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.
