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.
