DROPSICAL accumulations in the uterus, may consist of mucus or serous fluids. In the former case, they appear to be simply the result of such of its natural secretions. In the latter the fluids assume, in quality and quantity, rather the character of ordinary dropsical effusions.
Displacements of the uterus, by producing i of the cervix and so bringing its walls in contact the point of flexion, may occasion such an obstruction of its orifice as to cause the mucous accumulation the same result may follow the pressure of a polypus or tumor, or other approximation of the wall of he cervix. And as amenorrhoea is nearly always associated with uterine dropsy, this mucous secretion appears sometimes to take the place of the menses. Cases have been recorded in which these mucous accumulations would occur from time to time, in the obscene of he menses; and then again disappear on the return of the proper menstrual flow.
This mucous form of dropsy of the uterus may thus be called recurrent, in contradistinction from the other, serous variety, which is more continuously;persistent. Mucus from the accumulation sometimes appears to break away with more or less regularity; discharging itself and again reforming. This variety appears income instances to have relation other menstrual nisus; aggravating about the time of the usual monthly periods.
In many women the cessation of the menstruation extinguished the inflammatory affection of the womb, which has been kept up by inflammatory affection of the womb, which, has been kept up by the menstrual molimen. But in some cases the deprivation of the monthly discharge increases the inflammation nd renders chronic the congestion, which before had been but occasional and relieved by the menstrual flow. In such cases while the body of the womb becomes he seat of a persistent morbid activity, its neck becomes atrophied, d so as to impede more or less the exist of the fluids contained within the cavity of the uterus. The result is that the womb becomes more and more distended by a sero-sanguinolent, a much-sanguinolent or a much-purulent fluid. Severe uterine pains of an expulsive character may repeatedly occur, till at last the fluid is rejected and the patient is relieved. The same process of formation and expulsion of such accumulations may be renewed again and again.
While in. the persistent form of uterine dropsy the fluid appears to be of a a much more decidedly serous nature; and to be connected with a true dropsical diathesis. Reasoning form the analogy of similar disorder in other parts of the system, we may suppose that in this case, there is considerable thinning of the mucous membrane of he uterine walls and that this serous fluid is secreted from the submucous cellular tissue,-or rather from the vessels which it contains. This is the idiopathic dropsy of he uterus; and the accumulation may go on for years,-until relieved by art, or terminated by death.
Either of these forms of dropsy may be assisted with hysteria or anemia. And in those cases of dropsy of the uterus which appear in consequence of structural disease of hat organ, the fluid is generally mixed with purulent matter or blood. while in certain conditions of the system, the dropsical accumulations in the uterus, principally those of the mucous variety, become decomposed, and so give rise to volumes of gas, which may escape with a loud report. This is termed physometra; where both water and gas are contained in the womb the term pneumo-hydrometra is descriptive of this anomalous and unusual condition.
Dropsy of the uterus may be recognized by the enlargement of the uterus itself; but the sharp pains, which may be present; by the suppression of the menses by which it is attended; by the displacements, severe losses of blood, and other and perhaps malignant disorders of the womb which accompany or precede it; by tea constant oozing or occasional gushing of fluid from the uterus; or where no such escape of the fluid occurs, by the long continuance and gradual increase of the the enlargement of the uterus itself.
By a careful observation of all the attendant symptoms and circumstances of the cases, uterine dropsy may be distinguished from pregnancy, with which it is most apt to be confined; and from physometra, by the duller sound on percussion, and greater gravity of the concomitant symptoms. And in cases where the catheter or uterine sound can be introduced the discharge, whether mucous serous, purulent or bloody, will go far to determine both with existence of he dropsy and the nature of its cause. And where flexion for the disease prevents the introduction of the sound, this circumstance will prove scarcely less certainly diagnosis.
In case, especially recent ones, principally dependent inoculation of the cervix resulting from flexion, in displacement, the removal of the cause may at once relieve a careful comparison of all the symptoms and conditions, as well constitution as organic and local. And in cases of more direct dropsical condition, idiopathic dropsy; or where the dropsy appear sin connection with scirrhus or other malignant disease of the uterus or its appendages, symptomatic dropsy, the evacuation of the accumulated fluids may afford temporary relief, and give more time and better opportunity to remedy both the organic disease and its consequences
Those forms of dropsy which occur in cognition with pregnancy, whether the accumulation be formed between he membranes of the ovum and the uterus, or consist in an excess of he liquor amnii itself, will be considered with the other disordered accompanying the pregnant state.
Dropsy of the uterus, like that in all other organ of the human system, will case a corresponding sympathetic affection of the whole body.
Apis. Absence of thirst is very characteristic of Apis in uterine Dropsy. Stinging pains, as of be-stings. Abdomen very tender to the touch.
Arsenicum. Very thirty for small and often repeated portions of water. Water disagrees with her; it does no pass from the stomach; but seems to remain there and distress her. the lower limbs seem almost paralyzed. She can hardly walk. She is very weak, and easily warned from exertion. she wants to be in a warm place, and to be wrapped up warmer.
Belladonna. The characteristic symptoms of pressure as if all would pass out of the genital organs, particularly early in the morning. Urine dark and scanty; sometimes it is as yellow as gold. she is usually worse after three in the afternoon. the tenderness of the abdomen is aggravated by the least jar even of the bed or chair upon which she sits and she is obliged to step with great care, in walking, for fear of a jar.
Bryonia. The selling increase during the day and diminishes during the night. Her lips are dry, she wishes to moisten them often. She is thirsty for cold water. There urine is dark and scanty although discharged frequently, a nd it deposits of pinkish colored stain. All her symptoms are aggravated by motion. He stools, are hard and dry, as if burnt.
Calcarea carb. In persons of a leucophlegmatic temperament. She has been menstruating too often and too profusely; she has some vertigo on going up stairs; fluttering of he hear and faintness. Damp, cold feet. Swelling at the pit of the stomach. She is very weakly in general.
Camphor. Red urine, depositing a thick sediment, with much coldness of the external surface. the urine is emitted very slowly, the bladder being nearly paralyzed. the urine is sometimes green.
Cantharis. More or less strangury. Tenseness of the cervix vesicae. Bloody urine. Pains in the limbs, coryza. There is much swellings of the uterus; pain in the abdomen, vomiting an fever.
China. The dropsy has been developed by profuse hemorrhages, or in aged women. Uncomfortable distention of the abdomen, she wishes to belch up wind frequently, -whichever affords no relieve. Urine dark, scanty and sandy.
Colchicum. The urine is very dark, very scanty and discharged in drops depositing a whitish sediment. Watery stools without sensation. the dropsy has supervened upon he sudden suppression of he menses, which had but just made their appearance. Much flatulence.
Conium. the mammae sympathize very much; they enlarge, become hard and painful. The urine intermits. There is vertigo when lying in a recumbent position, especially on turning over.
Digitalis. the heart sympathizes very much; the pulse is accelerated; or intermittent. The stills are very light-colored.
Dulcamara. This remedy will be indicated when the dropsical affection makes its appearance after the suppression of perspiration by cold damp air. Every cold change in. the whether makes he worse.
Ferrum. Dropsy of he uterus with germ debility and fiery red face.
Helleborus. the secretion of urine is almost suppressed the urine is very dark, and deposits a dare,. coffee-ground sediment. Debility; coma somnolentum; piercing pains in. he limbs; loose gelatinous evacuations.
Kali carb. Will often be found particularly indicated in aged women.
Lactuca. Excessive swelling of the abdomen, feet and eyelids.
Ledum. Pains in all the limbs; the akin is dry;-she feels very cold and cannot keep warm. Worse from warmth.
Lycopodium. There is much red sand in the urine. Borborygmus, particularly in the left hypochondrium,. Sensation of fullness clear u to the throat, on eating even a little. constant sense of satiety.
Mercurius. Much perspiration avoiding no relief. Constant, short and choking cough. Anguish.
Phosphorus. OEdematous selling of the hands, feet and face. Cough. shaking and exhausting, with shortness of breath. The urine contains quantities of gray sand. the bowels are loose and stools whitish. belching up of quantities of wind after eating evens little.
Rhus t. In cases of dropsy resulting from amenorrhoea caused by being drenched in the rain. rheumatic stiffness. Restless at night; she must change her position frequently. terrible cough. which seems as if it would tear sometimes out of the chest.
Sepia. Dropsy supervening upon a case of miscarriage. the urine is veg putrid; or deposits a clay-like sediment which is difficult to remove front the vessel. She feels as if the must cross her limbs to hinder the escape to some of the internal parts through the vagina.
Sulphur. In persons whose skin is full of pimples and eruptions. Heat upon the crown of he head, with coldness of the feet. Frequent hot flushes with spells of faintness. She is unusually hungry before noon cannot wait for her dinner. The soles of her feet are hot, she walks all bent over forwards.
PHYSOMETRA or UTERINE TYMPANITES consist in the formation and accumulation of gas in the uterus. this may be of two kinds; first, that in which the gaseous fluid is secreted, that tin which the gas is the result of he decomposition of certain substance,-such as shreds of the membranes, portions of a dead foetus or of putrid coagula, which may be retained within the cavity of he uterus.
The first mentioned kind, is the true idiopathic physometra. the air formed within the cavity of the womb, may be retained for several; months, distend it to a considerable magnitude, and then be expelled at once. Of this variety a signed intense is mentioned by Dr. Gooch. Or the air thus formed instead of being retained, as as to distant the uterus, is expelled with noise many times a day. In another instance of this sort related by the same author, the woman ‘was subject o this infirmity only when not pregnant; but she was a healthy and breeding woman, and the instant she became pregnant he troublesome malady ceased. she continue entirely free from it during the whole of her pregnancy but a few weeks after her delivery it returned. In this idiopathic physometra, or flatus of that uterus, the gas is usually inodorous.
This affection has sometimes proved so exceedingly troublesome as to have become a cause of seclusion from society; and its usually accompanied by an excessive secretion of a viscid mucus-like fluid. Idiopathic physometra may be the result of the reflex influence of irritable uterus or it may result from morbid nervous excitement of he uterus; as in patients affected with hysterical or dysmenorrhoea.
In the second variety, the gas results from the decomposition of a foetus, or any extraneous substances remaining in the uterus after parturition; from the composition of the products of menstruation, where by sudden suppression of the catamenia by cold they may have been retained in the womb, or from the decomposition of leucorrhoea mucus,. or of cancerous discharges. All the effluvia from such putrifying processes are fetid and offensive. and many of them are inflammable. In these cases there may be serious constitutional symptoms and even putrid fever.
Symptoms. The uterus distended with gas forms a round and more or less extended tumor in the hypogastric region; in the idiopathic variety of uterine tympanites there may be no constitutional symptoms, nothing to attract attention save the increase in size, or occasional discharge of flatus per vaginam. In the symptomatic occasional discharge of flatus per vaginam. In the symptomatic variety, which results from decomposition, there may be chills, a low from of fever with symptoms more or less grave, according to the quantity of the matter undergoing decomposition in the womb, and to the rapidity with which the process takes place.
Diagnosis. I. Idiopathic physometra may be distinguished from pregnancy, by the resonance of the tumor; by the absence of ballottement, of foetal movement and of the signs afforded by auscultation, and by the occasional pain.
2. From hydrometra, or dropsy of the uterus, by the greater elasticity of the abdominal tumor, and by its resonance.
3. From ascites by the defined shape of the tumor, by its resonance, and by the absence of fluctuation.
4. From scirrhous and steatomatous depositions, by the elasticity and resonance of the tumor. – Churchill.
The objective symptoms, – noisy discharges of flatus; and the circumstances of the patients, as in those cases succeeding parturition, will greatly aid in determining the nature of the difficulty.
Treatment. Idiopathic uterine tympanites may be radically cured by one or the other of the following named remedies, selected according to the indicating symptoms. The symptomatic variety, inasmuch as it depends upon the decomposition of foreign bodies remaining within the cavity of the womb, may require special attention to remove these decaying substances if possible. And injections of warm water may be employed to cleanse away the peccant matters. For other remedies consult gangrenous affections of the uterus.
Bromine. Loud emission of flatulence from the vagina. Aggravation of the symptoms from evening till midnight. Rest also aggravates; motion relieves. The left side is the most affected.
Phosphoric acid. Meteoristic distension of the uterus. She has always a pain in the liver during the menses. She passes large quantities of colorless urine at night. Indifference to all the duties and concerns of life.
Lycopodium. Discharge of wind from the vagina. Great sense of dryness in the vagina. The symptoms are worse, or come on about four or five P.M., and abate four or five hours later. Much borborygmus in the abdomen, and in the left hypochondrium. Red sand in the uterine. Much pain before urinating.
The various shapeless bodies which are occasionally discharged from the vagina are termed Moles. These may consist of masses of squamous epithelium from the vagina itself; of the membranous product which is expelled in some cases of dysmenorrhoea; or of fibrinous collections from the cavity of the uterus. These constitute three varieties of what may be termed false or spurious moles, as occurring in the unimpregnated female.
The flakes or tubular pieces of squamous epithelium exfoliated from the vagina are easily recognized. “The fibrinous masses expelled from the uterus resemble an almond in size and shape; being to some extent casts of (the interior of) the uterus; they are smooth externally, and possess a very imperfect central cavity. The dysmenorrhoeal product consists of the uterine mucous membrane, exfoliated in a more or less perfect form. When entire it has the shape of the cavity of the body of the uterus, is rough externally, and smooth within, having a distinct triangular cavity, with two openings above and one below, at the sites of the Fallopian tubes and the canal of the cervix uteri. – Smith.
The true or genuine moles are all the result of impregnation, and their different varieties may be arranged under three classes; blighted ova; fleshy moles; vesicular moles or hydatids.
In the BLIGHTED OVA which compose the first class of these moles, the embryo itself early perishes, while the ovum being retained increases in size and solidity, not by the normal growth of regular pregnancy, nor even as in cases of tumor and polypus, – but by the effusion of coagulable lymph from inflammation of the lining membrane. This forms successive layers over the surface of the dead ovum, giving it eventually a great degree of consolidation. Some of the masses, when cut into, have no cavity; but the chorion and amnion are demonstrable, although the enveloping membrane may be one or two inches in thickness. It seems somewhat surprising, that the covering of the foetus should be so carefully constructed when there is no embryo. But such is the fact. (*Ashwell.) In such cases the foetus is indiscoverable, because it has been dissolved in the liquor amnii; but the remains of the umbilical cord may however be generally discerned, attached to some part of the inner surface. In addition the membranes may be traced, with the placental development, on some portion of the periphery of the ovum.
The influences which cause the death of the embryo transform the ovum from a perfectly normal development into a more or less disorganized mass, which is sooner or later expelled as a foreign body. The blighted ovum, if not expelled within two or three months, degenerates into a fleshy mole. Plus (Plus Churchill) The influences which originally destroy the embryo, are usually supposed to consist in certain already mentioned changes in the structure of the ovum itself. But we believe the reverse to be the case; that disorganization of the ovum and membranes results from embryonic death in the first instance. Whence then come the fatal forces? That on the maternal side all is comparatively well, is implied in the continuation of the original growth of the ovum considered externally. That the fatal elements may have been inherent in the more interior constitution of the female ovum, is indeed possible. But in most cases we believe it is originally continued in the seminal aura of the male, and thus imparted to the ovum in fecundation. In many instances in which the husband has been affected with syphilis, – which has been treated allopathically and so completely suppressed externally as to induce the belief or a radical cure, – the offspring come into the world wrinkled as if with old age; prove entirely incapable of independent nutrition, and constantly decrease in weight from the moment of the birth till that of their death. These received from the paternal side the element which destroyed their vitality as soon as the support of the mother (in utero-gestation) was withdrawn and the stores laid up by her, in the mass of the infant’s body, were consumed. Just so, in those cases, where a still more concentrated and active form of the fatal element is imparted by the male; by the time the supplies originally furnished by the ovum are exhausted, the embryo is blighted, destroyed; – and the vital forces which should have formed the foetal body, are vitiated, and perverted, – till the mole is the only result.
The FLESHY MOLES appear to be but the fuller development of the perverted process just described in connection with blighted ova. These in the modern pathological language are termed cancerous degenerations. They remain three or four months – “until at length the degenerated ovum is expelled, consisting of the nest- like membranes and a small embryo of two or three weeks’ growth, or in some instances the foetus may have disappeared, and traces only of the umbilical cord remain. They may either consist of a solid mass, or they may contain a central cavity possessing a distinct lining membrane, in which there yet remains some of the liquor amnii. The solid moles are generally much larger than the hollow ones, and of a more irregular form. The larger ones are abut the size of two fists. If the texture be examined, it will be found solid, but not very dense, spongy like the placenta, but more filamentous in some parts; in others consisting of fibrinous clots, and also portions of the foetus such as one or other extremity. The limbs of the foetuses have occasionally, though very rarely been discovered. – Churchill.
The HYDATIDS, or VESICULAR MOLES constitute what are termed the hydatiginous degenerations of the ova. “The hydatids themselves, in the recent state, are full of transparent fluid, and are either round, pyriform or oblong in shape, the size of the vesicles greatly varying. Some of them are borne upon pedicles, others are growing from the larger hydatids. As a rule, the activity of the growth and the increase of the villi, (which degenerate into hydatids) are greatest in early pregnancy, and it is at this time that the hydatiginous degeneration is most prone to occur. These hydatids bear a very close external resemblance to polypi or pediculated tumors; so much so that some of the latter named growths occurring in the virgin females have been considered to be hydatids. But it is now well settled that the name hydatids shall be applied only to such formations as may arise in connection with or subsequent to sexual intercourse and impregnation. Although here it must be remembered that the death of the embryo not being immediately followed by the expulsion of the ovum, the molar formation may be retained for months; and the hydatiginous variety for years, and then be discharged without prejudice to the character of the female who may have become a widow in the meantime.