On uterine and ovarian inflammation : and on the physiology and diseases of menstruation

II I

I to

ON

UTERINE AND OVARIAN INFLAMMATION ;

AND ON THE

BY

EDWARD JOHN TILT, M.D.

MEMBER OF THS KOTA.L COLLEGE OF PHYSICIiNS ; CONSULTINO PHYSICIAN TO THE FARRINQDON GENERAL DISPBNSVRT; FELLOW OF THE ROYAL MEDICAL AND CHIRURGICAL SOCIETY, AMD OF SEVERAL FOREIGN SOCIETIES.

WITH COLOURED PLATES.

*' More will be done, and better, and with greater ease, when every one does but one thing, accordiog to his genius, at the proper time, and when at leisure from all other pursuits." — Plato, Republic, B. II., Chap. XI.

LONDON :

JOHN CHURCHILL, NEW BURLINGTON STREET.

MDCCCLXII.

LONDON :

AND EDWARDS, PRINTERS, CHANDOS- STREET, COVENT GARDEN.

Preface To The Third Edition

The approbation bestowed on my mode of investigating the diseases of menstruation has been to me an additional motive to use every endeavour to perfect the work according to the original plan. I may say the same of the treatise on the diseases of the ovaries, and in re-writing it, I have had the satisfaction of being able to show that the main points, which were affirmed by me in previous editions, had been confirmed by high authorities at home and abroad.

In treating of Uterine Inflammation, I have had principally in view the pathology of the body of the womb, which is so important and so little understood, that it imperatively calls for further researches. If I have only been partially successful in attempting to unravel the obscurities that beset the study of internal metritis, I hope the difficulties of the undertaking may be pleaded in extenuation of my imperfections, and that my exertions may be useful in stimulating fellow -labourers to give the subject all the attention that it so well deserves.

60, Grosvenoe-steeet, May, 1862.

PKEFACE TO THE FIRST EDITION.

It is not without some degree of diffidence that I venture to add even a small volume to the number of those which overload medical shelves, for I feel that the flattering reception of an ephemeral production* offers no guarantee of similar success for a work addressed to the profession on the treatment of important diseases. Urged, however, by a conviction that books are not only useful to diffuse the knowledge of great discoveries_, but also to connect those facts which, although sterile so long as they are left disjointed, assume importance when connectedly put together, I have here more methodically arranged, and more fully developed, views first expounded in a series of papers on the- sub-acute form of ovarian disease, which appeared in the Lancet in 1849.

I am further induced to do so, because those contributions were favourably noticed in various organs of the medical press,t and also on account of the gratifying concurrence in my views which has been spontaneously offered to me by many of my brethren engaged in practice.

Perhaps it would not be unbecoming for me to state, that whether as pupil or house-physician to the Paris hospitals, I have, from the beginning of my career, enjoyea the full advantages of the widest field for uterine investigations which

* The Serpentine as it is, and as it ought to be ; and the Board of Health as it is, and as it ought to be. 1848.

t JEdinhurgh Monthly Journal, 1849; Dr. Eanking's Betrospect, January and June, 1849; Braithwaite's Retrospect, January and June, 1849 ; American Journal of Medical Science, Vols. XLIII. and XLIV. ; London Journal of Medicine, December, 1849.

viii PREFACE TO THE FIRST EDITION.

can ever be afforded by a medical school ; and that whilst practising in Paris and in various other capitals of Europe, I not only had abundant opportunities of testing the value of my views relative to diseases of menstruation, but also of strengthening them by an acquaintance with the practice of those who so well represent our profession in each country.

I might even add, that since my return to England I have found abundant opportunities of confirming my peculiar views on the diseases of menstruation, while attending the numerous patients at the Earringdon General Dispensary and Lying-in Charity, and also those of the Paddington Eree Dispensary for Diseases of Women and Children, to which institutions I am attached in the capacity of Physician.

My aim has been to perform, for the ovaries, the principal organs of menstruation, what has been successfully done for other organs by many eminent men ; and I feel assured, that although some of my deductions may be contested, my practice will be admitted by all to be indubitably safe, and necessarily destined to diminish the number and intensity of female complaints.

I can lay claim, unfortunately, to no discoveries ; but from an acquaintance with the literature of that branch of the profession to which I have devoted my chief attention, I feel justified in affirming that in no other work will the reader find so complete an account of the various ways in which sterility is produced by the action of inflammation on the ovarian tissues, of the great importance of ovarian peritonitis as a cause of disordered menstruation, or of the influence of ovarian inflammation in the production of uterine disease — facts forcibly exemplified and proved to be, not mere conventional possibilities, but events of frequent occurrence.

I must also observe, in reference to the numerous cases with which 1 have enriched my work, that I have given them more with a view of illustrating, than of establishing, each particular point of ovarian pathology. I have therefore taken

PREFACE TO THE FIRST EDITION. ix

from my own case-book only those select cases vvhich bear forcibly on the subject, borrowing from authors and contemporary observers, facts, rendered much more valuable by their not having been collected under the influence of the views which they will be found so admirably to exemplify. If I have derived my cases more from foreign than from British practitioners, it is simply because Continental obstetricians, having been the first to investigate scrupulously the diseased organs of generation by the combined assistance of the touch and of the eye, have been able, in many instances, to detect the hidden causes of those diseases which, until late years, were only guessed at, and could only be treated symptomatically.

As a fitting introduction to this work, I intended to prefix an essay on the natural history of women ; but finding the matter to grow rapidly under my hands, and the vast importance of the undertaking becoming every day more perceptible, I have, for a time, desisted from the accomplishment of what must be considered the only rational introduction to any treatise on the diseases of women.

In noticing the many deficiencies of this work, the reader will also remember that it is the first systematic attempt to do, for the principal organs of generation in women, what has now been done for every other important organ of the body; and that, considering the rapid progress which has lately been made in ovarian physiology, it cannot be wrong if some one should seek to give to the pathology of the ovaries a development which would be greater and more satisfactory if the labourer were better able to accomplish his self-imposed task.

I cannot record the progress of ovarian physiology without testifying my admiration for the illustrious Kegnerus de Graaf, who, nearly two centuries since, originated a movement which has only been followed up within the last few years. Can I better conclude this address than by borrow-

X

Preface To The First Edition

ing the words in which he ends the preface to his immortal work ?

Edward John Tilt.

Marcl 2UTi, 1850.

Contents

Preface v

Preface to First Edition vii

Introduction 1

The dark ages of uterine pathology 1

Defective noraenclature of diseases of menstruation 2

the ovaries 4

,y „ womb 5

Inflammation in ovario-uterine pathology ^

Ovai'ian pathology little understood 7

Frequency of uterine inflammation 9

Frequency of ovarian inflammation 10

Ovaritis a cause of metritis 15

Comparative frequency of uterine and ovarian inflammation . . .16

Topographical anatomy of the ovarian region 18

Abdominal examination 19

Vaginal exploration 20

Eectal exploration 23

Exploration by the double-touch 25

Specular examination 30

Part I

PHYSIOLOGY AND DISEASES OF MENSTRUATION. CHAPTEE I.

Symptoms of menstruation from healthy becoming diseased ... 34

Menstrual modificators 35

Hereditary influences 35

Race 38

Early marriage 40

Temperature 40

Date of first menstruation in different countries 40 xii

CONTENTS.

PAGB

Habitation 43

Civilization 44

Determining causes of first menstruation 46

Date of last menstruation 49

Causes of protracted menstruation 61

Causes of early cessation 53

Duration of menstruation 65

CHAPTER II. Theories op Menstruation 67

The ovaria are the principal organs of menstruation 67

Relative importance of the ovaries and of the womb proved by cases

of congenital absence of each 68

Effects of spaying, as practised on the lower animals 61

Menstruation and ovulation not synonymous terms 65

Final cause of menstruation 68

CHAPTER III. Ovarian Nisus 70

The ovarian nisus a function of the ganglionic nervous system . . 70

Physiology of the ganglionic nervous system 71

The ganglionic nervous system has a centre of action 75

The menstrual force, or ovarian nisus, dependent on the ganglionic

nerves 76

Therapeutical indications during the menstrual epochs 78

CHAPTER IV. Ganglionic Symptoms of Menstruation 80

Epigastric sensations and prostration 81

Epigastralgia 83

Therapeutical indications of ganglionic neuralgia 90

Chlorosis and its indications 91

Influence of menstruation on caloricity 92

Heats and flushes 92

Catamenial fever 95

Sensations of cold 97

CHAPTER V. Classification of cerebral symptoms 99

Nervous irritability 99

Relative proportion of the cerebral symptoms of menstruation . . 100

Pain in the head 101

Therapeutical indications of headache 103

Sick headache and its therapeutical indications 103

CONTENTS. XUl

Pseudo-narcotism 104

Frequency of pseudo-narcotism at each successive phasis of reproductive life 105

Illustrations of pseudo-narcotism and hysterical apoplexy .... 106

Modes of interpretation of pseudo-narcotism 113

I. Cerebral disease 114

IT. Plethora 115

III. Ansemia 115

IV. Biliary derangement 116

v. Toxsemic eflfects of retained menstruation 116

YI. A ganglionic nervous influence 117

Theories of sleep 117

Therapeutical indications of pseudo-narcotism 117

Hysteria 121

Hysterical neuralgia .121

Frequency of hysteria at the successive, &c. &c 122

Hysterical convulsions 123

Mechanism of hysteria 127

Therapeutical indications of both forms of hysteria 129

Catalepsy 130

Epilepsy and its mechanism 131

Therapeutical indications of epilepsy 133

Insanity 133

Insanity often produced by perverted visceral action 137

CHAPTER VI. Spinal Symptoms of Menstruation 138

Nerves which supply the ovario-uterine organs 138

Spinal Symptoms of menstruation 140

Cerebro-spinal symptoms in relation to the menstrual flow . . . .139

Lesions of sensibility 141

Dorsal pains 141

Hypogastric pains 142

Hysterical pains 143

Therapeutical indications of lesions of sensibility 144

Lesions of motility 145

Therapeutical indications of lesions of motility 149

CHAPTEH VII.

Critical Discharqes op Menstruation 150

Analogy between the critical discharges of menstruation and those of

fever and hemorrhage . . . . i 150

CHAPTER VIII. Sanguineous Discharges op Menstruation 152

Three origins of the menstrual discharge 152

Amount of sanguineous discharge 156

CONTENTS.

Duration of the menstrual flow 157

Quantity of menstrual flow at difi'erent epochs of life 158

Hemorrhoids in relation to menstruation 159

"Varicose veins in relation to menstruation 160

Deviations of the menstrual flow 160

Morbid increase of menstrual flow . .161

Modes of termination of the menstrual flow 162

Therapeutical indications of monorrhagia 163

Deficiency or non-appearance of the menstrual flow 164

Retention of the menstrual flow 166

Quality of the menstrual discharge 167

Therapeutical indications of the perverted menstrual flow .... 169

CHAPTER IX. Mucous DiSCHAKGES OF MENSTRUATION 170

Leucorrhceal discharge at first menstruation 170

Vicarious leucorrhceal discharge 171

Catamenial leucorrhcea 173

Intermenstrual leucorrhcea 173

Leucorrhceal discharge at cessation 173

Chemical constituents of leucorrhceal discharges 174

Therapeutical indications of the mucous discharges of menstruation . 176

CHAPTER X. Gastro-Intestinal Discharges op Menstruation 177

Vomiting and gastric symptoms 178

State of the bowels during the menstrual periods 180

Diarrhoea as observed at first and last menstruation 181

Diarrhoea as a symptom of uterine disease 182

Rationale of diarrhoea as a symptom of menstruation 184

Relation between the amount of carbon consumed by the lungs and

the menstrual flow 185

Therapeutical indications of the intestinal mucous discharges . . . 1 86

CHAPTER XI. Mammary Symptoms op Menstruation 190

Nature and frequency of mammary symptoms 191

Innocuous mammary tumours 192

Therapeutical indications of mammary symptoms 194

CHAPTER XII. Influence of the Ovarian Nisus on the Cutaneous and on the

Urinary Surfaces 195

The relation of cutaneous exhalation to diseases little known . . .195 Influence of the reproductive organs on the cutaneous surface . . . 195 Perspiration at various epochs of reproductive life 196

CONTENTS. XV

PAGB

Cutaneous discolorations 197

Cutaneous eruptions in connexion with menstruation 198

Therapeutical indications of the same 200

CHAPTER XIII. Vesical Stmptoms and Urinary Deposits 201

Urinary deposits critical of menstruation 202

CHAPTER XIV. Type in Menstruation ■. 203

Importance of type in menstruation 203

Remittent menstruation and its causes 205

Consequences of remittent menstruation 206

Therapeutical indications of remittent menstruation 207

Preventive treatment of the same 210

Part II. Inflammation Of The Womb

CHAPTER XY.

Inflammation op the Neck oe the Womb 212

Anatomy of the neck of the womb 213

Cervical catarrh 214

Blennorrhagic uterine catarrh 218

Simple ulcer of the neck of the womb 219

Varicose ulcer 220

Pseudo-membranous ulcers 220

Syphilitic ulcers . . .223

Prognosis of inflammation of the neck of the womb 224

Pathology of the disease 277

Morbid anatomy 278

Causes and symptoms 278

Senile internal metritis 281

CHAPTER XXII. Indications op Constitutional Treatment 283

Indications of surgical treatment 284

Cure of cervical inflammation 285

Dilatation of the neck of the womb 285

Intra-uterine injections 286

Intra-uterine cauterization 287

Scraping of the intra-uterine surface 287

Advantages and dangers attending the operation 289

PAKT III.

INFLAMMATION OF THE OVARY.

CHAPTER XXIV. Morbid Anatomy op Sub-acute Ovaritis 297

CONTENTS. xvii CHAPTER XXV.

PAGB

Predisposing causes 301

Ovulation 302

The ovarian or the lymphatic temperaments 307

Sexual intercourse imprudently indulged 307

Privation of sexual intercourse 308

Psychical causes 309

Exciting causes 311

Mechanical injuries at parturition 312

Blennorrhagia 314

Inflammation of the neck of the womb 318

Injections 321

Caustics to the neck of womb 322

Instrumental measures 323

Metrotome 324

Stem- pessaries 325

Mammary irritation 328

Cold and emotional shocks 329

Medicinal agents 330

CHAPTER XXVI. Symptoms common to all types of ovaritis . 333

Pain and its modifications 333

Mammary pain 336

Nymphomania 336

Types of sub-acute ovaritis 338

Amenorrhoeal type 338

Menorrhagic type 340

DysmenorrhcBal type 341

Hysterical type 342

Ovaritis as a determining cause of insanity 347

Puerperal sub-acute ovaritis 348

CHAPTER XXVII. March and Terminations op Sub-acute Ovaritis ....... 352

Sterility 352

Peritonitis and pelvi-peritonitia , 357

Cases in illustration 359

Ascites 364

Insidiousness of chronic peritonitis 366

Abortion 369

Uterine inflammation and illustrations 370

b xviii

CONTENTS.

CHAPTEK XXVIII.

PAGE

Lumbo-abdominal neuralgia and ovarialgia 376

Ovaritis mistaken for chronic peritonitis 378

Prognosis of sub-acute ovaritis 378

CHAPTER XXIX. Bleeding and leeches 382

Purgatives 383

Enemata 383

Medicated pessaries and suppositories 384

Hydropathy 385

Treatment of the several types of subacute ovaritis 386

Treatment of pelvi- peritonitis 390

CHAPTEE XXX.

"Varieties of pelvic abscesses 392

Statistics of acute ovarian inflammation 393

Pathological anatomy of acute idiopathic ovaritis 393

Pathological lesions of puerperal pelvic morbid lesions 396

Morbid lesions of the Fallopian tubes 397

CHAPTER XXXI. Local symptoms of acute ovaritis 399

Pain 399

Dysuria 400

Constipation and ileus 401

Nymphomania wrongly considered a symptom of acute ovaritis . . 401

General symptoms 402

Anomalous symptoms 402

CHAPTER XXXII. Resolution more frequent than is admitted 404

Elimination of pus from ovarian abscesses, and statistics thereof . . 405

Cutaneous opening 406

Vaginal opening 406

Intestinal opening 407

Vesical opening 409

Peritoneal opening, and its fatality 409

CONTENTS. xix CHAPTEE XXXIII.

PAGE

Difficulties of abdominal diagnosis 411

Ovarian abscess simulated by metritis 412

By deviations of the womb 413

By iliac abscess 413

By pel vi- peritonitis 415

By sanguineous pelvic tumours 416

By stercoral tumours 416

Prognosis of acute ovaritis , 418

Inflammation of the Fallopian tubes 419

CHAPTER XXXIV. Bleeding in the treatment of acute ovaritis 425

Mercurial inunctions in high doses 428

Purgatives and rectal injections 429

Dangers of the spontaneous opening of the abscess 429

Puncture of the abscess 432

Vaginal incision of the abscess 433

Dangers of using force when injecting the abscess with water . . . 434

Rectal incision of the abscess 438

Opening of the ovarian abscess through the abdominal parietes . . 439

Recamier's mode of operating by caustic 440

Rupture of the abscess into the peritoneum, treatment of ... . 441

CHAPTER XXXV. Pathology and Treatment of H^ematocelb 442

Sanguineous pelvic tumours caused by the effusion of the menstrual

blood from the Fallopian tubes into the peritoneum 442

By the effusion of blood from the rent Fallopian tubes in the

peritoneum 442

By the effusion of blood from the rent ovary into the peritoneum

during menstruation 442

Resolution of 443

Opening into the rectum 444

Vaginal incision of 444

Causes of 451

Symptoms of ^ 452

Diagnosis of 452

Treatment of 453

Prevention of 455

Bibliographical Index 456

ON

UTEEINE AND OVAEIAN INFLAMMATION,

AND ON

DISEASES OF MENSTRUATION.