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-UTERINE TYMPANITES
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.
MOLES. HYDATIDS.
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.
