EROSION.
ULCERATION of the uterus may be divided into four distinct classes: Erosion; Simple Ulcer; Malignant or Corroding Ulcer; and Cancerous Ulcer. The two former will be considered under the general head of ulceration. The latter being a special form of ulceration, distinct and well defined in its character and causes, will be described under its appropriate head.
And as we come now to the consideration of the less general and more minute and particular forms of organic disease of the uterus, it seems proper to say a few words relative to the methods of examination to be pursued in such cases. In the forms of disease of uterus hitherto treated of in the present work, the touch has been deemed amply sufficient to enable the practitioner to determine with sufficient exactness the nature of the difficulty. And in fact the well practiced touch is a surer guide to diagnosis in such explorations than is the speculum, which must necessarily interfere more or less with the position and appearance of the vagina. And the touch, whether per vaginam or per anum, or both, is fully competent to determine the nature of the various forms of displacement. But in the examination of cases of suspected ulceration of the cervix, the speculum may be used to confirm the indications obtained by the touch; and to assist in deciding as to the simple, malignant or cancerous nature of the ulceration itself.
Still from the very great reluctance of many females to submit to such ocular examination, even when conducted in the most delicate manner possible, it seems better for the young physician to learn to depend more upon the touch in forming his diagnosis, in fact to reply upon that in almost all cases; and only to resort to the speculum in doubtful or difficult cases, or perhaps in the first examination of such as come under Homoeopathic medication, form Allopathic hands. The finger may be as truly educated to discriminate the different conditions of the uterine surface and substance, as it may be to strike the stings of the harp or the keys of the piano. And it is a subject of no small gratulation to remember that no only the most eminent Homoeopathic physicians, but also the entire body of respectable practitioners of our School, have set their faces against the disgusting and disgraceful resort to the speculum upon every possible pretence and occasion. However fashionable the use or rather abuse of the speculum was at one time in the Allopathic ranks, and we are glad to say it is now so no longer, such cultivation of morbid curiosity on the part of the physician, to give to no worse name; and such pandering to the prurient sensualism of some women, and such unnecessary wounding of the delicate sensibilities of others, has never obtained currency in our School. And not only do all the soundest principles of medical exploration dissuade from the indiscriminate introduction of the speculum, but the whole tenor of our Homoeopathic therapeia leads to a more excellent way, by constituting thee subjective, the sensational, the constitutional and functional symptoms for the pathological details of structural changes, as the basis for medical treatment.
Hence we think that in most cases the touch alone will prove amply sufficient for the purposes of diagnosis, and far superior in certainty too the speculum in the great majority of cases. In displacements of the womb and other organs, it may be necessary to investigate by the touch, the situation of the parts. And in some of these cases of mal-position, as in retroversion of uterus, manual assistance may be needed in order to restore thee parts to their proper place. Butt in actual practice, so long as we do not give Homoeopathic remedies for diseases by name, as do the Allopaths, so long as we do not wish to confine ourselves merely to the removal or palliation of the consequences of the illness, so long as we make it out great aim, as skilful physicians, to restore our patients to health, and so long as we consider thee disease removed only so far as we see such restoration to health, just so long shall we seek to find the remedy which shall correspond to all the symptoms of the case and which shall especially represent the subjective and constitutional symptoms, instead of relying mainly upon the indications afforded by the speculum or even by the touch.
And we believe that a careful and attentive study of these symptoms, and of the attendant conditions, will enable the physician to make the right, the best possible prescription for his patient. For thus he regards the first elements, the dynamic causes, rather than the ultimate results of the morbid affection. And herein do we differ from the so-called physiological School, as well as from the pathological and chemical Schools. The method here inculcated is in strict accordance with pure Homoeopathy; and it might perhaps be deemed the physiological method, were not this term already appropriated as the designation of a entirely distinct system. This method, which we may perhaps be permitted to call our own, since we adopt and advocates it, may be termed the vital method. It is essentially the method of Hahnemann, of Boenninghausen and others, whose learning and skill have contributed to make Homoeopathy an honor to the medical profession. In this method, we realize that pains, or subjective (sensational) symptoms come before the functional derangements, as these latter come before structural or organic changes; and that the two latter forms of disease are but the extension and ultimate development of the morbific influences shadowed forth in the former. So that is we pay strict attention to the subjective, the sensational, the constitutional symptoms, in addition to the local manifestations, and to the attendant circumstances and conditions (which are also constitutional symptoms, and so of the first importance) we shall come far nearer the mark, and be far more sure of healing the sick, than if we directed our principal attention to the more external and ultimate symptoms or forms of the disease.
For purposes of diagnosis, and especially to satisfy the patient, and her friends, the touch may be resorted to, and in some cases the speculum even. But for guides in the selection of the remedy, the indications afforded the patient herself, those which we have designates as subjective, sensational, constitutional and functional, afford us the greatest certainty, and lead most directly to the happiest result.
But to return from this digression to the ulcerations of the uterus. The first form is that of simple erosion, or abrasion of the cervix. This is in reality an ulceration of the mucous coat alone, and might have been described under the head of the consequence of mucous inflammation, but that we think it is dependent upon inflammation of the submucous tissue, that it does not occur where the inflammation is confined to the mucous membrane alone. This is called superficial ulceration or excoriation, since it does not include the deeper tissue of the womb. When an abrasion or excoriation only is present, the cervix is generally of a vivid red, and the granulations are often so minute, that it is at first difficult to ascertain whether the membrane is abraded or merely congested, or to perceive the limits of the ulceration when once it has been ascertained to exist. These superficial erosions are with difficulty recognized by the touch. They may sometimes exist for a long time without the patient being aware of them; the only sufferings which their presence occasions being and indefinite sense of pain ion the pelvis; and slight leucorrhoeal discharge which becomes tinged with blood after sexual intercourse.
The superficial erosions or mucous ulcerations of the cervix are mostly the result of violence or excess in sexual intercourse; but they may arise form friction of the cervix against the walls of the vagina in case of displacement. In connection with these causes, such superficial ulcerations are much more apt to occur in those whose general health is poor. In such cases these erosions may bleed readily; and even develop fungous tumors, or other abnormal growths, from the mucous membrane of the cervix. In some cases minute pustules appear in the mucous membrane of the cervix, which, on being brushed off, leave bright red spots. This may constitute an aphthous form of erosion, corresponding to the aphthous ulceration of the mucous membrane of the mouth. And cases have been known in which the aphthae repeatedly appeared at the same time in the buccal mucous membrane and in that of the cervix uteri.
According to the constitution of the patient these ulcerations may be regarded as the development of an herpetic, scrofulous, or even syphilitic taint in the system. Hence a careful study of the constitution and of all the attendant symptoms of the case will be necessary in order to effect a radical cure of the dyscrasia which they may represent. And the same remark is equally true, even if from their deeper nature these erosions, should more properly be included under the second class of:
