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We confess we have read this mode of treatment with some misgivings. We have never as yet even ventured to inject fluid into the body of the uterus. It may be unnecessary caution on our part; still we have never done it, lest an inflammation should be set up which might baffle all remedial means.
We should certainly think the saving clause," when all febrile excitement has become completely subdued,” ought to be rigidly adhered to.
CHAPTER 5. Signs of Pregnancy. We pass over this chapter and come to
CHAPTERS 7, 8, 9. On the Causes of Abortion. These ar the most interesting chapters in the book.
Two general causes; 1, disease of the cervix uteri; and 2, a venereal taint, are by far the most influential causes in the
production of abortion.
Out of 378 cases examined carefully, 275 arose from diseases of the lower part of the uterus. What are these diseases? The author enumerates them as follows: 1. Inflammation, and superficial erosion of the cervix. 2. Varicose ulcer. 3. Edema of the cervix. 4. Fissurated ulcer of the cervix. 5. Endo-uteritis. 6. Follicular ulceration.
To our mind the importance of attending to diseases of the cervix, in cases of abortion, cannot be too highly valued. Any one who will run his eye over the works on midwifery and the journals of the day, will perceive how inadequate are the means proposed to overcome abortion in an individual liable to abort. Rest, opiate injections, separation a thoro, all aid in certain cases; but most assuredly in many they fail.
Convinced, as we now are, of the frequency of diseased os and cervix uteri in recurring abortion in the same individual, we always call in the aid of the speculum. We have known, in more than one instance, a pregnant woman to be afflicted with what was termed a fooding, for months; abortion has followed; and on examination afterwards we have found a highly irritable state of all the parts, even extending to the bladder; a red, ugly looking ulcer, extending into the os itself, and oozing out from it a bloody fluid.
In all the forms of ulceration, escharotics to the ulcerated surface are indispensably necessary, and, for the most part, an alterative course of mercury and sarsaparilla.
The author prefers leeching to the hypogastrium. We prefer leeches applied directly to the os uteri, and occasionally scarifications with a sharp scarificator, attached to a long handle.
The French practice of applying a hot iron to the part is not so painful as might be supposed, if done with tact and delicately; in some obstivate cases of ulceration it is a valuable agent, more terrible in appearance than in reality.
The author lays down the three following positions from the cases narrated in these chapters on abortion.
1. That what is commonly called ulceration of the cervix uteri may be the predisposing, as well as the immediately exciting cause of abortion.
2. That the purulent product of uterine ulceration, under some forms, at least, possesses virulent properties, capable of producing disease in another individual, or in another part of the same individual, by inoculation; and probably capable also, by being absorbed into the circulation of the same person, of materially disordering the fluids, and of creating thereby a peculiar susceptibility to disease.
3. That the application of caustics to the nterus, and the employment of other active measures which I have heard practitioners object to during pregnancy, as likely to endanger the well-being of the offspring, may not only be safely administered, but that they constitute in fact one of the principal means of securing both mother and child from danger.
Several cases are narrated of varicose ulcer of the cervix, and the appropriate treatment given. We have not room for more than the three points which the author lays down, and which, if proved by experience hereaster to be true, will clear up some heretofore anomalous cases of what is termed menstruation during pregnancy.
1. That menstruation during pregnancy is, for the most part, perhaps always, associated with an abnormal condition, generally with ulcerative disease of the uterus, requiring at all times active remedial treatment.
2. That hæmorrhage during pregnancy is not necessarily associated with an altered relation of the parts within the uterus,
and, by timely care, need not interfere with the integrity of the ovum.
3. That menstruation, during the early periods of lactation, is not always natural menstruation, but that it is generally associated with morbid conditions which are amply adequate to the satisfactory explanation of the phenomenon; that secondary hæmorrhage is, in the majority of instances, not owing to imperfect contraction, or atomy of the uterine fibres; and that the discharge very probably proceeds, under these circumstances, not from the inner surface of the uterus, but from the diseased surfaces situated upon parts external to the cavity of the organ.
Syphilis as a cause of Abortion.
The author confesses that when he commenced his investigations on the subject of abortion, he had no idea that syphilis was so common a cause as he afterwards was induced to believe it to be.
He thinks, and, we doubt not, justly, that the notion entertained of late by some that syphilis can be radically cured without the aid of mercury, is the cause of many disastrous consequences. Individuals have supposed themselves rid of this fearful disease, when, in fact, it was only covered over, as it were; subsequently they have married, and consequences most unhappy have followed. All practitioners in large cities must have seen examples of this kind. Mercury is to syphilis, what quinine is to ague. Without its use, in genuine syphilis, we do not think an individual safe.
The local pathognomonic signs of the uterus in a venereal
1. Endo-cervicitis, or inflammation of the lining membrane of the cervix uteri.
2. A mottled or patchy appearance of the cervix.
The author, as one of the remedial means, highly extols the Rumex Hydrolapathum. “I have used it for several years extensively, both in public and private practice, with the most gratifying results, in cases where sarsaparilla had been given in large doses for many months together, without the slightest benefit."
Of Prolapsus Uteri it is said: “That prolapsus uteri can be effectually treated, and the position of the organ permanently restored, without the aid of the pessary, there exists not a doubt or my mind!” Would that this could be proved experimentally true! How much trouble, vexation, and disappointment at last, in this very affection, have not the fairest of our race suffered !
So far as our observation goes it confirms the following statement:
“ The cases (prolapsus uteri) are generally accompanied with leucorrhea, and with inflammation or ulceration of the cervix uteri, evidences of which are found in almost all instances to have prevailed at a period anterior to the occurrence of the dis. placement.”
The treatment is to be directed locally to the diseased cervix, and generally to the constitution.
Of the first, nit. argent., or other suitable remedies; medicated tents are to be applied to the os, by means of a tube, and changed every one or two days. The metallic preparations should be used not oftener than every third or fourth day, vegetable applications, as matico, tannin, &c., being adopted intermediately.
Of the second, when all febrile excitement is absent, quinine, metallic oxides, iodine, iron combined with cinchona extract or taraxacum, gentian, &c.
CHAPTER 10. Sterility. It is true, as the author observes, that the cause of sterility is generally attributed to a faulty condition of the female organs. No doubt correctly. When we consider the complicated female genital apparatus, the chances are certainly vastly in favour of the faulty condition of this, as compared with that of the male.
The author, however, in this work proposes merely to treat of those cases of sterility, which result from a morbid state of the uterus, originally of a normal condition.
Three principal calises are mentioned, viz: 1. Endo-uteritis; 2. Spyhilis; and 3. Ulceration of the cervix.
The means employed in the treatment of the first and third, are such as have been already given-viz: local applications to the diseased surfaces, and constitutional treatment of an alterative and tonic character, as jodide of iron and sarsaparilla.
In some cases, according to Mr. Whitehead, the interus has resumed its natural function, after an appropriate course of treatment; leading to the hope that as our knowledge advances we may be more and more enabled to overcome this abnormal state of the uterine function, the cause often of much unhappiness.
We trust that the views expressed by the author of this work, especially on the subject of abortion, will be more generally entertained and carried out in daily practice. We feel confident that if they do become more generally understood, and practised upon, much suffering and danger will be obviated, and relief and comparative health afforded to those who otherwise may be doomed to drag out a miserable existence.
The American Medical Almanac, for 1948, containing statis
lics of the various Medical Collezes, Hospi!als, Dispensaries, etc., of the United States; together with other information of value to the Physician and Student. 18mno. pp. 224. Lindsay & Blakiston, Philadelphia.
The title page of this publication indicates very truly the character of its contents. Beside the account of Colleges, Hospitals, Dispensaries, private associations for granting instruction on the various branches of Medical Science, the work contains the or. ganization of the National Medical Association; the code of ethics adopted by the late National Medical Convention ; a chapter on Poisons, their antidotes, and the treatment proper in cases in which the various poisons have been taken ; several articles on the inhalation of ether; Dr. Burder's letters on the importance of promoting the religious welfare of patients, and various miscellaneous articles of general interest to medical men, making altogether an exceedingly interesting and useful volume.