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 canal 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, aud 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 felt, 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 education. 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 disease 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,

and Pae judiciousness of his treatment. No patients submit to so much eroneous 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 manki, wulen ate not the source of sorrow and humiliation to an ingenuous mind.

ACUTE METRITIS.

Or acute infamination 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 gwen, 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.

THIS disease is generally partial, being confined to the posterior wall of the uterus. This arises from the fact, that the muscular fibres of that wall are continuous with those in the neck of the womb, and chronic metritis is generally caused by the extension of inflammation from the neck to the body of the organ. The symptoms of the disease are, a dull aching deep-seated pain in the hypogastric region, just above the pubis; also still more constantly, a pain in the loins and sacral region, extending down the inside of the thighs. These pains are increased by walking, and are accompanied by an oppressive feeling of pelvic weight. On examining by the finger in the vagina, an extremely sensitive protuberance is felt on the posterior surface of the body of the womb, sometimes smooth, sometimes irregular and knotty. Pressure here causes exquisite pain and nausea. The womb being an organ very delicately poised in the pelvis, any increase of weight in one part makes it incline in that direction; and therefore it is in this disease retroverted, and lies upon the rectum, causing obstinate constipation, and the passage of the fæces gives great pain. There is generally some leucorrhoeal discharge.

The constitutional symptoms are the usual ones expressive of impaired health, namely, headache, want of sleep and bad dreams, foul tongue, want of appetite, and dyspepsia. No organ sympathises so much with the womb as the stomach, and there is very generally nausea, along with much dyspepsia, present in this disease. A peculiar appearance of pallor and languor, which is very characteristic of inflammatory diseases of the sexual organs, and hence called the facies uterina (uterine face) is in no affection more strongly marked than in this. The patient looks worn out by habitual suffering. Although this affection is a most wearing and distressing one, yet it is not incompatible with what a superficial observer might think tolerable health, especially in the menstrual intervals. But during menstruation all the pains are greatly increased, and are often agonising. The disease is of an exceedingly chronic and obstinate nature, like all inflammations in tissues of low vitality, for instance bones, ligaments, &c.; and also because it is kept up by the periodical congestion of menstruation. Indeed Dr. Bennett, who was the first accurately to describe this, and several other uterine inflammations, says, he never

saw a case get well spontaneously, as long as menstruation lasted. He says, that in most of the cases he had seen, the disease had continued for years unknown, the patient having been supposed to suffer from irritable or displaced uterus, or from functional dysmenorrhoea. We see in this, what miserable and protracted sufferings may arise from erroneous diagnosis.

The cause of this painful disease is in some cases an attack of acute metritis, which is not perfectly subdued. But in general it results from the extension of inflammation from an ulcerated cervix, and when so, it is peculiarly intractable.

The treatment is, first to cure the ulceration of the cervix, if such exist. This often removes the chronic metritis, but not always, and in these cases the tenacity of the disease is extreme, and from months to years may be necessary for its treatment. The means to be used are, rest in the recumbent position, with emollient or astringent vaginal injections, and the occasional applications of leeches to the os, before, during, or after menstruation. At the menstrual exacerbations, opiate injections into the rectum should be used, or the inhalation of chloroform, if the pain be agonizing. The constipation, which is almost always obstinate, is very difficult to treat. Injections cannot be used, for they cause great pain. It is a good sign, when the patient becomes able to bear them. Mild aperients should therefore be used. By these means, long and perseveringly applied, together with lying out in the open air, whenever the weather is favourable, tepid sponging, and other modes of bracing the general health, the disease can almost always be at last cured; but this depends greatly upon the patience and perseverance of the sufferer, and whether she have the power of using the various requisite means for so long a time.

To prevent this disease, its chief cause, ulceration of the cervix, should be prevented, or if it do occur should be met by prompt treatment, so as to prevent its giving rise to this much more tedious and painful affection.