In the preceding chapter was commenced the consideration of a class of cases which, although neither structural nor directly functional, are not less important both from the severe sufferings in which they principally consist, and from the complications to which they eventually consist, and from the complication to which they eventually give rise. These are the nervous disorders of the uterus, which in their various forms are included under the names of Hysteria, Hysteralgia, Irritable Uterus, Neuralgia of the Womb, &c.
The two different nervous systems of the human body, the ganglionic and the cerebro-spinal, although distributed to some considerable extend to the same organic structures, possess entirely different function and susceptibilities. Thus the ganglionic nervous system is the one which supplies all the organic structures and sustains all the functions of the organic and involuntary life. While the cerebro-spinal nervous system supplies the same structures in their various degrees, with the still higher powers of voluntary action, sensation, perception and sensibility. The former has exclusive relation to the phenomena of nutrition and reproduction; and so its filaments and ganglionic connections are distributed more or less palpably to all the substances and tissues of the body. The latter has more especial relation to sensation, volition, volition, perception and sensibility; hence also its fibres are to be found in nearly all the structures of the body. even in those known as involuntary and not directly subject to the voluntary nervous system.
Thus while the nerves form each of these two great vital centres are supplied alike to almost every structure or tissue in the body, those form each centre have their appropriate and readily distinguishable functions. And the disorders which may arise in connection with the nerves from the ganglionic system, are entirely different from those which may arise in connection with the nerves from the voluntary or cerebro-spinal system. In the former case we have inflammation, congestion, engorgement, in connection with the circulatory apparatus, which is under the immediate and absolute control of the organic or involuntary nervous system. This inflammation may be active; and it is then usually considered to be more immediately dependent upon excitement of the arterial circulation. Or it may be passive; and it is then supposed to be connected with arrest or stagnation of the venous circulation. Thus organic nervous irritation gives rise to inflammatory congestion, both active and passive, acute and chronic.
On the other hand the cerebro-spinal irritation gives rise to a purely nervous congestion; that is to one which corresponds in the nervous system, to the inflammation of the circulation in organic irritation. Thus in disorders which arise in connection with the cerebro-spinal nervous system, we have irritation, irritability, increased and excessive sensibility. And the susceptibility to this painful irritability is augmented just in proportion to the extent of this form of nervous development in the particular structure. As where the tissues are most vascular there may be the most active inflammation, the most violent congestion, so where the voluntary and sensitive nervous filaments are most abundant, there may be the most excessive irritability, the most distressing sensibility. Such is the case in the most remarkable manner in the uterus. In addition to its necessary relation to the ganglionic nervous system, the womb, although not immediately subject to the voluntary nervous system, is alive with nervous filaments and most intimately connected with the entire cerebro-spinal system and sensitive sphere of the whole female body. The womb and ovaries are the seat of the highest vital action and functions of the female life; the highest and functions of the female life; the highest and holiest joys and hopes are associated with the healthy condition of their functions; and the profoundest suffering and the the most extensive and lifelong distress must necessarily result from from the disorder of the nervous system connected with them and form the impairment of their functional action.
Inflammation, whether acute or chronic, active or passive, involves, some structural change, especially some more or less perceptible derangements of the arterial or venous circulation; and is essentially a disorder of the ganglionic nervous system of organic life. Irritation, whether existing in the condition of excessive irritability of the nerves, or of positive pain, as in neuralgia, is essentially an affection of the cerebro-spinal nervous system, the nervous apparatus of animal life. And as inflammation may exist, even very extensively without pain, so pain, or the disorder of the higher nervous system, may exist without inflammation. Inflammation necessarily involves a certain amount of structural change of tissue, as in congestion; but irritation does not involve change of tissue, except perhaps such modification of the substance of the nerve itself as is entirely beyond our minutes scrutiny. In inflammation the development of the disorder is always, perhaps, at the originally affected part: while in irritation the sensation of pain or other evidence of nervous disorder may be at the sentient extremity of the affected nerve, or it may be in some other and remote part. Inflammatory congestion leads to effusion or too suppuration, according to the nature of the tissue which becomes thee seat of the morbid action and to the severity of the action itself. Irritation or nervous congestion may result in irritability, excessive sensibility, intense pain, cramps or spasms where the nerves distributed to the muscles are affected, and finally in paralysis from exhaustion or collapse of the nerve power itself.
As too ready susceptibility to inflammation indicates a weakness of the organic nervous system, so excessive irritability indicates a corresponding debility of the cerebro-spinal nervous system. The weaker are the nerves the move sensitive they are, and the less can they bear of opposing influence without being thrown into a state of excessive irritability, or pure nervous erethism. Bust this form of nervous debility which leads to excessive suffering does not seem incompatible with a most remarkable power of endurance of pain. Females of delicate constitution and exceedingly irritable nervous system, are often seen to endure for days and night such distressing neuralgia with entire loss of sleep, as would seem capable of destroying a strong man. Such pains are often seen to come on with suddenness, to continue with most intense severity for many hours, and often finally to disappear with equal suddenness, and leave no mark or trace of their long continued presence.
But as in those forms of disease which have been referred to as connected with the organic nervous system, pain may precede the acute inflammatory action, so in those forms of purely nervous disorder, which have been described as irritation, the excessive sensibility and distressing irritability may precede such nervous derangement as would actually impair the function action of the parts. Thus we find in the first stage of a purely nervous irritation of the uterus, no positive failure of its functions; but only an exceedingly great amount of pain in their performance. The menstrual function may be neither prevented nor impaired otherwise than by an intense and agonizing pain preceding and accompanying it; so in coition especially if the womb is touched; and so finally in pregnancy, the nervous irritation may not at first prevent the fulfilment of functions of the uterus, only render them exceedingly painful. Butt such irritation cannot but cause all these functions to become more or less impaired in the course of time, even without producing any positive structural changes.
These nervous affection, thus shown to be irritations of some portions of the cerebro-spinal nervous system in its connection with the uterus, may be transitory and evanescent, when are the influences from which they arise. Or they may be permanent and life-long, in accordance with the persistent nature of their causes. But as we have shown that the irritability of the nervous system is in proportion to its weakness, so it will presently appear that debilitating influences are among the most frequent causes of this irritation of the uterus; thus complete recovery can only be possible in those cases in which the patients can altogether escape from these debilitating influences, and also have their dynamic effects entirely remedied and removed by suitable medication.
IRRITABLE UTERUS; HYSTERALGIA; NEURALGIA OF THE WOMB.
In irritable uterus the womb is in a painful and tender state; morbidly sensitive and irritable; the least touch or pressure producing the most exquisite pain; still there is not apparent congestion, inflammation or induration.
The principal symptoms which may indicate this condition are, deep-seated pain in the lower part of the abdomen, as if in the pelvis; aching pain in the back and loins, always present, but sometimes much more and sometimes less severe. Upon examination by the touch or even by the speculum where this is practicable (which is seldom the case in this affection) the os and cervix uteri are found in their normal condition, except the remarkable sensitiveness to the touch. And as remarked by Dr. Gooch, who described this form of uterine disorder as distinct from inflammation, this painful and tender state of the organ is neither attended by, nor tends to produce change in its structure.
Late writers on female disease have inclined to consider irritable uterus a very rare form of disease. Thus Tilt says: “Irritable uterus as an essential disease independent of inflammation, can only be Hysteralgia, a rare disease of which I have only seen two instances, and Scanzoni three. ( Uterine and Ovarian Inflammation, London, 1862, P.228). But even if this irritable uterus is but rarely found as an original disorder, it is still so common, being an almost universal attendant upon displacements of the womb, and it exerts so important an influence upon the entire female economy, that there is little danger of attracting too much attention to it. And in fact under this general head are properly enumerated many conditions and symptoms, which Allopathic nosologists might designate by other names; but these conditions and symptoms are the very things which make up the case of the patient for who we wish to prescribe, and not for some nosological disease by which she may be supposed to be infested.
The pain is not confined to the sacral and pubic region; it is often felt in the sides of thee abdomen; in the hips, or in other parts of the body, or it may extend form the back completely around to the groins, the hypogastric region, and down the thighs. In its nature the pain of irritable uterus is as various as is its seat. “It is most frequently described as a dull, aching, wrong feeling in the back, with more or less sense of pressure, weight, dead feeling heaviness, fatigue or debility. Not unfrequently, in the abdomen, it is a sore pain, a sharp, needle-like, lancinating pain. With some it is mere soreness, and in very many, after the acute character has subsided, soreness remains often so great that the weight of the bedclothes becomes troublesome. In the hips and down the limbs, there is often the same wrong and dull pain with a sense of fatigue and an inability to move; but sometimes it is sharp, neuralgic and toothache like, and occasionally excites spasmodic and painful action of the hips, thighs, &c. The sensations are often pulsatile, resembling those preceding or accompanying the suppurates stage of inflammation. This beating, ‘strumming,’ vibrating pain is referred to the womb, vagina, bladder, rectum, &c., and is often very tormenting. A burning sensation, or feelings of moderate or severe degrees of heat, are not uncommon in the vagina, the vulva, urethra, sometimes in the sacral or hypogastric regions, over the whole lower part of the abdomen, and extending to all the anterior portions of the thighs. This is very distressing, and sometimes so severe that patients have declared the burning could not be greater were they to stand perfectly exposed before a hot fire, or if coals of fire were placed within them. ( Hodge, Diseases Peculiar to Women, P.55).
In addition to pain and very frequently where there is not pain whatever, there are numerous sensations more or less distressing, indicating an irritable state of the uterus and the adjacent organs. Some of these are very common, as sensations of weakness, debility, languor, often with feelings of fulness, pressure, weight; a bearing down sensation in the back, vagina, rectum; an open feeling as if there were no support, and all the pelvic contents must escape, or as if the patient would “fall in pieces” when in the erect position; a sense of pressure on the rectum as if the bowels must be moved, or simulating the fulness and weight of haemorrhoidal tumors. A great sensation of distress, of prostration, often exists the bowels have been moved. Similar troubles are also experienced about then neck of the bladder and the urethra, especially at its orifice, with frequent, sometimes almost constant inclination to urinate, and then a burning scalding sensation.
Such are some few of the multitude of sensations which arise from irritable uterus, sensations which vary in different cases both in kind and in severity. Some persons having some and other persons other symptoms, which may be so mild as hardly to be noticed, or so intensely painful as to be almost unendurable.
These sensations are very severely aggravated by every kind of motion, such as walking, sneezing, coughing, vomiting, and by every effort or movement of the body which may cause pressure of the contents of the abdomen upon the irritable womb. They are also aggravated in the most remarkable manner by menstruation. It may be that a disorder of the ovaries was the original cause, in part at least, of the irritability of the uterus; and that such ovarian disease also tended to produce what is termed dysmenorrhoea. But even if this were so, the irritable uterus could not but render the function of menstruation still more intensely painful. When perfectly quiescent and motionless, even the most irritable womb may be comparatively easy. But physiological stimulus no less than mechanical violence arouses its painful irritability; hence both before and during menstruation, in such cases, the pain is intense and agonizing. And from whatever cause the irritability of the uterus arises, dysmenorrhoea is an invariable result.
Leucorrhoea of some kind is also an almost invariable attendant upon irritable uterus. This discharge may be functional and not inflammatory; it may even be apparently vicarious, as appearing in place of the menstrual flux at the first onset of puberty in the young, or sometimes instead of the regularly catamenia; or it may appear as a temporary substitute for the menses at the change of life. In each of these various forms of leucorrhoea, this discharge is the result of what may be termed a physiological irritability of the uterus, a condition of thee womb which will be regarded as more or less morbid, according as it give a more or less abundant secretion, and is more or less persistent in its duration.
As has been elsewhere shown, irritation of the organic nervous system leads to inflammatory congestion; while irritation of the cerebro-spinal nervous system leads to simple congestion, and to painful sensations or to spasmodic contraction, according to the sensory or motor nature of the nerve filaments which are principally involved. This irritability of the uterus, it it be supposed to involve each of the classes of nerves distributed to that organ and its appendages, becomes the initial stage of a great variety of disorders of the sexual apparatus and of the entire organism of the female. And this general conclusion has been reached by some, who certainly did not understand the reasons which support it. This is fully implied in the expression of a recent and able English author, where, speaking of irritable uterus, he calls it “that scapegoat of uterine pathologists in England. ( Tilt, “Uterine and Ovarian Inflammation, P. 334). The whole subject has been discussed in an extended manner and with remarkable clearness and ability, by Professor Hodge, to whom, in the preparation of the present work, and in common with the profession at large, we are greatly indebted, and to whose work ( Plus On Diseases peculiar to Women, including Displacement of the Uterus. By H.L. Hodge, M.D., Professor of Obstetrics, etc., in the University of Pennsylvania, Philadelphia. Blanchard & Lea). We would refer all those desirous of a more thorough exploration of this kindred subjects. The various disorder of the female sexual system, Dr.Hodge considers as the causes, the consequences or the complications or irritable uterus
Hysteralgia or neuralgia of the uterus needs here to be considered as connected with irritable uterus, and yet as to a certain extent distinct from it. Irritable uterus is rather a negative condition of susceptibility or excitability from general nervous weakness in the organ, while hysteralgia is a more positively painful conditions, which may be considered to be added to the irritable state by some special provoking cause. Thus in cases or irritability of the uterus, the patient may be comparatively easy when perfectly at rest; while any exertion, such rising from the bed, walking, coition, or menstruation, may develop the most painful sensations. “In dysmenorrhoea, or painful menstruation, the greater portion of the pain consists, I am convinced, of neuralgia; the deep lumbar pain is decidedly ovarian, and not uterine. Tyler Smith. There it is evident that both irritable uterus and hysteralgia may depend upon some primary morbid condition of the ovaries.
Symptoms. “Neuralgia of the neck of the womb often exists independently of any other lesions of this organ or the body of the uterus, the patients complain of pains that are seated high up in the vagina, without any alteration being perceptible, even after the most minute investigation. Contact is always painful, and sexual intercourse often produces such agonizing distress that the patients would rather bear any other torture. Jahr. “In real uterine neuralgia, the pain is situated in the uterus itself, to which it is referred by the patient throughout the attack, or in the uterus and ovaries simultaneously. This pain, generally speaking, comes on suddenly, without being preceded by any premonitory symptom, unless it be slight numbness. A few minutes before and after the attack, the patient may be perfectly well and free from pain; whereas, during its existence she is often rolling in agony on the bed or the ground. Real neuralgia is essentially intermitting in its character, returning for a limited time, at stated intervals during the twenty for hours. Sometimes the attacks only occur once in the twenty-four hours, sometimes oftener. They last from one hour or two, to or twelve. An attack is composed of a series of paroxysms, each of which is followed by a period of comparative freedom, of variable duration. During the attack, pains are also felt in the lumbo-dorsal, ovarian, and other uterine regions; and there may be exquisite cutaneous sensibility of the entire abdominal region. All these pains, however, disappear along with the uterine tormina, as soon as the attack ceases, merely leaving for a time numbness and soreness.”Bennet.
“That affection, which we shall designate acute hysteralgia, is sometimes the immediate consequence of marriage. The pains in such cases, sometimes of burning nature, are more generally attended with a sensation of pinching, and of forcible pressure in the hypogastrium and pelvic cavity, occasionally extending to the groins and loins. Like cramp and colic, they are intermittent, leaving, however, in the intervals, a tenderness and sensibility of the hypogastrium, which them liable to be confounded with slight metritis. In chronic hysteralgia, the real uterine neuralgia, the paroxysms occur without assignable cause, and without anything of an inflammatory character. It appears in paroxysms, varying in frequency and regularity. Boivin and Duges.
The causes of hysteralgia, or uterine neuralgia, may be of two kinds: First, those influences, termed provoking, which may develop a position neuralgic condition form an already existing negative state of uterine irritability or excitability. Second, those influences which are capable of developing a true uterine neuralgia where there was no pre-existing irritability. In the first class, as already mentioned, every bodily exertion, the orgasm of coition, or the molimen of menstruation, as in dysmenorrhoea, may easily induce the neuralgic sufferings. In the second class, patients of general nervous temperament, subject perhaps to what is termed “spinal irritation, may experience neuralgic paroxysms in various parts of the body upon every over-exertion. Fatigue, too severe long continued labor, or any undue exercise, in which such persons go beyond their strength, will invariably produce neuralgia. And it requires only some special, local or function influences, such as excessive coition, over-exertion while menstruating, to cause the neuralgia to be developed as an hysteralgia, rather than as a prosopalgia, a megrim, or a tic douloureux. And in either of patients there is no doubt that the local irritation unavoidable arising from displacements of the uterus and its appendages, may occasion constant or periodically recurring neuralgic sufferings, which may be felt in the womb itself, in its immediate vicinity, or developed in the epigastric or other region remote form the real and original seat of the disorder.
For the treatment of the various forms of the more painful nervous disorders of the womb and its appendages, irritable uterus, hysteralgia, or uterine neuralgia and painful coition, study and compare the following remedies.
Asafoetida. May be indicated in decidedly venous systems and nervous temperaments. Labour-like pains with cutting and bearing down. Menses too frequent and too scanty. Hysteria. Hypochondriac, anxious, sadness and apprehension of dying; paroxysms of shuddering. Fits of great joy with occasional bursts of laughter.
Asterias rubens. General feeling of distress in the womb as though something were pushing out. Twitching in the uterus. Feeling of extreme anxiety, as though some misfortune were impending; as though some bad news were about to arrive. The menses are apt to delay.