ends of
the ligatures (if any have been used) out at the most de-
pendent portion of the wound. Apply long adhesive straps
to support the tissues and prevent strain on the sutures, and
over these apply a compress and bandage as before, moist-
ened with Calendula wash or warm water and Arnica.
No opiates or stimulants are required. Lay the patient
so that the fluids which may accumulate under the flaps may
find exit readily. The compress should be removed and
charged every six hours at most; and Arnica 6 should be
given internally every three hours. Gentle, plain nourish-
ment only should be allowed. The ligatures will ordinarily
be found loose in about five or six days, when they may be
removed, as well as the sutures at about this time. If the
secretions cause the lower flap to pouch down, and they do
not find exit, we should make an incision at the most depend-
If adhesion of
ent portion, and allow them to drain away.
the flaps to the muscular tissue of the ribs does not readily
take place we may inject some Solution of Iodine to stimulate
We must keep up gentle press-
granulations and adhesions.
ure till the flaps have become adherent.
PUERPERAL PHLEBITIS.
705
CHAPTER LXII.
PHLEGMASIA DOLENS— PUERPERAL PHLEBITIS, OR MILK-LEG.
THIS disease is peculiar to women, and is usually con-
nected with the puerperal state, though phlebitis of the limb
has been known to affect men,* following ulceration of the
intestines and disease of the hæmorrhoidal veins; and also
has occurred in connection with cancer of the rectum. Rams-
botham, White, Hewson, Twedie, Cheyne, Ferrion, and De-
wees mention cases occurring independently of the puerperal
state; but to one case occurring independently of the puer-
peral state there have probably been ninety-nine in connection
with it. Of late years the disease seems to be less frequent
than formerly, several late writers having failed to make any
mention of it.
An attack of phlebitis usually occurs during the first four
weeks after confinement, although sometimes later. The
inflammation is supposed to commence in the uterine veins in
these cases, and extend to the iliac and crural veins. The
disease may affect one or both of the lower limbs; generally
only one is affected, but sometimes it migrates from one to
the other. Blundell, Campbell, || and Churchill § state that
the left limb is most frequently affected. This is my own
experience, and has also been observed by Ramsbotham.T
The tendency of the disease is to progress to a gangrenous
condition, especially of the cellular tissue; in cases where this
is affected, ulceration at some point being a not uncommon
result. It seldom, if ever, attacks the same limb twice.
*Lee, page 163.
Obstetricy by Costle, page 786.
? Midwifery, page 462.
Ramsbotham's Obstet., page 490.
System of Midwifery, page 371.
¶Obstet., page 488.
45
706
EATON ON DISEASES OF WOMEN.
Diagnosis.
The symptoms in a case of phlegmasia dolens, or puer-
peral phlebitis, are very much the same as in ordinary inflam-
matory attacks the rigor followed by heat, fever, etc. The.
wiry pulse is sure to be present in the early days of an
attack; the pain, however, is only moderate in the pelvis,
and is severe in one of the lower limbs.
On examination of the limb we find it much swollen,
especially in its upper part-the foot and ankle remaining
normal in most cases, but the calf of the leg is generally
somewhat affected. The swelling is hard and slightly elastic
to the touch; the color of the integument of the affected
limb is white and glossy. The distension of the tissues is
sometimes enormous.
For a day or two preceding the swelling of the limb, in
some cases, we may feel the inflamed veins in the upper part
of the limb like cords, as hard as tendons. The swelling is
distinguished from dropsy in not pitting on pressure. It is
not red and shiny like erysipelas, but white and glossy.
As the disease progresses the fever and pain abate, the
swelling becomes less tense, the tissues commence to pit on
pressure.
In bad cases dark spots appear in several places, varying
in size from a half dollar piece to the palm of the hand,
and sloughing sometimes takes place. There seems to
be a great variety in the seat of the inflammation, some-
times affecting the internal coat of the veins, and giving
rise to the formation of pus, in which case the symptoms of
pyæmia are manifested. The case then assumes typhoid
symptoms, and the outcome is doubtful. In other cases the
outer coat of the veins is mostly affected, and the inflamma-
tion extending to the cellular tissue, gives rise to a great
amount of effusion of lymph and serum, though the case may
not be as dangerous to life as when the internal coat of the
PUERPERAL PHLEBITIS.
707
veins is affected, though in the latter case there is much
less swelling.
Etiology.
The disease evidently in most cases commences in the
uterine veins, and their large distension seems to predispose
to an attack. Those cases which have been affected with
post partem hemorrhage are most liable to the disease;
not, I think, so much that the hemorrhage causes the inflam-
mation, as that a condition of atony and dilatation of the
veins causes both the hemorrhage and the attack of phle-
bitis, the immediate or exciting cause being cold, arrest of
insensible perspiration, glandular action, etc.
I need not occupy space and time in noting the various
theories which have been held regarding this complaint
since the commencement of the history of medicine. Suffice
it to say, that the profession is now well satisfied that the
disease is one of inflammation of the veins primarily; and
secondarily, of the cellular tissue of the limb. The oedema.
or rather great enlargement followed by oedema, is due to
obstructed circulation in the veins. To Dr. David Davis*
we are indebted for elucidation of the pathology of the dis-
ease, aided in later years by Dr. Robert Lee. It is my
duty to say, that the disease has been occasionally caused
by suppression of menstruation and cold, causing inflamma-
tion of the veins of the uterus and limb; also, in a few in-
stances of malignant disease of the womb crural phlebitis
has resulted. These cases are, however, exceedingly rare.
POST-MORTEM APPEARANCES. The crural and femoral
veins are found obliterated, and converted into cords in
some cases. In others, pus is found in the hypogastric,
common iliac and femoral veins. In cases where sloughing
had occurred. the femoral vein was obliterated. The iliac
glands are sometimes found inflamed, and sometimes con-
verted into abscesses.
* Reports Medico-Chirurgical Society, Vol. XII, p. 419.
708
EATON ON DISEASES OF WOMEN.
Treatment.
Aconite and Secale cor. are indicated in the outset, either
singly or in alternation, followed by Bell. or Bry. Evacuat-
ing the bowels with enema of tepid water, and putting the pa-
tient into a warm pack, are very useful adjuncts. We should
keep the lower part of the body and limbs well wrapped in
flannel. In some cases Merc., Ars., Rhus, Carbol. acid, etc.,
are indicated.
Indications for Remedies.
Aconite, for the wiry pulse; chilliness; fever; restless-
ness; dizziness; dry, hot skin, etc.
Ars. Alb., for great prostration; alternating heat and
cold; aching of the limbs; restlessness; thirst; nausea; œde-
matous swelling, etc.
Bell., for dullness of sensation; intolerance of light or
noise.
Bry., for sharp, cutting pains in the affected limb.
Carb. Ac., in a tendency to suppuration; great exhaus-
tion (used in 6x dilution).
Merc.-Dry, shiny skin; torpidity of the secretions;
diarrhoea; weakness, etc.
Rhus.-Exhaustion; pain while still, relieved by motion;
inability to move the affected limb, etc.
Secale Cor.-Numbness and coldness of the limbs; diar-
rhoea; stupid condition of the brain (Cowperthwaite).
If a slough forms, a poultice of yeast is to be applied;
and after the dead tissue is separated Vaseline may be ap-
plied to the sore, and the whole lower part of the limb
should be bandaged with a roller applied evenly and gently,
commencing at the foot, and applying the bandage upwards.
The limb should be kept elevated upon a hard pillow.
SUB-INVOLUTION OF THE UTERUS.
709
CHAPTER LXIII.
HYPERTROPHY, AND SUB-INVOLUTION OF THE UTERUS.
HYPERTROPHY of the uterus is a condition of chronic en-
largement or thickening of its tissues. Sub-involution is ap-
plied to the chronically enlarged uterus following the delivery
of a child or fœtus. It may either follow confinement at full
term, premature delivery, or abortion.
The uterus after impregnation seldom becomes reduced to
the size of the organ in the virgin state, except in old age;
but the enlargement above the normal condition is but slight—
about one-half an inch, as a rule. While the virgin uterine
cavity measures about two and one-half inches, the uterus
after impregnation seldom measures less than two and three-
fourths or three inches, after the uterus has been emptied of
its contents, and complete involution has taken place. The
uterus must, then, show a measurement in excess of three
inches before we can term it hypertrophied, or call it a case
of sub-involution, and then we can not where the elongation.
is due to hypertrophy of the cervix.
Sub-involution is one of the most common conditions
which we find among the ailments of women, and demands
more attention than is usually given the subject (for several
authors on "Diseases of Women" have entirely ignored it,
while others have given it but a page or two). It causes
many of the cases of leucorrhoea, displacements, symptoms
of spinal disease, mental hallucinations, dyspeptic symptoms,
etc., etc.
Chronic sub-involution and hypertrophy of the uterus are
usually accompanied with a low grade of chronic inflammation,
termed chronic metritis, or areolar hyperplasia. This inflam-
710
EATON ON DISEASES OF WOMEN.
t
!
mation often extends to the ovaries and peritoneal membrane,
as well as the cellular tissue. In this condition the body and
cervix of the uterus are both usually affected about alike;
but in some instances the fundus alone is affected, the cervix
being normal. Where the cervix alone is enlarged the dis-
ease is termed hypertrophy of the cervix, and is treated of
separately by most authors. I shall follow the usual plan of
nomenclature, and intend that the reader shall understand
that by hypertrophy of the uterus we mean either enlarge-
ment of the whole organ or the fundus.
Symptoms.
The symptoms characteristic of hypertrophy, we can only
positively ascertain by the aid of the uterine sound, which
will show an elongation of the entire uterine canal; and at
the same time we note the absence of elongation of the
cervix uteri. Besides this distinctive symptom, we have

ཀ
FIG. NO. 65.-SUB-INVOLUTION, WITH PROCIDENTIA OF
THE UTERUS.
rection, though occasionally it is also
thickening of the walls
of the uterus, to be de-
termined by pressing
one hand above the
pubis, while the sound
is introduced with the
other to the fundus.
When the disease af
fects both the body
and cervix,we feel the
cervix thickened and
enlarged in all direc-
tions, but more promi-
nently in a lateral di-
much elongated. In
introducing the sound, the expert notices the internal open-
ing of the cervical canal into the body of the uterus by its
more contracted condition; and if we withdraw the sound,
SUB-INVOLUTION OF THE UTERUS.
711
and observe the length of the cervix, and again measure the
cervix and body together, we can determine the relative en-
largement of both or either, as the case may be. In these
cases there is usually a feeling of weight in the pelvis, a
bearing down sensation often in both back and bowels. Def
ecation is usually difficult; and frequently dysuria is com-
plained of. Usually a leucorrhoeal discharge is present,
which stains the linen worn a yellow color, though it may
appear white as it emerges from the vaginal orifice. Usually
in cases of hypertrophy the uterus is lower in the pelvis
than normal, owing to its increased size and weight. (See
Fig. No. 65.)
Retro-flexion or ante-flexion is quite frequently found
to complicate these cases, the former being more common
than the latter.
Etiology.
The cause of hypertrophy is most frequently inflamma-
tion, sometimes, it is true, moderate in degree, but, never-
theless, inflammation, or a condition of areolar hyperplasia.
causing gradual enlargement from effusion of plastic material
into the interstitial tissue. These inflammations which give
rise to hypertrophy are caused by cold at the menstrual period,
excessive venery, the use of remedies to prevent conception
or produce abortion, rising too soon and taking cold after a
miscarriage, the retention of a small portion of the placenta,
cold baths, and cold vaginal injections, caustic applications to
the os uteri, the wearing of improper and ill-adjusted pessa-
ries, tight lacing, excessive dissipation, over-work, heavy
lifting, suppressed menstruation, uterine tumors, etc., etc.
The cause of sub-involution is supposed to be an atonic
condition of the system, and especially of the nerves of the
pelvis, causing want of firm, muscular contraction after deliv-
ery, leaving the uterus flabby, tending to produce flexions,
and with all the blood-vessels dilated there is a tendency
712
EATON ON DISEASES OF WOMEN.
to favor congestion and effusion. We find in women who are
exhausted with frequent gestations and lactations a greater
liability to this disease than in those of robust health.
Laceration of the cervix in labor is also a fruitful cause.
of hypertrophy and sub-involution of the uterus. (Refer-
ence to the chapter on Lacerations of the Cervix will more.
fully explain).
Treatment.
The first thing to do in the treatment is to remove the op-
erating cause, if it can be ascertained. The next is to rectify
any flexion or version which may complicate the difficulty.
Little can be done to remove the hypertrophy or the symp-
toms accompanying it until this is done. With this accom-
plished we may observe great benefit from the use of Secale,
Nux, Sepia, Bell., Iod. of Ars., Ars. of China, or Kali iod.,
given homoeopathically, in accordance with the totality of
the symptoms in the case. In some instances these remedies
will prove curative by establishing an activity of the absorb-
ents, and producing contraction of the blood vessels and mus-
cular tissue as well as tonicity of the nerves of the uterus
and the entire system, thereby strengthening digestion and
assimilation as well.
Regarding local treatment great diversity of opinion ex-
ists, some claiming that local treatment is of no use, others
relying upon it almost, if not quite, exclusively. My own
experience is in favor of a combination of local and general
treatment, using both internal remedies as indicated, and also
some local treatment. The local treatment should be varied
according to the condition of the uterus.
If somewhat tender and soft, compressible and spongy to
the feel, I get fine results from the application of Glycer-
ine and Hydrastis Tr., equal parts, applied directly to the
cervix by means of a cotton wad inserted in the vagina, or
by inserting a sponge tent, partially moistened with the same
medicine, into the cervical canal. This treatment causes
SUB-INVOLUTION OF THE UTERUS.
713
a drainage of the serum from the parts. The sponge tent
compresses the capillary circulation and repels its activity,
thereby reducing the congestion and size of the organ. Tents
may be used made of cloth wound around bonnet wire, in
shape like the ordinary sponge tent. These may be satu-
rated with the same medicine, or Glycerine and a Solution of
Iodine or Comp. Tr. Iodine, and inserted well up into the
fundus uteri. These tents are highly recommended by Pro-
fessor Hunt, of Covington, Kentucky, and I can add my own
and many others' experience in favor of their efficacy in
some cases.
Medicated suppositories have long been used by the allo-
pathic profession, and an effort is being made by the manu-
facturers to inveigle the homoeopathic profession into their
use. We are sorry to say that we think more zeal than
wisdom is manifested by some physicians in advocating them.
Remedies may be more readily administered by the mouth
than the os uteri in most instances; and they are not likely
to cause as much injury given in proper attenuation by the
first named method. We feel that administering remedies
via the os uteri as a rule (which some would seem to desire
should become a general practice) is running gynæcology into
disrepute.
We do not say that good may not sometimes result from
their use. Allopaths have obtained good results from scari-
fications of the cervix uteri, and from leeching it. Must we
rush in and adopt such practice just when they are beginning
to learn better? We think not. Some uteri will not tolerate
the presence of any substance in the cervical canal without
being thrown into spasmodic contraction, causing the patient
great pain. The suppositories sometimes do this. This is
one objection to them; another is, their expense; and,
thirdly, they are unnecessary.
We feel it our duty to say this to the student, although
the experienced gynecologist will occasionally find a case of
714
EATON ON DISEASES OF WOMEN.
well dilated cervix where the local application of some rem-
edies like Glycerine, Hydrastis, Belladonna, or Iodine may be
41
FLEMMING & TALBOT
PHILADELPHIA.
10
FIG. NO. 66. FARADIC BATTERY.
-
tolerated, and in a few cases
may act beneficially in this
form. They are not so very
easy of introduction, as has
been stated by interested
parties. A well dilated os
uteri is necessary in the ap-
plication of any intra-uter-
ine medication. With a
soft, long-handled brush we
may apply these remedies
to the cervix conveniently;
and in most cases this is
the preferable plan in the
treatment of hypertrophy
or sub-involution. In some

cases of hypertrophy and sub-involution there is absence of
tonicity and sensibility, a want of feeling instead of tender-
ness. In these cases I use electricity as a stimulant, using
a gentle current with the uterine electrode in the uterus, and
the other electrode to the spine, gently increasing the cur-
rent till it is felt by the patient in some small degree, then
allowing it to pass steadily for about three minutes, using this
treatment once in three days; sometimes for two weeks,

G.TIEMANN-CO.
FIG. 67.-INTRA-UTERINE ELECTRODE.
omitting the electricity and applying Tr. Iodine Comp. to the
cervix with a soft brush, and introducing it into the cervical
canal with a probe covered with cotton and saturated with
the wash.
SUB-INVOLUTION OF THE UTERUS.
715
MAN'F'D BY MAX. WOCHER & SON CIN.O.
FIG. NO. 68.-PALMER'S UTERINE APPLICATORS.
Professor Palmer, of
this city, has invented a
set of uterine applicators
which makes the applica-
tion of remedies to the
intra-uterine surface quite
easy and thorough. (See
Fig. No. 68.) The right
hand figure represents a
tube with a handle, which
is to be introduced into
the cervical canal after
having placed in it the
plug printed beside it.
This rounds the extremity
of the tube and renders its
introduction easy, when
the canal is well dilated.
withdraw the

We
now
plug and introduce the
sponge saturated with the
medicine by means of the
long sponge holder, as seen
in the next figure; or we
may wrap the probe (figure
to the left hand) with raw
cotton, saturate it with the
medicine, and apply to
the intra-uterine surface
through the tube first men-
tioned. Without the tube
we may apply the medi-
cine thoroughly to the cer-
vix, and with it, to the in-
terior of the fundus.
716
EATON ON DISEASES OF WOMEN.
CHAPTER LXIV.
HÆMATOCELE, PELVIC HEMATOMA, THROMBUS, ETC.
Ir is now only about twenty years since hæmatocele has
been at all well understood by the profession; although as
early as 1843, M. Velpeau had the honor to diagnose the
disease during life, without making an explorative incision.
Hæmatocele, sometimes denominated thrombus, pelvic
hæmatoma, peri-uterine hæmatocele, etc., consists of a blood
tumor or effusion of blood into the peritoneum, or into the
cellular tissue of the pelvis. Its location is usually posterior
to the vagina; and, I think, most frequently, in Douglas' cul-
de-sac.
SOURCE OF THE HEMORRHAGE.-Bernutz and Trousseau sup-
posed the hemorrhage to be from retained menstruation,
flowing back through the Fallopian tubes into the peritoneum;
but this view is untenable, as there is suppression in but few
cases of hæmatocele, and it is now well understood that the
contents of the distended uterus will not pass through the
Fallopian tube readily. The hemorrhage may come from the
bulb of the ovary or from the rupture of the Graafian follicle
in some cases, which, though usually producing no hemorrhage,
may do so from the rupture of a small blood vessel; in this
case, the blood would be contained in the peritonæum. If it
arise from the pampiniform flexus, between the folds of the
broad ligament, or from about the vaginal junction with the
uterus, the blood will be contained in the cellular tissue.
Etiology.
Hæmatocele is most common in women who are exhausted
from frequent gestations, and those who labor, the rich
HEMATOCELE.
717
being seldom affected. The unmarried and barren are also
seldom affected. I have, however, seen one case in a lady
forty-two years of age, who had always been barren, though
married over twenty years. It occurs generally during the
woman's greatest genital activity.
The laceration of a sort of false membrane formed over
the ovary, as a result of peri-metritis at the time of the rup-
ture of a Graafian follicle, may cause this hemorrhage. Rup-
ture of the distended ovary is another cause which may
produce hæmatocele. Generally occurring at the period, or
just following a normal menstruation, it is apparently con-
nected with this function; usually, in my own experience,
caused by straining or hard work while menstruating, when
the pelvic blood vessels are distended with blood. It is not
strange that some severe exertion might lacerate some of
them in this condition. Excessive coitus has appeared to
cause hæmatocele in some cases. The hyperæmic condition
of the system may predispose to the disease, as well as a
condition of extreme impoverishment of the blood, and the
condition called purpura hæmorragica.
Symptoms.
The occurrence of an effusion of blood into the peritonæum,
or into the cellular tissue of the pelvis, produces the faint-
ness which any other great loss of blood would induce, pre-
ceded in some instances by severe, lancinating pain in the
pelvis. This pain in the pelvis is more or less constant for
some days. There is often vomiting and considerable fever.
The face exhibits a shrunken, cadaverous appearance; the ex-
tremities are cold; pulse rapid, weak, and sometimes almost
imperceptible. There is usually constipation, but the consti-
pation is sometimes accompanied with a distressing tenesmus.
On making a digital examination per vaginam, we detect
the pelvis filled almost entirely, or in part, with a smooth
mass, generally situated in the posterior part, and between
718
ΕΑΤΟΝ ΟN DISEASES OF WOMEN.
the vagina and rectum. This is called a retro-uterine, or
recto-vaginal, hæmatocele when the tumor consists of blood.
Sometimes we find the mass seems to surround the vagina,
and it is then called peri uterine hæmatocele. In case the
tumor occupies the entire posterior part of the pelvis, as
represented in Plate XXVIII, it shows that the blood is
infiltrated into the cellular tissue.
In case the effusion is into the peritoneum, and the
blood gravitates into Douglas' cul-de-sac, the tumor is found
higher in the posterior part of the pelvis, behind the cervix
uteri, and feels circumscribed. Sometimes we may feel fluc-
tuation, and sometimes we can not, depending upon the
amount and condition of the effusion.
When the effusion is into the peritoneal cavity it may,
after filling the lower portion of the abdomen, extend up-
wards, even reaching to the umbilicus.
It will be observed by this description so far, that hæmat-
ocele is only a symptom of an effusion of blood, and that
the cause of the effusion, and the exact locality of the point
from which it comes, is often very obscure. Hence, we name
the condition as hæmatocele, though not a disease in itself
per se.
As time passes the symptoms in most cases moder-
ate, although there may be more tenderness in the vagina for
a time, and a considerable febrile condition. In other in-
stances we have symptoms of acute inflammation in the
pelvis, resulting in the formation of a pelvic abscess some-
what similar to that occurring in cellulitis. Extreme sensi-
tiveness of the stomach is one of the most constant symptoms
of these cases. There is also often much cystic irritation,
the urine either being passed with difficulty or frequently
with much pain. Sometimes the use of the catheter is de-
manded in these cases.
Prof. Byford* gives to this accidental hemorrhage the
term Metatithmenia, signifying misplaced or vicarious men-
* Byford on "Diseases of Women," p. 101.
PLATE XXVIII.

RECTO-VAGINAL, OR PELVIC HEMATOCELE, WITH ELEVATION
OF THE UTERUS.
PELVIC HÆMATOCELE.
719
struation. But as this term would indicate a suppression of
normal menstruation it is not applicable, as there is suppression
of the catamenia in very few cases of hæmatocele.
Hæmatocele may occur several times in the same patient.
Dr. Byford has seen over twenty attacks in one patient dur-
ing a period of seven years. Sometimes women suffer from
slight hemorrhages of this character at nearly every menstrual
period; and the presence of this effused blood in the vicinity
of the ovary gives rise to a burning pain, hot flashes, and
general sympathetic disturbance of the entire system, con-
sisting of backache, headache, general nervousness, palpita-
tion, nausea, etc., etc. In some of these cases it is hard to
differentiate between them and ovaritis, or mild peri-metritis.
Still, the significant symptom will be found to be the occur-
rence of fainting, which does not ordinarily take place in the
other disease just mentioned; and the attack is usually after
the menstrual flow has ceased, corresponding to the time of
the rupture of the Graafian vesicle, which occurs soon after
the menstrual flow.
Differential Diagnosis.
The differential diagnosis between pelvic hæmatocele and
cellulitis, pelvic abscess, retro-version of the uterus, ovarian
cystoma, etc., deserves some attention. The onset of the attack
with faintings occurring without much, if any, premonition, is
very characteristic of hæmatocele (but might be a symptom
of cardiac disease). The attack of cellulitis occurs with
chilliness, soon followed with heat and fever, accompanied
with the similar pain as in hæmatocele. In hæmatocele the
face is blanched and cadaverous, in cellulitis it is flushed and
plump; pressure upon the tumor of hæmatocele through the
vaginal walls causes little pain if examined soon after the
attack before cellulitis complicates the case.
In cases which are complicated with cellulitis and the
formation of an abscess, we have to depend largely upon the
720
EATON ON DISEASES OF WOMEN.
history of the case for differential points. The slow growth
of ovarian cystoma and its height in the pelvis, with its devel-
opment in the abdomen, will distinguish it from hæmatocele,
being free from the symptoms of faintings and severe pain.
If retro-flexion of the uterus is suspected, we had better
make an effort to rectify the misplacement; if menstruation
has been recent we may at once pass the sound, and discover
in a few moments the nature of the case. I was recently
called to see the wife of a physician who had had the counsel
of an eminent surgeon a few days before, who had (without
the aid of the sound) diagnosed retro-version. I immediately
passed the sound, and found the uterus normal in position,
and diagnosed a recto-vaginal hæmatocele (from the history
of the case and vaginal examination), which was undergoing
suppurative inflammatory action. My diagnosis was con-
firmed in a few days by the discharge of the abscess into the
rectum, followed by relief and health. The violent efforts
which this consulting surgeon made to replace this tender
hæmatocele with his fingers was injurious and painful to the
patient, and disgraceful to himself.
In pelvic cellulitis the tumor develops more gradually, is
more tender on pressure, is generally more diffused, though
not always. There is some heat in the vagina in cellulitis,
and very little in a recent hæmatocele.
Extra-uterine pregnancy, either ovarian, tubal, or abdom-
inal, may slightly simulate hæmatocele. The tubal and ova-
rian pregnancy may produce hæmatocele from the laceration
likely to occur about the third month, and the hæmatocele in
these cases may contain a foetus. This is most likely to be dis-
covered at the autopsy which we will have an opportunity to
make soon after the laceration occurs.
Prognosis.
Generally, the prognosis is favorable. About ninety per
We have, however, to fear
cent of these cases recover.
PELVIC HÆMATOCELE.
721
adhesions, perforations, exhaustion; thickening of the walls
of the uterus, rectum, bladder, or vagina, or severe inflamma-
tion. Sometimes months are required for recovery, while in
others the cure is effected in two or three weeks.
Our prognosis must be modified by the amount of inflam-
mation, exhaustion, diarrhoea, etc., which is present, diarrhoea
sometimes supervening upon the condition of constipation
usually first present.
Treatment.
If called to a case of hæmatocele in its first stage, while
the hemorrhage is going on, we should at once give Ipecac
or Aconite, followed in a few hours with Secale, and apply
cold to the pelvis. But it is not often we are called till the
hemorrhage has ceased, the tumor of large dimensions in the
pelvis, and the patient suffering from exhaustion, at which
time we should select remedies best suited to the condition,
such as China, Ars., Chi. ars., Nux, Ignatia, Rhus, etc. Beef
tea, wine-whey, egg-nog, and the like, should be given, and
warm vaginal and rectal enemata should be used. Warmth
should be industriously applied to the extremities and about
the pelvis. Perfect rest and quiet must be enjoined and
secured, with good air and the best of nursing.
Evacuating the effused blood is sometimes demanded by
the urgency of the symptoms of pain and enormous disten-
sion, in which case it should be done with a long curved
trocar, and liquid Persulphate of Iron should be diluted four
times with water and injected if the blood seems to be still
flowing from the ruptured vessels. In the great majority of
cases there is no call for surgical interference; but allowing
nature to have her way is usually the best practice, aided by
remedies, diet, and warm vaginal and rectal injections; often
the effusion is absorbed without producing serious injury:
whereas, too much interference might cause an increase of
inflammation, which might result fatally. When suppuration
takes place (which is characterized by rigors and a feeling
46
722
EATON ON DISEASES OF WOMEN.
of fluctuation supervening on hardness of the tumor), it is
sometimes advisable to evacuate the pus by a free incision
of the bistoury through the vaginal wall, the abscess being
for some reason more liable to point into the rectum and
leave an internal fistula, or cause pyæmia through the
absorption of pus into the general circulation.
The treatment of an abscess caused by hæmatocele does
not differ from one caused by cellulitis. The hardness caused
by coagulated blood, called Thrombus, is more likely to result
in abscess than where the effused blood does not coagulate,
and remains fluid.
•
PLATE XXIX.

HERMAPHRODITE, OR NONENTITY.
UTERUS ABSENT.
VAGINA SMALL. CLITORIS ENLARGED.
HYPERTROPHY OF THE CLITORIS.
723
CHAPTER LXV.
ELEPHANTIASIS OR HYPERTROPHY OF THE CLITORIS, LABIA
MAJORA, AND LABIA MINORA, HERMAPHRODITES, NONEN-
TITIES, TUMORS OF THE LABIA, ETC.
ELEPHANTIASIS or hypertrophy of the clitoris is quite rare.
(See Plate No. XXIX.) I have seen but three cases in an
experience in hospital and private practice of over twenty
years. It occurs as a congenital deformity, and as an ac-
quired affection from diseased action.
Occurring as a congenital affection, in connection with
partial atresia of the vagina or abnormal development of the
uterus, ovaries or vagina, has given rise to the term hermaph-
rodite, signifying the union of both sexual organs in one
person, as in these cases the labia are ordinarily developed.
The term nonentity, we think, would be more appropriate. as
they certainly can not be considered either male or female.
The enlarged clitoris in these cases is capable of little or
no erection, and can not be used as a copulative organ to any
considerable extent. A sort of sexual excitement with
slight erection is sometimes possible, but there is no semen
secreted or ejaculated.
On the other hand, we can not consider such persons as
females, as the absence of the vagina, uterus or ovaries, very
common in these cases, makes them incapable of copulation,
or conception, though in case of enlargement of the clitoris
from disease, the vagina and uterine organs may be perfect.
and copulation and conception be possible. Such a person
would, of course, be a female deformed, and not a nonentity
or hermaphrodite. In one case which I saw the sexual in-
stinct seemed entirely wanting. In the two other cases it
་
724
EATON ON DISEASES OF WOMEN,
existed somewhat in excess. These were cases of hyper-
trophy from inflammatory action, one in a lady aged about
twenty-three, the other over fifty. Neither suffered much
inconvenience from the enlargement, except a slight irritation
and soreness at times.
Nymphomania is said to be caused by, and be the cause
of, enlargement of the clitoris, but I have not observed it.
Dr. C. D. Palmer, of Cincinnati, reported two cases to the
Cincinnati Medical Society, at the October meeting, 1879.
They were two sisters, in whom menstruation had been en-
tirely absent, though they had attained to the ages of twenty
and twenty-two years respectively. This absence of menstru-
ation and a failure to effect its establishment by remedies, led
to a physical examination, which revealed the vagina in each,
short and small, the clitoris large and long, resembling greatly
the penis. No uterus could be found in either. The parents
of these persons were first cousins, and both died of phthisis.
A. S. Taylor, in his work on Medical Jurisprudence, reports
a case of Prof. Mayer's, of Bonn, which is the nearest approach
to a true hermaphrodite which I can find on record. The
autopsy revealed on the right side a withered testicle with
a prostate gland and penis; while on the left there was the
uterus, ovary, Fallopian tube, and vagina.
Around these cases clusters considerable interest, not
only on account of their abnormal development, but on account
of their legal rights as individuals,-whether they may vote
or not, as being a ground for divorce, and regarding the
paternity and maternity of offspring claimed to have been
born of such people.
Hypertrophy of the labia minora, or nymphe, is more com-
mon. It may also occur as a congenital or acquired deform-
ity. Sometimes only one side is enlarged, and sometimes
both. I have thought that these women were more than
ordinarily passionate, and their own testimony corroborates
the correctness of the statement. The labia minora extend,
+
PLATE XXX.

#
WIN
HYPERTROPHY OF THE LABIA MINORA.
HYPERTROPHY OF THE LABIA.
725
in many of these cases, much beyond the labia majora (see
Plate XXX), and as they are very elastic they may be drawn
down six inches or more. These cases are much more fre-
quent than enlargement of the clitoris. They seem ordinarily
to consist of a pure hypertrophy of tissue. Though perhaps
not thicker than normal, they are enormously enlarged in cir-
cumference. Their friction against each other in walking seems
to excite sexual passion, and give rise in some cases to nymph-
omania. Normally in young girls the labia minora are larger
proportionately to the labia majora than in womanhood; but
this condition in the young girl is not to be considered a dis-
eased or deformed condition, as they shrink when the girl be-
comes older, and the labia majora becomes more developed.
Hypertrophy of the labia majora is said to be more com-
mon in the East-i. e., Eastern Hemisphere-than with us.
Here it is seldom met with, except as the result of the
development of tumors in the parts (which may be solid or
cystic). These solid tumors may be fibrous or fatty. Usu-
ally but one side is affected in the same person.
Diagnosis.
The diagnosis of either of these conditions is to be made
by physical examination. There is no opportunity to be
mistaken in regard to their nature. The question of greatest
interest is regarding their treatment.
Treatment.
The enlargement of the clitoris usually demands no treat-
ment. It has been amputated, but the operation is not rec-
ommended.
The enlargement of the nymphæ is sometimes such a
source of irritation and annoyance as to demand removal.
This is easily and safely accomplished with scissors, after
placing the patient under the influence of an anaesthetic.
(See Fig. 69.) The hemorrhage is usually not severe, and
726
EATON ON DISEASES OF WOMEN.
women.
may be arrested by applications of cold cloths. If a blood-
vessel is cut of any size, it may be twisted with forceps,
or ligated. The Ferri persulph. should, however, be at hand
in case of troublesome oozing of blood. The entire nymphæ

#G TIEMANNSC
FIG. No. 69.-EMMET's CURVED SCISSORS.
8
need not be removed, as the excision of the excess of devel-
opment is all which is required.
In hypertrophy of the labia majora nothing need be done.
unless the enlargement is so excessive as to obstruct the
limbs in walking, in which case the enlargement is usually
due to the growth of a tumor in its substance, or pudendal
hæmatocele. This may be removed by incising the mucous
membrane, and enucleating the tumor, if possible. This can
readily be accomplished in case the tumor is fibrous, hard,
encysted, or fatty; but when cystic it is sometimes impossi-
ble, in which case we may evacuate the cyst, and attempt
to peel off the cystic wall with the fingers, or the handle of
the scalpel, being careful about incising the deep tissues of
the labia. If we can not detach the cyst wall we may mop
it out with T. of Iodine, and apply compression.
After the removal of the tumor in the labia the enlarge-
ment shortly disappears by absorption. Small, hard, or en-
cysted tumors, or thrombi in the labia, may exist for many
years without causing any inconvenience, and, hence, require
no treatment.
Thrombi in the labia, or pudendal hæmatocele, may cause
an abscess, in which case it is to be evacuated, and treated
as directed under the head of "Abscess of the Labia."
PLATE XXXI.

---
HYPERTROPHY OF THE LABIA MAJORA.
EXTIRPATION OF THE UTERUS.
727
CHAPTER LXVI.
EXTIRPATION OF THE UTERUS—ABLATION OF THE UTERUS,
HYSTEROTOMY, ETC.
EXTIRPATION of the uterus has been, and is still, consid-
ered one of the most formidable operations in surgery.
There is little experience to guide our opinion of its
advisability. Pean, of Paris,* gives the results of forty-four
cases, by different operators, of partial or complete ablation
of the uterus, by gastrotomy. Fourteen recovered, and
thirty died. Dr. Péan does not appear to mean that the
entire uterus was extirpated, but that the supra-vaginal por-
tion was, as he says: " 'Amputation of the supra-vaginal
portion of the uterus is not an operation of much graver
character than extirpation of ovarian cysts complicated by
adhesions.'
""
The operation can not be advisable in cases of cancer, as
the entire system is so much affected as to make the appear-
ance of the disease in other parts only a question of time.
Large intra-mural uterine fibroids (either subserous or sub-
mucous) give rise to the advisability of the operation for the
extirpation of the uterus by means of gastrotomy.
T. Wood, M. D., of Cincinnati, stands to day the most
successful operator in extirpation of the uterus (so far as I
can learn) who has ever lived. He reports eight cases of
extirpation of the uterus, with but three deaths. His report.
was published in the Cincinnati Lancet and Clinic, and repub-
lished in the Obstetric Gazette, March, 1879. I take pleasure
in making a quotation of his report, and presenting cuts of
Hysterotomie," by J. Péan and L. Urdy, Paris, 1873.
†Thomas's "Diseases of Women," p. 519.
728
EATON ON DISEASES OF WOMEN.
the tumor and uterus removed from case No. 8 (for which
I am under obligation to the publishers of the Lancet and
Clinic).
"I wish to distinctly impress on your mind the fact,
that in every operation given in this report, the body of the
uterus was removed-amputated through the neck as close
to the vaginal connection as possible without opening the
vaginal cavity. The removal of fibroids is secondary, and
not the prime object to which I wish to claim your atten-
tion. I make this report to give evidence that it may be
construed by the profession as favorable or unfavorable to
hysterotomy. The question whether a woman can bear
without a fatal result the complete ablation of her uterus
and thereafter enjoy life and health, is the one that an en-
lightened profession now desires to have answered either in
the affirmative or negative. Then if in the affirmative every
individual operator desires to have light from the experience
of others—to determine whether any special case that may
come under his care can possibly survive so formidable a
procedure.
"Tables of statistics are valuable guides to the formation
of a correct judgment, but at the present time, though there
are several extant, they are too loosely put together or in-
efficient to establish clearly the legitimacy of the operation.
So we find that wherever the operation is presented to any
of our learned bodies for discussion a great diversity of
opinion is expressed, and the preponderance is adverse to its
performance.
"If we examine the tables of Dr. Samuel Pozzi, of Paris,
published in 1875, we find tabulated all of the reported opera-
tions up to that time; but if we examine closely the cases
here tabulated, we discover that the largest number were
only gastrotomy with partial operations on the uterus, and
in many that organ was not touched by the knife, as when
pedunculated, sub-peritoneal, or fibro-cystic tumors were
EXTIRPATION OF THE UTERUS.
729
removed, and should not be set down either for or against
hysterotomy.
"Of the 119 cases tabulated by Dr. Pozzi the smallest
number were complete operations, the balance were partial as
applied to the uterine body. Further analysis shows that
the partial operations were more fatal than the complete.
"This view of Dr. Pozzi's tables confirms the opinion
that has long since been forced on me by sad experience,
that partial operations on the uterus when reached by gas-
trotomy are more fatal than its entire ablation. I could
give many cases that have occurred in my own practice that
fully sustain this opinion. If an ovarian tumor or cyst im-
pinges on the uterus and becomes closely adherent to it so as
to require a dissection to separate them, it will very much
enhance the danger of the operation, and will most likely
prove fatal.
"I might speculate much in explanation of this fact, but
will dismiss the subject with the remark that the uterus is
much more tolerant of violence done to the interior mucous
surface than to injury through that of the peritoneal.
,
"CASE FIRST.-Mary W widow; was admitted to
the Commercial Hospital, Oct. 1st, 1866. Her abdomen was
enlarged to about the size of a six months' pregnancy. En-
largement hard and smooth, occupying the medium posi-
tion-is only slightly movable. She has a constant leucor-
rhoeal discharge from the vagina-frequent attacks of pain in
the abdomen-painful micturition-and great difficulty in
forcing a passage from the bowels. The tumor was first
noticed by her about three years before her admission to the
house.
"The diagnosis was, fibrous tumor of the uterus, and its
removal by abdominal section was decided on. On the 31st
of October I operated in the presence of a large class of
students and medical gentlemen of the city. The early
steps of the operation were the same as in ovariotomy,
730
EATON ON DISEASES OF WOMEN.
and are so familiar to you all that I need not repeat them
here.
"The patient was, of course, anesthetized, chloroform
being the agent used. The uterus containing the tumor was
raised from its position and supported by assistants-while
ligatures were applied to the ovarian vessels on each side,
and lateral attachments were dissected from the uterus down
to its connection with the vagina. Here a needle was passed
through the neck of the uterus armed with a strong, double
silk ligature. The ligatures being tied, the neck was cut off
and the tumor removed. The ends of the ligatures were
brought out together at the lower end of the abdominal
wound, and the subsequent dressing was the same as in
ovariotomy.
"The loss of blood was very small, and the prostration
of the patient was not greater than in ovariotomy. The
ligatures separated, and were taken away on the twentieth
day after the operation. The suppuration ceased, and the
wound was closed in about thirty days after the operation.
and the patient was up and about the house. She soon after
getting up began to show symptoms of phthisis, and in about
three months died of tubercles in the lungs.
"CASE SECOND.-Mrs. B, of Newport, Ky., presented
herself with two well defined tumors occupying the left and
right iliac regions, extending as high as the umbilicus, and
one developing in the pelvis occupying the fossa of Douglas,
and pressing severely on the rectum, bladder and vagina,
and forcing the os uteri above the pubis so far that a sound
could not be made to enter it. She suffered much from re-
tention of urine and feces. On the 17th of June, 1872, I
operated in the same manner as in case first, but found much
difficulty in dislodging from the pelvis the lower tumor,
merely from its size and impaction, but there were no peri-
toneal adhesions.
"The arteries and pedicle were secured as in the first
EXTIRPATION OF THE UTERUS.
731
case, and the same dressings applied. The progress of re-
covery was very favorable up to the twenty-seventh day.
She had been up and walking about the room, (though the
main ligature had not parted) when she was suddenly taken
with severe abdominal pain, soon sank in collapse, and died
the same day. A post-mortem revealed foecal matter diffused
between the convolutions of the bowels. A small opening
was found in the ilium, where it had rested near the uterine
stump; from this the contents escaped. I had used very
strong, thick, hard-twisted ligature for the pedicle, and it had
irritated the point of the bowels that pressed against it,
ulcerating through the coats. Since then I have used none
but the softest, slack twisted silk.
"CASE THIRD. Mrs. C of this city had a trilobed
tumor, almost precisely the same size and form of the one
taken from Mrs. Burns. I operated on the 29th of October,
1872. She recovered perfectly and is now living.
“CASE FOURTH.—Mrs. C—, of St. Louis, had a single
fibroid of the uterus, that, when removed, weighed 5
pounds.
"She suffered with paroxysms of severe pain in the ab-
domen, and cerebral and nervous disturbance. She would
often fall as with epilepsy, and sometimes remain for two or
three days completely unconscious. I operated on her on
the 14th of April, 1874. The uterine sinuses and ovarian
veins were much enlarged and distended with very dark,
venous blood, and a large quantity of blood was lost in
operating.
"Since the removal of the disease the peculiar nervous
disturbance has entirely disappeared, and she enjoys com-
paratively good health. She is still living, and visited this
city a few weeks since.
"CASE SIXTH.-Mrs. B
?
of St. Louis. In this case
there was a fibroid within the uterus that carried it some
distance above the umbilicus.
The tumor had existed about
732
EATON ON DISEASES OF WOMEN.
four years, and her general health was much broken. Loss
of appetite, vomiting after eating, and considerable emacia-
tion; her complexion was bad, presenting a peculiar, waxy ex-
sanguinous appearance. I operated on the 6th October, 1874.
The operation was performed on Tuesday, and she died on
the Friday following of peritonitis. I had to remove an ovary.
"CASE SIXTH.-Mrs. F, of Jefferson County, Ohio.
There were two large fibroids in this case-one developed
in the pelvis and the other above the pubis, reaching as high
as the umbilicus.
"The bladder was attached to the upper tumor in front,
and had to be dissected from it for a distance of five inches.
The broad ligaments were thickened and drawn tightly across
the uterus between the tumors with strong adhesions, re-
quiring much dissection to free the lower tumor from its bed
in the pelvis. The operation was made on the 24th of
October, 1874. The patient recovered and is now living,
enjoying, I believe, good health.
"CASE SEVENTH.-Mrs. S—— of New Richmond, Ohio.
This was a trilobed tumor, one in the pelvis and two above
the pubis. One ovary had several small fibroids growing
upon it and had to be removed, and the neck of the uterus
was so much involved that I had to ligate the vagina, and
had to remove the entire uterus.
"The bladder was attached to the sulcus between the
two upper tumors, and was twisted round so as to be behind
them. The lower tumor was firmly adherent at many points,
and had to be dissected loose, and several arteries in those
adhesions had to be tied.
"I operated on the 9th of November, and did not see the
patient that day; but she reacted favorably, and seemed to
promise a good recovery until about Christmas, when a hem-
orrhage from the vagina made its appearance, continuing until
New Year's day, 1875, when she died, living fifty-three days
after the operation.
EXTIRPATION OF THE UTERUS.
733
"CASE EIGHTH.-Miss C., aged thirty-six years. Noticed
an enlargement of the abdomen about twelve years since.
Did not experience much inconvenience before the last two
years. Now suffered very much at her menstrual periods,
though she has always been regular and never troubled with
profuse menstruation. Uses Morphia largely. The tumor is

FIG. No. 70.-EXTIRPATED UTERUS.
solid, smooth, and even on its surface. Slightly movable,
and extends nearly to the ensiform cartilage. She is ema-
ciated, and bears a haggard, distressed countenance.
was operated on on the 20th of February, 1878.
She
The abdominal incision was extended about two inches
above the umbilicus before the tumor could be raised from its
position. Both ovaries were involved in the disease, and
were renioved with the uterus. Her recovery was slow, be-
ing retarded by the immoderate use of Morphia, which I
could not, for a time, prevent. She eventually left off the
Morphia, gained health and strength rapidly, and made a
good recovery. She now lives in this city in full enjoyment
734
EATON ON DISEASES OF WOMEN.
of perfect health, walks all around the city, goes to picnics,
and says she never felt better in her life.
"The cuts exhibit two views of the tumor from Case
8th, one anterior and one posterior.
"The termination of these eight cases, then, was as
follows:
Mrs. W
recovered.
Mrs. B
died.
Mrs. B-
died.
Mrs. F
recovered.
Mrs. C
recovered.
Mrs. S
died.
Mrs. C-
recovered.
Miss C-
recovered.
,
Recoveries, 5; deaths, 3.

་་་
FIG. NO. 71.-EXTIRPATED UTERUS.
6
"Dr. Gilman Kimball, of Lowell, Massachusetts, in his
report on 'Extirpation of the Uterus' (see Transactions of
the American Medical Association,' Vol. XXVIII, page 330),
in enumerating the dangers and objections to the opera-
tion, says:
"Another difficulty oftentimes met with in this opera-
tion is adhesions, more or less extensive. If these implicate
EXTIRPATION OF THE UTERUS.
735
the bladder, as they frequently do, they of course add im-
mensely to the embarrassment as well as the dangers of
the operation.'
"Two of my cases had this very complication, requiring
extensive dissection to separate the bladder from the tumor.
One of them recovered, and the other survived the operation
fifty-three days, and had no urinary inconvenience resulting
from the dissection. Again, Dr. Kimball says (on the same
page): There is still another class of uterine fibroids where
surgical interference would be still more objectionable than in
the cases just referred to. I allude to instances where the dis-
ease has developed in a downward direction and become fixed,
as it were, in the lower portion of the pelvic cavity.
In such a state of things extirpation would scarcely be
thought of except by the most reckless operator.'
6
"And yet four of my cases had just such a state of
things,' and it was because that state of things' existed and
rendered the lives of my patients an intolerable burden that
I was called on for relief, and for which I operated. Two
of the four recovered, and are now living; two died, one
twenty-seven days and the other fifty-three days after the
operation."
We notice that in the one case where the vagina was
ligated and the cervix was removed with the body of the
uterus the patient died.
Extirpation of the fundus uteri would appear a more
appropriate term than extirpation of the uterus, or ablation
of the uterus, as used by Professor Péan in such cases.
Professors Wood and Péan have demonstrated the prac-
ticability of removing the fundus uteri, together with a
fibrous tumor of the walls of the uterus, Dr. Wood giving
us a report of sixty-two and a half per cent of recoveries
from the operation.
1
736
EATON ON DISEASES OF WOMEN.
CHAPTER LXVII.
HYSTERALGIA — NEURALGIA UTERI-
NEURALGIA UTERI — IRRITABLE UTERUS —
ASCITES IN WOMEN.
THE terms hysteralgia, neuralgia uteri, formerly termed
irritable uterus, etc., indicate a neuralgic condition of the
organ, which is sometimes very severe, although no organic
disease of the parts can be discovered. It is to be diagnosed
by the severe pain of a neuralgic character in the uterus, and
the occurrence in some other parts of the body of neuralgic
pain, and from the fact that physical examination reveals no
lesion or displacement of the uterus.
It is notable that of late years irritable uterus, hyster-
algia, etc., are seldom mentioned, while formerly they were
diagnosed almost as frequently as some physicians now diag-
nose liver complaint (whenever the disease seems obscure).
This is possibly due to the fact that uterine diseases of late
years have been better understood than they were formerly.
It may have been the case that diseases of the uterus, which
are now readily diagnosed and treated, were formerly de-
nominated irritable uterus, or hysteralgia, from the fact of
pain being suffered in the part, and from the fact that, the
physician being unable to discover any abnormal condition
of the substance or position of the uterus, no other name
seemed appropriate. The uterus is liable to be affected with
neuralgia as well as the stomach or other parts of the body,
and, consequently, the physician should recognize the disease
when present, and treat it properly, though we know from
experience that it is not a very common affection.
Neuralgic dysmenorrhoea is of occasional occurrence, but
is not one-tenth as frequent as is generally supposed.
HYSTERALGIA.
737
i
Neuralgic dysmenorrhoea we do not discuss as hysteralgia,
purely for the reason that its consideration comes as well
under the head of dysmenorrhoea. It is, however, strictly
one form of hysteralgia.
Etiology.
The causes of hysteralgia, or neuralgia of the uterus, are,
first, cold affecting especially the nerves of the system, and
manifesting the most severe symptoms at the point of irrita-
tion, or in a part connected with the affected portion through
the ganglionic nervous system; atmospheric influences, severe
mental excitement, imperfect digestion, torpidity of the nor-
mal secretions, etc., etc.
Symptoms and Diagnosis.
Pain in the uterus is the important symptom. The pain
is of a darting, cutting character, and is changeable, affecting,
perhaps, the uterus one hour, and the face, back, or thigh
the next. Changing from place to place is, perhaps, the
particular characteristic of the pain. Sometimes it is period-
ical, occurring at the same hour each day, like an ague, or
twice in twenty-four hours in some cases. The paroxysms
are severe, but when they subside they leave the patient
feeling comfortable and easy. Dysmenorrhoeal pains are
intermittent, but the intervals are short, often not more than
five minutes. Examination of the uterus shows the organ
to be in proper position; and when examined between the
attacks of pain the examination gives no discomfort. There
is a small class of cases where the uterus is supersensitive
to the touch, although the sensation is a titillation, and not
a pain, where excessive sexual passion is present, and where
the term irritable uterus seems appropriate. In these latter
cases barrenness is the rule; and when conception does occur
the uterus soon contracts, and expels its contents, owing to
its excessive irritability. I refer now to cases where there
47
738
EATON ON DISEASES OF WOMEN.
is no leucorrhoea, and where previous to the occurrence of
pregnancy the uterine sound had been introduced, without
causing any pain, in order to discover if stenosis was the
cause of the barrenness.
As we become more familiar with the diseases and con-
ditions of the uterine organs we may discover that all of
these painful or supersensitive conditions have a cause aside
from nerve irritation. But at present we imagine that the
nerve tissue itself is alone affected in some cases of pain in
the uterus, giving rise to the propriety of using the terms
hysteralgia, neuralgia of the uterus, and irritable uterus.
In diagnosis it is necessary that we do so by exclusion
in part―i. e., by determining that this or that disease is not
present, which might cause pain if it existed. These patients
are usually fretful, moody, irritable, and disagreeable gener-
ally. They frequently manifest hysterical symptoms, mag-
nify every thing they speak about, whether good or bad.
They are active, but soon tire; are exceedingly lively at
times, and again as dispirited as possible.
Treatment.
This complaint has baffled the best endeavors of many
skillful men, and must in some cases continue to be an an-
noyance, because we can not always use all the treatment
we judge advisable, on account of the nervousness of the
patient. As to remedies, they are usually among the follow-
ing: Ars. alb., China, Hyosc., Acon., Nux, Ignatia, Camph.,
Kali brom., Bell., etc.
The diet should be strictly low and plain; stimulants are
to be avoided. Placing the patient under the influence of
an anaesthetic, and dilating the cervical canal with a dilator
partially, and then inserting a sponge tent for a few hours,
is sometimes a prompt cure. This overcomes the supersensi-
tive condition of the uterus, the same as dilatation of the vag-
ina relieves vaginismus.
ASCITES IN WOMEN.
739
"
NEUROMATA OF THE VULVA.
Neuromata of the vulva signifies the existence of small.
sensitive points around the margin of the vaginal orifice.
They are of two kinds: The first, and most common, consisting
of the remains of the hymen, and the other, true neuromata.
Treatment.
Complete extirpation is the treatment.
Seize the sensi-
tive point with the forceps, and lifting it up snip it off at
once with scissors; apply styptics if necessary, and anoint
with Vaseline till healed.
ASCITES IN WOMEN, TAPPING, ABDOMINAL DROPSY, ETC.
There
Tapping the peritoneal cavity in cases of ascites in women
is somewhat different from the same operation in men.
is also more difficulty in diagnosing ascites in the female
than the male, owing to the uterine and ovarian diseases and
enlargements which may simulate it.
Etiology and Pathology.
The causes of abdominal dropsy or ascites in the female
are similar to those in the male, with the additional irritation
liable to be communicated to the peritonæum from uterine
disease, especially inflammation.
Ascites must be preceded by some amount of peritoneal
inflammation. It may be of so mild a character as to escape.
observation by the careless or very busy practitioner, and the
pain experienced from it may not be very severe, and still
dropsy of the abdomen may result. Abdominal dropsy or
ascites consists of an effusion of serous fluid into the peri-
toneal cavity. The fluid effused is essentially serum, variously
changed, owing to the peculiar conditions of the patient.
Peritonitis may exist primarily in the female as well as
in the male, or be a result of extension of inflammation from
740
EATON ON DISEASES OF WOMEN.
the bowels or other abdominal organs. Accompanying this
irritation there usually is a torpid condition of the glandular
system, especially the liver and kidneys, and very frequently
there is a want of normal action in the skin, causing an arrest
of both sensible and insensible perspiration. This causes an
excess of serum in the blood, and it is consequently the
more readily effused into the serous cavities.
Diagnosis.
In ascites the lower part of the abdomen is first noticed
to be enlarged. This is most observable when the patient is
in an erect position, either sitting or standing. While reclin-
ing the enlargement apparently disappears as the fluid gravi-
tates upwards while the patient reclines, and downwards so
as to distend the lower abdomen when erect. As the dis-
ease progresses the entire abdomen becomes so much dis-
tended as to be observable when the patient reclines. Per-
cussion with the extended palm communicates a sense of
fluctuation to the other hand placed upon the opposite side
of the abdomen. Place the patient on her side, and the
most dependent portion of the abdomen is found to be dull
on percussion, while there is resonance in the upper portion.
This is due to the intestines floating to the top, as they
usually contain a small amount of gas, which renders them
lighter than the effusion with which they are surrounded.
This is an important point to recollect in diagnosis.
Differential Diagnosis.
The diseases and conditions liable to be mistaken for
ascites are ovarian cystoma, cyst of the broad ligament,
uterine fibroma, fibro-cystic tumors of the ovary, intra-mural
fibroids of the uterus, and pregnancy (especially extra-uterine
pregnancy).
The student is referred to these subjects for a more com-
plete description of the points which differentiate ascites from
ASCITES IN WOMEN.
741
these ailments and conditions; but we will briefly note a few
here, in order to save time in reading the rather extended dis-
cussion of some of these diseases, which we have made in other
places in this work. It would not be a pleasant experience
to mistake either of these conditions for ascites, and proceed
to tap for its relief; hence a careful diagnosis is desirable.
Ovarian cystoma, fibro-cysts of the ovary, and cysts of
the broad ligament, develop from the iliac regions, and not
from the entire lower abdominal regions, where ascites is
first observed. In these diseases the enlargement is felt
when the patient reclines, circumscribed in extent, somewhat
fluctuating, but not freely so.
In the advanced stages of these diseases they more per-
fectly simulate ascites than in their smaller development.
Here the resonance upon percussion over the superior portion
of the abdomen, while the patient is reclining, with dullness
on the sides, indicates ascites, while in the case of the cystic
tumors the intestines are usually crowded to one side, and
there is dullness over the superior part of the abdomen. In
ascites the resonance is found in one place at one time, and
in another at perhaps the next examination, while in these
tumors the resonant portion is found at about the same place
at each examination.
The history of the development of the abdominal enlarge-
ment is also an aid in the diagnosis. In normal pregnancy
there should be an arrest of menstruation, and the enlarge-
ment is felt as a circumscribed tumor in the hypogastric
region. In the later months of abdominal pregnancy the
pulsations of the foetal heart settle the diagnosis, though
pregnancy may be complicated with ascites in some cases.
In extra-uterine pregnancy the tumor is felt circumscribed.
and can be felt more distinctly when the patient is reclining
upon the back, while in dropsy in its earlier stages the
enlargement disappears when reclining. In the later months
of extra-uterine, or abdominal, pregnancy the foetal heart's
742-
EATON ON DISEASES OF WOMEN.
throbs again help us in making the correct diagnosis. Uter-
ine fibroma, fibroids of the ovary, and enlargement of the
uterus from the development of intra-mural fibrous tumors,
are hard to the feel, compared to ascites; and as they have
no fluctuation they should readily be differentiated from
ascites.
Treatment.
We do not deem it within the scope of this department
to enter into the general treatment of dropsy. I will barely
say that among the remedies I have found useful are Ars. alb.,
Ars. iodid., Dig., China, Merc. cor., Merc. iod., Kali iod.,
Sang., Sulph., etc. Remedies should be our main reliance,
administered according to their most prominent homoeopathic
indications, or key-note symptoms, if you please.
As there are occasionally cases which baffle the physi-
cian's best endeavors at a cure, palliatives are sometimes de-
manded. I do not mean opiates or anodynes; but I mean
that the friends of the patient, the patient herself, as well
as our sympathy for suffering humanity, require we should
do something to prolong life, and make it as comfortable as
possible while it lasts. For this purpose tapping is expedient
and proper. We do not think it wise to recommend or use
it, as has been before intimated, till remedies have failed us,
and not then, until the patient suffers great inconvenience
from the excessive accumulation of fluid, manifested by diffi-
culty of motion and respiration, inability to lie down and
rest, derangement of digestion, etc., etc.
OPERATION. The instrument necessary for this operation
is a short trocar. The patient may sit in an easy chair,
slightly tipped backwards. The abdomen is now fully ex-
posed, and a piece of sheet, about two feet wide and the full
length of the sheet, should be passed around the body, after
being torn down at each end into three strips within about
eighteen inches of the center on each side. These should be
interlocked, and held by an assistant on either side.
TAPPING.
743
We now make a puncture into the abdominal cavity with
the trocar, about midway between the pubis and umbilicus,
in the median line. After we feel the instrument pass
through the tissues we should at once withdraw the stylet,
and then press the canula further in to avoid its slipping
out. If we did not first withdraw the stylet we might
wound the mesentery, or intestines. A large vessel, previ-
ously procured, receives the discharge. We now direct the
assistants to make traction upon the ends of the bandage
to compress the abdomen, in order to force out the liquid,
and also to prevent collapse. Previous to the insertion of
the trocar it is best to manipulate the bowels to some extent,
to cause the intestines to rise out of the way, and float on
the surface of the fluid, so that they be not wounded.
After the fluid is all drained off the canula is to be with-
drawn, and a piece of adhesive plaster placed over the punc-
ture. The bandage is now to be slightly relaxed, and pinned.
If left too loose, faintness would be likely to ensue; if too
tight, the remaining fluid might be forced out of the perito-
næal cavity between the abdominal muscles.
By making the puncture in the locality named there is
ordinarily little danger of wounding any blood-vessel. The
puncture should not be made very much to one side of the
median line, for fear of wounding the epigastric artery. If
we wound an artery internally, by mistake, the patient will
not long survive. If an artery (epigastric) is wounded ex-
ternally we may try compression by plugging the puncture.
If this does not suffice we must incise the puncture suffi-
ciently to expose the artery, and ligate it.
744
ΕΑΤΟΝ ΟΝ DISEASES OF WOMEN.
CHAPTER LXVIII
BATHING-VAGINAL WASHES-STOMATITIS MATERNA.
WATER is like fire-very good in moderate amount, but
capable of harm when used to excess. Fire may burn your
house, though it is very good in the furnace in moderate
amount. Water may drown us, or save our lives.
Bathing is a necessity for health; still, it is possible to
bathe too much, and at improper times; and while we may
well recommend bathing we have often to caution ladies.
against bathing too frequently. Much depends upon the
temperature of the bath and the health of the person. One
patient may require frequent bathing for a time, and still it
might prove injurious if continued too long. There being
such a diversity of opinion regarding bathing and the use
of the vaginal syringe, we think it prudent to say a word to
the student upon these subjects, not only as remedial, but
as hygienic, agents.
Bathing should be used for purposes of cleanliness, and
to keep open the pores of the skin, and allow of the free
escape of the insensible perspiration constantly going off from
the healthy body. For this purpose the water used in bath-
ing should be of a temperature usually termed tepid or warm,
ranging from 60° to 70°. The use of pure soap, a little am-
monia or soda in the water is not objectionable, if only used
occasionally.
Once a week in cool weather, and once a day in very
warm weather, a bath may be allowed the healthy person ;
but she should not, as a rule, remain in the bath more than
ten minutes. Remaining in the bath an hour or more, as is
the practice of some, debilitates the system, and can not be
well endured except by those adipose individuals who seem
BATHING.
745
to be benefited by a sort of stew.
will be injured by it.
The lean, nervous person
On rising from the bath the entire surface of the body
should be briskly rubbed with a dry, coarse towel. When
the temperature of the bath-room is up to 68° or 70° the cold
shower bath may be taken for a moment when first rising
from the tepid or warm bath, which should be followed by
brisk rubbing, as before mentioned. After drying the body
thoroughly warm clothing should be put on, and some brisk
exercise at once taken, to keep the blood in active circula-
tion. Sitting or riding in cool atmosphere must be avoided
after a bath.
TIME FOR BATHING. The bath may be taken before eating,
on first rising in the morning most advantageously, if active
exercise can very soon be taken. A patient should not bathe
just after a full dinner. It is unsafe to take a warm bath
before retiring (the very time many choose). There is much
greater danger of taking cold after a bath at this time than
when bathing in the morning, and at once engaging in active
exercise.
THE SPONGE BATH.-Sponging the body does not require as
much precaution as the full bath. Active exercise after it is
advisable, however. The cool sponge bath is most desirable,
except in those very feeble patients who would feel chilled
by it. This bath must be followed by brisk rubbing until a
full glow of the skin is secured.
MEDICATED BATHS may at times be of use, as this is but
another way of taking medicine into the system. They
should only be used of a kind suited to the needs of the
patient, and are on no account to be used indiscriminately.
In electrical baths, so called, I have little or no confidence. ·
THE HIP AND FOOT BATH.-The warm hip and foot bath
is sometimes of great service in attracting the circulation to
the parts, and is useful in cases of amenorrhoea, especially
when caused from sudden cold.
746
EATON ON DISEASES OF WOMEN.
VAGINAL WASHES.
As a rule we do not recommend vaginal washes. Many
times, when the full bath, or the hip bath, can not conve-
niently be taken, the use of the vaginal injection of warm
water is desirable for cleanliness of the parts; and they are
sometimes useful in allaying irritation of the mucous mem-
brane of the vagina, and exert a good effect upon the inte-
rior uterine surface through continuity of surface. In using
the vaginal syringe the central opening in the tube should
be soldered up tightly to prevent the accidental introduction
of the water into the uterine cavity. The tube should not
be introduced against the os uteri in any case. The fountain
syringe of Davidson, or one similar, is most desirable, because
it is simple, cheap, and efficient. The quantity of water used
should be large, so as to keep the stream running evenly for
some time, the patient sitting the while over the chamber,
and pumping the water in a steady stream.
Complicated instruments, for giving vaginal injections will
be found more beautiful in theory than useful in practice.
Cold vaginal injections are not only detrimental, they are
dangerous. This should be told patients with decided em-
phasis. They are a fruitful source of uterine disease. Espe-
cially should they never be used immediately after copu-
lation (as is done by some to prevent conception). The
parts are then in a condition of congestion, and the applica-
tion of sudden cold is likely to produce inflammation, and
produce a nervous shock to the whole system. Cold water
thrown by accident into the uterus, in such a case, may pro-
duce death in a short time; and should death not ensue, the
uterine colic induced is sufficiently severe to cause the
stoutest nerves to quail. The depression following is equally
alarming, coldness of hands and feet, the feeble pulse, the
blanched, cadaverous countenance, are sufficient, when once
seen, to produce an impression for life upon the beholder.
STOMATITIS MATERNA.
747
But I only wish to say enough to put the student on his
guard and cause him to warn his patients in time.
STOMATITIS MATERNA, OR NURSING SORE MOUTH.
Stomatitis materna is a disease peculiar to women who are
nursing or pregnant, but sometimes continues after the mother
ceases to nurse her child. Its pathology and etiology are not
well understood. It is a distressing complaint, and right-
fully comes under the notice of the physician who makes the
diseases of women a special study, though very generally
ignored by writers upon these diseases.
Etiology.
The cause of stomatitis materna is mainly due, we believe.
to the irritation of the stomach from the enlargement or irri-
tation of the uterus, thereby causing irritation of the sym-
pathetic nerves; or producing irritation in the stomach
through the irritation of the breasts from nursing in women
of scrofulous constitution and nervous organization.
Why uterine disease does not, ordinarily, produce this
condition of the mouth we are unable fully to explain. The
abstraction from the system of the mother of nutrition,
either while the child is in utero or at the breast, seems the
most plausible explanation of the development of the disease.
It is usually not present in other cases of irritation of the
uterus, even where the uterine irritation is apparently much
greater than during gestation and lactation; but this cause
may keep up the disease. Imperfect digestion and assimila-
tion of food seem to be connected with these cases, rendering
the secretions irritating throughout the entire system.
Symptoms and Diagnosis.
Soreness of the mouth is the main diagnostic symptom.
This soreness is found to be connected with inflammation of
the mucous membrane of the mouth. The inflammation varies
748
EATON ON DISEASES OF WOMEN.
in grade from slight redness to fully developed ulcerative
inflammation. It may affect only a small portion of the
membrane of the lips or tongue, or it may affect the entire
membrane of the mouth and tongue, and even extend to the
nasal passages and down into the bronchial tubes.
There is usually present more or less gastric disturbance.
in the way of heat, burning, etc., or gastralgia after eating.
Heartburn and sour eructations frequently occur. Emacia-
tion is an almost constant symptom, especially in severe cases.
If left to itself ulcerative action sometimes goes on to an
alarming extent, destroying a large part of the tongue, lips,
etc., and causing death through the want of digestion and
assimilation, really amounting to starvation; as well as
through the ulcerative action, which sometimes affects the
stomach and intestines as well as the mouth.
Stomatitis materna seems in a measure hereditary, owing,
we presume, to inherited constitutional scrofulous taint and
nervous weakness. When a lady once has the disease she
appears more liable to have another attack in subsequent
pregnancies or lactations; in fact, under allopathic treatment,
the disease often reaches over and continues from one preg-
nancy to another. (See Byford's Diseases of Women.)
Treatment.
In the first place, let the child be weaned if there is a
severe and extensive inflammation. If the case is mild,
remedies may be tried for a short time, and allow the child
still to nurse; but should the remedies fail while the child
still nurses, it must be weaned and remedies continued.
When the attack come on during gestation palliatives must
be used as well as possible, together with indicated remedies
till delivery is accomplished, when the lacteal secretion
should be suppressed by the use of Bell., Camph., etc., applied
locally to the breasts, and let remedies for the cure of the
stomatitis be continued.
STOMATITIS MATERNA.
749
Among remedies for this disease I will mention Ars.,
Merc. cor., Borax, Bry., China, Ferrum, Kali chlo., Phy-
tolac. dec., etc. Arsenicum emphatically takes the lead, as
it is indicated in about every case, and is often the only
remedy required. In some cases Ars. may be followed with
advantage by some one of the remedies mentioned, when
used according to the totality of the symptoms.
In cases
which are pregnant, a valuable palliative remedy is Borax
and Honey, held in the mouth and then ejected. Sometimes
Pulv. Charcoal is found palliative to the burning in the mouth
and stomach in this class of cases.
750
EATON ON DISEASES OF WOMEN.
CHAPTER LXIX.
NYMPHOMANIA (THE "FUREUR UTERINE" OF THE FRENCH)-ATROPHY
AND HYPER-INVOLUTION OF THE UTERUS— ABSENCE OF
THE UTERUS- MALFORMATION OF THE UTERUS- ANÆS-
THETICS.
NYMPHOMANIA consists in an uncontrollable desire in women.
for sexual congress. The passion becomes after a time insa-
tiable and irresistible. At last mental alienation becomes
complete, and no sense of modesty seems to be left. The
patient will solicit, and attempt to consummate, the sexual
act with any man who comes near her, without regard to
those present.
Etiology.
The disease is supposed to be usually caused by mas-
turbation. This is, doubtless, often the case; but, we think,
not always, as we have personally known of instances where
the disease existed in its mildest form, i. e., where we would
have been unaware of its existence but for the voluntary
avowal of the patient (a condition not suspected by friends),
where masturbation was denied by the patient.
In these cases it seemed that a highly nervous organiza-
tion with complete sexual development, and the excitation of
the passions by the reading of exciting works of fiction, the
stimulating effect of high living, and the caresses of lovers,
had developed the condition, especially as marriage had not
been consummated. In one case it seemed to be caused
from the incomplete attempts at copulation on the part of a
husband, many years her senior, who had become impotent.
In another case, where the husband was young, but par-
tially impotent. We have seen other cases, where the very
NYMPHOMANIA.
751
large development of the nymphæ congenitally seemed to be
the exciting cause. Enlargement and hypertrophy of the
clitoris seems to have been the cause of this disease in some
instances related to me; but I have not seen an instance
where this appeared to be the cause.
Symptoms and Diagnosis.
In the earlier stages of this disease the patient is shy of
the presence of men, and would be considered rather diffident
and modest in company; but while alone with a male friend
a striking change is perceptible. The eye kindles and stares,
the countenance becomes flushed, and conversation upon im-
modest subjects is invited by insinuation, or directly com-
menced herself. The discussion of other subjects is dis-
tasteful; marriage, love, lovers, beaux, etc., scandal and the
like, seem to be her whole stock in conversation, though she
may have been well educated.
After a time her demeanor in company excites comment,
and she openly speaks as she formerly would do only in
private. Mentally she seems degenerated, memory is evi-
dently impaired, and her attentions to gentlemen become too
marked to come within the scope of propriety.
Still later, the disease manifests the symptoms of com-
plete abandonment, without modesty, shame or concealment,
to the extent of making it impossible to allow her to come
into the presence of men at all. In these sad cases, which
may be found in almost any insane asylum or large “poor
house," the mental faculties are about gone, a condition of
dementia seems to be the true term to express her condition.
Prognosis.
When taken in its earlier stages and properly treated
many cases recover. When fully developed the disease
renders the case hopeless.
752
EATON ON DISEASES OF WOMEN.
Treatment.
In the treatment of cases of this kind much tact and
delicacy is required, as well as firm principles. The patient
should at once engage in some manual labor to the full
extent of her strength, and this must be continued. Canthar.
30* should be given, Camph. or Kali bro., Platinum, Picric ac.,
or Veratrum alb., given low, are also efficient remedies. Allow
no beaux company to be received, recommend a cold bath
daily. Let the patient's diet be very plain and non-stimulating.
Let no novels be read, and the occupation of the mind should
be secured by the reading of works upon geology, or by
the study of mathematics. After a year of this treatment,
entrance into society may be allowed, and if a suitable
matrimonial alliance can be consummated, sanction it.
Cauterization of the clitoris is a barbarous, and so far as
I can learn, a useless, practice in these cases. Clitoridectomy
or amputation of the clitoris has also been practiced, and
been found unavailing, and is to-day entirely abandoned.
ATROPHY OF THE UTERUS, AND HYPER-INVOLUTION.
The uterus may be smaller than normal from infancy,
which is termed congenital atrophy, or it may become atro-
phied after the delivery of a child, which is termed hyper-
involution.
The condition of atrophy of the organ after the cli-
macteric period is passed is normal. The girl affected with
congenital atrophy of the uterus or ovaries will show less
of sexuality in other ways; the breasts are found rudi-
mentary, the hair upon the mons veneris is small in amount,
resembling a girl of fourteen, when she has attained to
twenty-five or thirty years of age. Sexual passion is feeble
or entirely absent. There is usually an absence of men-
struation; or, if present, it is scant and irregular. Mental
ATROPHY OF THE UTERUS.
753
+
disturbances frequently accompany this condition, especially
a want of mental capacity is manifest.
Mr. Walter Whitehead relates a remarkable case of
hyper-involution, after confinement, going on to the extent of
causing entire absorption of the organ. She became quite
indifferent to sexual intercourse, and no examination could
detect any uterus remaining.
Etiology and Pathological Anatomy.
One cause of the congenital atrophy of the uterus may
be found in some instances in the near blood relation of
father and mother. Other causes are the tuberculous or
scrofulous diathesis, chlorosis, etc.; but in some instances.
the cause is obscure, from the fact that the development of
other parts of the body, and the health, appear good. In
these cases the walls of the uterus and cervix are thin and
flabby, appearing to indicate a want of normal amount of
muscular fibre. Ossification of the arteries may cause
atrophy of the uterus.
Symptoms.
Absent or scant and irregular menstruation; want of
energy; childish appearance generally, in cases where the dis-
ease is congenital.
Diagnosis.
The diagnosis is to be made by means of conjoined manip-
ulation, one finger of the left hand in the vagina pressing
against the os uteri, and the right hand pressing down upon
the fundus through the abdominal walls; or we may pass
the uterine sound, when we will find that the flabby condi-
tion of the organ present is in striking contrast to its normal
stiff and firm feel; and we find that its length is much less
than natural.
*Brit. Med. Jour., Oct., 1872.
18
754
EATON ON Diseases of wOMEN.
Treatment.
The scrofulous or tuberculous patient should be given
Phytolac. dec., Calc., Chi., Arsen., etc., according to their
homœopathic indications. The chlorotic case demands Merc.
cor., Ars. iod., Ferrum, Ignatia, etc., ordinarily. Electricity is
one of the most useful agents, as I have proven in many in-
stances. Let the positive pole be attached to the uterine
electrode when introduced into the uterus, and apply the
negative to the spine, using a very mild primary current for
about ten minutes, once in three days. The cool hip bath
is also a useful adjuvant. Use a liberal farinaceous diet, with
free exercise in the open air.
ABSENCE OF THE UTERUS-MALFORMATIONS OF THE UTERUS.
Cases of the entire absence of the uterus in women are
exceedingly rare. The organ occasionally exists in a rudi-
mentary state, having no cavity, and being of very small
size. Malformations of the uterus are not so uncommon,
though sufficiently so as to be of considerable interest. A
FIG. No. 72.-DOUBLE
UTERUS.
septum existing in the organ, dividing it
into two about equal parts, is perhaps the
most frequent malformation. It is a condi-
tion frequently not recognized, as impreg-
nation may take place on one side, and the
gestation and delivery may go on normally;
menstruation may go on from the opposite
side; and this condition may account for
those anomalous cases where menstruation.
continues in spite of pregnancy. Concep-
on the opposite side from which gestation
(See Fig. No. 72.)

tion may take place
is already going on.
The septum represented in the cut is not always contin-
uous down to the os; still, if only extending down to the
internal part of the cervical canal, it makes a double uterus
MALFORMATIONS OF THE UTERUS.
755
(termed uterus bilocularis), just as much as if continued down
to the external part of the canal. Sometimes there exists
a double cervical canal and a single uterine cavity. (See
Fig. No. 73, representing the case of Mrs. T., of Cincin-
nati.) This lady has never been pregnant, and has been
troubled with excessive uterine hemor-
rhage, for which she consulted me. I
found a number of mucous polypi situated
in the cervix, and cured her of these tu-
mors; some months after which, the pa-
tient, desiring offspring, again consulted
me regarding her sterility. In attempting
to examine the uterine cavity thoroughly,
I found the cervix apparently ended in a
pouch. As she menstruated, I was sure
there was some communication with the
interior of the body of the uterus by way of the cervical canal.
I, therefore, persevered in my examination with the sound,
after dilating the canal with sponge tents. I now discovered
a septum in the cervical canal. By passing the sound into
the smaller opening in the os I succeeded in directing it into
the cavity of the uterus. I found, however, a constriction
at the internal os. This I also dilated with a tent.

FIG. No. 73. -- DOUBLE
CERVIX UTERI
If the sterility continues it will be advisable to divide the
septum with scissors, that the semen may more readily gain
access to the uterine cavity. This case suggests the possi-
bility that a septum in the cervical canal may be a cause of
sterility when the septum leaves one side of the canal to end
in a pouch. This condition may make the introduction of
the sound into the uterine cavity an apparent impossibility.
ANESTHETICS.
Anaesthetics are a great boon to suffering humanity.
They have taken from surgical operations more than half
their terrors. Anaesthetics may be used locally to produce
756
EATON ON DISEASES OF WOMEN.
L
insensibility of a part of the body, which is done by a spray
usually, and is most useful to the surgeon in general prac-
tice. In gynæcological examinations or operations, general
anesthesia is demanded. This is accomplished by inhala-
tions, and we prefer pure Chloroform, or a mixture of one
part of Sulph. Ether to two parts of pure Chloroform.
The important points in the safe administration of anæs-
thetics consist in securing a partial inhalation of atmospheric
air at the same time, and in having our patient in the reclining
posture, with the head about as low as the body. Accidents
from the use of anesthetics have been mostly in those cases
where the patient has been allowed to sit or semi-recline.
Anæsthetics should only be given by assistants of expe-
rience and judgment. The operator should not have his
mind distracted by the care of the patient in this respect.
We should also always have at hand a bottle of Spts. Ammo-
nia and Nit. Amyle to revive the patient in case respiration
ceases, and there is danger of dissolution. I will not go into
the history of anaesthetics, but will simply suggest some pre-
cautions as to their use, and recommend them when used with
care and discretion. The question frequently arises, whether
or not they may be used in cases of weak lungs or with
those who have heart disease. On general principles, we
say no; still some palpitation of the heart in women who
have uterine disease, does not preclude their use, as this pal-
pitation is usually the result of sympathetic nerve action.
In cases where a severe operation is imperatively de-
manded in a lady suffering with some weakness of the lungs
or heart, anæsthetics may be used in moderation and with
special care. In cases of confirmed phthisis or severe valvular
lesions of the heart, both the giving of the anaesthetic and the
operation may usually be dispensed with, as life must soon
ebb away at best, and it is useless to place the patient's
life in imminent peril from an operation under such cir-
cumstances.
HYSTERIA
757
CHAPTER LXX.
HYSTERIA.
HYSTERIA is the term applied to the manifestation of a
class of symptoms peculiar in themselves, but varied in char-
acter. Hysteria is not a disease in itself, but may be mani-
fested in connection with a variety of diseases, notably those
of a uterine or ovarian character; and hence hysteria is pe-
culiar to women, though men are liable to nervous symp-
toms, in part simulating those called, hysterical in the female.
Conditions indicating a sort of trance in the male have been
termed hysteria by some old authors, but they were evi-
dently cases which were malingering, as it is called (that is.
pretending to disease which was not present). Doubtless in
some women, as well as in men, there is malingering, and
they frequently may manifest symptoms which, taken in
themselves would be alarming, but when taken in connection
with the hysterical symptoms in the case, they sink into
insignificance,
Hysteria is most common in women during the time that
ovulation is going on, though some manifestations have been
noted in young girls and in old women. It is aggravated,
if not most frequently induced, at the menstrual epoch. It
may, however, be developed during the intervening period.
or it may come on during the period of gestation or nursing.
Hysteria has been considered by some simply a pretense
to disease, a malingering, for the purpose of exciting sym-
pathy and attention. Now, while some women may be guilty
of malingering to deceive and obtain sympathy where they
are suffering from no disease worse than laziness, it is a
great cruelty to accuse all women who show nervous, change-
758
EATON ON DISEASES OF WOMEN.
.:
able, spasmodic symptoms (called hysterical) of being simply
pretending.
In many cases the suffering of these patients is intense
from disease, and they are as unable to control these mani-
festations as they would be the agonies of labor. But very
few can do it. We therefore bespeak for this class of pa-
tients sympathy and kindness, often mingled with firmness,
it is true; still let firmness be mingled with gentleness, at all
times, with these patients.
Etiology.
The cause of hysterical manifestations lies primarily in
the irritable and weak condition of the nervous system. This
may be hereditary or acquired by mental or physical labor in
undue amount, by dissipation, late hours, loss of sleep, stimu-
lating diet (to the neglect of that which is substantial, plain,
and nourishing). Disorders of menstruation, frequent child-
bearing, mental shocks, etc., may also induce this irritable,
weak condition of the nervous system. These causes may
be termed predisposing.
Direct causes are to be found in displacements of or inflam-
mation in the uterus or ovaries; dysmenorrhoea, excessive or
entire want of sexual congress; indigestion, causing gastralgia
or flatulency, constipation; worms, vaginitis, vaginismus, dys-
pareunia, pruritus vulvæ, etc. The enlargement of the uterus
in gestation, irritation of this organ from sympathetic irrita-
tion of the breasts in nursing, disagreeable home associations,
sudden colds causing amenorrhoea, etc., may develop hysteria.
I believe all these causes, and perhaps many more, tend
to produce hysteria in those patients who have a high ner-
vous organization, and who are debilitated, especially those
poorly nourished and of weakly constitution. There is in
some an appearance of plethora and vigorous health. In
these cases there is a want of proper balance of nerve
strength, owing to some of the enumerated direct causes.
A
HYSTERIA.
759
highly excitable sexual organization predisposes to hysteria,
and it is seldom manifested in women sexually torpid.
Diagnosis and Symptoms.
The symptoms of hysteria are extremely various. In
the first place we note a perverted judgment, and an ex-
tremely vacillating mind. They decide this way now and
very soon reverse their opinion, laugh immoderately at trifling
things and cry at mere nothing, stop sobbing and laugh at
their own foolishness, and in a few moments weep again.
At these times they often complain of a choking sensation
in the throat, the "Globus Hystericus" as it is called. They
cry out they are choking, and laugh and cry again. This
class of symptoms are most common in the more chronic
cases.
In recent cases pain in the abdomen is often complained
of, especially where there is indigestion and flatulency,
dysmenorrhoea, constipation, or pregnancy; and pain in the
pelvis in cases of displacement of the uterus, or inflamma-
tion of the uterus or ovaries. The patient in these cases
sometimes falls down unconscious, froths at the mouth, tears.
her hair or clothing, bites her tongue, etc.; every muscle is
rigid in spasmodic contraction, opisthotonos being common.
The jaws are often spasmodically closed, as in tetanus. The
patient rolls about irrespective of the injury she may do
herself. Semi-consciousness returns and lasts a few moments,
and again an active convulsion sets in. These convulsions
may come on in those cases which ordinarily show the
milder symptoms, or the manifestations may be uniformly
violent. These symptoms are likely to cause grave appre-
hensions in the minds of her friends, and the physician
should be quick to detect their nature, in order to allay their
fears.
In those women hysterically inclined or predisposed, the
occurrence of almost any disease, or an extraordinary amount
760
EATON ON DISEASES OF WOMEN,
of fatigue, may develop such severe symptoms as to mislead
the physician, unless he is aware of the patient's peculiarity
in this regard.
Hysterical women are prone to magnify every slight ail-
ment which they have. They, perhaps, do suffer more than
others, because of the acute sensitiveness of their nerves.
HYSTERICAL RAGE OR MANIA.-Raving and paroxysms of
anger followed by sorrow, 'remorse, weeping, and self-con-
demnation, is a symptom in some cases. They may, how-
ever, laugh in a few moments, and again go into a causeless
rage.
Treatment.
In violent cases, the first thing to do is to see to it that
the patient does herself or others no harm. Physical re-
straint is often absolutely necessary. A thin piece of a
large cork placed between the teeth and then binding the
jaws firmly, serves to keep the patient from biting her
tongue, and also will enable us to administer remedies, which
otherwise we might be unable to do. See that the feet are
warm, the head cool, etc. Select remedies according to the
condition of the patient, as well as the symptoms present at
the time. Cimicif. Rac., is an excellent remedy when we
have the history of the patient, showing ovarian pain. Puls.
when there is amenorrhoea from cold, with tenderness in
iliac region. Aconite, Gelsem., or Arsen., may be indicated by
the pulse and the temperature of the skin, etc.
Ignatia is, perhaps, our best remedy, so far as the purely
spasmodic symptoms are concerned. When there is any
tendency to conjestion of the lungs, Verat. viride, Gelsem., or
Bryonia, may be indicated. Hyosc. is indicated if there is a
tendency to immodesty manifested.
Nux and Colocynthis, in alternation, are indicated in flatu-
lency, and especially when pain centres around the navel.
When the flatus is evidently in the colon, an enema of warm
water, followed in a few minutes by one of quite cool, is very
HYSTERIA.
761
useful to assist in relieving the distended bowel, which is
not only painful in itself, but may cause pain in the ovary
or uterus from pressure, particularly affecting these organs
when they are inflamed.
Hysteria is often unsatisfactorily treated, from the fact
that patients will often neglect treatment in the intervals of
the attacks, when they are of recent origin, and sometimes
when chronic, on account of the mildness of the symptoms
and the mental weakness accompanying this condition, which
makes the patient a poor judge of her own case and her needs.
Kali bro. is indicated in those women who have excessive
sexual passion, notably young widows.
In case hysteria is manifested during gestation either
Bell., Hyosc., Ignatia, Aconite, Col., Nux, Puls., or Secale, are
homoeopathically indicated, together with rest and a very
light diet.
When the violence of the symptoms has subsided the
physician does well to make a physical examination of the
pelvic organs, as well as the spinal cord and the system
generally, in order to discover the predisposing and exciting
causes. If they can be found they should, of course, be
treated upon the general principles laid down in connection
with their occurrence in other cases, and may be found under
their appropriate heads. It is unnecessary to recapitulate
here the proper treatment in cases of uterine or ovarian
diseases.
It is, however, of the greatest importance that these dis-
eases be treated if we would cure the hysteria. It is true,
a woman may have a single attack of hysteria owing to vio-
lent emotions of the mind at or about the time of the men-
strual period, and not have a recurrence of it, though she
receive no further treatment. But these cases are excep-
tional, and do not invalidate the general rule of the liability
and probability of its recurrence in the great majority of
cases when left to themselves.
·
762
EATON ON DISEASES OF WOMEN.
Special Indications for Remedies.
Aconite-Hysterical condition, characterized with fear
as a prominent symptom where the disease developed from
fright, or where the prominent symptom is fear, together
with tenderness of the uterus or ovaries; the wiry pulse;
dizziness on rising, etc.
Asafoetida - Hysterical condition, with burning in the
œsophagus; sensation of a lump in the throat, termed globus
hystericus.
Aurum, is indicated in suicidal hysteria.
Bell., is indicated in hysteria when there is a flushed
face; redness of the eyes; throbbing headache over the eyes.
Bry., when there are sharp pains in the limbs or chest,
worse on motion, with hysterical spasms occurring only at the
menstrual period.
Cal. Carb., is indicated in the leuco-phlegmatic tempera-
ment where hysteria is manifested, where leucorrhoea is a
complication; patient is very sensitive to cold, etc.
Chamomilla, in hysteria, where a bad temper is a prom-
inent symptom as a complication.
Col., is indicated where the hysteria is complicated with
cutting pains around the navel; gas in the intestines, etc.
Gelsem., is indicated in hysteria, where there is also an
intermittent fever present in the case.
Hyosc., in hysteria, with tendency to immodesty; tears
come to the eyes without cause; hysterical spasms, etc.
Ignatia, hysteria, with silent morose condition; angry
mood; comes out of her spasm with deep sighing.
Ipecac, where vomiting precedes or follows the hyster-
ical spasm.
Nux Vom., in hysteria with constipation, indigestion,
loss of appetite, etc., especially in women who have been
drinking much wine or other liquor.
Phos., in tall, slender women with hysteria, having stool
HYSTERIA.
763
which is dry, hard, and narrow; much gas on the stomach,
which is raised after eating.
Puls., hysteria at the menstrual periods, with partial
amenorrhoea; pain in the ovaries; indigestion; headache, etc.
Secale, in high attenuation is indicated in hysteria with
threatened abortion.
Verat. Viride, hysteria, with tenderness of the spinal
cord, with profuse perspiration.
INDEX.
ABORTION,
({
((
·
etiology,
symptoms,
convulsions in,
(
((
diagnosis, .
((
prognosis,
{{
((
treatment,
•
remedies in threatened,
PAGE.
PAGE.
421, 675 Absence of the uterus, 750, 754, op. 723
422
(
ovaries,
423 Ablation of the uterus, .
424
((
•
cases requiring,
425
(C
{{
(1
•
experience in,
•
265, 754
- 727
727
. 727
•
•
a cause of uterine diseases,
Abdominal dropsy,
((
•
•
426 Acute inflammation of the uterus,
426
(C
•
•
ovaritis,
430 Adhesions in the vagina,
18
739
supporters, 156, 557, 558
parietes failure of to ad-
here after ovariotomy, . 334
gestation,
•
642
Abnormal conditions, tolerance of, . 479
(4
•
menstruation, 34, 56, 242, 498
Abscess of the breast,
(C
(
({
•
symptoms of,
etiology of,
treatment of,
Abscess of the labia, .
(C ((
etiology of,
((
(
diagnosis of,
((
(
((
treatment of,
•
. 697
.697
406, 410
({
labia,.
·
77
•
265
•
186, 190
186, 190
(C prevention of, . 195
Adenoid tumors of the breast,. . 698, 699
Advancing senile atrophy of female
genitalia, .
Albuminuria,
·
fluences,
•
caused from psychical in-
simulating phthisis pul-
.504
.662
•
692, 695
Alveolar cancer of the breast,.
Alimentation, rectal,
Amenorrhoea,.
. 701
.683
•
•
31, 32, 223, 242, 499
. . 696
6
symptoms of,
etiology of,
32
34
((
treatment of,
36
411
•
35
411
({
•
412
monalis
36
652
((
((
causing cough, . 32, 26, 242
exceptional cases of, 32, 26
ovariotomy,
"the uterus,
•
241 Amputation of the breast,
Abscess, pelvic, 69, 110, 113, 125, 295, 718
etiology,
cervix uteri,.
inverted uterus,
clitoris, .
335
((
242
•
692
((
115
((
116
((
·
119 Anæmia,
>
122, 125 Anomalous cases,
169
.576
.752
350, 358
Abscess in inguinal glands, .
((
abdominal muscles after
(6
symptoms,
**
prognosis,
(C treatment,
Absorption of the uterus,
•
•
753 Antiseptic treatment,
.577
. 135
3
766
INDEX.
"
"
((
{t
etiology,. . 599
diagnosis, . 599
treatment, . 600
715
Antiseptic spray apparatus, .
Anæsthetics,
i
in diagnosis,
•
•
PAGE.
Plate XI.
368, 750, 755
Bearing-down pains,
Bilocular uterus,
Bantam diet,
Bed swing,
•
28
•
563, 598
((
etiology of, 599
((
diagnosis of, 590
แ
66
treatment of, 600
|
Ante-version of the uterus,
"
((
Ante-flexion of the uterus, . . . 563, 598
(i
((
Bigelow's apparatus for washing out
the bladder,
Blind vaginal fistula,
Bloody tumors of the tubes,
Bladder, inflammation of,
•
PAGE.
.700
338
220
755
•
466
•
•
537
•
439
•
. 445
(C
stone in,
•
462
fissures of the neck of, . 445
Bozeman's tenaculum,
curved scissors,
scalpel,
•
•
•
Plate XIII.
•
523
•
102
. 105
. 106
relief of chronic cystitis,
•
•
.458
Plates IX and X.
153
•
154
•
739
•
•
•
Applicator, uterine,
Areolar hyperplasia of the uterus, 87, 709
CC
46
711
(( course and termination, 100
predisposing causes, . 101
((
(L
((
symptoms,
(l
(L
(
(C
prognosis,
treatment,
·
•
Artificial vesico-vaginal fistula for the
Aspirators, .
Aspirator, Tiemann & Co.'s, .
Dieula foy's,
Ascites in Women,
(C
(<
Broken breast,
Breast, abscess of, .
inflammation of,
malignant tumors of,
hypertrophy of,
induration of,
amputation of,
•
.630
695, 696
692, 695, 697
•
operation for,
. 691
692, 700
. . 692
697, 698
. 697
. 697
692, 702
((
cancer of, .
((
(!
16
tumors of, .
แ
(C
fatty tumors of,
แ
((
66
diagnosis,
te
"(
(6
treatment,
((
((
tapping in,
<<
740
milk tumors of,
742
((
adenoid tumors of,
•
743
•
complicating ovarian cystoma, 299
Attenuation of remedies,
•
Atrophy of the uterus, . . 255, 259, 750
Atmospheric pressure,
Atresia of the cervix uteri in young
girls,
4
367, 556
((
505
Atresia of the cervix uteri in old
women,
504
Atresia of the hymen,
"L
{t
cervix uteri,
502
((
((
vagina,
503
(
แ
(6
<<
uterus,
502
chronic,
of the uterus,
(4
cervix, artificial,
532
แ
((
(:
uterus, artificial,
532
(:
tubes,
cervix,
•
•
BARRENNESS,
66
249
Caustics, warning against,
•
a cause of cellulitis, .
255 Cancroid tumors of the fundus uteri, . 293
. 703
•
. 700
.698
. 699
malignant tumors of,
. 700
sero-cystic tumors of,
699
137
แ
hydatid tumors of, .
699
gangrene of, .
non-malignant tumors of, 697, 698
Broad ligament, cysts of,
66
treatment, .
Bulbs of the vestibule, rupture of, . . 490
197 CATARRH, acute, of vagina, 186, 219, 240
697
437
•
. 438
380
188
211, 240, 380
439
211
•
234
115
diagnosis,
treatment,
•
•
•
•
257 Cauliflower excrescence,
400
Bathing,.
Battery, combination,
(6 Faradic,
744 Cæsarian section,
644
•
38
•
160, 714
Babcock's Supporter, 595, and Plate VII.
Caruncles of the urethra, irritable, . . 445
Catheter, self-retaining,
Plate XIII.
•
·
(6
reversible,.
•
457, 466
INDEX.
767
提
​Cancer of the uterus,
(
tr
66
1
breast,
tubes,
•
uterus, scirrhous, . 167, 400
PAGE.
167, 400 Chronic inflammation of female gen-
PAGE.
. 700
439
•
•
"
italia,
cellulitis,
cystitis,
. 62, 70, 87
117
•
.458
tr
encephaloid,. . 400
(C
66
པ
66
breast, colloid,
700
parenchymatous metritis, .
Chancre, Hunterian,
87
. 657
((
scirrhous,
700
•
t
CC
melanoid,
. 700
((
•
soft, .
hard,
. 657
.657
•
པ
፡፡
gelatiniform,. . 701
alveolar,
701
•
Chapter on Instruments,
Chancroid sore,.
. 142
•
. 657
•
Ovary,.
Cancerous ulceration of vagina, . 629
Chair for examinations,
387
Child-bed fever,.
. 126
•
22
(C
cachexia,
24, 630, 701
Chlorosis, .
•
32, 754
{{
Catamenia,.
(
uterus,
liver,
Calculi in the bladder,
•
Cachexia, cancerous,
tuberculous,
Carcinoma of the ovaries,
(C
400 Clitoris, amputation of, .
24, 630, 701
Chills caused from retro-version of the
24
uterus,.
31 Change of life,
25
•
494
·
300 Civiale's lithotriptor,
Plate VIII.
. . 752
(( ureters,
phosphatic,
287
elephantiasis of,
462
462, 469
''
hypertrophy of,
cases of,
723
723
724
752
•
462 Clitoridectomy,
462 Clamp for pedicle in ovariot-
uric acid,
causes of,
462
((
one cause of vesico-vaginal
463
•
17
fistula in some cases,
Causes of female diseases,
omy, 160, and Plate XV.
Thomas',
Spencer Wells',
Dawson's improved,. . 321
Caution against uterine injections,. . 216 Climacteric period,
Cervicitis,
Cervical metritis,
CC
hyperplasia,
endo-metritis,.
Cervix uteri, incisions of,
"
CX
3
66
3
X
35
66
indurations of,
hypertrophy of,
·
►
66
46
•
494
211
treatment of diseases of, . 500
79 Conjoined manipulation,
28
•
103 Cold vaginal injections injurious, 701, 746
218 Colostrum,
•
596 Combination battery,
162 Complications of metritis,
162 Coccygodynia,
lacerations of, 115, 539, 550
a cause of hypertrophy, 166
"areolar hyperplasia, 102
artificial atresia of,
cancerous diseases of,
stenosis of,
atresia of,
tumors of,
•
•
amputation of,
Cellulitis, pelvic,
description of,
แ
•
<<
symptoms of,
•
chronic,.
•
·
694, 695
38
82
396
•
Color of the discharge in endo-metritis, 220
CC
CC
Cover for use in examinations,
•
532 Colpeurynter,
400 Colpeurysis,
•
·
endo-cervicitis, 212
30
•
45, 350, 364
45
452 Corporeal hyperplasia of the uterus, . 104
502 Colic, uterine, .
•
343 Copulation, injurious effects of,
169 Convulsions in the puerperal state from
•
110, 113
113
•
116 Crabs,
·
albuminuria,
in hysteria,
586
83
.662
.759
.408
117 Cutler's forceps and suture cutter, . . 535
prognosis of,
((
treatment of,
•
119 Cut of fistula,
•
122 Curved scissors, .
524
.
. 530
768
INDEX.
Curved scissors, long,
Cystitis,
symptoms,
etiology,.
treatment,
Cystocele,
•
PAGE.
PAGE.
•
146 Discharge, color of in endo-cervicitis, 212
•
455 Diseases of pregnancy,
•
•
.660
455
•
of the ovaries,
. 265
455
•
uterus, sympathetic, 472, 487
457
་
•
•
389, 391
tubes,.
439
urethra,.
445
Plate XVI.
treatment of, .
448
•
A
. 280
•
•
301, 437
•
406, 414
Drainage tube,
·
414
Dropsy in women,
•
•
414
(6
(6
415
415
66
298
462
•
of the breasts,
356 Double tenaculum forceps,
uterus,
cervix uteri,
sympathetic,
472
692
323
754
755
•
•
333
739
740
742
301
Cystoma ovarii,
Cystin calculi,
Cysticercus, .
•
Cysts of the ovary,
broad ligament,
i
66
vaginal,
แ
((
•
pathol. anatomy,
etiology,
diagnosis,
ર
*
•
diagnosis,
treatment,
of the Fallopian tubes,
356 Dyspareunia,
treatment,
of the uterus,
{{
•
ovary, rupture of,
permanent opening into, 309
. 310
CC
DAWSON'S improved Sims' speculum,
Dysuria,.
Plate III.
•
symptoms,
etiology, .
treatment,
treatment of,
29 Dysmenorrhoea,
•
Dead foetus in utero, .
Denidation,
Decidua (nidal),
Dermoid cysts,
•
Diet, Bantam system of,
Dilutions, homoeopathic,
•
49
49
•
162, 173
173
. 175
176
•
·
646
·
648
•
46
47
50
50
·
145, 521, 527
Fig. of, Plate VI.
267, 277, 278
CC
diagnosis,
prognosis,
treatment,
·
700
•
Diphtheritic inflammation of the
vagina,
•
Diathesis seu Infectio purulenta,
hemorrhagic,
Diagnosis, general,
CC
66
138 EATON'S needle-holder,
46
186, 194 Eaton's wire holder and twister, 146, 522
•
•
136
203, 493
21
of female diseases,. 21
•
of adhesions in ovarian tumors, 296
differential,
66
Fig. of, Plate VI.
Eaton's improved London sup-
•
porter,
158, 665. See Plate XII.
Also uterine displacements.
Ecraseur,.
369
s
283
Edwards' ecraseur,
369
567
Effects of conception in cases of endo-
metritis,
. 223
568
Effects of uterine disease,
17
439, 443
Elevators, uterine, .
159
385
159
•
. 159
of inversion of the uterus, .
difficulties of in inversion of the
uterus,
Displacements of the tubes,
(C ovaries, .
of the uterus, 552, 663
•
•
symptoms, 561
etiology, . 561
treatment, 562
•
Elevator, Sims', .
(C
Elliott's,.
Elevators, uterine,.
Elevation of the uterus,
σί
Electrical batteries,
Electrolysis needles, .
Diseases, female, causes of, .
17
Dilator (Emmet's sponge tent), Plate IX.
CC
Palmer's uterine, .
146
(C
·
Discharge, color of iu endo-metritis, . 220 Electrical baths,.
•
See Plate XVI.
563, 577
Plate XXVIII.
38, 159, 160, 714
•
in ovarian cystoma,
. 160, 370
•
309
. 745
INDEX.
769
Electricity,
<<
•
PAGE.
.479 FALSE pregnancy,
in treatment of atrophy of
(1
•
uterus, . . 754
amenorrhoea, 37, 479
sub-involution,
<<
peritonitis,.
•
Fallopian tubes, diseases of,
714
•
(C
(C
uterine fibroids, . 349
Elongation of cervix uteri,
Elytroplasty,.
Elephantiasis of the clitoris,
(C
•
labia majora,
164
<<
(6
536
Facies ovariana,
723 Faradic battery,
723
Femoral hernia,
CC
minora,
. 723
Fever, hidrotid,
•
•
Plate XXIX.
<<
milk,..
puerperal,
child-bed,
cancer of,
fibroma of,
displacements of,
dropsy of,
•
PAGE.
375, 498
•
131
•
439
•
443
443
443
439, 301
283, 285
38, 160, 714
404
•
. 130
. 126
(C
(C
Elytrorrhaphy,
clitoris,
labia majora, Plate XXX.
minora, Plate XXXI.
•
CC
. . . 392, 393, 617, 623
Elasticity of the connective tissue in
Female genitalia, .
. 136
..694
Plates I and II.
•
adv, senile atrophy of, 501
the pelvis, .. 367 Fissures of the vagina, .
uterine tissue, 163, 390
Emmet's sponge dilator,
(C
curved scissors,
·
151
•
Plate IX.
nipple,
anus,
•
. 630
.692
. 260
neck of the bladder, . 445
. . 726 Fibroids, uterine,
sponge tent applicator, . 366, 597
Endo-metritis,.
<<
effects of,
Endo-cervicitis, .
•
218, 253
•
225
211, 253
Endometrium, vegetations of, 352, 353, 355
46
CC
•
granulations of,. . . . 353
inflammation of, 218, 253
Enucleation of submucous fibroids, 347, 348
Enucleator, Sims' (three figures), . . 347
Encephaloid cancer of the breast, . . 701
Enterocele,
Endoscope, urethral,
Enlargement of the clitoris,
Enuresis,
Episiorrhaphy,
Ephemera,
•
CL
CL
•
292, 302, 342
diagnosis from pregnancy, 345
" . submucous,
(6
pedunculated,
"by other operations, 348
of the cervix uteri, .
of the Fallopian tubes,
Fibro-cysts of the uterus,
Fibroids of the vagina,
Fibroma, uterine,
343
343
439
•
302, 346
•
. 406, 414
varieties of,
343
A
symptoms of,.
343
•
prognosis,
345
CC
treatment,
346
"
'
by sponge tents, 349
<<
subserous,
343
·
•
(C
treatment of,
347
. 343
treatment by enucleation, 347
389
((
446
CC
723
labia majora,
723
•
Co
minora,
•
•
723
•
647, 648
•
537
695
•
vaginal,
Fibrous tumors of the uterus,
702
•
•
702
346, 727
319 Fitch's supporter,
22 Fistulæ, vaginal,
30
،،
286, 642
692
24
in ano,
•
cervix, .
vagina,.
•
•
302
406, 417
342, 352
•
300
342, 352
406, 417
158
. 511
Sims' operation for, . 534
Simon's
treatment,
vesico-vaginal,
،،
535
511
533
. 511
•
•
•
•
(C
ovary,
K
Ergotine injections in uterine fibroids, 348
Extirpation of the breast,
Exsection
Extirpation of the uterus,
Examination table,
chair,
•
rectal,
►
•
Extra-uterine pregnancy,
Excoriated nipples,
Examination of virgins.
Excessive venery a cause of sterility, 255
49
770
INDEX.
vesico-cervical,.
•
520, 523
528
PAGE.
PAGE.
Fistulæ, vesico-vaginal, treatment, 516, HÆMATOMETRA, . . 198, 345, 502, 505
<<
"L
(C
recto-vaginal,
treatment,
simulating ovarian cystoma, . 294
•
(C
511 Hæmatocele, recto-vaginal,
287
. 511
recto-uterine,
pelvic,
718
716
•
•
516
. 511
516, 526
. 511
532
(C
(C
etiology,
. 716
•
•
66
(6
แ
symptoms,
diagnosis,
prognosis,
treatment,
pudendal,
•
717
. 719
•
720
. 721
•
แ
" treatment,
urethro-vaginal,
66
4
treatment,
intestino-vaginal,
((
66
แ
treatment,
recto-vesical, .
treatment,
ureto-vaginal,
แ
ctiology,
•
diagnosis,
treatment,
Forceps, vulsellum,
แ
lithotomy,
•
uterine dressing,
Nelaton's tumor,
•
.490
748
. 404
511
46
•
•
•
532 Heartburn,
•
•
511, 532 Hernia in women,
•
•
512
.515
"L
532
CC
แ
66
•
แ
(6
of the ovary,
treatment of,
crural,
ischiatic,
. 385
.388
386
886
vaginal,.
386
uterus,
385
•
404
•
•
•
Plate X.
Plate VII.
Plate V, 184
แ
แ
Plate XI.
Front view of uterine organs, . . Plate I.
GANGRENE of the breast,
ovary,
. . 697
. 268
(6
Gastralgia,
""
femoral,.
inguino-labial,
inguinal,
labial,
vaginal,.
748 Hemorrhage,
•
Galactocele,.
. 695
66
uterine,
Gelatiniform cancer,
701
፡፡
66
General diagnosis,
21
66
LL
diagnosis,
Gentleness in examination,
23
"L
treatment,
·
•
•
404
385, 404
385, 404, 491
404
201, 222, 350
201, 222, 254, 500
etiology,.
202
205
205
•
Genitalia, inflammation of in female,
Gestation, abdominal,
62
286, 642
diagnosis,
แ
แ
prognosis,
แ
643
•
644
แ
•
65
66
(6
treatment,
interstitial,.
แ
•
diagnosis,
prognosis,
CC
sponge tents in, . 349
pudendal, .
after ovariotomy, .
644 Hemorrhagic diathesis, .
•
•
·
643 Hemiplegia,
643 Hermaphrodites, .
644
แ
644 Hemorrhoids,
490
•
. 331
treatment of, 332
•
•
203, 493
484
723
·
Plate XXIX.
66
แ
แ
treatment,
•
440 Hidrosis,
tubal,
extra-uterine,
Glandula coccygea,
Globus hystericus,
•
Gonorrhoea in women,
แ
66
แ
แ
''
etiology,.
symptoms,
buboes in,
tt
young girls,
•
•
. 398
73, 759
260
•
130
745
•
130
varieties of,
130
•
286 Hip baths,
Hidrotid fever,
650, 62 Homoeopathic remedies,
. 137
attenuations of, . 137
trituration of, . . 138
. 138
dilution of, . .
fluxion process, . 138
650
. 651
66
€ 653
แ
46
•
treatment, 653
treatment,.
Granulations of the cervix uteri,
653
action of,
•
•
654 | How to make a diagnosis,
•
•
. 353 Hunterian chancre,
139
21
.657
INDEX.
771
197
87
Hydrosalpinx,
PAGE.
Hunterian chancre, treatment of, . . 659 Inversion of the uterus, diagnosis, .
Hydrometra,
Hydatids of the breast, .
เ
**
406
("
699 Inguinal hernia,.
uterus, 352, 353, 356, 372 Inguino-labial hernia, .
treatment of, . 372 | Intra-uterine stem,
Hymen, imperforate,
atresia of,.
•
Hyperplasia, areolar, of uterus, .
cervical, "
corporeal,"
66
<<
26, 197 Inverted uterus, .
•
103
. 104
301, 439
PAGE.
567
•
เ
treatment, . . 569
404
401
€593
563
·
<<
66
(
amputation of,
etiology, .
576
•
. 565
((
diagnosis,
. 567
treatment,.
.569
errors in diagnosis, .
.568
Hyperæsthesia,
แ
·
etiology,
pathology,
diagnosis,
prognosis,
Hydrops, folliculi, .
folliculorum,
(6
tubal, .
•
480
66
•
recent,
.570
480
((
•
chronic, .
. 571
481
((
(
operations for,
572
482
(C
*
66
White's method, 573
483
เ
(( Barnes'
575
277
"
•
Simpson's
575
298
-
{{
((
Thomas'
575
439
((
•
Watts'
575
404
(
((
. 405
spontaneous reduction, . 576
anomalous cases of,. . .577
•
727 Injections of iodine in ovarian cys-
toma,
ergotine in uterine fibroids, 348
304
•
Hydrocele in women,.
Hysterotomy,
Hysterotomes,
،،
Hysteralgia,
•
( treatment,
145, 453
Plate V.
•
*
736 Infractus, .
Hyper-involution of the uterus, . 750, 752 | Indigestion,
Hypertrophy of the clitoris,. 223, 751
((
**
Plate XXIX.
labia majora, . 723, 725
(C
<<
"(
"(
"Plate XXXI.
minora, 723, 724
•
t '
({
(C
66
แ
፡፡ Plate XXX.
treatment, 726
((
"L
93
•
. 487
Induration of the cervix. .
162
(
(4
etiology,
"pathology,
diagnosis,. 166
•
treatment, 167, 171
local
. 155
•
. 165
[C
CC
breast,
((
((
nymphæ,
724 Inflammation of the female genitalia,
treatment, 726
((
(
uterus,
•
. 162, 219, 710
((
171
697
•
60
bladder,
vagina,.
455
•
•
186
ic
،،
CC
cervix uteri,. . 162, 253
((
169, 219
66
breast,
698
Hysteria,.
Hysterical mania,
757
760
=
༤
•
spasms,.
759
(C
convulsions,
paralysis,
759
(<
486
Hysterocele,
INTRODUCTION,.
Imperforate hymen,
Inversion of the uterus,
(<
etiology,.
•
•
. 565
(
Fallopian tubes, . 439
acute, of female genitalia, 62
chronic,
sub-acute,
of the breast,
แ
diphtheritic, of vagina,. 194
385 Intestino-vaginal fistula, .
Instruments, chapter on,
17 Interstitial pregnancy,
gestation,.
26, 197
•
563 Injections into the uterus,
.511
of wine, in ovarian cystoma, 308
urethra,.
14
62, 67
62, 64
chronic sub-acute,
62, 70
671
. 445
•
142
•
. 643
643
•
171
772
INDEX.
Intra-uterine medication, .
PAGE.
PAGE.
229, 713 Leucorrhoea, remedies in, . . 243, 244, 246
special indications for, . 245
Injury to the spine, causing urinary
calculi,.
Insanity,.
462
CC
. 688 Lente's inhaler,
caused from uterine diseases, 479
Incisions of the cervical canal,
Intestinal inhaustion,
•
66
•
•
246, 247
156
•
Plate XI.
169, 346
·
535
465, 467
. 465
465
Plate VIII.
ic
•
. 596
Inhaler, Lente's,.
684, 685
. 156
((
Plate XI.
Iodine injections in ovarian cysts, . . 304
("
309
Ligatures,
Ligature cutter,
Lithotomy in women,
Lithotrity
Lithectasy "
Lithotriptor,
·
·
(C
ic
•
•
•
445 Lithotomy forceps,
not painful,
Irritable urethral carunculæ,
uterus,
66
Ischuria,
•
treatment,
KOLPOKLESIS,.
Kent's nipple shield,
LATERAL displacements of the
uterus,
•
Lacteal tumor of breast,
•
93, 736 Little's antiseptic spray apparatus, . 156
. 646
it
648
Local anesthesia,
London supporter,
537
66
(C
694
66
i
. 563, 603
·
. . Plate VIII.
Plate XI.
756
Plate XII.
Eaton's improved, 158, 665
Plate XII.
Long curved scissors,
66 trocar,
•
((
uterine,.
698 | Luska's gland,
Laceration of the perineum, . 629, 631, 635
((
{{
:
(6
etiology,
diagnosis,
•
630 MAMMITIS,
•
632 Mastitis,
•
•
146
•
125
•
510
398
695
•
695
.695
. 750, 754
CC
،
treatment,
operation for cure of,
633 | Mammary abscess,
•
634
"time for operating, . . 639
"removal of sutures,
treatment,
cervix, etiology,
•
Malformation of the uterus,
Mania, puerperal,
·
640
(
hysterical,
445, 449 Malignant tumors of the breast,
[
((
(6
((
แ
་
(6
(C
66
•
.688
. 760
. . 697
scirrhous, . . 700
encephaloid, 700
melanoid,. . 700
colloid,.
•
700
gelatiniform, 701
(C
: urethra,
•
CC
cervix uteri,
•
•
115, 539
(
a cause of cellulitis, . 115
แ
66
CC
vagina,.
629
(C
(C
66
630
แ
((
(6
541
. 545
((
*
. 550
<<
186, 190
404, 491
((
((
(C
(L
((
726
"C
·
of the breast,
•
•
•
700
•
406
(
"diagnosis,.
66
"
treatment,
Labia, adhesions of, .
hernia into, .
tumors of,
•
""
alveolar, . 701
of the uterus, . 395, 400
،،
scirrhous, . 400
encephaloid, 400
66
པ
abscess of,
แ
66
" etiology,
•
407 Metrorrhagia,
C6
"
(
66
diagnosis,
treatment,
•
408 Menorrhagia,
·
409
•
•
etiology,
•
hypertrophy of,.
Leucorrhoea,
vicarious of menstruation, . 34
treatment,
Metro-phlebitis, .
peritonitis,
.723
240, 670
(<
แ
color of discharge,
diagnosis,
•
(( treatment,
·
Fallop'n tubes, 439
•
41
41, 222
42
43, 45
·
126
240
Menstruation,.
►
126
19, 31
240
((
·
idiosyncrasies of, 19, 31, 32, 242
242
66
vicarious,
34
INDEX.
773
32
etiology,
•
(C
66
prognosis,
34
36
CC
પ
treatment,
•
caused from psychical
influences,
simulating phthisis,
profuse, .
36
·
Menstruation, time of cessation,
arrest of, .
PAGE.
•
494
31, 223, 242
suppression of, 31, 223, 242
66
symptoms,
Moles in the uterus, treatment,
Mucous polypi of the uterus,
patches,
•
•
PAGE.
· 376
352
. 655
439
736
ovaries (see Dysmenorrhoea), 46
Myoma of the tubes,
NEURALGIA of the uterus,
(C
Neuromata of the vulva,
35
Nelaton's tumor forceps,
•
•
36
•
41
•
:
excessive,
painful,
41
•
CC
46
Method of making vaginal examina-
tions,
Medicated suppositories,
Metatithmenia,
Menopause,
•
Medicated baths,
Metritis, acute,
CC
diagnosis,
CC
Neck of the bladder, fissures of, .
Nelson's tri-valve speculum,
(
Needle-holder, Eaton's,
143
Plate IV.
145
·
739
365
Plate XI.
•
445
•
Plate VI.
21
"6
229, 713
Sims',
. 719
Needles, electrolysis,
·
520
160, 370
•
CC
496
in ovarian cystoma, . 309
745
Pease's,
•
66
77
suture,
•
78
open-eyed,
. 148
Plate XIII.
326
•
79
·
80
•
82
66
CC
X
པ
cervical,
CC
•
treatment,
complications of,
•
tendency to dropsy in, .
amaurosis caused from,
sterility
abortion
menstrual derangements
caused from,
remedies in,.
Non-malignant tumors of the ovaries, 275
82 Nipple shield (Kent's), .
66
83
83
•
83
excoriated,.
fissured,
retracted,
Nidation, .
84 Nidal decidua,
84 Nonentities,
•
•
691
.692
692
. 693
46, 49
49
(C
(C
uterus, 352, 395
breast, 698, 699
(C
general effects of,
•
chronic parenchymatous,
Milk-leg, .
diagnosis,.
etiology,
723
•
83
or hermaphrodites,
723
•
87
CC
**
Plate XXIX.
•
705 Normal position of the uterus,
•
•
554
706
((
•
(C
ce
в
Plates I and II.
707 Non-malignant tumors of the breast, 697
treatment,
Milk tumor of breast,
(C
fever,.
abscess,
•
diet,
Mono-cysts of the ovary,
Morphia, hypodermic injection of, . . 81
CC
Moles in the uterus,
•
708
.698
(
(C
(
((
fatty,.
fibro-cystic,
•
694
แ
. 695
((
"
of the uterus,
fibroid, 292, 302, 342
70
"
((
((
"L
subserous,
298
แ
(
(L
submucous,
แ
((
of the labia,
.700
346
352
343
343
726
objections to, 81
of the ovary,
294
. 375
((
((
((
((
cystic,
294
CC
(C
etiology,
375
(C
(C
<<
(C
deficiency of spermatozoa
(C
((
(C
((
fibro-cystic,
fibroid,
294
300
a cause of,
376
((
((
·
of the Fallopian tubes, .
443
135
'
35
25
diagnosis,
•
376 Nott's depressor,
522
<<
prognosis, .
. 376 Nursing sore mouth,
747
774
Nymphomania,
INDEX.
PAGE.
724, 750 Ovaritis, diagnosis,
etiology,.
66
symptoms,
diagnosis,
treatment,
•
Nymphæ, hypertrophy of,.
750
•
treatment,
•
•
751 Ovariocentesis,
751 Ovariocele,
·
}
•
PAGE.
. 268
•
. 269
310
. 389
752 Ovarian cyst, rupture of,
724
•
•
•
. 310
permanent opening into, 309
OBJECTIONS to abdominal support-
ers not tenable,
Objections to the ligature in the re-
moval of uterine polypi,
Occlusion of the Fallopian tubes,
66
แ
Oligocysts of the ovary,
Open-eyed needle,
·
•
Opium habit, remarks on,
statistics of,
•
congenital, 442
Operations for stone in the bladder, . 467
Operating table,.
Opisthotonos,
Os uteri, ulceration of,
(
virgin,.
((
66
66
in old age,
·
319, 703
•
759
179
•
treatment,. . 185
"Tumors,.
. 275
(6
classification of,
. 275
158
66
etiology,
. 276
(6
แ
symptoms,
. 281
367
((
differential diagnosis,
. 283
.439
prognosis,
. 303
•
(C
(6
treatment,
. 303
•
298
"
(6
diagnosis from cellulitis,
. 288
•
326
81
(C
"from enlarged liver,
. 287
fecal tumors,
. 287
<<
(C
81
"retro-uterine hæmotocele, . 287
.
"abdominal ascites,
•
. 290
26
64
27
"C
hernia of,.
•
66
after lacerations,
Ossification of the arteries a cause of
atrophy of the uterus,
Ovaries, prolapse of, .
•
treatment,
displacements of,
removal by operation,
·
162
CC
((
•
t
753
CC
""uterine fibroids,
417
"
•
419
<< CC
•
•
•
385
385
(C (C
cases of,
388
diseases of,
265
66 CC
•
པ
malformation of, .
265
(6
"
"of
(6
cancer of,..
387
carcinoma of,
300
"" varieties of,
·
*
པ
แ
*
papilloma of,
enchondroma of,
osteoma of, .
fibroid tumors of,
inflammation of, .
•
•
cystic tumors of,.
fibro-cystic tumors of,
oligocysts of,
·
(" dermoid cysts of,
gangrene of,
Ovaritis,.
chronic sub-acute,
•
395
·
•
"" causes of,
ཝཱ
"L
པ
46
(
66
པ
"
*
"hydatids of the omentum, 291
•
cyst of the uterus,
"dropsy of the amnion,
((
floating kidney,
"pelvic abscess, .
"distended bladder,
pregnancy,
.294
. 293
292
•
•
•
295
"extra-uterine pregnancy,
•
295
. 285
. 286
292
"carcinoma of fundus uteri, . 292
""hæmatometra,
•
294
•
cyst of the broad ligament, 301
""hydrosalpinx,
"
. 301
cysts of mesenteric glands, . 302
""fibro-cyst of the uterus, .302
"C
comparative differential,
of adhesions of, . .
""conditions mistaken for,
.
. 296
296
289
275
. 276
•
·
300
·
derangements of mentruation in, 279
•
300
.300
(4
"sterility as a cause,
66
etiology,
•
"sometimes congenital,
แ
"rectal examination in,
"" stages of development,
treatment,
•
. 279
280
case,
. 281
282
. 283
303
304
312
272
.305
"by iodine injections,
. 265
(C
298
298
298
፡፡
275
(C
268
surgical,
265
(C
"medical,
266
((
268
•
jecting,
experience in tapping and in-
INDEX.
775
Ovarian tumors, use of gum-elastic
((
tube in,
"wine as an injection in,
" iodine
" modus operandi of treatment
by injection,
"electrolysis in treatment, . . 309
cystoma, spontaneous rupt're of, 310
((
fibroids,
แ cyst, rupture of, .
''
Ovariotomy,
(C
•
history of,
•
•
objections to,.
•
•
•
312
"permanent opening into, .
PAGE.
308
•
Parenchymatous metritis, Dr. Thomas
on,
.308
Dr. H. Bennett on,
PAGE.
89
90
•
304
Dr. Graily Hewitt on, . 92
66
Dr. Noeggerath ou,.
92
. 309
Dr. Peaslee on,
92
(C Dr. Kammerer on,
Dr. Kiwisch on, .
93
93
300
"
Sir James Simpson on,
95
.310
309
Pathology of,
•
Dr. West on,
95
97
312, 313, 314
314
66
Dr. Snow Beck on, 97
course and termination, 100
predisposing cause, . . 101
66
when should it be performed?
. 315
exciting
46
แ
when improper,
((
time of the year for,
place,
causes of death from,
•
when it should be abandoned,
preparatory treatment,
316
(C
316
•
318
•
317
· 103, 104
. 318 Palliative treatment in uterine
·
318
fibroma,
the operation for, by gastrotomy, 321 Palmer's uterine dilator,
different methods of operating, 328
แ
vaginal,.
·
·
335
·
((
.105
106
treatment of the pedicle in, 325, 328 | Patient, efforts of, to mislead the physi-
(C
symptoms,
physical signs,
" prognosis,
•
. 101
. 102
treatment,
349
. 146
.
แ
66
Plate VIII.
applicator, .
. 715
"after operation,.
"of pedicle by torsion,.
•
327, 331
329
cian as to her disease,
Pains, bearing-down,
19
•
220
by tors'n of separate vessels, 329
Para-metritis, .
113
66
by the clamp,
•
.329
Paquelin thermo-cautére,
460
"
"" by ligature,
328
Pain in the sacral region as a
hemorrhage after,
331, 332
symptom,
221
septicemia or pyæmia after, . . 332
66
loins as a symptom,.
. 221
•
CC
CC
(<
vomiting after, .
"treatment, 333
333
Peri-metritis, .
·
110, 218
(C
abscess in abdominal muscles
Co
symptoms,
etiology,.
•
•
after,
•
385
แ
CC
·
sequelæ,.
treatment,
•
PAINFUL menstruation,
Papilloma of the ovaries,
395
Papillary tumors of the ovaries, 301, 395
46 Pelvic cellulitis,.
etiology,.
•
•
110
. 111
112
111
110, 113
115
symptoms,
66
(C
CC uterus, . .395
•
prognosis,,
CC
"treatment, 396
CC
"(
treatment,
▼
Paraplegia,.
(6
diagnosis,
(< treatment,
Paralysis,
diagnosis,
treatment,
•
•
484
485
486
*
tr
complications of,
caused from lacerated cer-
•
vix uteri,
·
hysterical,.
Parenchymatous metritis, .
484 Pedicle of ovarian tumors,
clamp in ovarian tumors, . 160
485
•
•
•
486
486
87
C
<<
tr
321
Dawson's,
"Spencer Wells' original,
Plate XV.
116
•
119
122
•
120
115
•
•
300, 328
776
INDEX.
PAGE.
Pedicle clamp in ovarian tumors, new,
PAGE.
،،
((
Plate XV.
Thomas', Plate XV.
Peritonitis, puerperal, treatment,
false,
133
•
131
•
Peritoneo-vaginal fistula,
•
•
537, 538
(6
แ
((
objections to,
(L
((
((
advantages of,
•
((
treatment of, in ovariotomy,
. 328
66
(C
((
by crushing,
"L
(C
((
ligature,
((
((
the actual cautery,
•
•
325, 328
328
329
329 Perineo-vaginal fistula,
328 Phlegmasia dolens,
537
treatment of, . 538
treatment of, 538
·
705
(
diagnosis,
706
·
(L
(6
((
((
(
པ
((
torsion of separate vessels, 329
transfixing it to the abdo-
etiology,
"treatment,
707
.708
•
•
"post-mortem appearances, 707
men,
330
Physometra,
295
Peri-vaginitis phlegmonosa dissecans, 195
Pediculi,.
Pelvic hæmatoma,
hæmatocele,
source of the hemorrhage in, 716
•
•
•
408, 409
Placenta previa, .
204
Placental polypus,.
354
716
Polypi of the urethra,
445
716
Polypi of the uterus,
352, 354
"
fibrous,
352, 353, 354
etiology,
716
<<
etiology,.
354
•
•
symptoms,
717
(C
(C
66
diagnosis,
357
•
3
66
((
differential diagnosis,
719
tr
(C
((
((
prognosis,
treatment,
abscess,.
720
•
. 721
3
:
≈
(C
differential diagnosis, .
360
prognosis,
362
66
treatment,
363
•
·
110, 295, 718
46
(C
((
((
etiology,
115
(C
((
·
CC
symptoms,
"prognosis,
"
treatment,
·
•
. 116
. 119
122, 125, 722
Peaslee's improved perineum needle, . 147
66
Pease's needle,
Pessaries, vaginal,
แ
66
"the use of abdominal support-
ers in connection with,
clastic,.
ཡ
(C
314
66
(" Plate VI.
148
པ
39
ະ
33
66
•
•
148, 236, 593, 603
"C
*
(C
149
<<
(C
•
149
(( 66
•
66
cup and stem,
objections to,
149, 150
C
(C
148, 149
(C
Perineum needles, .
•
lacerations of,
diagnosis,
629, 631
632
treatment,
operation for,
•
time of,
•
•
634
.639
640
(
operation for removal of, 364
use of ecraseur in,
treatment,
vascular,
((
((
mucous,
hydatid,
•
placental,
·
369
352
372
·
354
•
. 352
352, 353, 356
•
cystic,
•
353, 356
367
·
ligature in treatment,
sponge tents in
removal by torsion,.
treatment of cystic, .
365, 369
. 367
. 371
•
hydatid,.
. 372
(small) treatment,
147 Polypi of the vagina,
Potencies,
Poly-cysts of the ovary,
633 Pruritus vulvæ,.
•
•
•
·
373
406, 417
137
299
406, 664, 670
etiology,
((
diagnosis,
treatment,
. 407
408
. 409
503, 605
removal of sutures,
Peri-uterine hæmatocele, .
Perineorrhaphy,
Peritonitis, puerperal,
623
126
"
•
symptoms,.
•
(C
etiology,.
129
131
(
((
•
((
*
prognosis, .
complications, . 132
132
16
"
718 Prolapsus uteri,
((
•
etiology,
"pathology,.
symptoms,.
•
606
606
613
differential diagnosis, . 614
causing throat trouble, 29
treatment,.
. 215
INDEX.
777
PAGE.
Prolapse of the ovaries, . . 406, 417, 419 Puberty,
(C
66
((
vagina,
CL etiology,
•
PAGE.
494
.389
treatment of diseases of,
498
►
·
•
389 Pyosalpinx,
439
•
•
(
(
diagnosis,
•
.390 Pyæmia after ovariotomy,
332
{{
(
t
((
treatment,
urethra,
bladder,
Procidentia uteri,
•
•
•
etiology and pathol.,
563, 605
•
. 391
·
445 QUILL suture,
637
•
389
{{
({
adjusted,
638
•
cut of,
638
. 606
symptoms,
•
. 613
RAPID dilatation of os uteri,.
146
((
differential diagnosis,
614 Rectal examination,
30
แ
แ treatment,
515
alimentation,.
. 683
((
surgical,
623 Rectocele,.
.389
385
375, 498
660, 672
tubal,
*
*
((
**
prognosis,.. 644
treatment, 644
•
abdominal,
•
molar,
vomiting in,
►
Processus vaginalis peritonæi,
Pregnancy, false, .
diseases of,.
treatment,
extra-uterine,
diagnosis,
410, 642 Recto-vaginal fistula,
442
642, 286
643
Rectitis as a complication of pelvic
Removal of sutures,
642 Retro-uterine hæmatocele,
symptoms,
"differential diagnosis, 719
Retracted nipples,
. 693
Retention of urine,
. 646
t
treatment,
. 648
. 511
treatment, . 528, 531
vesical
((
แ
511, 531
cellulitis, .
. 121
535
287, 716
66
etiology,
((
treatment,
•
375
668, 672
،،
(C
(
673
(
674
(
717
▼
Primary syphilis,
shall abortion ever be
·
induced to relieve? 675
1C
prognosis,
treatment,
720
721
Recto-vaginal hæmatocele,
716, 287
symptoms,
717
.657
differential diagnosis, 719
<
(
367, 556
t
prognosis,
"treatment,
720
721
137
Reversible catheter, .
457, 466
498
126
351
•
Pressure, effect of in uterine polypi, . 369
"
atmospheric,.
in treatment of uterine
Pseudocyesis,
Puerperal fever,.
•
(C mania,.
metritis,
phlebitis,
peritonitis,
(
•
displacements, 367, 556
+
symptoms,
CA
etiology,
•
"prognosis,
Remedies homoeopathic,
Removal of the ovaries for hemorrhage
caused by uterine fibroids,
688 Retro-version of the uterus, 563, 578, 663
126
705
(
*
126
C
،،
CC
129
(6
etiology, .579
diagnosis, . . 581
treatment, . . 587
in pregnancy, 589
131 Retro-flexion of the uterus,... 563, 578
132
etiology, .579
complications,.
132
post-mortem appearances, 133
(C
6
((
treatment,
Pudendal hemorrhage, .
·
diagnosis, 581
treatment,. 587
. 269
36
133 Remedies in acute ovaritis,
amenorrhoea,
areolar hyperplasia, . . 107
. 490
แ
((
treatment,
·
•
hæmatocele,
492
490
(C
((
((
cystitis
CO
treatment, .
({
.492
dysmenorrhoea,
461, 467
54
778
INDEX.
PAGE.
แ
แ
"l
((
((
Remedies in hysteria,
leucorrhoea,.
•
•
462 Sound, uterine, Skene's,
243
((
((
•
menorrhagia,
44
steel,
•
"
((
metritis,
pelvic cellulitis,.
"peri-metritis,
"prolapsus uteri,.
puerperal mania,
84
66
PAGE.
·
144
Plate V.
•
144
Plate V.
122
'
Simpson's,
144
·
•
111
66
•
•
Plate V.
. 626
แ
•
. 691
Spontaneous rupture of the uterus in
((
"
((
((
แ
((
((
"(
sterility,
peritonitis, . 134
phlebitis, . . 708
. 708
. 261
(1
hard rubber,.
uterine fibroid,
Spencer Wells' clamp,
original clamp, Plate XV.
144
•
•
•
346, 362
. 160
Plate XV.
66
"(
"
stomatitis materna, . 749
stone in the bladder,. . 470
sympathetic affections, . 487
•
CC
trocar,
320
artery forceps, .
. 322
.759
·
662, 666
. 143
threatened abortion, . 429 Spasms, hysterical,.
vaginitis,.
Round elastic pessary,
·
•
. 217
Li
puerperal,
·
149 Speculum, Wocher's bi-valve,
Rupture of the bulbs of the vestibule, 490
((
351
spontaneous, of the uterus,
from uterine fibroids,
SARCOMA of the uterus,
400, 402
Salpingitis,
•
·
Sclerosis
((
Scirrhus
((
((
breast,.
•
•
439
100, 105
. 400
. 700
Sero-cystic tumors of the breast, . . 698
Sexual intercourse a cause of inflam-
((
•
66 interdicted in pregnancy,
Septicæmia,.
Septæmia,
•
(C
(C
Nelson's tri- valve,
(6
Ferguson's mirror,
((
Sims' original,
((
mation, 60, 224, 233 Sponge teuts, .
669
332
·
332
(C
པ
230
(
537
folding,
Plate IV.
143
•
Plate IV.
·
143
Plate IV.
142
·
Plate III.
142
•
Plate III.
Dawson's improved, . 142
•
Plate III.
150, 230, 349, 350, 365
602, 713
in treatment of fibroids, 349
in flexions,
. 596
Sea-tangle tents, .
Simple vaginal fistula,
Sims' operation for vesico-vaginal
Simon's
แ
Sims' vaginal dilator, .
original speculum,
fistula, 534 Sphygmographs, .
535 Steps to be taken in making a vaginal
examination,
dilator, Emmet's,
151
•
(C
Plate IX.
bath,
745
. 161
(6
C
،،
folding
''
"
แ
66 uterine elevator,
แ
.(
enucleator,
Simpson's sound,
แ
hysterotome,
Sound, uterine,
<<
Plate VI.
·
•
Plate III.
Strangury,
142
etiology,.
•
142
"
diagnosis,
•
Plate III.
"
prognosis,
treatment,
21
646
•
. 646
647
647
. 159
Plate XIV.
347
144
•
Stem pessaries, objections to,
Straight needle forceps,
Plate V. Stone in the bladder, .
. 648
.593
. 526
lithotomy forceps, .
Plate VIII.
. 462
•
145
(
. Plate V.
•
22
<<
CL
symptoms,
diagnosis, .
treatment,.
468
464
464
·
•
INDEX.
779
PAGE.
Stone in the bladder, operation for, . 467
66
66
(
after treatment, 470
•
PAGE.
655
symptoms and diagnosis, . . 657
•
.658
Syphilis, how contracted,
470
(( treatment,
Syringe for injecting fibroids,. . 171
Sympathetic affections, .
·
472, 487
remedies for,
removal by lithotrity, 465
Stenosis of the uterus,
Sterility,
•
'
cervix uteri,
66
lithectasy, 465
•
•
•
452
452, 256
treatment, 453
as a result of pelvic cellulitis, 120
Syphilitic ulceration of the vagina, 629
•
•
treatment, 477, 486
electricity in, . 479
249
•
TAPPING,
739, 743
255, 358
Tampon, vaginal,
350, 363
257 Tenesmus, uterine,.
747 Tents, sponge, 150, 230, 349, 365, 602, 713
. 220
diagnosis,.
treatment,.
•
Stomatitis materna,
etiology,
symptoms,
diagnosis,.
(3
747
747
sea-tangle,
cotton,
230
229
747 Tenaculum, Bozeman's,
·
แ
treatment,
748 Tetanus,
Plate XIII.
759
•
Suppression of the urine, .
646
. Plate XV.
แ
(6
·
490, 716, 722, 726
46
66
Eaton's,
menstruation, . . 268
Sub-acute inflammation of the
uterus, .
. 62, 64
Suppositories, uterine, medicated, 713, 229
Suspended animation,
Suture needles,
•
Supports of the uterus,
Thomas' clamp,
Thrombus, .
Tiemann & Co.'s aspirator, Plate IX.
•
Tolerance of the system to abnormal
conditions,
Trocar, Spencer Wells',
•
•
756
Plate XIII.
66
long curved,
•
559.
แ
uterine,
Treatment of acute metritis,
•
Plate XII.
Tri-valve speculum, .
·
157
Supporters, abdominal,. 156, 157, 557, 558
(C
CL
479
320
125
710
80
Plate IV.
•
66
•
158
((
CC
66
Old London,
Plate XII.
Plate XII.
Treatment of ovarian cysts with iodine
uterine fibroids (submucous)
injections,
301
with sponge tents,
. 349
Silk elastic, .
158
•
palliative of uterine polypi, 349
Plate XII.
*
Babcock's uterine, 149
M'Intosh's
150
Triturations of remedies, .
Transmissibility of syphilis,
Tumors of the breast,
. 138
. 655
.697
Sub-acute ovaritis,.
Subserous fibroids of the uterus,
Submucous
Sub-involution of the uterus, 219, 709, 710
symptoms, . 710
etiology,.. 711
แ
แ
(C
(<
results
treatment,
266
non-malignant, 699
343
malignant, 692, 700
343
66
•
(C
cancerous, 692. 700
fatty,
. 700
Success of iodine injections in ovarian
cystoma,
Swing bed,
•
Symptoms of uterine disease,
Syphilis in women,
(C
secondary,
(C
tertiary,
•
709
•
712
304
•
*
labia,
uterus,
44
fibrous,
polypoid,
. 343
•
. 352
vagina,
ovarian, .
•
•
406, 417
. 275
338 Tubal gestation, .
•
440, 643
21
655
pregnancy,
operation,
•
440, 643
.443
655 Tubes, Fallopian, diseases of, .
439
655
6C
cancer of,.
443
.726
. 352
780
INDEX.
PAGE.
Tubes, Fallopian, displacements of,
•
443 Uterus, hypertrophy of, .
Tuberculosis of the uterus,
403
"
•
vagina,.
•
451
'
bilocularis,
irritable, .
Fallopian tubes, . 443
Tuberculous ulceration of vagina, 629
PAGE.
162, 219, 709
•
755
. 93, 736
"hyper-involution of, 255, 259, 750
•
((
•
hydatids of,
•
Tumor forceps,
·
Tympanites,.
Plate XI.
((
•
hydatids of, treatment,
487
supports of,
normal position of,
356
•
372
•
539
554
ULCERATION of the vagina,
(L
66
cancerous, . 629
syphilitic, . 629
629
((
((
((
•
•
"Plates II and III.
((
«
inversion of,
"C
ཅ
((
33
urethra,.
((
os uteri,
((
•
. 449
แ
179
(C
etiology,
diagnosis,
•
treatment,.
563
565
. 567
.569
66
cervix uteri, . 179
•
(( causes of, 180
diagnosis, 183
66
66
66
(L
"treatment, 185
((
((
ic
of chronic cases, 571
of operation for,
·
. 572
Simpson's operation for, 575
Urine, suppression of,
retention of, .
Urethritis,
Urethro-vaginal fistula,
Ureto-vaginal fistula,
Uræmia,
Urethra, diseases of, .
inflammation of,
prolapse of, .
ulçeration of, .
fissure of,.
caruncles of,
polypi of,.
Urinary calculi,.
•
"L
Thomas'
("
575
646
(C
(C
•
Barnes'
((
575
646
66
((
Watts'
"
ic
575
445
!
White's
(6
"(
573
511
CC
((
•
. 511
CC
66
284, 662
<<
<<
445
•
445
-
445
(C
·
445
445
(6
•
extirpation of,
•
445
(C
(
((
•
445
462
•
(C
prolapse of,
·
446
CC
•
•
77, 126
CC
•
·
736
64
452
'
453
(6
((
•
•
380
381
((
(C
381
(C
treatment by amputation, 576
spontaneous reduction, . 576
anomalous cases of,
displacements of,
CC
ablation of,
·
symptoms, . 561
treatment, . 562
727, 346
experience in,.
cases of,.
treatment,.
procidentia of,
66 treatment,
retro-flexion of,
(
etiology,
diagnosis,
729
. 727
. 729
563, 605
563, 605
. . . 615
563, 605
.579
. 581
treatment, . . . 587
retro-version of, . . . 563, 578, 663
•
. 577
·
552, 663
•
etiology,.
561
.. 615
•
·
383
(C
•
•
66 66 caused from spinal injury, 462
Urethral speculum bi-valve,
Uterus, inflammation of,
"L
neuralgia of,.
stenosis of,
treatment,
(( catarrh of,.
((
(
แ
แ
แ
((
" cancer of, .
etiology, .
diagnosis,
treatment,
malformation,
tuberculosis of,
abscess in,.
แ
66
"(
แ
((
167, 400
750, 754
C
66
C6
แ
etiology, .
diagnosis,
.579
•
. . 581
(6
treatment,
•
. 587
403
((
lateral flexions,
•
563, 603
241
(C
ante-version of,
•
563, 598
219, 709
(
etiology and diagnosis, 599
LL
((
symptoms,
. 710
((
66
(<
"treatment, .
•
"
etiology, .
"
"
แ
แ
effects of,
711
.709
"C
(6
(4
(C
ante flexion of, .
66 etiology and diagnosis, 599
.600
563, 598
((
((
แ
treatment, .
712
"treatment,.
.600
sub-involution of,.
INDEX.
781
Uterus, elevation of,
(<
ic
(C
"
•
papillary tumors of, .
carcinoma of,
•
PAGE.
PAGE.
563, 775 Uterine fibroids treated by ergotine
Plate XXVIII.
395
·
292, 400
injections,
348
fibro-cyst,
. 291
polypi, vascular,
.352
•
(6
fibro-cyst of,
•
<<
tumors of,
แ
polypi of,
"C
302
((
แ
66
•
treatment of, .
.372
292, 302, 342, 352
((
mucous,
352
352
((
·
treatment,
372
•
scirrhus of,
•
encephaloid of,
•
400
hemorrhage, . 201, 222, 254, 500
400
•
Li
sarcoma of,
•
400 VAGINAL examination,
22
cauliflower excrescence of,.
hemorrhage from, 201, 222, 254, 500
Uterine organs, front view,
•
•
Plate I.
•
.400
CC
66
side view,
C
trocar,
66
•
r
electrode,
applicators,
•
·
repositor, White's,
dressing forceps,
"
•
et
sounds,
Plate II.
•
•
510
714
. 715
. 573 Vaginitis,
. 184
Plate V.
•
22
"
•
washes,.. 233, 603, 744, 746
ovariotomy,
•
. 335
pessaries, 148, 236, 593, 603
fistulæ,
simple,
blind,
•
. 511
. 537
. 537
other varieties, . . 537
treatment of, .
remedies in,
diphtheritic,
•
•
.
186, 219, 254
. 189
•
. 192
194
(6
•
Plate V. Vagina, inflammation of,
CC
diseases, symptoms of,.
dilator,
elevator,.
21
CC
•
cysts of,
. 186
406, 414
€ 146
r'
pathol. anat.,
414
Plate VIII.
"
"
CC
etiology, .
414
•
Plate XIV.
(C
(C
<<
Sims',
159
(C
(L
པ
CC
Plate XIV.
((
((
*
་
"
Elliott's,
.
. 159
t
Plate XIV.
"
<<
tenesmus,
220
•
་
CC
colic,
(C
myoma,
(<
fibroids,
586
•
342
302
•
(*
*
stem pessary objectionable, .593
cervix, lacerations of,
•
.539
injections, caution against, . . 216
tr
symptoms,
"diagnosis,
treatment,
fibroids of,
polypi of,
catarrh of the,
prolapse of, .
hernia of, .
atresia of,
406, 417
406, 417
. 186, 380
389, 406
404
. 502
operation for, . . 507
lacerations of,
•
.629
cancerous ulceration of, . . .629
415
415
415
•
CC
polypi,
"
•
etiology,
morbid anatomy,
diagnosis,
differential diagnosis, . 360
(
66
treatment,
CC
((
.352
354
354
•
357
syphilitic
629, 655
tuberculosis of, .
fissures of,
. 451
630
fistula of,
. 511
Vaginal tampons,
363
350, 363
352, 372
343
•
•
162, 172, 254
(C
375
•
symptoms,.
eticlogy,.
376
•
treatment,
. 174
. 175
. 176
376 Vegetations of the endometrium, 352, 353
sponge tents in treatm't, 349
operation for removal of, 364
352, 356
hydatids,
<<
moles,
(< causes of,
treatment,
tr
fibroma,.
•
•
Vascular polypi of the uterus,
Varieties of uterine fibroids,
Vaginismus,
•
342
(C
355
782
INDEX.
" operations for, . 523
#
•
•
Vesico-cervical fistula, .
Vesico-vaginal fistula, artificial, for
relief of chronic cystitis,
Virgin os uteri,
<<
•
examination of,
Vicarious menstruation,
८८
26 Wocher's bi-valve speculum,
34, 56, 498 Womb, inflammation of, .
treatment of,. 58
Vomiting in pregnancy,
"
"
(6
(4
(C
. . .668, 672
diagnosis, . .674
treatment, . . 674
after ovariotomy,
Vulvæ, pruritus of, 406, 409, 664, 670
•
•
PAGE.
Venery, excessive, a cause of sterility, 255 | White's hysterotome, .
Vesico-vaginal fistula, . . . 511, 520
C
Vesico-uterine fistula,
•
ic
hysterotome, .
treatment of inversion,
((
"
Watts'
Whites (leucorrhoea), .
66
PAGE.
145
•
•
•
Plate V.
573
511, 531
.575
. 531
. 240
Wire holder and twister, Eaton's,
.146
•
.458
แ
แ
แ
LL
((
Plate VI.
143
24
(C
"
Plate IV.
77, 126
((
((
แ
"L
chronic,.
. 62, 70
tumors of,
symptoms of disease of, .
(see Uterus.)
343
31
CC
neuromata of,
Vulsellum forceps, .
WASHES, vaginal,
Weed in the breast,
Wells' clamps,
66
66
333
treatment,. 334 | YOUNG GIRLS, gonorrhoea in,
.653
•
"L
vaginitis in,.
. 191
739
"
แ
treatment of,
. 191
Plate X.
menstruation in,
31
•
แ
•
233, 603
· 695
160
Plate XV.
"(
atresia of cervix uteri in, 505
time and symptoms of pu-
berty in,
494
•
แ
treatment of diseases pe-
culiar to,
•
498
•
FINIS.
:
A
BOERICKE & TAFEL'S
HOMOEOPATHIC PUBLICATIONS.
ALLEN, DR. T. F. The Encyclopedia of Pure Materia Medica;
a Record of the Positive Effects of Drugs upon the Healthy
Human Organism. With contributions from Dr. Richard Hughes, of
England; Dr. C. Hering, of Philadelphia; Dr. Carroll Dunham, of New
York; Dr. Adolph Lippe, of Philadelphia, and others. X volumes. Price
bound in cloth, $60.00; in half morocco or sheep,
$70 00
This is the most complete and extensive work on Materia Medica ever
attempted in the history of medicine-a work to which the homœopathic
practitioner may turn with the certainty of finding the whole pathogenetic
record of any remedy ever used in homoeopathy, the record of which being
published either in bookform or in journals. The volumes average about
640 pages cach. The work is now completed, and an index or symptom
register to the Encyclopedia will be issued within a short time.
ALLEN AND NORTON. Ophthalmic Therapeutics, by Timothy
F. Allen, M.D., Surgeon to the New York Ophthalmic Hospital, Professor
of Materia Medica and Therapeutics in the New York Homœopathic
Medical College, and Geo. S. Norton, M.D., Surgeon to the New York
Ophthalmic Hospital, and Ophthalmic and Aural Surgeon to the Homoeo-
pathic Hospital on Ward's Island. 269 pages, 8vo. Cloth, . $2.00
"This work contrasts favorably with many similar treatises. It has not been
written by inexperienced practitioners, but of men who write of that which they have seen-
of that which they have accomplished.
It is, in short, a useful book, and as such
we commend it to the study of our readers."-Monthly Hom. Review.
ANGELL, DR. H. C. A Treatise on Diseases of the Eye; for the
Use of Students and Practitioners. By Henry C. Angell, M.D.,
Professor of Ophthalmology in the Boston University School of Medicine,
Fifth edition, enlarged and illustrated. 343 pages. 12mo.
$3 00
etc., etc.
Cloth, .
The fifth edition of this standard work has just been issued from the press, and shows that
the whole work has been thoroughly revised and brought up to the latest dates in ophthal-
mology. Exquisite clear photographic illustrations have been added, and an exposition given
of the dioptric or metric system, as applied to lenses for spectacles.
BAEHR, DR. B. The Science of Therapeutics according to the
Principles of Homoeopathy. Translated and enriched with numerous
additions from Kafka and other sources, by C. J. HEMPEL, M.D. Two
volumes. 1387 pages,.
$9.00
"In short Dr. Baehr has presented us with the results of his observations at
the bedside rather than of his researches in the study. It is this which renders his work
valuable and which at the same time accounts for his occasional imperfections. We know
BOERICKE & TAFEL'S
2
of no work of the kind in homeopathic literature where the suggestions for the choice of
medicines are given in a fresher or clearer manner, or in one better calculated to interest
and inform the practitioner. We have only to add that the two volumes are highly credit-
able to the publishers. The type is good, the paper good, and the binding excellent."-
Monthly Homœopathic Review.
·
BECKER, DR. A. C. Dentition, according to some of the best
and latest German authorities. 82 pages. 12mo. Cloth,. 50 cts.
BECKER, DR. A. C. Diseases of the Eye, treated homœopathi-
cally. From the German. 77 pages. 12mo. Cloth,
50 cts.
BELL, DR. JAMES B. The Homœopathic Therapeutics of
Diarrhoea, Dysentery, Cholera, Cholera Morbus, Cholera In-
fantum, and all other loose evacuations of the bowels. 168
pages. Bound in Muslin. 12mo. Cloth,
$1 00
This little book had a very large sale, and but few physicians' offices will be found with-
out it. The work was, without exception, very highly commended by the homeopathic
press.
BERJEAU, J. PH. The Homœopathic Treatment of Syphilis,
Gonorrhoea, Spermatorrhoea, and Urinary Diseases. Revised,
with numerous additicus, by J. H. P. FROST, M.D. 256 pages. 12mo.
Cloth,
$150
"This work is unmistakably the production of a practical man. It is short, pithy, and
contains a vast deal of sound practical instruction. The diseases are briefly described; the
directions for treatment are succinct and summary. It is a book which might with profit
be consulted by all practitioners of homeopathy."-North American Journal.
BREYFOGLE, DR. W. L. Epitome of Homœopathic Medi-
cines. 383 pages,
Interleaved with writing paper. Half morocco, .
We quote from the author's preface:
$1 25
$2 25
"It has been my aim, throughout, to arrange in as concise form as possible, the leading
symptoms of all well-established provings. To accomplish this, I have compared Lippe's
Mat. Med.; the Symptomen-Codex; Jahr's Epitome; Benninghausen's Therapeutic Pocket-
Book, and Hale's New Remedies."
BRYANT, DR. J. A Pocket Manual, or Repertory of Homoeo-
pathic Medicine, Alphabetically and Nosologically arranged, which
may be used as the Physicians' Vade-mecum, the Travellers' Medical Com-
panion, or the Family Physician. Containing the Principal Remedies
for the most important Diseascs; Symptoms, Sensations, Characteristics
of Diseases, etc.; with the Principal Pathogenetic Effects of the Medi-
cines on the most important Organs and Functions of the Body, together
with Diagnosis, Explanation of Technical Terms, Directions for the selec-
tion and Exhibition of Remedies, Rules of Diet, etc. Compiled from
the best Homœopathic authorities. Third edition. 352 pages. 18mo.
Cloth,
$150
BUTLER, JOHN. A Text-Book of Electro-Therapeutics and
Electro-Surgery, for the Use of Students and General Prac-
titioners. By John Butler, M.D., L.R.C.P.E., L.R.C.S.I., etc., etc.
Second edition, revised and enlarged. 350 pages. Svo. Cloth, $3 00
"Butler's work gives with exceptional thoroughness all details of the latest researches on
HOMEOPATHIC PUBLICATIONS.
3
1
Electricity, which powerful agent has a great future, and rightly demands our most earnest
consideration. But Homœopathia especially must hail with delight the advent from out
the ranks of her apostles of a writer of John Butler's ability. His book will also find a
large circle of non-homœopathic readers, since it does not conflict with the tenets of any
therapeutic sect, and particular care has been bestowed on the technical part of electro-
therapeia."-Homœopathische Rundschau.
DAKE, DR. WM. C. Pathology and Treatment of Diphtheria.
By Wm. C. Dake, M.D., of Nashville, Tenn. 55 pages. 8vo. Paper, 50 cts.
This interesting monograph was enlarged from a paper read at the Third
Annual Meeting of the Homoeopathic Society of Tennessee, held at Mem-
phis, September 19, 1877.
It gives a report of one hundred and seventy-six cases treated during a
period of eleven months. It well repays a careful perusal.
DUNHAM, CARROLL, A.M., M.D. Homoeopathy the Science
of Therapeutics. A collection of papers elucidating and illustrating
the principles of homoeopathy. 529 pages. 8vo. Cloth,.
Half morocco,
$3 00
$4 00
"After reading this work no one will attempt to justify the practice of alternation of
remedies. It is simply the lazy man's expedient to escape close thinking or to cover his
ignorance. The one remedy alone can be accurate and scientific; a second or third only
complicates and spoils the case, and will inevitably ruin a good reputation. But to come to
more practical matters, more than one-half of this volume is devoted to a careful analysis of
various drug-provings. It teaches us Materia Medica after a new fashion, so that a fool can
understand, not only the full measure of usefulness, but also the limitations which surround
the drug.
We ought to give an illustration of his method of analysis, but space
forbids. We can only urge the thoughtful and studious to obtain the book, which they will
esteem as second only to the Organon in its philosophy and learning."-The American
Homœopathist.
DUNHAM, CARROLL, A.M., M.D. Lectures on Materia Medica.
858 pages. 8vo. Cloth,
Half morocco,
$5 00
$6 00
"Vol. I is adorned with a most perfect likeness of Dr. Dunham, upon which
stranger and friend will gaze with pleasure. To one skilled in the science of physiognomy
there will be seen the unmistakable impress of the great soul that looked so long and stead-
fastly out of its fair windows. But our readers will be chiefly concerned with the contents
of these two books. They are even better than their embellishments. They are chiefly
such lectures on Materia Medica as Dr. Dunham alone knew how to write. They are pre-
ceded quite naturally by introductory lectures, which he was accustomed to deliver to his
classes on general therapeutics, on rules which should guide us in studying drugs, and on
the therapeutic law. At the close of Vol. II we have several papers of great interest, but
the most important fact of all is that we have here over fifty of our leading remedies pre-
sented in a method which belonged peculiarly to the author, as one of the most successful
teachers our school has yet produced.
Blessed will be the library they adorn, and
wise the man or woman into whose mind their light shall shine."-Cincinnati Medical Ad-
vance.
EGGERT, DR. W. The Homœopathic Therapeutics of Uterine
and Vaginal Discharges. 543 pages. Svo. Half morocco, $3 50
The author brought here together in an admirable and comprehensive.
arrangement everything published to date on the subject in the whole.
homoeopathic literature, besides embodying his own abundant personal ex-
perience. The contents, divided into eight parts, are arranged as follows:
PART I. Treats on Menstruation and Dysmenorrhea; PART II. Menor.
rhagia; PART III. Amenorrhea; PART IV. Abortion and Miscarriage; PART V.
4
BOERICKE & TAFEL'S
Metrorrhagia; PART VI. Fluor albus; PART VII. Lochia; and PART VIII.
General Concomitants. No work as complete as this, on the subject, was
ever before attempted, and we feel assured that it will meet with great
favor by the profession.
"The book is a counterpart of Bell on Diarrhoea, and Dunham on Whooping-cough.
Synthetics, Diagnosis and Pathology are left out as not coming within the scope of the work.
The author in his preface says: Remedies and their symptoms are left out, and the symp-
toms and their remedies have received sole attention-that is what the busy practitioner
wants. The work is one of the essentials in a library."-American Observer.
"A most exhaustive treatise, admirably arranged, covering all that is known of therapeu
tics in this important department."-Homœopathic Times.
GUERNSEY, DR. H. N. The Application of the Principles and
Practice of Homœopathy to Obstetrics and the Disorders Pe-
culiar to Women and Young Children. By HENRY N. GUERNSEY
M.D., Professor of Obstetrics and Diseases of Women and Children in the
Homœopathic Medical College of Pennsylvania, etc., etc. With numerous
Illustrations. Third edition, revised, enlarged, and greatly improved.
1004 pages. 8vo. Half morocco,
$8 00
This standard work, with the numerous improvements and additions, is the most com-
plete and comprehensible work on the subject in the English language. Of the previous
editions, almost four thousand copies are in the hands of the profession, and of this third
edition a goodly number have already been taken up. There are few other professional
works that can boast of a like popularity, and with all new improvements and experiences
diligently collected and faithfully incorporated into each successive edition, this favorite
work will retain its hold on the high esteem it is held in by the profession, for years to come.
It is superfluous to add that it was and is used from its first appearance as a text-book at the
homoeopathic colleges.
GUERNSEY, DR. E. Homœopathic Domestic Practice. With
Full Descriptions to the Dose to each single Case. Containing also
Chapters on Anatomy, Physiology, Hygiene, and an abridged Materia
Medica. Tenth enlarged, revised, and improved edition. 653 pages.
Half leather,
$2 50
GUERNSEY, DR. W. E. The Traveller's Medical Repertory and
Family Adviser for the Homoeopathic Treatment of Acute
30 cts.
Diseases. 36 pages. Cloth,
•
This little work has been arranged with a view to represent in as compact a manner as
possible all the diseases—or rather disorders-which the non-professional would attempt to
prescribe for, it being intended only for the treatment of simple or acute diseases, or to allay
the suffering in maladies of a more serious nature until a homoeopathic practitioner can be
summoned.
HAHNEMANN, DR. S. The Lesser Writings of. Collected and
Translated by R. E. DUDGEON, M.D. With a Preface and Notes by E.
MARCY, M.D. With a Steel Engraving of Hahnemann from the statue
$3 00
of Steinhauser. 784 pages. Half bound, .
This valuable work contains a large number of Essays, of great interest to laymen as well
as medical men, upon Diet, the Prevention of Diseases, Ventilation of Dwellings, etc. As
many of these papers were written before the discovery of the homoeopathic theory of cure,
the reader will be enabled to peruse in this volume the ideas of a gigantic intellect when di-
rected to subjects of general and practical interest.
HOMEOPATHIC PUBLICATIONS.
5
HAHNEMANN, DR. S. Organon of the Art of Healing. By
SAMUEL HAHNEMANN. Aude Sapere. Fifth American edition, translated
from the Fifth German edition, by C. WESSELHEFT, M.D. 244 pages.
8vo. Cloth, .
$1 75
This fifth edition of "Hahnemann Organon" has a history. So many
complaints were made again and again of the incorrectness and cumber-
some style of former and existing editions to the publishers, that, yielding
to the pressure, they promised to destroy the plates of the fourth edition,
and to bring out an entire re-translation in 1876, the Centennial year. After
due consideration, and on the warm recommendation of Dr. Constantine
Hering and others, the task of making this re-translation was confided to
Dr. C. Wesselhoft, and the result of years of labor is now before the pro-
fession, who will be best able themselves to judge how well he succeeded
in acquitting himself of the difficult task.
"To insure a correct rendition of the text of the author, they (the publishers) selected as
his translator Dr. Conrad Wesselhoft, of Boston, an educated physician in every respect,
and from his youth up perfectly familiar with the English and German languages, than
whom no better selection could have been made." That he has made, as he himself de-
clares, 'an entirely new and independent translation of the whole work,' a careful compari-
son of the various paragraphs, notes, etc., with those contained in previous editions, gives
abundant evidence; and while he has, so far as was possible, adhered strictly to the letter of
Hahnemann's text, he has at the same time given a pleasantly flowing rendition that avoids
the harshness of a strictly literal translation."-Hahnemannian Monthly.
HALE, DR. E. M. Lectures on Diseases of the Heart. In Three
Parts. Part I. Functional Disorders of the Heart. Part II. Inflamma-
tory Affections of the Heart. Part III. Organic Diseases of the Heart.
Second enlarged edition printing.
HALE, DR. E. M. Materia Medica and Special Therapeutics of
the New Remedies. Fourth edition, revised and enlarged. In two
Volumes.
Vol. I. Special Symptomatology. With new Botanical and Pharmaco-
logical Notes. 672 pages. Cloth, .
$5 00
Vol. II. Special Therapeutics. With Illustrative Clinical Cases. 900
pages. Second enlarged edition. Cloth,
$5 00
N. B.-Same in half morocco, per Volume,
$6 00
"Dr. Hale's work on New Remedies is one both well known and much appreciated on this
side of the Atlantic. For many medicines of considerable value we are indebted to his re-
searches. In the present edition, the symptoms produced by the drug investigated, and
those which they have been observed to cure, are separated from the clinical observations,
by which the former have been confirmed. That this volume contains a very large amount
of invaluable information is incontestable, and that every effort has been made to secure
both fulness of detail and accuracy of statement, is apparent throughout. For these reasons
we can confidently commend Dr. Hale's fourth edition of his well-known work on the New
Remedies to our homeopathic colleagues."-Monthly Homeopathic Review.
“We do not hesitate to say that by these publications Dr. Hale rendered an inestimable
service to homeopathy, and thereby to the art of medicine. The school of Hahnemann in
every country owes him hearty thanks for all this; and allopathy is beginning to share our
gain. The author is given credit for having in this fourth edition corrected the mistake
for which the third one had been taxed rather severely, by restoring in Vol. II the 'special
therapeutics,' instead of the 'characteristics' of the third edition.”—British Journal of Ho-
mœopathy.
6
BOERICKE & TAFEL'S
HALE, DR. E. M. The Medical, Surgical, and Hygienic Treat-
ment of Diseases of Women, especially those causing Sterility,
the Disorders and Accidents of Pregnancy, and Painful and
Difficult Labor. By EDWIN M. HALE, M.D., Professor of Materia
Medica and Therapeutics in the Chicago Homœopathic College, etc., etc.
Second enlarged edition. 378 pages. 8vo. Cloth, .
$2.50
"This new work embodies the observations and experience of the author during twenty-five
years of active and extensive practice, and is designed to supplement rather than supersede
kindred works. The arrangement of the subjects treated is methodical and convenient; the
introduction containing an article inserted by permission of Dr. Jackson, of Chicago, the
author upon the ovular and ovulation theory of menstruation, which contains all the obser-
vations of practical importance known on this subject to date. The diseases causing sterility
are fully described, and the medical, surgical, and hygienic treatment pointed out. The
more generally employed medicines are enumerated, but their special or specific indications
are unfortunately omitted. The general practitioner will find a great many valuable things
for his daily rounds, and cannot afford to do without the book. The great reputation and
ability of the author are sufficient to recommend the work, and to guarantee an appreciative
reception and large sale."-Hahnemannian Monthly.
HAYWARD, DR. JOHN W. Taking Cold (the Cause of half
our Diseases): Its Nature, Causes, Prevention and Cure; its
frequency as a Cause of other Disease, and the Diseases of
which it is the Cause, with their Diagnosis and Treatment.
Fifth edition, enlarged and improved. London, 1875. 188 pages. 18mo.
Cloth, .
50 cts.
We quote from the author's preface:
"This Essay was originally published under the conviction that, by attention to the di-
rections it contains, persons may not only very frequently avoid taking cold, but may them-
selves frequently cure a cold at the onset, and thereby prevent the development of many of
those serious diseases that would otherwise follow. The favorable reception it has met with
is a sufficient testimony that it has been found useful."
HELMUTH, DR. W. T.
568 Engravings on Wood.
1000 pages. Sheep,
A System of Surgery. Illustrated with
By WM. TOD HELMUTH, M.D. Third edition.
$8 50
This third edition of Dr. Helmuth's great work is already in appearance a great improve-
ment over the old edition, it being well printed on fine paper, and well bound. By increas-
ing the size of the page, decreasing the size of type, and setting up solid, fully one-half more
printed matter is given than in the previous edition, albeit there are over 200 pages less.
And while the old edition, bound in sheep, was sold at $11.50 by its publishers, this im-
proved third edition is now furnished at $3 less, or for $8.50. The author brought the work
fully up to date, and for an enumeration of some of the more important improvements, we
cannot do better than to refer to Dr. Helmuth's own Preface.
$1 75
HEMPEL, DR. C. J. The Science of Homoeopathy; or, A Critical
and Synthetical Index of the Doctrines of the Homœopathic School.
Second edition. 180 pages. Large 8vo. Cloth,
HEMPEL, DR. C. H.
Materia Medica.
Complete Repertory of the Homœopathic
1224 pages,
$6 00
The object of this work is simply to make the finding of any symptom or group of symp-
toms, which a physician may be called upon to treat, a matter of perfect certainty; provided
always such may exist among the results of our physiological provings. The classification
of the symptoms which has been adopted is more complete, and at the same time more
simple and practical, than anything of the kind ever published in our language.
HOMOEOPATHIC PUBLICATIONS.
7
HEMPEL, DR. C. J., and DR. J. BEAKLEY. Homœopathic
Theory and Practice. With the Homœopathic Treatment of Surgi-
cal Diseases, designed for Students and Practitioners of Medicine, and
as a Guide for an intelligent public generally. Fourth edition. 1100
$3.00
pages,
HERING, DR. C. Condensed Materia Medica. Second edition.
More condensed, revised, enlarged, and improved,
$700
•
In February, 1877, we were able to announce the completion of Hering's Condensed Ma-
teria Medica. The work, as was to be expected, was bought up with avidity by the profes-
sion, and already in the Fall of 1878 the author set to work perfecting a second and im-
proved edition. By still more condensing many of the remedies, a number of new ones
could be added without much increasing the size and the price of the work. This new
edition is now ready for the profession, and will be the standard work par excellence for the
practitioner's daily reference.
HILDEBRANDT, PROF. H. Catarrh of the Female Sexual
Organs. Translated, with the addition of the Homoeopathic Treatment,
by S. LILIENTHAL, M.D.,
30 cts.
HITCHMAN, DR. W. Consumption; Its Nature, Prevention,
and Homœopathic Treatment. With Illustrations of Homœopathic
Practice. 184 pages, .
60 cts.
HOLCOMBE, DR. W. H. Yellow Fever and its Homœopathic
Treatment,
10 cts.
HOLCOMBE, DR. W. H. What is Homœopathy? A new expo-
sition of great truth. 28 pages. 8vo. Paper cover, per doz., $1.25, 15 cts.
"Prove all things, hold fast that which is good."-St. Paul.
HOLCOMBE, DR. W. H. How I became a Homœopath. 28
pages. 8vo. Paper cover, per dozen, $1.25,
15 cts.
HOLCOMBE, DR. W. H. Special Report of the Homœopathic
Yellow Fever Commission, ordered by the American Institute of
Homeopathy for presentation to Congress. 32 pages. Svo. Paper,
per 100, $4.00,
5 cts.
This Report, written in Dr. Holcombe's masterly manner, is one of the best campaign
documents for homeopathy. The statistics must convince the most skeptical, and every
homeopathic practitioner should feel in duty bound to aid in securing its widest possible
circulation.
HOMEOPATHIC POULTRY PHYSICIAN (Poultry Veterina-
rian); or, Plain Directions for the Homœopathic Treatment of the most.
Common Ailments of Fowls, Ducks, Geese, Turkeys, and Pigeons, based
on the author's large experience, and compiled from the most reliable
sources, by Dr. Fr. Schröter. Translated from the German. 84 pages.
12mo. Cloth,
. 50 cts.
•
We imported hundreds of copies of this work in the original German for our customers,
and as it gave good satisfaction, we thought it advisable to give it an English dress, so as to
make it available to the public generally. The little work sells very fast, and our readers
will doubtless often have an opportunity to draw the attention of their patrons to it.
8
BOERICKE & TAFEL'S
HOMEOPATHIC COOKERY. Second edition. With additions by
a Lady of an American Homœopathic Physician. Designed chiefly for
the Use of such Persons as are under Homœopathic Treatment. 176
pages,.
50 cts.
HUGHES, DR. R. Manual of Pharmacodynamics. 500 pages.
American reprint out of print. See list of British books.
HUGHES, DR. R. Manual of Therapeutics. 540 pages. American
reprint out of print. See list of British books.
HULL'S JAHR. A New Manual of Homeopathic Practice,
Edited, with Annotations and Additions, by F. G. SNELLING, M.D. Sixth
American edition. With an Appendix of the New Remedies, by C. J.
HEMPEL, M.D. 2 vols. 2076 pages, .
$9 00
The first volume, containing the symptomatology, gives the complete pathogenesis of two
hundred and eighty-seven remedies, besides a large number of new remedies are added by
Dr. Hempel, in the appendix. The second volume contains an admirably arranged Reper-
tory. Each chapter is accompanied by copious clinical remarks and the concomitant symp-
toms of the chief remedies for the malady treated of, thus imparting a mass of information,
rendering the work indispensable to every student and practitioner of medicine.
JAHR, DR. G. H. G. Therapeutic Guide; the most Important Re-
sults of more than Forty Years' Practice. With Personal Observations
regarding the truly reliable and practically verified Curative Indications
in actual cases of disease. Translated, with Notes and New Remedies,
by C. J. HEMPEL, M.D. 546 pages,
$3.00
"With this characteristically long title, the veteran and indefatigable Jahr gives us
another volume of homeopathics. Besides the explanation of its purport contained in the
title itself, the author's preface still further sets forth its distinctive aim. It is intended, he
says, as a guide to beginners, where I only indicate the most important and decisive points
for the selection of a remedy, and where I do not offer anything but what my own individual
experience, during a practice of forty years, has enabled me to verify as absolutely decisive in
choosing the proper remedy.' The reader will easily comprehend that, in carrying out this
plan, I had rigidly to exclude all cases concerning which I had no experience of my own to
offer.
We are bound to say that the book itself is agreeable, chatty, and full of
practical observation. It may be read straight through with interest, and referred to in the
treatment of particular cases with advantage.”—British Journal of Homœopathy.
JAHR, DR. G. H. G. Clinical Guide, or Pocket Repertory for
the Treatment of Acute and Chronic Diseases.. Translated by
C. J. HEMPEL, M.D. Second American revised and enlarged edition.
From the third German edition, enriched by the addition of the New
Remedies. By S. LILIENTHAL, M.D. 624 pages. 12mo.
rocco,
Ilalf mo-
$2.50
'To those of our readers who have used the old edition, nothing need be said to induce
them to procure a copy of the new. To others, however, we feel free to state that as a
volume of ready reference to lie on the office desk, or be used at the bedside, it is very valu-
able, and will save many tedious and distracting hunts through the symptomen coder. The
typographical execution of the book is excellent."-Hahnemannian Monthly.
JAHR, DR. G. H. G. The Homœopathic Treatment of Diseases
of Females and Infants at the Breast. Translated from the French
by C. J. HEMPEL, M.D. 422 pages. Half leather,
$2.00
This work deserves the most careful attention on the part of homoeopathic practitioners.
The diseases to which the female organism is subject are described with the most minute
correctness, and the treatment is likewise indicated with a care that would seem to defy
criticism. No one can fail to study this work but with profit and pleasure.
HOMOEOPATHIC PUBLICATIONS.
9
JAHR, DR. G. H. G. Diseases of the Skin; or, Alphabetical Reper-
tory of the Skin Symptoms, and External Alterations of Substance, to-
gether with the Morbid Phenomena observed in the Glandular, Osseous,
Mucous, and Circulatory Symptoms. Arranged with Pathological Re-
marks on Diseases of the Skin. Edited by C. J. HEMPEL, M.D. 515
pages. 12mo. Cloth, .
$1 50
JAHR, DR. G. H. G. The Venereal Diseases, their Pathological
Nature, Correct Diagnosis, and Homoeopathic Treatment.
Prepared in accordance with the author's own, as well as with the expe-
rience of other physicians, and accompanied with critical discussions.
Translated, with numerous and important additions, from the works of
other authors, and from his own experience. By C. J. HEMPEL, M.D.
428 pages. 8vo. Cloth,
$3 00
This is the most elaborate treatise on the subject in print. The work is divided into four
divisions, of which the first treats on Primary Forms of Venereal Diseases, in four chapters:
On the Venereal Phenomena in general; the Different Forms of Gonorrhoea; the Various
Forms of Chancre; and other Primary Forms of Syphilis. The second division, on Second-
ary Forms of Syphilis, treats in three chapters, of Secondary Syphilis generally; Syphilitic
Cutaneous Affections, and Intermediate Forms of Syphilis. The third division: General
Pathological Observations on Syphilis and its course generally, in three chapters; Patho-
logical Nature and Origin of Syphilis; on Venereal Contagia; General Development,
Course, and Termination of Syphilis. The fourth division: General Therapeutic Observa-
tions on the Treatment of Syphilis; General Diagnostic Remarks; General Therapeutic
Observations; Pharmaco-dynamic Observations, and Addenda.
INDEX to the first eighteen volumes of the North American Journal of
Homœopathy. Paper,
$2.00
JONES, DR. SAMUEL A. The Grounds of Homoeopathic Faith.
Three Lectures, delivered at the request of Matriculates of the Depart-
ment of Medicine and Surgery (Old School) of the University of Michi-
gan. By SAMUEL A. JONES, M.D., Professor of Materia Medica, Thera-
peutics, and Experimental Pathogenesy in the Homoeopathic Medical
College of the University of Michigan, etc., etc. 92 pages. 12mo. Cloth,
per dozen, $3; per hundred, $20,
30 cts.
Lecture first is on The Law of Similars; its Claim to be a Science in that it Enables Perver
sion. Lecture second, The Single Remedy a Necessity of Science. Lecture third, The Mini-
mum Dose an Inevitable Sequence. A fourth Lecture, on The Dynamization Theory, was to
have finished the course, but was prevented by the approach of final examinations, the prepa-
ration for which left no time for hearing evening lectures. The Lectures are issued in a con-
venient size for the coat-pocket; and as an earnest testimony to the truth, we believe they
will find their way into many a homeopathic household.
JOHNSON, DR. I. D. Therapeutic Key; or Practical Guide for the
Homœopathic Treatment of Acute Diseases. Third edition. 312 pages.
Bound in linen,
Bound in flexible cover,
$1.50
$2.00
This has been one of the best selling works on our shelves; more copies being in circula-
tion of this than of any two other professional works put together. It is safe to say that
there are but few homeopathic practitioners in this country but have one or more copies of
this little remembrancer in their possession.
JOHNSON, DR. I. D. A Guide to Homœopathic Practice. De-
signed for the use of Families and Private Individuals. 494 pages.
Cloth, .
$2.00
10
BOERICKE & TAFEL'S
This is the latest work on Domestic Practice issued, and the well and favorably known
author has surpassed himself. In his book fifty-six remedies are introduced for internal ap-
plication, and four for external use. The work consists of two parts. Part I is subdivided
into seventeen chapters, each being devoted to a special part of the body, or to a peculiar
class of disease. Part II contains a short and concise Materia Medica, i. e., gives the
symptoms peculiar to each remedy. The whole is carefully written with a view of avoiding
technical terms as much as possible, thus insuring its comprehension by any person of ordi-
nary intelligence. A complete set of remedies in vials holding over fifty doses each, is fur-
nished for $7, or in vials holding over one hundred doses each for $10, or book and case
complete for $9 or $12 respectively. Address orders to Boericke & Tafel's Pharmacies at
New York, Philadelphia, Baltimore, Chicago, New Orleans, or San Francisco.
JOSLIN, DR. B. F. Principles of Homœopathy. In a Series of
Lectures. 185 pages. 12mo. Cloth,
60 cts.
JOSLIN, DR. B. F.
Homoeopathic Treatment of Epidemic
Cholera. Third edition, with additions. 252 pages. 12mo. Cloth,
75 cts.
This work offers the advantage of a threefold arrangement of the principal medicines, viz.,
with reference, I-to the varieties of cholera; II-to its stages; and III-to its symptoms as
arranged in repertories. These last will give the work a permanent value in treating the
more frequent complaints of summer.
LAURIE AND MCCLATCHEY. The Homœopathic Domestic
Medicine. By JOSEPH LAURIE, M.D. Ninth American, from the Twenty-
first English edition. Edited and revised, with numerous and important
additions, and the introduction of the new remedies. By R.J. MCCLATCHEY,
M.D. 1044 pages. 8vo. Half morocco,
$5.00
"We do not hesitate to indorse the claims made by the publishers, that this is the most
complete, clear, and comprehensive treatise on the domestic homeopathic treatment of dis-
eases extant. This handsome volume of nearly eleven hundred pages is divided into six
parts. Part one is introductory, and is almost faultless. It gives the most complete and
exact directions for the maintenance of health, and of the method of investigating the con-
dition of the sick, and of discriminating between different diseases. It is written in the
most lucid style, and is above all things wonderfully free from technicalities. Part two treats
of symptoms, character, distinctions, and treatment of general diseases, together with a chap-
ter on casualties. Part three takes up diseases peculiar to women. Part four is devoted to
the disorders of infancy and childhood. Part five gives the characteristic symptoms of the
medicines referred to in the body of the work, while Part six introduces the repertory."-
Hahnemannian Monthly.
"Of the usefulness of this work in cases where no educated homeopathic physician is
within reach, there can be no question. There is no doubt that domestic homeopathy has
done much to make the science known; it has also saved lives in emergencies. The prac-
tice has never been so well presented to the public as in this excellent volume."--New Eng.
Med. Gazette.
A complete set of remedies of one hundred and four vials, containing over fifty doses each,
is furnished for $12, put up in an elegant mahogany case. A similar set in vials containing
over one hundred doses each, is furnished for $18, or book and case complete for $17 or $23
respectively. Address orders to Boericke & Tafel's Pharmacies at New York, Philadelphia,
Baltimore, Chicago, New Orleans, or San Francisco.
LILIENTHAL, DR. S. Homœopathic Therapeutics. By S
LILIENTHAL, M.D., Editor of North American Journal of Homœopathy,
Professor of Clinical Medicine and Psychology in the New York Homœo-
pathic Medical College, and Professor of Theory and Practice in the New
York College Hospital for Women, etc. Second edition. 8vo, $5 00
Half morocco,
$6 00
"Certainly no one in our ranks is so well qualified for this work as he who has done it,
and in considering the work done, we must have a true conception of the proper sphere of
HOMEOPATHIC PUBLICATIONS.
11
such a work. For the fresh graduate, this book will be invaluable, and to all such we un-
hesitatingly and very earnestly commend it. To the older one, who says he has no use for
this book, we have nothing to say. He is a good one to avoid when well, and to dread when
ill. We also hope that he is severely an unicum."-Prof. Sam. A. Jones in American Home-
opathist.
It is an extraordinary useful book, and those who add it to their library will
never feel regret, for we are not saying too much in pronouncing it the best work on therapeu-
ties in homeopathic (or any other) literature. With this under one elbow, and Hering's or
Allen's Materia Medica under the other, the careful homeopathic practitioner can refute
Neimayer's too confident assertion, 'I declare it idle to hope for a time when a medical pre-
scription should be the simple resultant of known quantities.' Doctor, by all means buy
Lilienthal's Homeopathic Therapeutics. It contains a mine of wealth."-Prof. Chas. Gatchel
in Ibid.
LILIENTHAL, DR. S. A Treatise on Diseases of the Skin. A
new edition in preparation for the press.
LUTZE, DR. A. Manual of Homœopathic Theory and Practice.
designed for the use of Physicians and Families. Translated
from the German, with additions by C. J. HEMPEL, M.D. From the
sixtieth thousand of the German edition.
leather,
750 pages. 8vo. Half
$2.50
This work, from the pen of the late Dr. Lutze, has the largest circulation of any homeo-
pathic work in Germany, no less than sixty thousand copies having been sold. The intro-
duction, occupying over fifty pages, contains the question of dose, and rules for examining
the patient, and diet; the next sixty pages contain a condensed pathogenesis of the remedies
treated of in the work; the description and treatment of diseases occupy four hundred and
eighteen pages, and the whole concludes with one hundred and seventy-three pages of reper-
tory and a copious index, thus forming a concise and complete work on theory and practice.
MALAN, H. Family Guide to the Administration of Homœo-
pathic Remedies. 112 pages. 32mo.
32mo. Cloth,
MANUAL OF HOMEOPATHIC VETERINARY PRACTICE.
Designed for all kinds of Domestic Animals and Fowls, prescribing their
proper treatment when injured or diseased, and their particular care and
general management in bealth. Second and enlarged edition.
684 pages.
Svo. Half morocco,
30 cts.
$5 00
"In order to rightly estimate the value and comprehensiveness of this great work, the
reader should compare it, as we have done, with the best of those already before the public.
In size, fulness, and practical value it is head and shoulders above the very best of them,
while in many most important disorders it is far superior to them altogether, containing, as
it does, recent forms of disease of which they make no mention."-Hahnemannian Monthly.
MARSDEN, DR. J. H. Handbook of Practical Midwifery, with
full instructions for the Homeopathic Treatment of the Dis-
eases of Pregnancy, and the Accidents and Diseases incident
to Labor and the Puerperal State. By J. H. MARSDEN, A.M., M.D.
315 pages. Cloth,
$2 25.
"It is seldom we have perused a textbook with such entire satisfaction as this. The
author has certainly succeeded in his design of furnishing the student and young practitioner,
within as narrow limits as possible, all necessary instruction in practical midwifery. The
work shows on every page extended research and thorough practical knowledge. The style
is clear, the array of facts unique, and the deductions judicions and practical. We are par-
ticularly pleased with his discussion of the management of labor, and the management of
mother and child immediately after the birth, but much is left open to the common-sense
and practical judgment of the attendant in peculiar and individual cases."-Homœopathic
Times.
12
BOERICKE & TAFEL'S
MILLARD, DR. H. B. The Climate and Statistics of Consump-
tion. Read before the American Geographical and Statistical Society.
With extensive additions by the author. 108 pages. Cloth, . 75 cts.
MOHR, DR. CHARLES. The Incompatible Remedies of the
Homœopathic Materia Medica. By CHARLES MOHR, M.D., Lecturer
of Homœopathic Pharmaceutics, Hahnemann Medical College, Philadel-
phia. (A paper read before the Homœopathic Medical Society of the
County of Philadelphia) Pamphlet, in paper cover,
10 cts.
This is an interesting paper, which will well repay perusal and study. It gives a list of
fifty-seven remedies and their incompatibles, diligently collated from the best-known sources.
MORGAN, DR. W. The Homœopathic Treatment of Indiges-
tion, Constipation, and Hæmorrhoids. Edited with Notes and
Annotations by A. E. SMALL, M I).
166 pages
12mo. Cloth, 60 cts.
Diseases resulting from irregularity or debility of the digestive organs are so frequent in
their occurrence, that scarcely a family can be found in which one or more of its members
are not sufferers thereby. The present work gives in a concise manner the hygienic meas-
ures as well as the medical treatment that should be observed, calculated not only to obviate
the necessity of recourse to dangerous palliatives, but to promote a complete restoration of
health.
MORGAN, DR. W. The Textbook for Domestic Practice; being
plain and concise directions for the Administration of Homœopathic
Medicines in Simple Ailments. 191 pages. 32mo. Cloth, 50 cts.
This is a concise and short treatise on the most common ailments, printed in convenient
size for the pocket; a veritable traveller's companion.
A complete set of thirty remedies, in vials holding over fifty doses each, is furnished for
$4.50, in stout mahogany case; or same set in vials holding over one hundred doses each,
for $6.50; or book and case complete for $5 or $7 respectively. Address orders to Boericke
& Tafel's Pharmacies, New York, Philadelphia, Baltimore, Chicago, New Orleans, or San
Francisco.
MURE, DR. B. Materia Medica; or, Provings of the Principal Ani-
mal and Vegetable Poisons of the Brazilian Empire, and their Application.
in the Treatment of Diseases. Translated from the French, and arranged
according to Hahnemann's Method, by C. J. HEMPEL, M.D. 220 pages.
12mo. Cloth,
$1 00
This volume, from the pen of the celebrated Dr. Mure, of Rio Janeiro, contains the patho-
genesis of thirty-two remedies, a number of which have been used in general practice ever
since the appearance of the work. A faithful wood-cut of the plant or animal treated of ac-
companies each pathogenesis.
•
NEIDHARD, DR. C. On the Universality of the Homœopathic
Law of Cure,
30 cts.
NEW PROVINGS of Cistus Canadensis, Cobaltum, Zingiber, and Mer-
curius Proto-Iodatus. 96 pages. Paper,.
'75 cts.
NORTH AMERICAN JOURNAL OF HOMEOPATHY. Pub-
lished quarterly on the first days of August, November, February, and
May. Edited by S. LILIENTHAL, M.D. Vol. X, New Series, commenced
in August, 1879. Subscription price per volume, in advance,. $4.00
Complete sets of the first twenty-seven volumes, in half morocco binding,
including Index to the first eighteen volumes,
Index to the first eighteen volumes.
$90 00
$2.00
HOMEOPATHIC PUBLICATIONS.
13
OEHME, DR. F. G. Therapeutics of Diphtheritis. A Compilation
and Critical Review of the German and American Homœopathic Litera-
ture. Second enlarged edition. 84 pages. Paper, .
Same, in cloth, .
60 cts.
75 cts.
'This pamphlet contains the best compilation of reliable testimony relative to diphtheria
that has appeared from the pen of any member of our school."-Ohio Medical and Surgical
Reporter.
Although he claims nothing more for his book than that it is a compilation, with 'criti-
cal reviews,' he has done his work so well and thoroughly as to merit all praise."-Hahne-
mannian Monthly.
Dr. Oehme's little book will be worth many times its price to any one who has to treat
this terrible disease."-British Journal of Homœopathy.
"It is the best monograph we have yet seen on diphtheria."-Cincinnati Medical Advance.
PETERS, DR. J. C. A Complete Treatise on Headaches and
Diseases of the Head. I. The Nature and Treatment of Headaches.
II. The Nature and Treatment of Apoplexy. III. The Nature and
Treatment of Mental Derangement. IV. The Nature and Treatment of
Irritation, Congestion, and Inflammation of the Brain and its Membranes.
Based on Th. J. Rückert's Clinical Experiences in Homœopathy. 586
$2.50
pages. Half leather,
PETERS, DR. J. C. A Treatise on Apoplexy. With an Appendix
on Softening of the Brain and Paralysis. Based on Th. J. Rückert's
Clinica Experiences in Homœopathy. 164 pages. Svo. Cloth, $1 00
PETERS, DR. J. C. The Diseases of Females and Married Fe-
males. Second edition. Two parts in one volume. 356 pages
Cloth,
PETERS, DR. J. C. The Diseases of Married Females.
of Pregnancy, Parturition, and Lactation. 196 pages. Svo.
$1.50
Disorders
Cloth,
$1 00
PETERS, DR. J. C. A Treatise on the Principal Diseases of the
Eyes. Based on Th. J. Rückert's Clinical Experiences in Homœopathy.
291 pages.
Svo. Cloth,
$150
PETERS, DR. J. C. A Treatise on the Inflammatory and Organic
Diseases of the Brain. Based on Th. J. Rückert's Clinical Experi-
ences in Homœopathy. 156 pages. 8vo. Cloth,
$1 00
PETERS, DR. J. C. A Treatise on Nervous Derangement and
Mental Disorders. Based on Th. J. Rückert's Clinical Experiences in
Homoeopathy. 104 pages. 8vo. Cloth,
$1 00
PHYSICIAN'S VISITING LIST AND POCKET REPERTORY,
THE HOMEOPATHIC. By ROBERT FAULKNER, M.D. Second
edition,
$2 00
>
"Dr. Faulkner's Visiting List is well adapted to render the details of daily work more
perfectly recorded than any book prepared for the same purpose with which we have hitherto
inet. It commences with Almanacs for 1877 and 1878; then follow an obstetric calendar;
a list of Poisons and their Antidotes; an account of Marshall Hall's ready method in As-
phyxia; a Repertory of between sixty and seventy pages; pages marked for general memo-
randa; Vaccination Records; Record of Deaths; Nurses; Friends and others; Obstetric
14
BOERICKE & TAFEL'S
Record, which is especially complete; and finally, pages ruled to keep notes of daily visits,
and also spaces marked for name of the medicine ordered on each day. The plan devised
is so simple, so efficient, and so clear, that we illustrate it on a scale just half the size of the
original (here follows illustration). The list is not divided into special months, but its use
may be as easily commenced in the middle of the year as at the beginning. We heartily
recommend Faulkner's List to our colleagues who may be now making preparations for the
duties of 1878:"-Monthly Homœopathic Review, London.
RAUE, DR. C. G. Special Pathology and Diagnosis, with Thera-
peutic Hints. 344 pages. 8vo. Half morocco,
$5 00
This standard work is used as a textbook in all our colleges, and is found in almost every
physician's library. An especially commendable feature is that it contains the application
of nearly all the new remedies contained in Dr. Hale's work on Materia Medica.
RUDDOCK, DR. Principles, Practice, and Progress of Homo-
opathy, 5 cts. ; per hundred, $3; per thousand,
$25 00
RUOFF'S REPERTORY OF HOMEOPATHIC MEDICINE.
Nosologically arranged. Translated from the German by A. H. OKIE,
M.D. With additions and improvements by G. HUMPHREY, M.D. 251
pages. 12mo. Cloth,.
$1.50
As a book of reference for the practitioner, the present work far excels every other work,
presenting him at a single glance what he might otherwise seek for amidst a confused mass
of records and never find. The indefatigable author has drawn his matter from the infallible
results of experience, leaving out all guesswork and hypothesis.
RUSH, DR. JOHN. Veterinary Surgeon. The Handbook to Vet-
erinary Homœopathy; or, the Homœopathic Treatment of Horses, Cattle,
With numerous
Sheep, Dogs, and Swine. From the London edition.
additions from the Seventh German edition of Dr. F. E. Gunther's "Ho-
mœopathic Veterinary." Translated by J. F. SHEEK, M.D. 150 pages.
18mo. Cloth,
50 cts.
SCHAEFER, J. C. New Manual of Homœopathic Veterinary
Medicine. An easy and comprehensive arrangement of Diseases,
adapted to the use of every owner of Domestic Animals, and especially
designed for the Farmer living out of the reach of medical advice, and
showing him the way of treating his sick Horses, Cattle, Sheep, Swine,
and Dogs, in the most simple, expeditious, safe, and cheap manner.
Translated from the German, with numerous additions from other veteri-
nary manuals, by C. J. HEMPEL, M.D. 321 pages. 8vo. Cloth, $2 00
SCHWABE, DR. WILLMAR. Pharmacopoeia Homœopathica
Polyglottica. Second edition. Cloth, .
Of this valuable work, the second edition has just been issued.
SHARP'S TRACTS ON HOMEOPATHY, cach,
Per hundred,.
No. 1. What is Homœopathy?
No. 2. The Defence of Homoeopathy.
$3.00
5 cts.
$3.00
No. 7. The Principles of Homeopathy.
1
No. 8. Controversy on
No. 3. The Truth of
No. 9. Remedies of
No. 4. The Small Doses of
(C
No. 10. Provings of
No. 5. The Difficulties of
(C
No. 11. Single Medicines of
66
<<
No. 6. Advantages of
No. 12. Common-sense of
HOMOEOPATHIC PUBLICATIONS.
15
SHARP'S TRACTS, complete set of 12 numbers,
Bound,
50 cts.
75 cts.
SMALL, DR. A. E. Manual of Homoeopathic Practice, for the
use of Families and Private Individuals. Fifteenth enlarged edition.
$2.50
831 pages. Sro. Half leather, .
$2 50
SMALL, DR. A. E. Manual of Homœopathic Practice. Trans-
643 pages.
lated into German by C. J. HEMPEL, M.D. Eleventh edition.
8vo. Cloth,
SMALL, DR. A. E. Diseases of the Nervous System, to which is
added a Treatise on the Diseases of the Skin, by Dr. C. E. TOOTHACKER.
216 pages. 8vo. Cloth,
$1 00
This treatise is from the pen of the distinguished author of the well-known and highly
popular work entitled, "Small's Domestic Practice." It contains an elaborate description
of the diseases of the nervous system, together with a full statement of the remedies which
have been used with beneficial effect in the treatment of these disorders.
STAPF, DR. E. Additions to the Materia Medica Pura. Trans-
lated by C. J. HEMPEL, M.D. 292 pages. Svo. Cloth,
$1.50
This work is an indispensable appendix to Hahnemann's Materia Medica Pura. Every
remedy is accompanied with extensive and most interesting clinical remarks, and a variety
of cases illustrative of its therapeutical uses.
TESSIER, DR. J. P. Clinical Researches concerning the Ho-
mœopathic Treatment of Asiatic Cholera. Translated by C. J.
HEMPEL, M.D. 109 pages. Svo. Cloth, .
75 cts.
TESSIER, DR. J. P. Clinical Remarks concerning the Homœo-
pathic Treatment of Pneumonia, preceded by a Retrospective View
of the Allopathic Materia Medica, and an Explanation of the Homoea-
pathic Law of Cure. Translated by C. J. HEMPEL, M.D. 131 pages.
Svo. Cloth,
75 cts.
THOMAS, DR. A. R. Post-Mortem Examination and Morbid
Anatomy. 337 pages. 8vo. Cloth,
$2.50
VERDI, DR. T. S. Maternity; a Popular Treatise for Young
Wives and Mothers. By TULLIO SUZZARA VERDI, A.M., M.D., of
Washington, D. C. 450 pages. 12mo. Cloth,.
$2.00
"No one needs instruction more than a young mother, and the directions given by Dr.
Verdi in this work are such as I should take great pleasure in recommending to all the
young mothers, and some of the old ones, in the range of my practice."-George E. Shipman,
M.D Chicago, Ill.
"Dr. Verdi's book is replete with useful suggestions for wives and mothers, and his medi-
cal instructions for home use accord with the maxims of my best experience in practice."-
John F. Gray, M.D., New York City.
VERDI, DR. T. S. Mothers and Daughters: Practical Studies for
the Conservation of the Health of Girls. By TULLIO SUZZARA VERDE,
SUZzara
A.M., M.D. 287 pages. 12mo. Cloth,
$1.50
"The people, and especially the women, need enlightening on many points connected with
their physical life, and the time is fast approaching when it will no longer be thought sin-
.

1
&
f
!
1
!
1

9%%~
UNIVERSITY OF MICHIGAN
3 9015 01374 0983