THE prevention of cervical laceration includes every hygienic and therapeutic measure which can possibly be needed during the entire period of gestation; hence, the whole Materia Medica is tributary to the obstetrician. Still it may not be amiss here to refer to several points most likely to present themselves in the usual run of cases.
I am, however trading upon new ground. Clinical experience in this direction is, as yet, so meagre that it offers no guide to therapeutic study. And added to this, is the lamentable truth that our Materia Medica is deficient in clear and well- characterized symptoms of the cervix uteri. Gynaecologists, instead of following Dunham’s advice to institute provings on females, have too frequently discarded Homoeopathy, and has resorted to local devices suggested in Allopathic works.
What I shall offer, then, will be chiefly suggestive to be accepted and tried, or to be rejected, according to the judgment of the reader.
My predecessor has presented a graphic description of the causes of cervical laceration, some of which may be met with therapy or mechanical device.
The professional care of the enceinte woman usually dates from her distressing morning sickness. It is now recognized that this symptom is often, if not always, an evidence of disease of the cervix, disturbed uterine vascularity, etc.
It constitutes an early evidence of disease which may lead to the accident we desire to prevent. We should, therefore, pay careful attention to this symptoms, and combat it with medicines, or in the event of their failure, with mechanical means. One of the most promising medicines for morning sickness, reflex from a hard tumefied cervix, is sepia.
The physiological softening of the lower uterine segment, which suddenly develops about the seventh month and progresses thence until full term, may be interfered with in various ways:
If by undue congestion: SEPIA, NUX VOM., Sulphur, Aloes, etc.
If by weak heart, which favors venous stasis, the cervix appears patulous, congested, even livid, or oedematous; Digitalis, Lachesis, Lycopus, Arsenic, Apis, Lilium Tig., puls., Gels, Naja, Elaps.
It has been determined that heart-diseases are regularly and progressively aggravated by successive pregnancies. Since, therefore, weak heart may permit uterine engorgement, why should we not treat the heart when diseased, both with a view to stay its tendency to grow worse during gestation and labor, and also with the view of counteracting its baneful effects upon uterine nutrition?
If softening is interfered with by swelling or induration of the cervix: Conium, CARBO ANIMALIS, SEPIA, Phytolacca Iod., kali Iodium Thuja, ArsenicumIodium, FerrumIodium CalcareaCarb., Nat.Carb., Aurum Mur., Aurum Mur., Natronat., Hydrastis, Alumen, Cantharis, Mitchella, Platina, ArgentumMet., Hydrocotyle, Kreosote, Nux Vom.
Years ago Dr.Lippe stated that on being engaged to take charge of a lady in labor, she remarked that the must certainly bring instruments, for they were always necessary and according to her former physician, always would be necessary, because she had an indurated cervix. Dr.Lippe gave the patient Sepia, and she was delivered in due time without instruments.
In many cases Carbo An. will doubtless suffice.
CONIUM is suggested when there are stinging pains.
PHYTOLACCA deserves a trial when the hardened neck is dark red.
KALI IOD. claims attention in syphilitic or in scrofulous cases with swollen and contracted neck.
ARUM (Preparations of Gold) particularly the Aurum Mur. Natronat., may be needed especially, when there is much vascular engorgement, with melancholy, weariness of life.
PLATINA is preferable when there are shooting pains.
ALUMEN is required when the cervix is swollen, painful and narrowed.
MITCHELLA answers for a dark-red sore and swollen cervix.
HYDROCOTYLE should not be neglected when there is unnatural redness of the cervix, hot and red vagina with pricking and itching at the vulva; scaly eruptions on the skin.
HYDRASTIS will undoubtedly assist if the cervix is red, shining, or engorged and ulcerated, with gluey or ropy mucous Leucorrhoea.
The Salts of Iron, since they notably disturb the circulation, and include the uterus in their sphere of action, may serve a purpose here too. Ferrum Iod, has been proved to affect the uterus, inducing prolapsus, bloating of the abdomen, deep-seated intra-pelvic soreness, and a confirmed symptom on sitting she feels, as if she was pushing something up into the vagina.
ARGENTUM MET. may possibly come into service if the cervix is corroded and spongy.
KREOSOTE if it is tender, as if ulcerated.
NATRUM CARB. if ill-shaped.
USTILAGO if patulous, oozing blood when touched, etc.
COPAIVA if there are stitches, with dragging in uterus and bladder; burning spots in the vulva, itching; acrid Leucorrhoea.
If the softening process is excessive, we may study with advantages: Ustilago, Secale, and also remedies and hygienic measures looking to general uterine as well as systemic nutrition. For, if the body is ill-nourished, the new-tissue will be weak and readily susceptible or retrogressive changes. It would be folly to attempt a summarizing of such a vast subject as this.
The whole range of therapeutics must be consulted. Attention may be drawn, however, to two or three drugs which seem especially adapted to uterine debility. These are: Aletris Farinosa, Abies Canadensis, Cyclamen, Pulsatilla, Helonias, Caulophyllum, Secale, Ustilago, Sepia, etc.
ALETRIS suits when there is persistent morning sickness, debility, constipation, slow digestion.
ABIES CAN. should be thought of when there is abnormal hunger, with faint feeling, swimming tipsy sensation; she feels, as if the womb was soft and feeble; craves pickles. Compare Sepia.
CYCLAMEN causes weak digestion, even the plainest food cannot be digested; nocturnal flatulency, from atonic bowels, causing distention, relieved only by getting up and walking about. Nausea referred to the throat.
Helonias, as is well-known, causes a quantitative loss of blood-corpuscles. There are, consequently, languor, tiredness as after long exertion, aching of all the muscles, etc. If it fails, Picric Acid has proved a successful substitute.
If cicatricial tissue retards the necessary cervical changes, compare Graph, Phytolacca, Thuja.
Flexions, cervical contractions, and uterine deviations must be corrected by mechanical means. Tampons of cotton, so placed as to hold up the uterus, and so to straighten the flexed neck and permit free circulation, will be needed. If the uterus is retroverted or retroflexed, we have found Cutters pessary necessary until the uterus shall be large enough to rise out of the pelvis.
Rigidity of the various parts needed in labor, as well as inharmonious action of these parts, may also lead to lacerated cervix. It becomes the accoucher’s duty, then, to see to it, that his patient be free from any of these conditions. False labor-pains, which, as it were, mark the preparatory drilling of the uterus, should be controlled if they become excessive and spasmodic. The best remedies here are: Caulophyllum, Ignatia, Nux Vom., Viburnum Opium, Actea Racemosa, Cuprum and Coffea. The first is usually all-sufficient.
If the labor is too rapid, not permitting time for normal dilation, we may select such drugs as BELL., Chamomilla, Coffea, Actea Rac., CAULO., SECALE C., Apis.
BELLADONNA is suggested by the suddenness of the pains, coupled, with their too quick bearing-down, as if everything in the pelvis would be ejected.
CAULO. and SECALE are indicated by a prolonged bearing down without any intermission. The woman may talk or otherwise make inspiratory and expiratory motions, and yet the pain continues.
APIS. has bearing-down in the early stage of labor., and so may be needed to retard the too rapidly progressing second stage.
If, however, these fail, or if rapidity is due to a large roomy pelvis, we may press steadily, but not too strongly, upon the advancing head during the pains.
If the danger arises from too early escape of the amniotic fluid, from dry labor, or from protracted labor, frequent and through lubrication of the cervix and vagina will materially aid. Medicines, too, are of service. For dry labor, the parts feeling hot, give Aconite, Coffea, or Belladonna, especially the last, though mental symptoms will decide.
Delay at the public arch is very common. The anterior lip of the cervix is felt swollen, hot, and dry, between the advancing head and the public bones. By continued compression it loses it tone and readily yields latterly, when the head finally, and often suddenly, descends upon the perineum.
The tumefied lip, if there is not too much stretching of the tissues by the advancing head, may be held above the bones during two or three pains. The women may be directed to lie upon the abdomen, or the accoucheur can press with the hand upon the hypogastrium.
Neuralgia and Rheumatism of the uterus, by leading to protracted labor, favor the accident under consideration. Prominent remedies are, for the former: Actea Rac., Xanthoxylum, Lilium, Sepia, Pulsatilla, Ignatia, Helonias., Viburnum Opium, according to their respective indications. And for the latter, Actea Rac., Rhus Tox., and Pulsatilla