Femina, A Work for Every Woman

by John A. Miller

The acute variety of endometritis is much more prevalent as a disease than is commonly supposed, but, owing to an absence of specific or definite signs, pointing directly to the mucous membrane, which the woman herself can recognize, it is generally mistaken for something else.

The disease begins with signs of an active congestion in the pelvic organs; such as drawing pains in the small of the back and in the groins, and a feeling of fullness and weight at the bottom of the pelvic floor. The urine is voided with pain and there is a sensation of heat in some parts of the urethra. Pressure on the lower abdominal region is painful, and the sensitiveness diminishes from the middle towards one or the other side. In mild cases these symptoms are not accompanied with fever, headache or a disturbance of the nervous system; there may be diarrhœa due to reflex irritation of the rectum, and the stools are accompanied with bearing-down pain. After three or four days there is usually a discharge of a viscid liquid, which in eight or ten days becomes creamy, purulent and often tinged with blood. The fluids that are discharged from the vagina sometimes become so acrid and irritating that, when they come in contact with the skin of the vulva, abdomen or thighs, it becomes irritated and inflamed, which leads to excoriations and an itching, that may spread over the entire body. The reaction of this discharge is either acid or alkaline, depending upon whether the discharge of the uterus or that of the vagina predominates; as the discharge from the uterus is always alkaline and that from the vagina always acid, there is nothing of a practical diagnostic value in ascertaining the chemical reaction of the secretion. The vagina will generally be found to be hot and more or less swollen as in ordinary vaginitis. The womb itself, however, will be enlarged and sensitive, while the cervix is gaping or open. Through the speculum, it is seen to be red and congested, and from the gaping mouth there issues a clear, albuminous-looking fluid or a muco-pus.

In the subacute or chronic form the symptoms are by no means always so prominent as to indicate the existence of the affection, or they are so marked, by some of the numerous complications, which are in the nature of cause or effect, that its recognition will become extremely difficult. The effect which the disease has on the general organism varies greatly in different individuals. Some women of robust appearance have an aggravated form of uterine catarrh without any immediate ill effects on their nutrition or general health. Other women lose flesh early and become weak and worn; they become pale, and the face assumes a yellowish ashen hue with dark rings under the eyes. Through reflex irritation from the nerves of the uterus other nerve centers become involved, so that a general neurasthenia becomes developed with its characteristic concomitants of neuralgia, muscular spasms, uterine colic and hysteria.

With a third class the inflammation spreads from the lining membrane to the substance of the womb itself, causing an enlargement of the uterus, which induces displacements and a dragging sensation in walking, pain in coitus and painful defecation. The inflammation does not limit itself to the womb, but an ichorous discharge creates distressing symptoms of vaginitis, inflammation of the bladder, and pruritus vulvæ.

When the uterine cavity is the seat of an abnormal vascular activity, there often exist symptoms of pregnancy that may mislead the patient or physician. Nausea and vomiting are sometimes present, the darkening of the skin around the nipples, and an enlargement and sensitiveness of the breasts, meteorism, or a swelling of the abdomen, caused by the accumulation of air in the intestinal canal from reflex nervous irritation, and when this symptom is added to the irregularity of menstruation, it is easy to fall into the error of diagnosing pregnancy.

Sterility on the one hand, and habitual abortion on the other, should direct attention to the probable existence of endometritis. Very often barrenness has led to an investigation of the condition of the uterus which disclosed the existence of the disease. A woman who conceives, and then loses her child in the first months of pregnancy, is afflicted, in all probability, with a chronic endometritis. In these cases, where conception takes place, it is to be presumed that the sensitiveness and irritability of the inflamed mucous membrane is not suitable for the permanent fixation of the ovum, so that the slightest shock will open the flood gates of a congested uterus, and thus the embryo is separated from its attachment, and lost.

The cervix is sometimes the seat of a special feature of uterine catarrh, that is due to the chronic inflammation of the cervical mucous membrane, stimulating a growth or proliferation of its own tissue or structure. This growth causes an enlargement and elongation of the entire cervix, and a spreading of the lining membrane of the cervical canal to the vaginal surface of the cervix. This encroachment of the cervical lining on the vaginal lining is the displacement of the pavement epithelial cells of the vaginal portion by the cylindrical or columnar epithelial cells of the cervical canal, and this gives rise to erosions and follicular ulcers.

These erosions have a glandular arrangement, and are often mistaken for cancerous or malignant growths. There is no doubt in my mind, that most of the so-called successful cures of cancer were nothing but cures of erosions.

The microscopists, whose lively imaginations make them see things that do not exist, would make us believe that they can take a small section of the suspected growth, and establish the existence of cancer by microscopical examination; this is utterly impossible, because the cancer cell is no different from normal cells, and in erosions we often find the follicles so close to each other, and their cells so closely packed, one on the other, that no candid mind can say whether it is a malignant or an innocent growth.

The claim that “nests of epithelium cells,” as the stereotyped phrase goes, constitute scientific evidence of cancer, is utterly absurd. Such eminent authority as Professor Arnold, of Heidelberg, makes the assertion that positive diagnosis of cancer, from a small section or scraping, is impossible. I am myself fully convinced of the truth of this assertion, for while I was making microscopical studies in Germany, I had abundant evidence of the truth of this statement. It is indeed very unfortunate, both for science and suffering humanity, that as yet there is no absolute means of diagnosing cancer positively, and for that reason the quacks, and those who are not quacks, will continue to fleece their victims for supposed cancer.