SUBACUTE OVARITIS.

THIS is a much more common disease than the preceding. Dr. Tilt, who has lately directed the attention of the profession to the subject, says, he believes no disease is more common than, though so little understood as this. In subacute ovaritis, in general, the whole ovary is not affected, but the inflammation is limited to certain parts, as the Graafian follicles, &e. The symptoms of this important affection are, a dull pain in the ovarian region, increased by walking, riding, or pressure on the part, and also by straightening the leg. The pains radiate from the ovary to the loins, thighs, and anus, and are of a dull, dragging, and sometimes overwhelming character. But they are seldom so acute as to make advice be early sought, and are thus often endured for years. Sexual intercourse increases the pain. This wearing affection, like other inflammatory states of the ovaries and womb, deadens the sexual feelings. It very frequently gives rise to hysteria. It also frequently causes the various disorders of menstruation, which it produces either directly, or by occasioning a secondary congestion or inflammation of the womb, whose health depends greatly on that of the ovaries. It also gives rise to sterility, which Dr. Tilt believes to be much oftener connected with disease of the ovaries, than of the womb, although the contrary is the general opinion.

The morbid appearances so commonly found in the ovaries after death, and which have been caused by subacute ovaritis, are a red and inflamed state of the Graafian vesicles, which are sometimes full of pus. They are also frequently swollen to the size of a pea, denoting a state of chronic inflammation. The fallopian tubes are frequently found bound down by adhesions, so that they could not be applied to the ovaries. This appearance is very frequent in prostitutes, and is one cause of their general sterility.

The chief causes of subacute ovaritis, according to Dr. Tilt, are, "excessive venereal indulgence, which sometimes produces it in newly married women, but particularly in prostitutes, whose ovaries after death almost always present some morbid lesion; privation of the sexual stimulus, whether its absolute privation, as in single women, or sudden withdrawal as in widows, both of which leave the ovaries in a congested state;

late marriages, in which the venereal stimulus is liable to prove too powerful for the ovaries, unused to it; the decline of menstruation, both in the case of the involuntary nuns of a society over-stocked with women, and in those who have indulged in venereal excesses; moral emotions and ungratified desires, which are known in the male sex to have the effect of increasing the seminal secretion, and naturally have an analogous action on woman; arrest of menstruation, which is apt to be followed by this disease, along with dysmenorrhoea and hysterical symptoms; gonorrhoea, leucorrhoea &c." Dr. Tilt remarks, that the want of the appropriate stimulus to the ovaries, which should promote their healthy action, is often the cause of their becoming the seat of morbid affections.

Subacute ovaritis is thus a most important affection, from its great frequency, and from its obscure nature. There are doubtless very many such cases existing unknown at present, the hidden root of various miserable diseases, which cannot be cured without the prior removal of the ovaritis. Thus very many cases of amenorrhea, menorrhagia, dysmenorrhea, sterility, and hysteria, are owing to this disease, and in all these affections a careful examination should be made, if there be any symptoms of ovaritis.

The treatment recommended by Dr. Tilt is, leeches applied over the ovarian regions, succeeded by successive blisters to that part, so as to break the morbid chain of nervous action, and lastly to rub in an ointment composed of mercury and belladonna. The bowels should be kept open by aperients; and emollient injections into the rectum, with the chill taken off, should be used thrice a-day. Three or four ounces should be injected at a time, (the pelvis being elevated,) and retained as long as possible. They bathe and soothe the parts affected. By these means, which can be used only in the menstrual intervals, a radical cure may generally be effected; and after it, cold water injections, morning and evening, should be used. Sexual abstinence and a regular healthy life should be enjoined during the treatment; and for some time after the cure, sexual intercourse should be taken in moderation. Sterility and the various menstrual and hysterical affections, connected with subacuta ovaritis, frequently cease after its cure.

INFLAMMATION OF THE WOMB.

I Now proceed to the inflammations of the womb, of which much more is known than of the ovarian inflammations, in great part through the admirable work of Dr. Henry Bennett. In examining the diseases of the womb, we have fortunately a much more certain guide than the finger, namely, the eye. There are two kinds of specula used, the round and the bi-valve one, the latter of which consists of two separable blades, and is the best, for by means of it the mouth of the womb can be opened, and the cervical canai seen, which is very important, as disease often lurks in this part. But it is more difficult to manage than the round one, which answers excellently for many purposes. The patient should lie on the back, opposite a window, in specular examinations, so that the light should fall on the parts examined. Candlelight will do in the absence of daylight, though not so good. The womb is also examined by means of the touch, through the abdomen, vagina, and rectum. It is only when enlarged that it can be felt through the abdominal walls. Through the rectum, one half of the posterior surface of the womb can be feit, as the prostate gland in the male; and unless the examiner be experienced, he may think the healthy womb morbidly swollen. But the general mode of examining the womb is through the vagina. The fore-finger here readily reaches the mouth of the womb, and can in this way obtain most valuable information.

But the finger, to be a reliable guide, requires a great deal of edu. cation. Women seem to suppose that all they have to do is to consent to a digital examination, and all will be ascertained. But the fact is, that there are very few medical men, except those who give special attention to midwifery and female diseases, who can diagnose by the finger many kinds of uterine disease. It is a very difficult thing to tell by the finger, that the mouth of the womb is ulcerated; and the proof of this is, that this very common disease remained almost entirely unknown, till the free use of the speculum. It is necessary to educate the finger by the eye, with the greatest care, before it can be trusted to. Thus, unless a man's finger be a very sure guide, he should always use the speculum also. A woman should consider, that instead of ending, the real difficulties in the recognition and treatment of her case are only beginning, when she consults a medical man; but her mind, if she have had little sexual experience, is generally so much occupied with the unpleasantness of revealing her discase and consenting to an examination, that she loses sight of the only really important matters to her, namely, the competence of the man she consults,

Be judiciousness of his treatment. No patients submit to so much erroneous treatment, are so much quacked, and have so little to say in their own case, as sexual patients, especially women; for the unfortunate sexual bashfulness paralyses their common sense, and prevents them from reasoning vigorously as becomes grown up human beings, on a matter of such vital importance to them as their own health.

A very common and most unfortunate defect in medical men, is a dislike to confess their ignorance, and very great evils arise from this. Each one vies with his neighbour in vaunting his own knowledge and his own success. The great reason is, that the public are so utterly ignorant of medicine, that anything passes current with them; and thus is a man tempted to impose upon them, and to pretend to more knowledge than he really possesses. Public ignorance is certain to lead to pretence and to deception, and while that continues to exist, it is in vain to hope that these will not flourish.

There is no possible remedy for these evils, but an increased knowledge of health and disease throughout society generally, so that they shall be able to distinguish between true and pretended science, and to judge for themselves on so infinitely important a matter as their own health. There is no class of diseases in which there is so much assumption of knowledge, with so much real ignorance, as the sexual ones, just because they have been wrapped in such special obscurity. Every one connected with medicine, even to the midwives and nurses in our hospitals, affects to talk knowingly upon sexual matters, as if the most obscure and ill-understood part of our nature were patent to them. This assumption is favoured by the profound ignorance and secret curiosity of the public on sexual matters, and the pride of appearing to be one of the initiated. In fact, turn where we may, there are few things connected with the present sexual state of mankina, which ale not the source of sorrow and humiliation to an ingenuous mind.

ACUTE METRITIS.

Or acute infiamination of the womb, (from the Greek word signifying the womb,) generally arises from the sudden arrest of menstruation, when it occurs in the non-impregnated state. The symptoms are similar to those of acute ovaritis; severe pain in the hypogastrium, pelvic weight, fever and constant nausea. A digital examination by the vagina should always be used to ascertain this affection. The vagina will be found hot and dry; the cervix swollen, and often sensitive; while the body of the womb is exquisitely painful, any touch causing nausea. Nausea is a

very frequent symptom in affections of the womb, and arises from the intimate sympathy between that organ and the stomach. In incipient pregnancy, nausea generally occurs, and shows the sympathy of the stomach with the changes going on in the womb. In acute metritis the passage of the faeces is exquisitely painful, for the womb lies just upon the rectum, and, in passing, they lift it up.

Acute metritis generally ends by resolution, that is, complete subsidence of the inflammation, in from five to ten days. It rarely ends fatally, but in some cases, it degenerates into chronic metritis, which is an exceedingly wearing and painful affection. This is particularly likely to happen, if the acute disease be not recognised, (as is frequently the case in the absence of the necessary digital examination,) and styled loosely "inflammation of the bowels." If not recognised, it is not treated promptly enough; and there are few diseases which cause so much suffering, as the chronic metritis, which may follow.

The treatment should consist in the application of a large number of leeches, from ten to twenty, to the hypogastrium. This should be followed by large thin poultices to that part, or by warm fomentations, if the abdomen be too tender. Internally, tartar emetic should be given in small doses, which is a most valuable remedy in the majority of acute inflammations, producing sickness, relaxation, and perspiration, quieting the pulse, and reducing fever. Gentle saline aperients should also be gaven, to soften the fæces, and prevent them from irritating the womb, and to cool the system.

In acute ovaritis the same treatment should be used, and more actively to prevent suppuration if possible.