STERILITY.-DeSinety, Treub, Furbinger, et al., attribute 50 per cent. of unproductive marriages to the husbands, saying that sterility in the male is more often the cause of barren marriages than is generally supposed.
This cause of sterility I pass by, as also sterility due to mechanical obstruction, incomplete ovulation and the numerous other causes of this condition, too manifold for mere enumeration, to consider obesity as a causative agent in this condition. I need not say that the advocates for surgical interference for the relief of this condition are legion. Sims makes the assertion that sterility can be cured by surgical means only. That, of course, is Allopathic arguing pure and simple. Cases requiring surgical interference do arise, but any treatment which raises the nutrition of the entire organism, improves the blood-formation, and favors the resorption of pathological products in the sexual organs, is to be regarded as the indicated remedy.
Published statements are my authority for saying that excellent results have followed the administration of drugs, nevertheless; and in complete defiance of all therapeutic measures, a certain percentage of women remain barren; for with the more occult causes of sterility we remain, as yet, unacquainted, consequently they cannot all be reached with say kind of treatment whatever.
The following case I report somewhat in detail. Whilst not an exceptional case at all, it bears directly upon the subject under consideration, and possesses, it seems to me, some decidedly interesting features. My object in selecting this particular one is to call attention, if possible, to a condition not sufficiently considered. Mrs. J., aet. 26, married about two years and a half, appealed to my knowledge for a reason as to why she remained childless. The lady was carrying an excess of flesh, being under the medium height, and weighing 186 pounds, but appeared to be in good health; family and previous history all that could be desired.
Examination showed none of the common causes of sterility; neither, so far as I could ascertain, was the husband responsible for this unproductive condition of affairs. Some previous experiences of my own, with the added testimony of other and able men, was my reason for charging this condition of things to the excess of flesh, this, by the husband, being laughingly charged to excess of laziness.
We all, undoubtedly, are familiar with that peculiar disease of the blood-corpuscles which, whilst producing flesh, relaxes at the same time the muscular force; acting also, I believe, upon the muscular fibres of the uterus and upon the ovaries, inducing not only serious menstrual disorders but sterility. McKee, Philbert, and others give several instances of sterility chargeable to obesity, the women in question having been married several years without bearing children, and all became mothers after losing a portion of their flesh. If any other argument were needed in support of this theory we might turn to the quadrupeds, where we find the poorest breeders among the fleshiest animals.
Fournel has a very able treatise on “The Effects of Obesity on the Menstrual Functions and Parturition.” Without having had any actual case of this description to deal with, he inclines very strongly towards the belief that obesity favors sterility. In the treatment of the case before mentioned, the patient was subjected to a daily massage of the entire body, with a special pelvic massage three times a week. This, in the main, consists in elevating the uterus as high as possible with the finger in the vagina, ending with a quick and decided vibratory motion. The diet received particular attention, as at this time there was a slight gastric ailment.
The indicated remedy, Thuja, was given in the minimum dose. At the end of three months almost thirty pounds of flesh was gone, a considerable reduction. As an experiment, I recommended coitus in the knee-elbow position, advising that the lady remain quiet as long as possible after coition, with thighs well flexed. She became enciente, but miscarried at eight weeks. There was, comparatively speaking, but little pain and not much subsequent haemorrhage. She made a rapid recovery. Since then a living child has been born to them.
I believe I am safe in saying that this result would hardly have obtained were it not for the prophylactic measures adopted.
At the end of the first two months the patient was attacked with haemorrhage. A similar occurrence took place at irregular intervals during the following five months, the quantity of blood lost being much greater than that at the normal menstrual period.
For the greater part of the last five months she kept her bed, at the end of which time the tendency of the uterus to empty itself could be resisted no longer. A seven months’ child was born, and is to-day doing well.
Pseudocyesis cerebral pregnancy, phantom pregnancy (whatever name we may call it by) is a disease which must come under the head of those “complicating pregnancy.” Mrs. M., a lady, married two or three years, aet. 29. Previous history good, always enjoying perfect health. When I first saw the lady in question she was a perfect picture of health, and, according to appearance and her own statements, about seven months pregnant. I made no examination. This appeared to be a thoroughly intelligent woman, and, according to her own statement, there was cessation of the menses.
There certainly was an enlargement of the abdomen and breasts, a milky secretion, and the lady was sure that she felt foetal movement. On February 28th of the present year I was called to attend her in labor. Examination showed that no pregnancy existed. So far as I could ascertain there was no assignable origin for this condition other than nervous influences, the phenomena being purely muscular distension of the abdomen.
Mayham reports a case of a woman 73 years old, claiming to be pregnant; he also claims that subsequently she was delivered of a child; this is an Allopathic report, however, of which we will take a Homoeopathic dose. Haultain reports three cases of cerebral pregnancy. In the first, he says no cause whatever was to be found; in the second, there was a small fibroid growth in the anterior uterine wall. Hauck reports a case where the vomiting, peristalsis, and flatus, caused by alcoholism were supposed to be caused by the pregnant state. Such cases are uncommon, but they emphasize the importance of making a thorough examination, in all cases where positive information is desired of the existence or non-existence of pregnancy.
Hyperemesis Gravidarum.-An animated discussion, held recently between two celebrated Allopaths of Stuttgart and Leipsic, has served to awaken a renewed interest in this subject, without in the least adding anything new to our stock of knowledge regarding its aetiology. Notwithstanding the frequency of the vomiting of pregnancy, its very distressing character in many instances, and its imminent, its very distressing character in many instances, and its imminent danger, we find but very few contributions of any value, to either the aetiology of the disorder or its therapeutics.
I do not expect to add anything specially new myself, but it does seem to me that our knowledge of the vomiting of pregnancy, is to say the least, in a most contradictory state. Some physicians look upon it as a trifling matter, others as a thing to be endured, and some-these are in the right too-view even the mildest cases with gravity. Even in the mildest cases of morning sickness there is a constant drain upon the nervous system, putting the sufferer into a condition, in which she is very much less able to endure parturition than she would otherwise have been.
Dr. Harrison Mettler says: “After careful inquiry I find that women who suffer from much morning sickness have as a rule, tedious or otherwise troublesome labors. I have observed in multiparae that at one time they will have much nausea and vomiting followed by a difficult labor, while at another time they will be quite free from the vomiting, and will pass through the succeeding labor with comparative ease.” I must say my observations make me agree with Dr. Mettler entirely; when one thinks how rapidly the mildest of cases assume pernicious forms, indifference is certainly no longer to be excused.
There is a voluminous literature upon this subject, and many and varied are the aetiological reasons given for this very variable affection, a large majority of writers coinciding in the opinion that “many causes operate together,” to produce what we are pleased to designate the “vomiting of pregnancy.” I believe myself that in a large percentage of cases, this pernicious vomiting is simply the result of a reflex neurosis. Undoubtedly uterine displacements frequently cause vomiting; but when this is so, and the displaced organ is raised by packing the vagina with aseptic wool, the vomiting ceases.
Lillie reports a number of cases, where obstinate vomiting was caused by a retroflexed uterus, and restoration of the organ caused a cessation of the disorder. Bezugloff having a persistent case of morning sickness, introduced a bougie it no the uterus, the intention being to produce abortion; the immediate result was a stoppage of the vomiting, and the pregnancy went on to full term.
In the case just cited, I must say that I believe it was the fright, caused by the thought of abortion being performed, more than the effects of introducing the bougie, which operated so successfully; I say now, as I said before, I believe that the pre-eminent cause of this kind of sickness must be looked for i the nervous system. Flint speaks of this form of sickness as being decidedly neurotic in its origin, and cites a number of cases of a chronic variety of dyspepsia frequently occurring in young girls. I had one such case come under my personal care.
There was a persistent morning sickness, with this young lady, and a disagreeable nausea whenever food was taken; this patient was at some distance from her home, in a boarding school, and she will probably never know that the lady principal entertained very grave thoughts at one time in regard to her virtue.
It certainly was very difficult to differentiate between this and the vomiting of pregnancy; it was, however, simply due to a vitiated nervous system. My theory is supported by Alt, who records a number of such cases; I cite one only, the case being that of a highly hysterical woman, six months pregnant, suffering from the gravest vomiting, and anxious that miscarriage be induced. She was making preparation for entering the hospital for this purpose, when one of her children was seized with pneumonia. The anxiety felt over the child, forced all thought of self from the mother’s mind; from that moment the vomiting ceased and she remained well until the termination of pregnancy.-Minchener Medicinische Wochenschrift.
Whilst saying that I believe this disease to be in the majority of cases of purely nervous origin, I would not imply thereby that it is not to be feared, far from it; if neglected, we know how likely it is to pass quickly beyond treatment and our patient succumb from sheer exhaustion.
In the treatment cited such as insertion of bougies, dilation of the os, pelvic massage, etc., I believe it is merely the “doing something,” no matter much what it is, so long as you have gained the confidence of your patient, that does good. We have seen how suddenly Hyperemesis will cease if the patient be alarmed; it may be, has often been, and will to again, cured by a process skin to suggestion.
Kattenback had a case where the patient, a primipara, was seized with an incorrigible vomiting. It was suggested to her that her stomach contained some lumps of unwholesome material and their removal would cure her. Some milk was given her, and the stomach ceremoniously washed out. its contents bore no indications of either over-acidity or abnormal ferment She was informed that she was all right and the vomiting would not return; neither did if, and she was safely delivered at term.
There is a familiar and now well-know phenomena, by which these neurotics can be influenced; I speak of hypnotism; it is due to purely subjective conditions.
There is an identity of the hypnotic susceptibility with the condition of hysteria, and it is along these lines that we can work. Just as many times as I have tried this method of treatment, for these cases of excessive vomiting, just so many times has it given me gratifying results.
The patient can be to sleep by bi-ocular pressure, and the idea of cure suggested; the operation may have to be repeated several times, at intervals of a day or so, but you will be rewarded by the cessation of the vomiting, often with but one suggestion. Where the patient is not easily controlled by means of the bi-ocular pressure, Luy’s revolving mirror is a never failing resource.