Inflammation of the Womb. Metritis.
This disease very often follows delivery, and is connected with child bed fever.
Various Causes also produce it in the unimpregnated state. Inflammation of the ovaries, or of the uterine neck, may extend to the womb. Falling of the womb may cause it to be irritated by being placed in a new position, and thus bring on inflammation. In some temperaments, marriage may produce this disease; in others, singleness. It may also be brought on by painful menstruation, by forcing medicines, by constipation, by tight corsets, by solitary vices, and by excited sexual feeling.
This is the most common variety of inflammation found in the pelvis. It is often limited to the neck of the womb, and is then called endocervicitis; it may be limited to the lining membrane of the womb, and is then called endometritis, but practically it is all one and the same disease, and sooner or later involves not only the mucous membrane of the interior, but also the muscular structure of the womb itself. It is now considered a germ disease and rarely results in spontaneous cure. It proceeds from the entrance of germs into the uterus either at the time of labor or miscarriage, or from the entrance of the germ of gonorrhea ; germs, however, from the vagina, which are normal to that region, may often be carried into the cervix and there set up a trouble.
Symptoms: Pain in the back, nape of the neck, the right or left iliac region; leucorrheoa; painful menses; hemorrhage from the womb; symptoms from neighboring organs (bladder, rectum); and symptoms from distant organs, as stomach, heart, nerves, etc.
No disease gives rise to so many and so complex symptoms. Nausea and vomiting, flatulence, constipation, palpitation, headaches, cough, nervousness, loss of appetite, etc., are frequent symptoms of the various forms of metritis. On examination a hard, congested womb is felt, with perhaps enlargement either of the neck or the entire organ, erosions, ulcerations, eversion of the lips from a tear may be found, while issuing from the mouth of the womb is seen a plug of mucus which is either white, translucent and ropy, or yellow and more pus like. The womb is tender to touch, and this tenderness may be transmitted to the appendages (tubes and ovaries).
Treatment. This varies with the variety and the length of time the disease has existed. If there is inside the uterus any retained product of conception, placental tissue, or granulating surfaces, they must be curetted out as described in a previous article. This process is practically an operation and must be done thoroughly and under ether. If there is active inflammation going on m the tubes or ovaries, this procedure must be postponed and milder measures used for the time being, such as painting the vagina and neck of the womb with iodine and similar remedies.
Tampons of wool wet with glycerine are frequently used to deplete the engorged womb, applications of creosote and iodine will often heal over simple erosions, while hard cicatricial masses are often absorbed by applications of iron. Tampons are to be worn from twelve to forty eight hours, but should be removed whenever pain is produced. The womb is to be thoroughly scraped and washed out, and a good drainage kept for the escape of forming secretions whenever there is severe inflammation of the body of the organ. Lacerations of the neck, when extensive, are to be sewn up, but when only moderate may be successfully treated with strong styptic iron. Hot douches not only serve a good purpose in reducing congestion and inflammation, but are often very soothing. They are to be taken in the recumbent position; the water to be hot as can be borne 110 to 112' F. and as much as six quarts are to be used. One Should purchase for this purpose a large fountain syringe, or a tin pail, and hang it two feet above the head; it is to be used twice daily, and may be used every three or four hours. Patients suffering with this and similar diseases must not dance or take long walks, nor should they use the sewing machine; neither should they stand long at a time, but should have light exercise in the open air and general systemic medicine; they should lie clown every day from two to four hours, and in severe cases must retain the recumbent position. The bowels must be kept relaxed with cascara sagrada or some morning saline; a teaspoonful of the aromatic cascara at night, or a half glass of Hunyadi Janos water on rising, are excellent for this purpose. If the woman is pale, a prescription of some iron tonic will be useful, such as the four chlorides or Aiken's tonic pill.
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