Chapter 11 - Female Diseases
Introduction to Female Diseases
Inflammation of the Neck of the Womb
Inflammation of the Ovaries
Absence of the Menses
Profuse Menstruation
Painful Menstruation
Green Sickness
Cessation of the Menses
Polypus of the Womb
Uterine Hydatids
Inflammation of the Womb
Falling of the Womb
Falling Over of the Womb
Tumors of the Womb
Cancer of the Womb
Ovarian Tumors
Inflammation of the Fallopian Tubes
Inflammation of the Vagina
Itching of the External Parts
Tubal Pregnancy
Prevention of Pregnancy
Antiseptic Dressings
Milk Leg
Child Bed Fever
Puerperal Convulsions
Nursing Sore Mouth
Broken Breast
Sore Nipples
Sex of Child, How to Regulate Before Birth

11.2 Inflammation of the Neck of the Womb

Inflammation, Ulceration, and Enlargement of the Neck of the Womb.

INFLAMMATION Of the neck of the uterus is very common; ulceration and permanent enlargement (technically called hypertrophy), are its results, when it is not arrested in due time. These affections, in fact, and the same troubles as they affect the ovaries, make up the bulk of female diseases, being the real causes of the most of those symptoms which have passed under the name of whites, suppression, painful menstruation, sterility, general debility, etc.
The neck of the womb when healthy, is soft and smooth. No hardness or condensation of tissue can be felt by the finger on pressing over it. It is elastic, too, and feels unctuous to the touch. This latter sensation is communicated by the layer of mucus which covers it. Pressure upon it produces no pain.
Inflammation, when found in this part, may begin in the mucous membrane which covers the neck, or in that which lines its cavity, or in the small glands in the body of the organ.

Symptoms. Inflammation of the mucous membrane covering the neck of the uterus destroys the unctuous feel which it has in health. It also causes the neck to swell, its vessels being crowded full of blood. If the body of the organ, as well as the surface, be reached by the inflammation, it will be hardened and enlarged; and in consequence of its increased weight, it is apt to drop down somewhat into the cavity of the vagina. In married ladies, it is often, by physical pressure, pushed a little backward, or retroverted. Examination with the speculum shows the inflamed neck to be of a vivid red, instead of a pale rose color. It may be covered with red or white pimples, which are glands enlarged with muco pus.
In the healthy state, the mouth of the womb is so much closed as to be just perceptible when the finger passes over it. Inflammation causes it to be more or less open, and its lips to be parted.

Inflammation followed by Ulceration. In a majority of cases, inflammation of the neck of the womb and of its cavity is soon followed by ulceration, which generally appears first around the mouth, and just within the cavity of the neck. From thence it spreads both inward and outward.

Various Degrees of Ulceration, etc. Of course, these inflammations and ulcerations mix and run into each other in all possible forms, presenting excoriations, or raw places; granulations, or pimply surfaces; and indurations, or hardened parts. Sometimes these pimply patches will be. red and bard, and again the whole surface will be spongy, and will bleed upon the slightest touch.
In many cases, these ulcerations make wretched work with the mouth of the womb, eating deeply into the cavity, and giving it a ragged and unsightly appearance.

Velvety Feel from Ulceration. Ulceration generally gives to the surface on which it exists, a soft, velvety feel, which the finger generally recognizes. This velvety sensation, with the open state of the mouth, are the most important evidences we can derive from the touch, of this form of disease.
The Discharge from these Ulcers is always Pus, or, in common language, matter. It is sometimes poured out scantily, at other times very freely. It may be thick and yellow, or thin, and of a lighter color.
The inflammatory and ulcerated condition of the neck of the womb often gives rise to pain; and when the seat of the disease has not been examined, as it should be, this pain has frequently been called neuralgia. In this way, ignorance has compelled neuralgia to stand sponsor for a great many pains with which it has had nothing to do.

These Ulcers Disturb Menstruation. Menstruation is generally changed more or less in its character by the presence of inflammation or ulceration in the neck of the womb. It usually becomes more painful. In some cases it is made more profuse, in others more scanty. It may come on more frequently, or it may be postponed, protracted, or abridged in its continuance. There is generally pain of a dull, aching kind, low down in the back. There is often a feeling of fullness, pain, and a sense of bearing down in the lower part of the bowels; sometimes the pain extends to the groins and thighs.

Extensive Disturbances from these Inflammations, etc. The nerves with which the womb is liberally supplied belong to those of the sympathetic system. Hence, the condition of the uterus influences a wide circle of sympathies. By these nerves this organ is brought into close relationship with the organs of animal life. If the former suffer, the latter suffers also. The stomach, being intimately connected with the womb, physically, feels keenly these inflammations and ulcerations of the uterine neck. At times, the pain, debility, general disturbance, and dyspeptic state of the stomach are such as to cheat both the doctor and the patient into the belief that this organ is the seat of the disease. But in such cases, the symptoms of stomach disease will all disappear the moment the local affection is removed from the neck of the womb.
The liver, too, often participates in these troubles, and becomes sadly deranged. It is sometimes even greatly enlarged and congested, and patients frequently have the various symptoms of what are called liver complaints.
Severe pains are sometimes felt under the breast bone, and over the chest generally, making the patient apprehensive of disease of the lungs; and indeed consumption is not a very infrequent result of uterine diseases.
Pains are often felt in the region of the heart, which organ is often harassed with palpitations.
The flesh is apt to waste under the symptoms excited by these inflammatory and ulcerative processes in the uterine neck; and even the brain, though lying in some measure beyond the circle of influences set in motion by the organic nerves, suffers disturbance and pain.

Even the special senses of sight and hearing may be drawn into this general vortex, and both be much impaired. And to crown this; catalogue of ills, it may be mentioned that those distressing things called hysterical fits proceed from the same local disorders.
In brief, there is scarcely a point in ิthe human body to which these inflammatory and ulcerative conditions of the uterine neck may not send their sympathetic pains and aches, and where they may not in time induce real disease. This is the reason why so many women suffering from these local complaints, tell the physician, when consulting him, that they are 11 diseased all over." If asked where the complaint is located, they will answer, ,It is everywhere." In the most earnest manner the assurance will be given, "Doctor, there isn't any well part about me."

Treatment. It is just as unreasonable and useless to treat these inflammations and ulcerations through the stomach, as it is an inflamed or ulcerated throat. They are local diseases, affecting a particular part, and the remedy must be local.
Like all other affections, these can only be managed intelligently after their nature is well understood. Nothing can really be done towards a cure until it is known what the matter is; and no competent physician will move a single step in the treatment of one of these cases until he has made a thorough examination. He owes this to himself and to his patient, the more so as the neck of the womb may be as easily examined as the upper part of the throat, and the local remedy may be almost as readily applied in the former case as in the latter.
If, upon the introduction of the speculum, the uterine neck be found simply inflamed and enlarged, the application of ichthyol and glycerin to the canal will reduce the swelling and inflammation; while a tampon of wool soaked in the same and placed behind the womb will reduce the entire swelling of the womb by the watery discharges which are produced. The patient must learn to lie down most of the time.
One who is not accustomed to treat these affections in this simple way, will at first be surprised at the rapidity with which the local trouble will disappear, and with it the thousand and one aches and pains which torment the whole body. As the terrible pains in the whole face and head which are produced by a single tooth all instantly come to an end when the tooth is extracted, so do the bad feelings all over the body subside as fast as the local ailments of the uterine neck are cured. There is no exception to this rule, except where the sympathetic affection has become fixed by long neglect of the primary uterine disease. It is, therefore, surprising that so many excellent women, whose lives are of the greatest value to themselves and friends, should be permitted to perish of these ailments, when the cure is so simple, and many times so entirely within the reach of the most ordinary skill. It is a reproach to the profession which should be wiped away.
If there are a hundred motives for gaining the mastery over other diseases, there are a thousand for learning to control these. More than any other disease, or all others, they make the homes of men desolate, by robbing them of women, their ornament and solace. The physician who neglects to make himself acquainted with all there is to be known of these complaints, shows himself not only unfit for his profession, but deficient in some of the prime elements which combine to make a true man.

Hardening of the Uterine Neck. In many cases the uterine neck is not only inflamed and enlarged, it is indurated and hardened. At times it is enlarged and hardened on one side, and not much on the other. In still other cases, there are enlarged spots, or nodes, giving the whole neck a knotty feel under the finger.
These hardened conditions of the uterine neck proceed from various causes, and are more difficult to cure than the ordinary inflammation, or even ulceration. They sometimes indicate cancerous disease, and then, of course, involve the most serious considerations. The glycerin tampon and the hot vaginal douche will do more for this hardening than all else combined.

Uterine Syringe. For applying the several remedies to the internal cavity of the uterine neck, I have contrived a silver syringe, which is bent a little at the extremity, and pierced with fine holes all round. With this instrument, the remedy is carried directly to the diseased part, and applied instantaneously to every side of the cavity.
Besides these local applications, it is frequently necessary to resort to soothing or astringent injections into the vagina, hip baths, and injections into the bowels, some mild physic, and rest in a horizontal position. These matters will all be judiciously regulated by the attending physician, if he is master of his business.

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