The inflammation may be simply in the neck of the uterus extending to the posterior surface of the vagina, or the latter may not be affected; or it may extend to the whole internal surface of the uterus, producing swelling of that organ, both the fundus and neck.
The swelling may be confined mostly to the fundus, causing it to be too large for the space it ordinarily fills, hence there will be more or less displacement of the womb, and crowding upon other parts, as the bladder or rectum. In some cases, the swelling is more on one side than on the other, so that it will be crowded over to the opposite side. These displacements are often called prolapsus uteri, or "falling of the womb," carrying the idea that the difficulty depends upon a morbid relaxation of the ligaments that support the organ. Not one case in a hundred is of this latter character, but nearly, if not all, depend upon the inflammation and swelling above mentioned. How futile then, not to say hurtful, must be all instruments for, and all attempts at replacing and supporting it by force! All such mechanical meddling is injurious, and should, with all the "supporters," be condemned and discarded.
They may afford temporary relief, but this is at the expense of future health. Cure the disease, relieve the inflammation, and nature will replace the organ. Leucorrhœa is always present where there is ulceration of the neck of the womb, and this ulcerated condition exists to a greater or less extent, in many cases where it is not suspected by the patient. It is vastly more prevalent than is generally supposed. The symptoms are numerous. Among the more prominent are a sense of weight and bearing down in the pelvis, pains extending down the limbs, aching and weakness of the small of the back, headache, more or less gastric disturbance, dyspepsia, the food souring on the stomach. There is often, especially when there are ulcers on the parts, a distressing sense of heat or a smarting sensation. The menstrual function is frequently deranged, the bowels costive, the urethra, by being pressed, becomes irritable and burns and smarts whenever the urine is evacuated. The sleep is disturbed and unrefreshing, and the whole nervous system is unstrung.
The discharge from the diseased surfaces, in an ordinary case without ulceration, is of a mucous or muco-purulent character, not unlike an ordinary catarrhal secretion. When ulceration exists it is dark, fetid or bloody, or sanious and purulent, sometimes it is acrid, excoriating the parts.
TREATMENT.
Inflammation or ulceration, either acute or chronic, in these parts does not differ essentially in its characteristics from the same affection in other mucous surfaces.
The proper treatment for a catarrh of other mucous surfaces will be applicable to these, though there is no doubt but that some medicines are more specifically adapted to these than to other organs.
In the early stage of the complaint, while the inflammation is acute, or sub-acute, the discharge thin or white, Copaiva and Macrotin are to be given once in 6 hours alternately. During the same time let injections into the vagina of warm soap and water be used twice a day, to cleanse the parts of the secretion, followed in half an hour by a wash of warm water, into which tr. of Macrotys has been put in proportion of 40 drops to half a pint. The application should be made with an 8 ounce or at least 6 ounce curved pipe syringe, so as to throw it with considerable force. If there is a burning sensation, use the washes quite warm, until the heat of the parts is allayed. Avoid the use of cold injections as long as any inflammation exists. If the bearing down is present with burning in the parts, Bell. is to be used in rotation with the two former remedies. If the sensation is that of smarting, Cantharis is to be used in place of Bell.
Where the disease comes on soon after child-birth, Podophyllin is the Specific. It is to be given at the first attenuation three times daily in half gr. doses of the trituration. In this case let the parts be freely washed daily with a solution of borax, quite warm. In the chronic form of the disease, especially where barrenness exists, Macrotin, Podophyllin and Hydrastin, given morning, noon and night, in the order named, will, in nearly all cases, afford relief.
For females who have never borne children, give Phos. acid, 2d and Eryrgium Aquaticum 1, night and morning for a week, and then give them at the 3d dilution until the symptoms subside. If there are headache and derangement of the stomach, Macrotin and Podophyllin should be used, each once a day, between the latter remedies. When the discharge is colored and the pains darting, cutting or smarting, indicating ulceration, or if ulceration is discovered by examination, use Macrotin and Hydrastin internally, injecting the latter upon the affected parts freely. The ulcerated surfaces should be well washed off every day with soap and water, or a solution of borax, and the medicine (Hydrastin) in form of infusion, used half an hour after the other wash. If the neck of the womb looks dark, and is ulcerated, or is hard and painful to the touch, especially on probing the cavity, Cornus Sericea must be used both as a wash to the parts, and at the first dilution internally, using them twice a day. This remedy will often cure malignant cases.