INFLAMMATION OF THE SEXUAL ORGANS.

THE next class of diseases which I shall speak of are the infiammstions of the various sexual organs; an exceedingly important en: common class. The diseases which have been already treated of, are often termed in medical works the Functional ones, as they are frequently seen without any structural alteration, to be recognised either during life or after death. Still, all of them are frequently connected with, and dependent upon, inflammatory disease, and there has been a growing tendency of late years, since the more accurate investigation of the sexual organs by the speculum, to consider them more and more of an inflammatory nature. Leucorrhea used to be constantly regarded, as well by the medical profession as by women in general, as a disease of debility, and "the whites" are still prevalently thought to be only "a weakness." But Dr. Bennett has shown that in the great majority of cases of any severity, these discharges are of an inflammatory nature, connected very frequently with ulceration of the mouth of the womb; and that, instead of being the effect of the dyspepsia and general debility usually found along with them, they are the cause. He has shown likewise, that all the disorders of menstruation are frequently owing to such ulceration. Dr. Tilt has in like manner traced many of these diseases to an inflamed state of the ovaries, showing that amenorrhoea, dysmenorrhoea, menorrhagia, &c., are frequently dependent on this cause. Hence arises the extreme importance, in all cases of these so-called functional diseases, of making a careful examination, whether they be not connected with an inflammatory affection.

I shall begin with the ovaries, which are the most important parts of the female organs. There are very few organs in the body, which are so little understood, and have been so little attended to, as these most important ones. In reality they preside over the female sexual system, just as the testicles do over the male; and the peculiar sexual sympathies and feelings, both moral and physical, depend on them, and not on the womb. From their small size, their hidden position, and still more from the ignorance of their physiology, (for the new views of ovulation and menstruation are among the most recent discoveries in physiology,) they have been neglected; and the womb has received the main share of the attention of physicians, and to it were ascribed the various sexual sympathies. Hence the pathology, (or knowledge of the 'diseases) of the ovaries, is still quite in its infancy, and medical works are very meagre on this sub

ject. It is indeed known that the ovaries are exceedingly prone to disease, for in no organs are morbid appearances more common after death. But the causes of these appearances, and the symptoms of disease, which they produce in life, are still wrapped in great obscurity; although the new light thrown on the functions of the ovaries by the theory of ovulation, and the labours of physicians who are now earnestly investigating these organs, will, it is to be hoped, soon illus. trate the subject. Nothing more retards our knowledge than the false sexual delicacy, which prevents women from speaking of the minor derangements of menstruation, or of applying for aid in the incipient stages. Science and the female health alike suffer by this most unfortunate feeling. Moreover the repugnance to the necessary modes of examination is a great obstacle. Dr. Tilt remarks, that it is only when the patient's sufferings are habitually intense, or when the prospect of marriage has overcome her reluctance, that an examination is permitted; from this insufficient examination also the disease is frequently only partially cured, and relapses take place.

The necessary modes of examining the ovaries are through the walls of the abdomen, vagina, and rectum. All of these must be carefully used, where there is a suspicion that the ovaries are in a diseased state; and it is fortunate for woman that it is possible by these means to arrive at a true knowledge of the nature of some of her most miserable diseases, and to be able therefore to relieve them. But there are very few physicians, who have the tact and experience necessary to make such an examination with profit. To make a physical examination, to use the speculum or the finger with advantage, requires a long and careful training, of the difficulties of which the public seem to have no idea, but to suppose that all medical men have such knowledge by a kind of intuition, or as a matter of course. Now the fact is, that with regard to the examination of the female organs, and especially the ovaries, very few physicians have had a proper training, and most of them have had absolutely no training at all. The reason of this enormous medical deficiency is, that such training does not form a part, unless as a rare exception, of the ordinary medical education, on account of the unfortunate scruples of sexual delicacy; and thus the great mass of physicians, though fre quently called upon to treat female disease, are really quite incompetent to do so. Thus unfortunate woman, even when she does reluctantly make up her mind, after long concealed suffering, to apply for aid, very probably consults a man, who is not much more capable of forming a true opinion in her case than she is herself.

It is not correct to say, that this class of diseases is specially cultivated by certain physicians, and that it is sufficient for these to be conversant with female complaints; a large proportion of sexual diseases are masked diseases, whose real sexual nature is not recognisable without a careful analysis and examination of the organs, by a man who is competent to form a fair opinion on the matter. Although it is a great advantage, that some men should devote a special attention to certain organs and diseases, yet every medical man should be

able to examine all the different organs in the body, and have a tolerable degree of skill in the management of each. This is especially requisite for the great proportion of medical men, who live in the country, and in small towns, where there is no distinction of medicine into special branches, and each man has to treat every disease that may present itself.

In the abdominal mode of examining the ovaries, the patient lies on the back with the legs flexed, so as to relax the abdominal muscles. Unless however, the ovarian swelling be large, it will not be felt thus. In examining through the vagina, the patient lies in what is called the obstetric position, namely, on the side, with the legs drawn up. The fore-finger of one hand is introduced into the vagina, while with the other hand the examiner presses on the lower part of the abdomen, so as to bring the ovaries within reach of the finger. In examining by the rectum, the obstotric position should be used. The ovaries can be felt in this way, even in their healthy state, although with difficulty; but when enlarged by inflammation they are readily reached. The finger passed into the rectum can feel half of the posterior surface of the womb, bulging through its wall, and on each side the ovaries like two knuckles. When these bodies are healthy, pressure on them gives no pain, but it does, if they be inflamed. Increase of volume can also be recognised in this way. Another method of examining is by what is called the double touch, the fore-finger being in the rectum and the thumb in the vagina. This is very use ful in recognising tumours between these two passages.

ACUTE OVARITIS.

OR acute inflammation of the ovary--(itis being the termination used to signify inflammation in any organ.) It used to be thought by physicians, that this affection was almost confined to the puerperal period, namely, that period which immediately succeeds child-birth, and during which inflammatory diseases in the sexual organs are most apt to occur, and to be of unusual violence. But ovaritis occurs not unfrequently at other times, as Dr. Bennett has shown, but is constantly overlooked by the medical attendant, who confounds it with inflammation of the womb, or with iliac abscess, or "inflammation of the bowels," a general loose expression for obscure and undetermined inflammation in some pelvic organ, of whose nature the practitioner, from his inexperience in the examination of these organs, is uncertain.

Ovaritis may be spoken of along with the inflammation of that loose areclar tissue, which, as well as the ovaries, is contained between the fold of the peritoneum, called the broad ligament; for it is not possible to tell what exact part of these contained substances is affected. The general cause of this disease is the acute suppresion of menstruation, whether by cold, or violent mental emotions. The symptoms are very like those of acute metritis (inflammation of the womb,) namely, severe deep-seated pain in the lower part of the abdomen, with a feeling of weight and uneasiness in the pelvis; also pain in the loins, and tenderness on pressure in the abdomen. There is fever, with a hot skin and quick pulse. A digital examination through the vagina, is absolutely necessary here to learn what part is affected. It is very frequently neglected, and this neglect is the source of great evils. By the vaginal examination it will be found, that the painful tumour is not in the median line, but applied to the side of the womb. It is so closely applied, that it needs some tact to distinguish them. But it is very important to distinguish between the two, for metritis generally ends by resolution (or complete subsidence of he inflammation,) whereas ovaritis generally proceeds to suppuration, unless very active treatment be used. In this case matter forms, and escapes in time, either through the vagina or the rectum. Through the vagina is the most favourable method, for in this canal the pus causes but little irritation. If the abcess open into the rectum, much greater

irritation with griping and dysentery, frequently lasting for days, is produced. The bursting of the abscess, and discharge of pus, is rarely noticed by the patient, unless she be warned to expect it; or if noticed is not mentioned, from the reluctance to communicate information spontaneously in sexual diseases.

After the discharge of the pus, there is a decided improvement in the symptoms, and the patient is thought convalescent. But the disease is by no means radically cured; a chronic state of inflammation still continues, and this is aroused anew by each return of menstrual congestion. Fresh matter then gathers, and the former symptoms in a subdued shape are repeated. In this manner may this lingering affection last for one or more years; the patient suffering all the time from the symptoms of chronic inflammation in the sexual organs, namely, pain and weight in the pelvis, tenderness in the ovarian region, pain in the back, inability to walk much, and disorders of menstruation. The reason of her state is a mystery to herself, as well as to her medical attendant, if the real nature of the disease have not been recognised at first.

From this description it will be seen, what great evils may arise from not distinguishing this affection from inflammation of the womb, or of the bowels; which so constantly happens at present, from delicacy and medical inexperience in these diseases, preventing the necessary examinations. If this affection were recognised at first, suppuration might in some cases be prevented by active treatment, and if it did occur, well-directed means might subdue the lingering remains of the inflammation.

The general cause of this disease in the unimpregnated womb is sudden arrest of menstruation. It is very rare that acute ovaritis, or acute metritis, arises during the menstrual interval. After confinement however, acute inflammation of these organs is apt to arise from various causes, especially from too early exposure to cold, arrest of the secretion of milk &c.; and in this case the peritoneum is very apt to be involved, constituting a most dangerous and general fatal disease. But in the unimpregnated condition, the peritoneum is very seldom implicated, and fatal result rarely, if ever, occurs.