II. Softening of the walls of the womb, ramollissement, is another and more grave consequence of inflammation. This is sometimes found to be the condition of the uterus in females who have died of acute inflammation of this organ. The tissues of the uterus in such cases are found dark red, swollen, softened and friable; with even disposition to gangrene from decomposition of the unhealthy (purulent) blood with which these tissues are engorged.
III. Gangrene and sphacelus, is a much more rare, but necessarily fatal termination of acute metritis. This may result directly from violent inflammation; and occurs at any period from the third or fourth to the seventh or eighth day. It may result from such inflammation as occurs in consequence of strangulation of the uterus in case of procidentia; from the death and consequent decomposition of the foetus in utero; or finally it may appear in connection with phagedenic ulcers, which occupy the inner surface of the womb. Only the former of these three causes of gangrene concern us at present, but it seems best to give a complete picture of this rare form of uterine disorganization while under consideration. This gangrene generally begins in the cervix, and is confined to it. According to Allopathic authority, it is impossible to detect this form of disease before it terminates in death; since the cessation of the pain and of the fetid discharge from the vagina, may occur from other and independent cases. But a careful study of the symptoms present and a faithful application of the corresponding Homoeopathic remedies, will enable the physician to do all that human means can accomplish to arrest the mischief, even if he does not certainly know that such disorganization is imminent. “The pulse is low, quick, concentrated; the patients are seized with shiverings, startings and even convulsive shakings of the body, without any apparent cause; and at the same time they cases to feel any pain in the uterus, or but a less degree, they fall into a state of oppression or extraordinary uneasiness, which is but little short of fainting; and the extremities becomes so cold that scarcely any warmth can be detected in them. Such is the description, given from actual observation of uterine gangrene. As the disease advances other and still graver symptoms appear, which threaten the speedy close of life if not promptly arrested; from the vagina is discharged a brownish liquid of exceedingly fetid odor; a cadaverous-smelling diarrhoea sets in; and cold clammy perspiration appears over the whole body, or on some parts of it only; the features change, and the patient sinks into a prolonged coma, with or without delirium. And with symptoms so strongly marked, the physician would have no difficulty in selecting the proper remedy. Whether this would prove sufficient to arrest the disorganization, would depend upon how much progress it had already attained, and upon the constitutional strength of the patient. In some cases of gangrene of the uterus, this organ has been unknown to become detached from the body, expelled through the vagina, and the patient nevertheless survives this terrible accident. [ Jahr on Diseases of Females.)
Pus may be infiltrated into the tissue of the uterus, where the inflammation is very severe. And the reabsorption of his purulent formation, especially in cases of puerperal inflammation, gives rise to uterine phlebitis. (*See Puerperal Peritonitis.) In this case both the veins and the lymphatics become the receptacles of the puriform matter, which lodging in them, in different places, leads to the formation of fresh abscesses.
IV. The effusion of coagulable lymph is another consequence of acute metritis, especially in those cases in which the serous coat of the uterus is involved. The adhesions which result from the coagulation of this serous effusion, of confining the ovaries and especially the fimbriated extremities of the fallopian ovaries and especially the fimbriated extremities of the fallopian tubes to the neighboring parts, may become the occasion of sterility or of extra uterine pregnancy, preventing these extremities from embracing the ovaries.
Acute metritis, which occurs in pregnancy, from whatever cause, will commonly result in the death of the foetus. And the secondary inflammation, of a very low form, which is slowly developed in t he womb, in consequence of the retention of such blighted embryos, may even lead to the death of the mother. So intimate and profound is the sympathy between the life of the mother and of the foetus in utero, that while the death of the former almost necessarily leads to the destruction of the latter, the death of and subsequent putrefaction of the foetus, where it is not expelled from the womb, may result in fatal gangrene of that organ. A remarkable deathly look, sunken appearance of the eyes, and dark discoloration of the lids, together with a peculiar deathly feeling, malaise, which pervades the entire system of the patient without any especial assignable cause, may be considered ground of suspicion of the death of the foetus in utero. Especially were this state of things, beginning at a particular time from no other perceptible causes, has continued for months. Such cases have been known, in which the womb retained within itself and preserved from decomposition a obliged foetus which had attained the age of three months before its death. In these cases the constitutional symptoms attracted attention to the examination of the case, before any specific indications were given by uterine pains or vaginal discharge. In such cases the the womb may seek to retain the product of conception, till the full period; and then throw it off. Of course the farther advanced the ovum is before its vitality is lost, the more serious are the symptoms which ensue if it is retained in the womb. While in many instances, the products of conception, blighted in the first weeks, are entirely taken up by the uterine vessels, reabsorbed as it were, at any rate disposed of without being thrown off externally.
Aconite. This remedy is useful where there is a real synochal fever; hard rapid pulse, hot, dry skin, intense thirst; sharp shooting pains in the whole abdomen which is very tender to the touch.
Arnica. In cases where the inflammation has been caused by a bruise or a concussion.
Arsenicum. Burning, throbbing, lancinating pains; burning like fire. Great restlessness, and anguish, with fate of death. She is sure she will die. Thirst for frequent sips of water, only a little at a time. Cold water aggravates her symptoms. She wants more covering over her, wants to be wrapped up.
Belladonna. The pains are sudden, coming on quickly and ceasing as quickly after continuing a longer or shorter time. Or there are clutching pains, as if the hand were clawing with the nails. Pressure, as if all the parts would tissue out through the vulva. Throbbing headache with heat, red face and eyes; throbbing of the carotids. Involuntary flow of urine. Furious delirium. The menstrual or lochial discharges suppressed or very offensive. The parts are very sensitive; she cannot bear the least touch, or a part (jar) of the bed even.
Bryonia. The least motion aggravates her sufferings. Her head aches as if it would split open. Sitting up (as if in bed) causes nausea and fainting. Lips parched and dry; mouth dry, and very thirsty. Constipation, the stools being hard and dry, as if burnt.
Calcarea carb. This remedy will often be found indicated in persons of the leucophlegmatic constitution. The feet feel cold and damp. The head and upper part of the body are in a profuse perspiration; constant aching in the vagina. Thirst for cold water; worse at night. Pulse tremulous, or full and accelerated. Stitches in the neck of the uterus. The history of her case shows that her menses have been too profuse and return too often or too soon.
Cantharis. Frequent and almost continual desire to urinate, ineffectual, or with cutting burning pain, and passing a few drops only at a time, which are often mixed with blood. Burning in the uterine region. But the urinary symptoms are of the greatest importance in determining upon the selection of this remedy.
Carbo anima. In cases of metritis not very active or acute. Inefficient urging to urinate, with painful in the loins, groins and thighs. Great sense of soreness of pit of the stomach. General sense of lassitude. Leucorrhoea coloring the linen yellow.
Carbo veg. Much soreness about the vulva, with aphthae. Aching or pinching in the iliac regions. Languor, weariness and physical depression towards noon, with faintness and hunger. Flatulence, momentary relief from eructations, or towards emission. She wants to be fanned.
Chamomilla. In cases of inflammation, which come in connection with a fit of passion, Heat all over, with thirst and redness of the face; one side of the face red, the other being pale. Great impatience; she can hardly restrain herself to patience and to treat people with civility. Urine abundant and light-colored.
