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VERITAS
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HOMOEOPATHIC
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225

H618
I I
416
①

THE
MEDICAL, SURGICAL, AND HYGIENIC TREATMENT
OF
DISEASES OF WOMEN,
ESPECIALLY THOSE CAUSING
STERILITY,
THE DISORDERS AND ACCIDENTS OF PREGNANCY,
AND PAINFUL AND DIFFICULT LABOR.
い
​BY EDWIN MHALE, M.D.,
PROFESSOR OF MATERIA MEDICA AND THERAPEUTICS IN THE CHICAGO HOMEOPATHIC
COLLEGE; AUTHOR OF THE "MATERIA MEDICA, SYMPTOMATOLOGY AND
THERAPEUTICS OF NEW REMEDIES;" OF “LECTURES ON DISEASES
OF THE HEART;" MEMBER OF THE AMERICAN INSTI-
TUTE OF HOMEOPATHY; OF THE WESTERN
ACADEMY OF HOMEOPATHY;
HONORARY MEMBER OF THE HOMEOPATHIC STATE MEDICAL SOCIETIES OF ILLINOIS,
INDIANA, MICHIGAN, NEW YORK, MASSACHUSETTS, IOWA, WISCONSIN,
AND OF THE HOMEOPATHIC MEDICAL SOCIETY OF THE UNITED
STATES OF COLOMBIA, SOUTH AMERICA; CORRESPONDING
MEMBER OF THE MASSACHUSETTS SURGICAL AND
GYNECOLOGICAL SOCIETY, ETC., ETC.
BOERICKE & TAFEL :
NEW YORK AND PHILADELPHIA.
1878.
Entered according to Act of Congress, in the year 1878,
BY BOERICKE & TAFEL,
In the Office of the Librarian of Congress, at Washington, D C.
SHERMAN & CO., PRINTERS,
S. W. CORNER SEVENTH AND CHERRY STREETS,
PHILADELPHIA.
f
hom
Нас
!
то
SAMUEL LILIENTHAL, M.D.,
PROFESSOR OF CLINICAL AND PSYCHOLOGICAL MEDICINE IN THE NEW
YORK HOMEOPATHIC MEDICAL COLLEGE, IN TOKEN OF ADMIRA-
TION OF HIS PROFESSIONAL HONESTY, LIBERALITY, AND
EXTENSIVE LEARNING; OF GRATITUDE FOR NU-
MEROUS FAVORS, UNIFORM COURTESY, AND
UNINTERRUPTED FRIENDLY
SYMPATHY;
This Mork
IS INSCRIBED BY HIS FRIEND,
THE AUTHOR.
171282
PREFACE.
THIS work contains some of the results of the observation,
study, and experience of a quarter of a century of active practice.
It is not intended to take the place of such works as Jahr,
Leadam, Guernsey, Ruddock, Richardson, or Ludlam.
It occupies altogether another sphere in our literature, and
instead of superseding the above authorities will serve to supple-
ment them. I have purposely omitted the minute history, eti-
ology, diagnosis and symptoms of many of the diseases treated
of, referring the student to the larger systematic text-books,
and the practical physician to his own knowledge and experi-
ence in relation thereto.
The time has arrived when Homœopathy must occupy a
broader and more advanced position in the therapeutics relating
to Gynecology and Obstetrics, or its usefulness as a healing Art
will remain circumscribed and contracted.
The Law of Cure must not be hampered by such rules as
"the minimum dose, the single remedy, and the rejection of
local treatment." The physician who practices according to this
rule is only a half-homoeopathist. He avails himself of but
half the capabilities of our Law of Cure, and his sphere of use-
fulness is limited accordingly. There are conditions where
material doses are as homeopathic as an immaterial attenuation.
There are cases when medicines locally applied are as strictly
homœopathic to the disease as when taken into the circulation
by the mouth or stomach.
The Law of Cure, enunciated by Hahnemann, is universal
and all-embracing. Palliatives may be useful as aids to a cure-
in the same manner as surgical, mechanical and chemical meas-
ures—but no cure can be made by medicine, that is not a homœo-
vi
PREFACE.
pathic cure. The dose, the method of administration, and the
mode of application of the remedy are all of minor impòrtance, if
the drug is selected under the law of similia.
In the following work I have not, except in rare instances,
advised any remedy that is not homoeopathic, either constitu-
tionally or locally, or by virtue of its primary or secondary
action. I yield to no one in my adherence to the law of simi-
lia, or my devotion to the cause of the homœopathic healing
art, but I will not be bound down to old dogmas, or antiquated
therapeutic notions. I believe the "sole duty of the physician
is to cure the sick." Hahnemann taught us this duty.
To those who oppose all progress in therapeutics, outside of
their restricted views, I would commend the following noble
words of Hahnemann, written when he had been chastened by
age and purified by adversity, and during the last years of his
eventful life, when at last peace and happiness surrounded him:
'No reasonable physician can be satisfied with practicing
within the limits of antiquated rules, derived from speculative
theories, instead of pure experiments. His object is to cure the
sick, and the innumerable powers of nature, WITHOUT EXCLUD-
ING ANY, have been assigned to him to effect that process of re-
generation. And to carry out such noble ends he ought to have
a right to dispose of the curative powers of nature, for the pres-
ervation or partial regeneration of the body is a more noble
deed than any of the boasted deeds of history; but he ought
likewise to be permitted to employ those powers in THAT FORM
AND QUANTITY which seem to him the most adequate and the
most conformable to experience and wisdom; in this respect no
restriction ought to be imposed upon him as a free and indepen-
dent man, provided he is endowed with the necessary power and
knowledge to preserve human life, and with that delicate con-
science which every one whom God has appointed a guardian of
human life should possess."
CHICAGO, August, 1878.
EDWIN M. HALE.
CONTENTS.
PART I.
STERILITY.
PAGE
PREFACE,
V
INTRODUCTION: Discussion of the Facts and Theories of Ovulation and its
Relation to Menstruation and Conception,
9-42
CHAPTER I.
ENUMERATION OF THE CAUSES OF STERILITY,
43-45
CHAPTER II.
STATISTICS OF STERILITY,
46-49
CHAPTER III.
CONSTITUTIONAL CAUSES AND THEIR TREATMENT: Chlorosis-Scrofula-
Syphilis Obesity-Twin-Birth-Prostitution---Inordinate Sexual In-
Mineral Waters Improper Diet, Exercise, and Cloth-
tercourse
ing,
•
CHAPTER IV.
PSYCHICAL CAUSES: Incompatibility—Frigidity-Erotism,
CHAPTER V.
50-55
56-57
OVARIAN CAUSES: Absence of Ovaries-Imperfect Development-Atrophy
-Inflammation-Degeneration-Tumors-Dropsy,
CHAPTER VI.
58-60
UTERINE CAUSES: Stricture of Fallopian Tubes-Obstructions-Absence or
Defect of Uterus-Atresia of Uterus-Imperfectly Developed Uterus-
Atrophy of Uterus-Obstructions of the Os and Canal of the Cervix-
Stricture of the Canal-Displacements of the Uterus-Anteversion and
Flexion-Retroversion and Flexion-Lateroflexion-Prolapsus-Ele-
vation—Inversion—Tumors—Polypi-Fibroids-Endometritis—Endo-
cervicitis Abrasion-Erosion - Ulceration-Leucorrhoea-Dysmenor-
rhoea-Amenorrhea-Menstrual Irregularities-Areolar Hyperplasia-
Abnormal shape of Cervix,
61-130
1
viii
CONTENTS.
PAGE
CHAPTER VII.*
VAGINAL CAUSES: Atresia. Absence of Non-retaining - Imperforate
Hymen-Vaginismus-Leucorrhoea-Diseases of Clitoris,
•
130-145
CHAPTER VIII.
RENAL CAUSES: Diabetes Mellitus-Diabetes Insipidus,
146
CHAPTER IX.
VESICAL CAUSES: Irritable bladder-Catarrh of Bladder,
147-150
CHAPTER X.
URETHRAL CAUSES: Irritable Urethra-Chronic Catarrhal Urethritis-
Caruncles of Urethra - Granular Erosion of Urethra-Fissure of
Urethra-Vesico-vaginal Fistula-Vascular Tumor of Meatus, 151-154
CHAPTER XI.
RECTAL CAUSES: Hæmorrhoids-Prolapsus Recti-Fissure of Anus-Fis-
sure of Rectum-Ulcer of Rectum, .
155-158
CHAPTER XII.
THE MECHANISM OF CONCEPTION: The Nature and Properties of Semen-
Spermatozoa-Examination of Vaginal and Cervical Mucus for Sper-
matozoa—Hale's Speculum-The Passage of Spermatozoa to the Ovule
-The Successful Conditions of such Passages,
159-171
CHAPTER XIII.
HYGIENIC AND OTHER ERRORS CAUSING STERILITY: Improprieties of Dress
-Imprudence during Menstruation-Excessive Venery and Orgasm-
Improper Time for Coition-Coition during Treatment of Uterine Dis-
ease-Improper Position during Coition-Improper Conduct after Coi-
tion-Means Used to Prevent Conception-Abortion as a Cause of
Sterility, .
172-183
CHAPTER XIV.
GENERAL THERAPEUTICS OF STERILITY: Indications for the Use of Various
Medicines Miscellaneous Therapeutic Agents-Galvanism-Gymnas-
tics-Hydropathy-Mammary Irritation-Injection of Semen into the
Uterus,
•
184-199
* Erroneously numbered V.
CONTENTS.
ix
PART II.
DISORDERS OF PREGNANCY, AND DYSTOCIA.
PREFACE,
CHAPTER I.
PAGE
203
GENERAL DISORDERS OF PREGNANCY, REMEDIES FOR: Preventive Treat-
ment of Dystocia,
205
CHAPTER II.
SPECIAL DISORDERS AND ACCIDENTS OF PREGNANCY: Vomiting-Retro-
flexion of the Uterus-Cases Illustrating-Use of Pessaries in-Albumi-
nuria-Treatment of Uræmic Poisoning-Convulsions-Constipation—
Treatment of, .
224
CHAPTER III.
MEDICATION OF FŒTUS IN UTERO AS A MEANS OF PREVENTING DYSTOCIA:
Dystocia Due to the Fœtus-Unnatural Ossification of the Skull-Hy-
drocephalus of the Foetus-Tumors of-Monstrosities-Hardness of the
Bones of Fruit Diet for Dystocia, .
253
CHAPTER IV.
THE IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA: Extreme Slow-
ness of Labor-Rigidity of Cervix-Spasmodic Contraction of the Cer-
vix-Treatment of Second Stage of Labor-Feebleness of Contractions
-Excessive Distension of the Uterine Walls-Sudden Cessation of
Pains-Cramps in the Legs-Irregularity of the Pains-Position during
Labor-Use of the Hale's Small Forceps during Difficult Labor, . 267
B
:
"
t
LIST OF ILLUSTRATIONS.
FIG.
1. Fitch's Measuring Sound,
2. White's Hysterotome, .
3, 4. Jackson's Speculum,
5. Nelson's Tenaculum,
·
•
·
6. Sims' Intrauterine Stem Pessary,
7. Chambers' Stem Pessary,
8. Thomas' Anteversion Pessary,
9. Thomas' Retroversion Pessary,
10. Albert Smith's Retroversion Pessary, .
11. Simpson's Sound,
12. Sims' Sound,
PAGE
64
ΤΟ
71
72
•
74
2 2 2
75
76
76
77
77
13. Sims' Elevator,
77
14. Gardner's Elevator,
77
15. Elastic Ring Pessary,
81
•
16. Molesworth's Double Canula and Bulb Syringe,
93
17. Nott's Double Canula Catheters, .
93
18. Wylie's Cervical Protector,
94
19. Bozeman's Dressing Forceps,
99
20. Sims' Cervical Applicator,
101
•
21. Hale's Cervical and Intrauterine Applicator,
102
21 a. Sims' Porte-Tampon,
107
22. Chapman's Scarificator,
117
23. Buttles' Spear Scarificator,
117
•
24. Skeene's Hysterotome, .
25. Peaslee's Uterotome,
26. Conical Cervix,
27. Spermatozoa,
•
28. Hale's Expanding Speculum,
127
128
129
160
166
29. Hale's Small Forceps, .
289
30. Hale's Small Forceps Applied,
293
:
ON STERILITY.
INTRODUCTION.
IN the treatment of this subject I propose to adopt the
generally accepted meaning of the term, namely: the want
of the aptitude for being impregnated.
This definition does not restrict barrenness to those cases
where, from some cause, ovulation does not take place; for
that function may be perfectly performed, and yet, from
some abnormal condition of the organs of generation, the
ovule cannot become impregnated.
Impotence in the male cannot be considered as a cause
of sterility, and the consideration of this condition does not
fall within the province of this treatise.
Sterility may be congenital or acquired; or it may exist for
years, and a spontaneous cure result from the action of un-
known causes.
History relates many instances illustrating these condi-
tions. Anne of Austria had been married to Louis XIV
for fifteen years before she had a child. Another Anne of
Austria, wife of Louis XIII, was sterile for twenty-two
years. Catalina de Medicis, wife of Henry the Second, was
unfruitful during the first ten years of her marriage, after
which time she became so prolific that she had ten successive
children. Many similar cases are reported in the various
works on obstetrics.
There is still another class of sterile women, who become
so after having one or two children, and are afterwards bar-
ren, even when no cause is apparent in the condition of the
organs of reproduction.
2
10
ON STERILITY.
C
For a proper understanding of the subject, and a full ap-
preciation of the various causes of sterility, the latest views.
on the physiology of generation should be kept in mind.
It is generally believed that conception consists in the con-
tact of the fertilizing semen of the male with the ovum,
somewhere in the Fallopian tubes, or the cavity of the uterus.
It is taught by some authors, however, that the ovum may
or does become impregnated in the ovary. It is established
that the spermatozoa after being deposited in the vagina,
even at its entrance, find their way to the cervical canal,
which they enter, and thence proceed until they meet the
ovun, which they enter. This is impregnation. The ovum
passes into the cavity of the uterus, and if impregnated then
or during its progress to the cavity, becomes attached to the
interior surface of that organ.
But the subject of ovulation, and its connection with men-
struation and coition, is one which more concerns us, for un-
less ovulation and coition coincide, even in a perfectly normal
condition of all the organs of both sexes, impregnation will
not result.
It was my intention to collect and place before the student
and physician the very latest observations and facts relating
to ovulation; but I fortunately found a paper written by Dr.
A. R. Jackson, of Chicago, published in the American Journal
of Obstetrics, October, 1876, which contains all observations
of importance up to the present date.
By his permission I give his paper entire. After carefully
reading it this deduction will be evident to any practical
mind, namely, that in some cases of sterility the parties must
be informed of the main facts of the process of ovulation, in
order that they may try to make the period of ovulation and
coition coincident.
While I admit that probably no exact information as to
the time of ovulation can be given by the physician, it is
probable that careful experiment may enable the husband
and wife to ascertain its occurrence.
Dr. Jackson says: "It is my purpose, in this paper, to ex-
amine the evidence upon which is based the ovular or ovula-
tion theory of menstruation.
INTRODUCTION.
11
"This subject has received a large share of attention during
the past few years, and great discrepancy of opinion exists.
in regard to many points connected with it. I do not ex-
pect to reconcile these discordant views; indeed, in the
present state of our knowledge, it would perhaps be impos-
sible to do so. Our great need in this, as in many other
problems of a physiological character, is an increased num-
ber of well-observed facts; those which we have thus far
are too few in number, and, apparently, too contradictory to
warrant a definite and entirely satisfactory conclusion.
"The progress of scientific knowledge is greatly retarded
by the admission of what may be termed, paradoxically,
false facts; that is to say, facts which by representing only
partially the truth, lead to false results. Conclusions founded
upon such premises must almost necessarily be erroneous.
Truth in science is rarely found wholly unmixed with error,
and, in order that we may rightly appreciate the former, we
must properly estimate the latter also. Like the diamond,
whose facets reflect a differently colored ray according to the
angle from which they are seen, so may a scientific truth
present a different aspect to those who behold it from dif-
ferent points of observation. While to one person the gem
appears green, to another it is red, and to a third yellow.
He only who sees it from all directions can know the whole
truth. Thus it is that imperfectly observed, partial or per-
verted facts result in the formation of a false theory; and
a false theory, once adopted, has a most injurious influence.
He who is governed by it sees everything through a false
medium. As observed by Paris, He who is guided by pre-
conceived opinions, may be compared to a spectator who
views the surrounding objects through colored glasses, each
assuming a tinge similar to that of the glass employed.' The
advocates of the ovulation theory are, it seems to me, some-
what in this position. Many facts have been observed which
give apparent support to their opinions, and on these they
have been content to rest, overlooking, or, at least under-
estimating other facts, equally well known, which strongly
militate against those opinions.
"The ovulation theory of menstruation implies the follow-
ing essential propositions:
12
ON STERILITY.
"1. At regular periods, of about twenty-eight days, in
the human female, a matured ovule is discharged from the
ovary, passes into the Fallopian tube, and is transmitted to
the uterus.
"2. Coincident with and dependent upon the maturing
and bursting of the Graafiau vesicle and the extrusion of
the ovule, certain changes occur in the mucous membrane of
the body of the uterus, which result in a sanguineous dis-
charge from that organ.
"In support of these propositions, evidence consisting of
certain facts and analogies has been adduced, as follows: (a)
Observations made on the bodies of women who have died
during or soon after the menstrual period have revealed the
presence in one or other ovary of a ruptured Graafian vesicle,
and its cavity filled with a blood-coagulum, or its remains,
a corpus luteum, in various stages of development or deca-
dence; (b) Physiologically, the period of menstruation in
woman corresponds with the rut or astrus of other mam-
malia, when, it is well known, ova are discharged from the
ovaria; (e) The artificial removal of the ovaries causes an
immediate cessation of the menstrual function. I purpose
considering, seriatim, these propositions, together with the
facts which have been advanced for their support.
"1. AT REGULAR MONTHLY PERIODS IN THE HUMAN FEMALE,
AND COINCIDENT WITH THE MONTHLY FLOW, AN OVULE IS DIS-
CHARGED FROM THE OVARY, IS RECEIVED INTO THE FALLOPIAN
TUBE, AND BY IT TRANSMITTED TO THE UTERUS.
"The minor proposition, namely, that the matured ovule
passes from the ovary to the uterus through the Fallopian
tube is admitted on all hands, and, not being in dispute, need
not detain us The essence of the controversy centres in the
alleged periodicity of this process, and of its time relations
with the menstrual discharge.
"The Graafian vesicles, from the time of their description
in 1673, by De Graaf, down to the year 1827, were thought
to be the actual ova of manimalia. It was not until the last-
named period that Baer discovered the true ovule and the
relations it bore to its containing vesicle. However, as early
INTRODUCTION.
13
as 1672, Kerkringius* advanced the idea that the ova were
discharged at the time of menstruation, but it does not seen
to have been founded upon any observations. The first
writer who gives positive evidence upon the subject is Sir
Everard Home, who noticed the ruptured follicle during
menstruation, although its import was not then under-
stood. In 1821, Dr. l'ower clearly enunciated the doctrine
of the periodical ripening of the follicle at the menstrual
period; and the discovery six years later by Baer, already
alluded to, that this was only the enveloping structure of
the ovule and not the ovule itself, made the rupture an in-
telligible fact; and so we may regard this as the real birth
of the ovulation theory. In 1831, Negrier,† working in-
dependently, showed by anatomical preparations that the
periodical discharge of menstruation was the consequence of
an internal hidden function-ovulation. Fresh proofs were
brought forward by Gendrin, Paterson, Barry, Raciborski,
Bischoff, Pouchet, and others, all tending to show that ovu-
lation and menstruation are simultaneous and necessarily
connected one with the other; and the doctrine was so beau-
tiful and reasonable, and seemed so well sustained by the
evidence adduced, that we cannot wonder at the fact that it
was generally received and adopted by physiologists. Still,
there have always been some who were not convinced of its
correctness, and who regarded the proofs alluded to as
insufficient and inconclusive; who, in the language of Mr.
Kesteven, looked upon the doctrine as a plausible and in-
genious theory, wanting, however, in the true elements of
an inductive theory; in short, an example of the post ergo
propter line of argument."'
†
{
"In examining the cases which have been cited in support.
of the ovulation theory, one cannot fail to be struck with
the complacency with which conclusions are frequently
drawn from irrelevant, or, in some instances, even adverse
facts.
"An example of this is to be found in a review of Bischoff's
* Tyler Smith, Lectures on Obstetrics, third edition, p. 80.
† Recueil de Faits pour servir à l'Histoire des Ovaires. Angers, 1858.
Lond. Med. Gazette, 1849.
14
ON STERILITY.
work on Human Ovulation, in the American Journal of the
Medical Sciences, vol. 28, p. 137.
"These cases of Bischoff have always been regarded with
especial favor and as of great value by the advocates of the
ovular theory; and, as they are frequently alluded to, I feel
constrained to present a very brief synopsis of them.
"The observations* were thirteen in number. Of these,
the time of the menstrual period was known in only ten;
the remaining three have therefore no value so far as this
inquiry is concerned. Of the ten, three died during men-
struation, and in each of these there was found a ruptured
follicle. A fourth died two days after menstruation; the
right ovary contained a pretty large projecting follicle, which
was still closed. Both ovaries contained small corpora lutea.
In a fifth case, the menstrual period had just passed; the
left ovary contained a very distinct corpus luteum, and the
right ovary a ruptured Graafian vesicle filled with fresh
blood. Number six died seven days after menstruation; in
the right ovary was a recent corpus luteum. In the seventh,
death occurred ten days after menstruation; the right ovary
contained a very large Graafian follicle unopened. Number
eight died ten days after menstruation; the right ovary con-
tained a recently ruptured Graafian follicle and a fresh corpus
luteum. In number nine, menstruation had occurred eighteen
days before death; the right ovary contained a very large
corpus luteum. Lastly, number ten died four weeks after
menstruation; the right ovary contained a ruptured Graafian
follicle.
"After detailing these cases, the reviewer says: 'The re-
sults here obtained show that in the human female, at each
menstrual period, a Graafian follicle is ripened, swells, and
usually bursts, discharging an egg,† and forming a corpus
luteum.' Now, I submit to any candid inquirer that the
cases cited do not show these things. Indeed, so far as they
prove anything, it is that there is not even an approximate
correspondence between the rupture of the follicle and the
* Beiträge zur Lehre von der Menstruation und Befruchtung, 1853.
+ Notwithstanding the most diligent search, Bischoff was unable, in a sin-
gle instance, to discover the ovule.
INTRODUCTION.
15
menstrual period. In two of the cases menstruation had
occurred without any such rupture at all. In Cases 5 and 8
the ovaries are described as containing a fresh corpus luteum
and a recently ruptured follicle; yet, in the one case, men-
struation had 'just passed,' and in the other had ceased
ten days before death. Inasmuch as a corpus luteum is an
older formation than a recently ruptured follicle, we should
naturally refer the latter to the last menstrual period. But
to what period or periods do the fresh corpora lutea belong?
Dalton* says that the corpus luteum of menstruation 'reaches
its greatest development about three weeks after ovulation,
and from this time rapidly disappears, a small cicatrix only
remaining.' This being the case, can we refer these 'fresh'
corpora lutea to a menstrual period, in one case thirty, and
the other thirty-eight days past? If we can do so,—if a re-
cent corpus luteum signifies one which may be associated
with a menstruation which occurred four to six weeks before,
—then what shall we say of Case 6, where the presence of
such a one is connected with a period seven days past?
"Barnes, too, with a similar disregard of consistency,
after stating that the preparations of Coste, preserved in the
College of France, prove that the ripening of a Graafian fol-
licle always coincides with the turgescence of the genital
organs, and, according as the circumstances are more or less
favorable, bursts at the commencement, towards the end, or
at any time during the menstrual discharge-proceeds to
state what these preparations are in detail, thus: In a wo-
man who died on the first day of the appearance of the
meuses, the ovarian vesicle was manifestly ruptured. In
another, who died four or five days after the cessation of
the menses, the right ovary presented a vesicle still intact,
but so distended that the slightest pressure made it burst.
Lastly, in a young virgin, who died fifteen days after men-
struation, there was no recent trace of a yellow body, and it
could not be doubted that the Graafian vesicle had been
arrested in its development.' Surely, these cases, taken to-
gether, so far from proving that a Graafian follicle bursts at
* Prize Essay "On the Corpus Luteum of Menstruation and Pregnancy."
† Diseases of Women, p. 147.
16
ON STERILITY.
the menstrual period, show that menstruation occurs, in
two-thirds of the cases, without such rupture, and in one-
third without even a maturation of a follicle. For in one
only of the three was there actually found a ruptured follicle;
in one, menstruation had occurred and ceased several days
before without any rupture, the follicle being burst by ex-
ternal force post-mortem, and in the third there had not been
even the ripening of one!
"Such a course as is indicated in the foregoing instances.
is more reprehensible than reasoning without facts; it is
reasoning against them. Yet these are only samples of the
sort of argumentation which is frequently found in connec-
tion with this subject.
"(A.) MENSTRUATION MAY OCCUR WITHOUT ACCOMPANYING
OVULATION.
"At first glance it would seem that we ought to accept
the discovery of a rent follicle filled with blood, in persons
who have died during menstruation, as a proof that the flow
is, if not the result of, at least coincident with, ovulation.
But such evidence is not at all conclusive, and may be erro-
neous, for Ritchie* has 'repeatedly seen the opening of a
discharged vesicle to be still patent, and sometimes the
vesicle to be filled with a florid blood-clot in the third and
fourth month of pregnancy; and, in one case, he found the
corpus luteum of a woman in the ninth month to communi-
cate with the surface by a distinct foramen.'
"We must bear in mind, in the consideration of this sub-
ject, that Graafian vesicles are maturing and rupturing, and
corpora lutea are forming and disappearing continually;
hence it should be expected that, in a woman dying at almost
any time, some of these conditions would be found in the
ovary. And when we further consider that the menstrual
periods occupy from one-sixth to one-fourth of a woman's
lifetime for thirty years, we may equally expect to find such
ovarian changes at these periods also. So that it seems
strange, indeed, that persons who are satisfied of the correct-
* Tilt, Uterine and Ovarian Inflammation, p. 66.
INTRODUCTION.
17
ness of the ovular theory because occasionally a ruptured
follicle or a corpus luteum is found coincident with a men-
strual period, should ever have a lack of evidence. And yet
abundant as such evidence unquestionably is, it does some-
times fail; for menstruation frequently occurs without any
such contemporaneous change in the ovary. Many instances
of this character have been recorded, but it is only necessary
to call attention to a few of them.
"Dr. W. W. Gerhard* presented to the College of Physi-
cians of Philadelphia the uterus and appendages of a multi-
para, twenty-five years old, who died of apoplexy during a
menstrual period. At several points on the surface of the
ovary there were minute dotlike orifices, each one corre-
sponding to a Graafian follicle. Two of these being exam-
ined under the microscope, were found to present a few
granular nucleated cells floating in a homogeneous liquid.'
Although this woman had been the subject of menorrhagia,
the discharge latterly returning profusely every two weeks,
there was no evidence of any recent ripening or rupture of a
follicle. Again, Dr. Stedman† has reported the case of a mar-
ried woman, forty-five years of age, who died of some pulmo-
nary affection. Menstruation was regular nearly to the time
of her death, and yet on examination there was found no trace
of the left ovary, but in its place a thin and simple serous
cyst nearly two and a half inches in diameter; while on the
other side there was a collection of cysts, forming a mass
twice the size of an English walnut, upon the surface of
which were spread out the thin flattened atrophied remains
of the ovary.
66
Furthermore, it is the experience of ovariotomists, that
in many cases in which both ovaries have been removed,
these organs have been found so thoroughly diseased as to
preclude the idea that they could possibly have performed
their function of ovulation normally, if at all, and yet the
regularity of menstruation has suffered no interuption.
"Some of the reported cases of hernia of the ovaries throw
valuable light upon this question. For example, Dr. Oldham #
* Amer. Jour. Med. Science, vol. xxxvi, p. 410.
† Ib., vol. xxiv, p. 83.
Ib., vol. xxxv, p. 284.
18
ON STERILITY.
presented one to the Royal Society, the subject of which
was a tall, well-formed woman, nineteen years of age, in
whom both ovaries had descended through the inguinal canals,
and occupied positions in the upper part of the labia majora.
The mammæ and external genital organs were well developed,
but neither uterus nor vagina could be detected. The left
ovary was in a quiescent state, and had never been the seat
of pain or swelling. She was under Dr. Oldham's observa-
tion six years, during which time he had frequent opportu-
nities of seeing her. For the first three years the right ovary
was exclusively enlarged, the intervals varying from three
weeks to three months. For the last two years the left
ovary was most frequently affected, the right remaining
quiescent. Occasionally both were tumid, but one always
more so than the other. The swelling sometimes occurred
suddenly, although usually it was gradual, the volume of
the organ increasing slowly for four days, remaining sta-
tionary for three days, and then slowly declining, the whole
process lasting ten or twelve days. During this period the
organ was tender when pressed, but was otherwise not pain-
ful, and did not interrupt the patient's ordinary duties. There
were no manifest sympathies excited in the mammary glands
or other organs; and there was no vicarious flux, either of
blood or other secretion. The ovary alone seemed engaged
in the act. It was supposed, reasonably, that these periods
of enlargement were those of ovulation, and I beg to call
attention to the fact that they were quite irregular in their
occurrence, the intervals varying from three weeks to as
many months.
"Dr. Alfred Meadows,* also, mentions a case of similar
character. The patient was a single woman, twenty-three
years of age, who began to menstruate at fifteen, and con-
tinued doing so at regular intervals, with some pain, down
to the age of twenty, when, after stooping, a swelling sud-
denly appeared in the right inguinal region, caused, as was
subsequently learned, by the prolapsed ovary. At the men-
strual period following this she suffered violent pain of a
character different from any she had experienced before; it
* Amer. Jour. Obstetrics, etc., vol. vi, p. 231.
INTRODUCTION.
19
preceded the hemorrhage; at the same time the tumor was
much increased in size. From that time on she suffered in
a similar way, sometimes more acutely, so that at every
monthly period she was obliged to lie in bed for a week or
more. Sometimes the tumor would swell up to the size of
'two fists,' and be exquisitely tender to the touch. She had
no suffering during the intermenstrual periods. To what
does this history point? Are we not prepared to accept it
as an evidence of the truth of the ovular theory? Prior to
the occurrence of each monthly flow, for a period of three
years, the ovary enlarges, becomes the seat of pain, and the
swelling does not subside until after the cessation of the dis-
charge. What more ought we to require?
"Mark the sequel. At the suggestion of Dr. Meadows the
tumor was removed. It was not contained in any cyst or
sac, and was readily separated from its fatty and cellular
attachments. The upper portion or pedicle, which went
through the abdominal ring, was found distended with fluid.
This was punctured, and about an ounce of the contents let
out. The pedicle was then tied, and the tumor removed.
'The tumor, which measured about two inches in diameter,
proved, on section, to be the right ovary. It had, however,
undergone remarkable structural change. Instead of pre-
senting the usual dense compact appearance, it contained
throughout numerous irregularly shaped spaces varying in
size from a pin's head to a quarter or even half an inch, and
all were filled with the same kind of fluid as flowed from the
pedicle. These cells appeared to communicate with one an-
other, and the whole organ to be infiltrated, as it were, with
the fluid in question. There were no proper Graafian vesi-
cles to be seen.' No Graafian vesicles,—no ovules-no ovu-
lation, to account for the great increase in the size of the
ovary preceding and during the catamenial period. What
is the plain inference? Is it not that the swelling of the
ovary was caused by the pelvic congestion attendant upon
the menstrual period? And yet Dr. Meadows has intro-
duced the account of this case in an argument affirming,
among other things, the dominating influence of the ovaria,
and the fact of ovulation producing the menstrual flow.
"This last-mentioned case of ovarian hernia, as also one
20
ON STERILITY.
reported by Dr. McCluer,* and another which I am informedt
has been published by Dr. Joseph English, of Vienna, shows
that the cystic degeneration of the prolapsed ovary, even
when its essential vesicular structure is wholly destroyed,
does not prevent the organ from enlarging and becoming
painful during the menstrual epoch. In all of these cases
the ovary, which had swollen month after month at regular
periods corresponding with the menstrual flow, was found to
be so diseased as to leave no vestige of Graafian vesicles, thus
proving ovulation to be impossible.
"Dr. Tilt says: 'In three cases in which Dr. Ashwell had
opportunities of examining the ovaria of women who died.
during the flow of the catamenia, there were no signs of the
rupture of the Graafian vesicle and the escape of ovules. In
one of these cases the woman had menstruated regularly for
several years, and yet the ovaria were perfectly smooth; there
was neither rent nor cicatrix marking the site of either a
present or former maturation and escape of a Graafian vesicle.'
Ritchie also reports five examples of menstruation which
were not accompanied, and could not have been caused by
ovulation. In one of these the woman died ten days after
menstruation. The ovaries were filled with vesicles, but
neither of them presented either a puncture or cicatrix. In
another death occurred thirteen days after menstruation.
Here, too, the ovaries contained numerous vesicles, one as
large as a garden pea, but in neither of them was puncture
or cicatrix. In a third menstruation had occurred a week
before death, but there was neither scar nor opening on the
surface of either ovary. Again, in another case where death
occurred a fortnight after menstruation, neither ovary pre-
sented any sign of recent rupture.
"Dr. John Williams has published a series of cases bear-
ing upon the temporal relations of the discharge of ova with
the menstrual flow. He believes that the ova are discharged,
usually, before the appearance of the catamenial flux, and de-
tails observations made by him upon sixteen cases. In sev-
* Amer. Jour. Obs., vol. vi, p. 613.
+ Dr. Paul F. Mundé, private letter
+
Ovarian Phys. and Path., London, 1865.
¿ Obstet. Jour. Great Britain and Ireland, vol. iii, p 620.
INTRODUCTION.
21
eral of these, where death occurred during the intermenstrual
period, his conclusions are drawn from the condition of the
corpus luteum; but inasmuch as the changes in these bodies
do not always take place uniformly, and, as it is always diffi-
cult to determine the age of effused blood, the results found-
ed upon these cannot be accepted as certainly accurate. Pass-
ing by these, therefore, I wish to invite attention to those of
his cases in which death occurred during the menstrual
period.
“(1.) Was a young woman who died on the fifth day of the
flow. On the surface of the left ovary was a rough, brownish-
colored, star-like cicatrix. On section there was seen under
the cicatrix a corpus luteum dilated in the middle and narrow
at both ends, nearly three-quarters of an inch in length and
half an inch in width; its walls were in some parts of a
pinkish, and in others of a yellowish color. In the ceutre
was a partially decolorized clot.' (2.) Was a patient who
died on the ninth day of typhoid fever and the fourth day of
menstruation. One ovary contained a corpus luteum, simi-
lar to that in case No. 1. In both of these rupture of the
follicle had taken place evidently several days before. (3.)
Woman had undergone operation for fistula in ano, and died
five days after the appearance of menstruation; one ovary
contained a follicle five-eighths of an inch by one-third of an
inch, in which was found a bright-red, fresh, loose clot, and its
walls were thin and smooth. No rupture had taken place. (4)
Patient with fibroid tumor of the uterus; died on the third
or fourth day of menstruation. Left ovary contained a fol-
licle nearly an inch in length, in which was found a soft,
dark-colored clot, which appeared to be several days old; fol-
licle had not ruptured. (5.) Patient died when the menstrual
flow had almost ceased. There was no rupture in either ovary,
but the right ovary contained a Graafian follicle about the
size of a small pea. (6.) Young suicide; died three days
after cessation of the flow. There was no recent rupture in
either ovary; the left contained a follicle similar to the pre-
ceding.
"Of the foregoing six cases, in only two did a ruptured
Graafian vesicle even seem to correspond with a menstrual
period; and in two of the cases, the follicles most advanced
22
}
ON STERILITY.
were so immature that Dr. Williams expresses the opinion
that they would probably have ripened by the next return of
the flow.
"Mr. Paget* has reported a case of a woman who was exe-
cuted for some crime, and the post-mortem appearances tell
very forcibly against the ovular theory. The woman had
begun to menstruate twelve hours before her execution.
"The ovaries were of moderate size and presented numerous
marks of cicatrices upon their surfaces. In the right ovary,
three Graafian follicles projected slightly on the surface
and looked healthy, containing clear serous fluid.
A
fourth was of a very large size and prominent. In the left
ovary, one Graafian follicle was fully developed and promi-
nent. We looked for ova in the contents of all these, but in
vain. The surface of the ovaries was generally rather more
than usually vascular, but there was no peculiarly vascular
spot, nor any appearance of the recent rupture of a vesicle,
or the discharge of an ovum. In the right ovary, near the
surface, was a small cyst or cavity, containing what looked
like a decolorized clot, and bounded by a thin layer of a
bright yellow-ochre substance, an excellent example of a
fibro-corpus luteum, of one or more months' date, certainly
not more recent.'
"Dalton, in the essay on the Corpus Luteum already re-
ferred to, reports two cases, in one of which death occurred
during the menstrual period and in the other at its termina-
tion. In neither of them had a follicle recently ruptured,
although in the second there was one on the point of doing
So.
"I have had two opportunities of examining the ovaries of
women who died at or near the menstrual period. One was
the case of a healthy unmarried woman, twenty-eight years
of age, who died from an overdose of morphia, taken accident-
ally. She had menstruated regularly, and a period had ceased
four days before death. Both ovaries were normal in struc-
ture and size, the right being somewhat larger than the left.
It contained several Graafian vesicles scattered throughout
the stroma. Two of these were larger than the rest, one be-
Tilt's Uterine and Ovarian Inflammation, p. 64.
INTRODUCTION.
23
ing about an eighth of an inch in diameter, and the other as
large as a small currant. This latter was near the surface
and caused a slight projection. It contained a clear serous
fluid. The left ovary contained fewer vesicles, but had the
indistinct remains of a corpus luteum not less, certainly.
than four or five weeks old. The mucous membrane of the
uterine body was pale and covered with a grayish-pink mu-
cus. The other case was that of a young girl, fifteen years.
old, who died from the effects of a burn. She had com-
menced menstruating eighteen months before, but the func-
tion had been regularly performed only for about ten months.
A period had ceased twelve days prior to death. Neither
ovary contained corpora lutea, nor bore the marks of recent
rupture. The largest vesicle, which was about a quarter of
an inch in diameter, was found in the left ovary about a six-
teenth of an inch from the surface.
(6
(B.) OVULATION MAY OCCUR WITHOUT ACCOMPANYING
MENSTRUATION.
"I will next proceed to adduce evidence to show that ovu-
lation certainly and frequently takes place without men-
struation.
66
☀
Malpighi and Vallisneri long ago observed that fully de-
veloped Graafian vesicles are occasionally found in the fully
grown fœtus. Ritchie, also, has demonstrated by at least
ten dissections that in the ovaries of newborn infants, and
children as early as the sixth year, may be found highly
vascular Graafian vesicles; and that at the age of fourteen,
and prior to menstruation, they are found as large as small
raisins, filled with their usual transparent granular fluid;
that menstruation is not essential, either as cause or effect
of these conditions; that prior to menstruation, the vesicles
are found at every other period of life, in continual progres-
sion towards the circumference of the ovaries, which they
penetrate, discharging themselves through the peritoneal
coat, thus proving that the catamenial flow is not an indis-
pensable prerequisite to their rupture.
*Loc. cit., p. 62.
24
ON STERILITY.
"So, likewise, the more recent researches of Grohe, Slav-
jansky, and Haussmann have shown that the growth of the
Graafian vesicle is quite independent of the menstrual period ;
and the last-named authority,* whose observations were made
upon eighty-four subjects, asserts that such early develop-
ment of the follicles as was noticed by Ritchie takes place in
about ten per cent. of all cases. Dr. Sinetyt confirms these
observations, and maintains that 'in the ovaries of the newly
born, Graafian follicles are almost always visible to the naked
eye; and they may at this time often be discovered as well
developed as in the adult female, and constituting true cystic
ovaries, in which are to be seen ovules whose origin is indu-
bitable. In the ovaries of infants, there are often cicatrices
and follicles in different stages of atrophy.' What, I would
ask, canses the cicatrices? Is it aught but the rupture of
the Graafian follicles which, as would seem from the forego-
ing, may take place at any period of infantile and adult life?
Slavjansky, who has devoted a great deal of time to re-
searches on the physiology and pathology of the ovaries,
thus summarizes the results obtained by him:
66
"1. The Graafian follicles develop themselves from the
primordial follicles, and are growing towards maturity from
the first month of birth to the fortieth year. 2. The larger
number of follicles do not mature, do not rupture, do not
discharge their contents, but pass over into a condition of
atrophy which is analogous to the formation of the corpora
lutea. 3. The development and ripening of the Graafian
follicles do not take place periodically in a regular manner,
and there is no connection between ovulation and menstrua-
tion. 4. Menstruation is a physiological phenomenon un-
connected with the development and ripening of the Graaf-
ian follicle. 5. The rupture of the more or less ripe follicle
is associated with congestion of the genital organs, and is, as
yet, an unexplained matter.
"On the other hand, ovulation may continue after the
menopause. Lawson Taits says: The cessation of the
menses at the climacteric, though it diminishes the activity
† Le Progrès Mélical,
* Centralblatt, No. 2.
Allg. Med. Centr. Z., 54, 1874.
Hastings, Prize Essay of 1873, London, p. 4.
INTRODUCTION.
25
of the cell-growth at once to a marked extent, never extin-
guishes it; for the development and extrusion of immature
Graafian follicles ceases only with life itself. They are to be
found of some size even fifteen or twenty years after the ces-
sation of menstruation.'
“Of course, ovulation is the necessary condition of im-
pregnation, and it is admitted by all writers that conception
may occur in the absence of menstruation. Our literature
contains many instances of girls who have conceived prior
to the first appearance of the flow; of women who have be-
come pregnant subsequent to the menopause, and during
lactation before menstruation has reappeared. Dr. James
Young, Tanner,† Dubois,‡ Tilt, § and, indeed, almost every
obstetric author, mention cases of this character. Leishman
speaks of a woman who married at twenty-seven, and who
menstruated the first time two months after her eighth labor.
Raciborski states that he has seen on the ovaries one or two
cicatrices, although the subjects had never menstruated.
"An argument which has been frequently urged in support.
of the ovular theory, is the fact that conception is more likely
to take place shortly after a menstrual period than at any
other time.
"Dr. W. H. Studley, alluding to this, considers it as
admitting of a very different explanation, and not at all as
proving the coincidence of ovulation and the menstrual flow.
He says: 'My opinion in regard to the rationale of the fact
is this: impregnation is more likely to be secured at this
time because of the recent deluging with menstrual blood,
by which the secretions, especially of the cervical canal,
have been washed away, which secretions often prevent im-
pregnation either by their chemical incompatibility with the
vitalizing fluid, or by the mechanical obstruction in the form
of the firm mucous plug so often found in the canal.'
"If the ovular theory were true, conception could take
place only at or near a menstrual period; but there is abun-
* Am. Jour. Med. Science, vol. 1x, p. 568.
+ Handbook of Pract. Obstetrics, p. 24.
Journal de Méd., 1850.
Uterine and Ovarian Inflammation, p. 49.
Amer. Jour. Obstetrics, 1875, p. 487.
3
23
ON STERILITY.
}
dant evidence to show that it may and does frequently occur
at times quite remote from it. My own experience has fur-
nished me with a number of instances where married women,
anxious to prevent an increase of family, have observed the
'physiological rule' of abstinence for a fortnight after a
period, and who have found, to their chagrin, after a time,
that their precaution had been unsuccessful.
Dr. Oldham observes: 'I know of cases which I have
carefully inquired into, where impregnation occurred at the
respective times of ten, twelve, and twenty-one days after
the menstrual period; and while, on one hand, I am quite
ready to admit a greater disposition to impregnation shortly
after a menstrual period, yet I know of no facts to disprove
the opinion that the human female is susceptible of impreg-
nation at any time between her monthly periods.' Hirsch,*
likewise, has seen a case where impregnation took place
twenty-two days after a normal menstrual period; and he
observes that, as the Jewish women are obliged to abstain
from intercourse five days before and seven days after men-
struating, that race could not be so prolific as it is known to
be if the ovular theory of menstruation is true.' Tilt,† also,
mentions the case of a lady, aged forty-seven years, in whom
menstruation had been irregular for two years, and who after
a single coitus, seventeen days subsequent to a period, became
pregnant.
"An attempt has been made to explain these and similar
cases, by supposing that the spermatozoa, on the one hand,
and the ovule, on the other, may retain their vitality in the
generative passages for a sufficiently long time to permit the
occurrence of impregnation under the circumstances named.
But the facts bearing upon the subject, so far as known, do
not justify such an explanation. The ovule occupies from
eight to ten days in its passage from the ovary to the uterus,
and it may be impregnated at any time within that period,
provided it meet with fertilizing material If, as maintained
by Williams and others, the ovule is discharged at the com-
mencement of a menstrual period, rather than at or near its
termination, we can still understand how a coitus taking
* Schmidt's Jahrbuch, 1853, No. 2.
+ Change of Life, p. 69.
INTRODUCTION.
27
place within a few days prior to the flow might be fruitful
as well as one had within eight or ten days subsequent to a
period. But when a single intercourse takes place from
twelve to twenty-two days after a menstrual period, or ten
days before the next, and becomes fruitful, we cannot accept
the explanation given by the ovulationists without addi-
tional and different facts.
"To meet the obvious difficulty here presented, it is urged
that the spermatozoa may live a long time-indefinitely, in-
deed-in the generative passages of the woman.
While we
are not able to say positively that such is not the truth, we
do say, that so far as we have actual knowledge on the sub-
ject, the tenor of life in the spermatozoa is quite limited.
Dr. Sims,* who made many examinations of the semen in
order to determine how long the spermatozoa may retain
their vitality in the matrix, found none alive at a longer pe-
riod than forty hours, although he admits that they may
live longer under favorable circumstances. And he quotes
Dr. S. G. l'ercy as reporting a case in which he found living
spermatozoa, and many dead ones' issuing from the os uteri
eight and a half days after the last sexual connection. If
we admit the correctness of all these statements we have no
right to assume the persistence of vitality in the human sper-
matozoon for a longer period than that given. Granting this
term of vitality,—which I feel assured must be quite excep-
tional,―let us see whether it is sufficient to meet the require-
ments of some of these cases of impregnation following a
single coitus. For example, Moutgomery† reports a case in
which the last menstruation occurred on the eth of October.
Insemination took place on the 10th of November; preg-
nancy resulted. Now, if the ovule impregnated were shed
at the last menstrual period, twenty-three days must have
elapsed between that time and insemination. We cannot
suppose the ovule to have retained its vitality and capability
of impregnation during this long period, for such a supposi-
tion is quite at variance with all observed facts both as re-
*Uterine Surgery, p. 374.
† Signs, etc., of Pregnancy, p. 258.
28
ON STERILITY.
gards it* and the history of the decidua (Aveling, Williams,
Engelmann). On the other hand, if we suppose that the se-
men remained in the generative tract until an ovule belonging
to the next period was extruded, we must suppose the sper-
matozoa to resist the mechanical washing away by means of
the menstrual flow-a highly improbable notion, and one not
made more reasonable by the fanciful idea that the uterus,
by a sort of instinct, anticipates what is going to take place
and governs itself accordingly.† Likewise, it implies the
vitality of the spermatozoa for a period of eight days, plus
the time necessary to meet the descending ovule—probably
four or five days more.
"It is well known that many women continue to menstru-
ate, with entire regularity, for a considerable time prior to
the final cessation without conceiving; and I believe that
this fact is explainable by the gradual failure of the ovaries
to furnish perfectly developed ovules. Indeed, it is quite
probable that all ova which are thrown off are not capable
of impregnation at any period of life; for, where other con-
ditions are apparently equal, some females are impregnated
every twelve or thirteen months, others every eighteen
months or two years, while others have still longer intervals
of rest. Dewees mentions an instance of a lady who con-
ceived every seven years, and who bore four children at that
interval; and I knew one who had a lapse of three years
between each of six successive pregnancies. It would seem,
therefore, that it requires a certain period to perfect an
ovule, and that the time required is much greater in some
instances than in others. And if menstruation is produced
by ovulation, it appears scarcely probable that a succession of
imperfectly developed ovules-so imperfect, indeed, as not
to be susceptible of impregnation, or even of extrusion, as we
have seen is frequently the fact-should yet be sufficient to
maintain a completely normal monthly flow.
* "How long after its maturation the ovum can retain its vitality and
susceptibility to the seminal influence is not known, but probably the time
is short."-DUNCAN, Fecundity, Fertility, and Sterility, p. 428.
t "Under such circumstances menstruation often does not take place at
all, or only very scantily; the uterine system, as it were, anticipating the
conception and preventing the failure which might result from a free dis-
charge of blood."-DUNCAN, Fecundity, Fertility, and Sterility, p. 431.
INTRODUCTION.
29
66
Finally, it is not at all uncommon to find the menses sup-
pressed for some months immediately after marriage, with-
out the occurrence of pregnancy. Are these cases to be
explained by supposing that marriage suppresses or retards
the development of Graafian follicles?
"From all the foregoing considerations, it seems to me
conclusive that ovulation and menstruation may, and fre-
quently do, occur independently of each other; that while
they may be coincident, there certainly is no such constant
connection between the two as to warrant the assertion that
'at every menstrual period a matured ovule escapes from the
Ovary-an assertion which embodies the very essence of
the ovular theory.
66
2. PHYSIOLOGICALLY, THE PERIOD OF THE MENSTRUATION IN
WOMAN CORRESPONDS WITH THE ESTRUS OR RUT OF OTHER
MAMMALIA.
"It is well known that during certain periods, the inter-
vals between which vary in different species of mammalia
below man, ova are matured and extruded from the ovary,
and that this process is attended by great excitement of the
entire generative apparatus. Upon the supposed similarity
of this function-termed rut, estrus, or œstruation-to men-
struation in the human female is based one of the strongest
arguments in favor of the ovular theory. Indeed, Cazeaux*
and Pouchett lay especial stress upon it.
"Down to the time of Martin Barry it was believed that
sexual congress was the essential determining cause of the
rupture of the Graafian follicle, but the experiments of Bis-
choff, Coste, Pouchet, and others, proved that such rupture
was spontaneous and entirely independent of male influence
of any kind, both in man and the lower animals, although
it was hastened in some instances by coitus. Reasoning,
then, from the known analogy existing between this and
many other of the vital processes in the lower mammalia
and the corresponding ones in man, it was assumed that
the conditions of rut and menstruation were analogous, and
had the same significance.
* Second Amer. ed., p. 9.
† Théorie Positive de l'Ovulation Spontanée, p 227.
30
ON STERILITY.
"While it is true that many physiological conditions in man
and the other animals of the order to which he belongs are
subject to the same general laws, these conditions differ in
specific points just as much as do the different genera and
species of that order in their anatomical features.
"It may be well in this connection, and before enumerating
the important points in which estruation and menstruation
differ, to call attention to the fact, that even in those cases
in which the oestrus and ovulation are synchronous, it has
never been proven that the former is caused by the latter.
Indeed, it is far more probable that they are both the result
of a common cause-some erethism of the system resulting
in congestion and excitement of the entire sexual apparatus.
"The appeal to comparative physiology by the ovulation-
iss has always seemed to me an unfortunate one, for the
noteworthy differences between oestruation and menstrua-
tion are quite sufficient, I think, to stamp the two processes
as wholly dissimilar. These points of difference are as fol-
lows:
1. When, during the astrus, there is a discharge from the
genitals (which is not always the case), it is mucous in char-
acter, and its source is chiefly the glands of the external
organs; its object is to lubricate the parts, and, in some in-
stances, by its odor to attract the male. In woman the dis-
charge is blood, from vascular rupture; its seat, the mucous
lining of the body of the uterus, and its presence an indica-
tion of the disintegration of that structure.
"2. The excitement characterizing the ostrus is the only
period during which the male is received, and the only time
when impregnation is possible. In woman, while pregnancy
is posible at any time, it usually occurs during the period
of rest, that is, in the intermenstrual period.
"3. On the subsidence of the ostrus, there is a period of
inappetence, during which the female not only no longer in-
vites, but successfully resists the male approach. At the
corresponding time in women, sexual desire is commonly in-
creased, and in some, present at no other time.
4. The oestrus, or period of sexual desire, is necessary in
the lower mammalia, for the reproduction of the species. In
women, desire is not essential either for intercourse or impreg-
nation.
INTRODUCTION.
31
$
"5. Estruation and ovulation in many animals are deter-
mined by changes in the seasons and other surrounding cir-
cumstances,* and in some animals (deer) the semen is only
elaborated at such times. In man, changes of season, etc.,
produce no such effect, and semen is secreted constantly.
"6. The œstrus may be excited in some animals (the mare)
by the importunities or teasing of the male. Menstruation
is neither excited nor hastened by the presence of the male;
on the contrary, undue excitement of the generative organs,
or of the sexual passion, seems frequently to have a tendency
to arrest it, as witnessed in newly married women.
"7. During the estrus, both the male and female evince a
desire for copulation. During menstruation, the female has
a delicate shrinking from the act, and the male likewise feels
more indifference than at any other time, amounting in many
cases to positive repugnance.
"8. The ovaries in the lower animals contain ripe ova only
at the period of heat (Bischoff). In the human female, ripe
ova are found at all times without reference to the period of
menstruation.
"The foregoing points of dissimilarity are so distinctive,
aud refer to such important features, that I feel warranted
in denying that oestruation and menstruation are correspond-
ing processes.
3. THE REMOVAL OF THE OVARIES IS AT ONCE FOLLOWED BY
CESSATION OF MENSTRUATION.
"Percival Pott, Cazeaux, Wells, Battey, and others, have
reported cases in which the artificial removal of the ovaries
was followed by the immediate and permanent cessation of
the menstrual function; and these facts have been cited to
prove the necessity of these organs for the maintenance of
the periodical flow.
"It must be admitted that, if such an effect were the
constant and certain result of double ovariotomy, it would
* Barnes, Diseases of Women, p. 148, states that in the wild state the
rabbit has only one or two litters a year, but when its young are taken away
at a suitable time, it has perhaps seven. So likewise the period of ovular
maturation is changed in the case of the pigeon, domestic hen, etc.
32
ON STERILITY.
go far towards showing the necessity for ovarian influence.
But such result is not constant; indeed, the instances in
which both ovaries have been removed without interruption
or discontinuance of the menstrual flow are so numerous
and authentic, that recent writers, who, like Leishman, affirm
as an admitted fact the invariable aud immediate cessation
of menstruation when the ovaries have been removed,' sub-
ject themselves fairly to charges either of ignorance or want
of candor.
“Dr. John Goodman* has compiled the following table
showing the effect of double ovariotomy upon the menstrual
function in all the cases of which he could obtain informa-
tion down to the year 1872:
"Table of Cases in which both Ovaries have been successfully
removed from Women under Forty-five years of Age.
No.
123
456
Operator.
Pott,
J. L. Atlee,
Bird,
•
Peaslee,.
Burnham,
W. L. Atlee,
Quoted from.
Date. Age
178-
23
·
•
A. J. Med. Sci., 1844,
Lancet, 1848, .
1843 29
1817 32
*** **S
Menstruation uninterrunted;
tendency to menorrhagia.
Lyman's Table,
Lyman's Table,
Atlee on Ov. Tumors, 1854
1850
24
•
1853
42
35
7
W. L. Atlee,
·
Atlee on Ov. Tumors,
1855 19
8
W. L. Atlee,
Atlee on Ov. Tumors,
1861 40
Menstruation regular. Ceased
in 1864. forty-fifth year.
Regular molimen, with white
discharge.
Menstruation regular to 1833,
when last reported.
9
Peaslee,.
10
Peaslee,.
11 W. L. Atlee,
A. J. Med. Sci., 1863, .
A. J. Med. Sci., 1864, .
Atlee on Ov. Tumors,
1862
35
1863
39
1864
34
•
Last report 1870. Menstruation
regular to that time.
12
13
23
Beattey,
Storer,.
•
1865 37
1866
•
14 Storer,
Wells, Dis. of Ovaries,
A. J. Med. Sci., 1868,
Peaslee on Ov. Tumors, 1867 43
Menstruating regularly a year
alter operation.
15
Wells,
16 Wells,
Wells, Dis, of Óvaries,
1868 39
•
Wells, Dis. of Ovaries,
1869 22
17
Hicks,
Wells, Dis. of Ovaries,
1869 39
18
Monro,
*
•
•
19
Mayer,
·
Wells, Dis. of Ovaries,
Wells, Dis. of Ovaries,
1870
1871
34
29
20 Meadows,
Lancet, 1872,
1871
►
21
Priestly,
Wells, Dis. of Ovaries,
1872
22
26
27
2** **7
22
23
A. R. Jackson,
Le Fort,
Peaslee, Ov. Tumors, . 1865
44
Peaslee, Ov. Tumors,
24
Baker Brown,
Peaslee, Ov. Tumors,
Last report one year after opera-
tion. Menstruation regular.
Last report 6 m'ths after opera-
tion. Menstruation regular.
Continued to menstruate to the
forty-seventh year of her age.
Menstruation regular.
Menstruation, but not regularly
from
Menstruates regularly
•
25
Baker Brown,
Koeberle,
Battey,
Peaslee, Ov. Tumors,
Peaslee, Ov. Tumo's,
Personal information,
•
•
cicatrix and vagina.†
Menstruation regular.
Menstruation regular.
1872
23
Irregular sanguineous
dis-
charges; sometimes profuse.
Clay, of Manchester, had four cases in which there was subsequent sanguineous dis-
charge.-(Peaslec.)
* Richmond and Louisville Med. Jour., Dec. 1875.
†The whole uterus, except cervix, removed with ovaries.
INTRODUCTION.
33
"Dr. Goodman says: In order to determine as accurately
as possible the effects of the removal of both ovaries upon
the menstrual function, I have carefully examined and ar-
ranged all the cases of which I could obtain reports;
irregular sanguineous discharges, I have, of course, not
counted as menstrual.
"Of the twenty-seven cases here recorded, it will be ob-
served that in nearly one-half menstruation was not affected
by the removal of the ovaries; in one the hæmorrhagic dis-
charge was increased; in one it was diminished; and in
several sanguineous flows occurred at irregular intervals.'
"Dr. Ely McClelland, of Louisville, Ky., in a private letter,
dated March 18th, 1876, gives the following facts bearing upon
this point, and kindly places them at my disposal. The cases
referred to were operated upon for pernicious ovulation, by
'Battey's operation,' or that known as normal ovariotomy.'
“CASE I.—But one ovary was removed.
"CASE II. Both ovaries were removed, one in May, 1875,
and the other in September, 1875. This lady has regularly
and persistently menstruated since the operation.
"CASE III. Both ovaries removed in August, 1875. This
case had menstruated vicariously prior to the operation, and
is still the subject of such disorder.
"CASE IV. The ovaries of this lady were removed in
September, 1875. She menstruates regularly.
"So far as these Louisville cases go, the removal of both
ovaries, after the menstrual function has been established,
produces no influence upon the regularity of its occurrence.
What may result after the lapse of a few more months, it is
of course impossible to determine.'
"Indeed, it is so well known that the removal of the ovaries
does not necessarily induce the menopause, that many of
those who formerly denied the fact now admit it; but they
endeavor to explain the circumstance consistently with the
ovular theory. Some of these allege that the ovaries are
not the only source of Graafian vesicles. Spencer Wells, for
example, states that occasionally the essential elements of
the ovaries are sometimes scattered between the layers of the
peritoneum, as in the lower animals; and that in some cases
* Diseases of the Ovaries, p. 11.
34
ON STERILITY.
'Graafian follicles have been seen developing in some of the
mammalia at a distance from the entire ovary, and that such
vesicles have developed into unilocular tumors.' Sappey*
likewise states that it is not rare to find a score or more
cystic ovules, some of them the size of a pea, on the alar
mesentery, in the neighborhood of the ovary, and he accounts
for their presence in this unnatural situation by supposing
that they failed to reach their destination owing to some
abnormal relations on the part of the Fallopian tube.'
6
"Now, while it would be presumptuous to deny that such
a condition of things as that mentioned by the last-named
author is possible, surely it must be exceedingly rare; and,
so far as I am aware, there is no instance in which such an
anomaly has been found in the human female. I apprehend,
therefore, that not the most ardent advocate of the ovular
theory would be willing to advance such a hypothetical cir-
cumstance to account for the appearance of a periodic monthly
hæmorrhage in thirteen of twenty-seven cases of removal of
the ovaries. For such an argument would involve the absurd
assumption that an ovum which had failed to reach the
uterus after maturation and extrusion, could return to the
immature condition and ripen over again, and that, too,
without its enveloping fluid and capsule!
'
"The condition mentioned by Mr Wells must be equally
rare, and seems equally weak as a foundation for an argu-
ment. In regard to both of these conditions, Dr. Goodman,
in the paper already referred to, says: I think it a very fair
conclusion that if such vesicles really existed, they were
totally extirpated in some, if not the greater part, of the
thirteen cases in which menstruation continued after the re-
moval of both ovaries. Even if some of them remained, it
is clearly impossible that they could have been sufficiently
numerous to have afforded a ripened vesicle every month for
ten or more years. Their only effect would have been to
stimulate the nervous system, and maintain in a more perfect
degree the ovarian development.'
"Others again have explained the persistence of menstrua-
tion after extirpation of the ovaries by force of habit.
* Quoted by Savage, on the "Female Pelvic Organs."
INTRODUCTION.
35
(
Schroeder* expresses the argument thus: We prefer in such
exceptional cases, instead of drawing the conclusion which
is directly opposed to all our views, viz., that menstruation
has absolutely nothing to do with the presence of ovaries, to
assume that in these women, too, menstruation was caused
by the growth of Graafian follicles in their ovaries, but that
the organism had, in the course of years, become so accus-
tomed to the regular discharge of blood that this still con-
tinued, although the ovaries were removed.'
"But, surely, this is no explanation; it is nothing more
than a reiteration of the fact in other terms. The 'habits
of our bodies are not causeless; they are all explainable on
a rational basis. No act is performed in the animal economy
without some antecedent cause, and the same may be said of
every recurrence of such act. In the case of the menstrual
flow, if its periodicity were maintained in the past by the
successive evolution of ovules, such ovular action would be
necessary still; and if the cause ceased at any time to act,
so likewise would the effect cease. But even this alleged force
of habit fails to meet the facts in a case reported by the writer
in the Chicago Medical Journal, for October, 1870, and which
appears in Dr. Goodman's table as No. 22. In this case, the
patient, forty-four years of age, had both ovaries, together
with a portion of the Fallopian tubes, removed. A men-
strual period had ceased on the 30th August, 1865; the
operation was performed the following day. On October 1st,
thirty-one days afterwards, a sanguineous discharge appeared
and lasted four days, attended by the usual symptoms of
menstruation-lassitude, nervousness, backache, etc. There
now occurred an interval of eighty-three days, the discharge
reappearing December 22d. Its next appearance was on
January 20th, 1866,--four weeks after, and from this last
date it continued to return with entire regularity every twenty-
eight or twenty-nine days, attended by all the ordinary
menstrual accompaniments, and lasting each time from three
to five days, down to October, 1867-a period of twenty-
two months. It then ceased until February, 1867, when it
appeared for the last time, the lady being then forty-seven
years of age.
* Discases of the Female Sexual Organs, p. 318.
36
ON STERILITY.
"In this instance, the interval of nearly three months,
during which the discharge was absent, was certainly suffi-
ciently long to break up any mere habit, and shows that we
must look to some other impelling force in order to account for
the subsequent return to regularity. Here were no ovaries,
no monthly developing ovules, an interruption for nearly
three periods of the menstrual habit,' and yet menstrua-
tion returned and continued regularly to reappear down to
the normal time of final cessation.
"The facts of periodicity in the human body are more
numerous than generally supposed, and most interesting in
their character. Without any intention of amplifying upon
the subject, I will merely remark that it is now universally
admitted that all forms of periodicity, whether of a physio-
logical or pathological character, depend upon the nervous
system; and there are numerous facts which warrant us in
narrowing this dependence still further, and limiting it to a
particular division of the nervous system-the sympathetic.
It is well known that a frog's heart will continue its regular
systole and diastole a considerable time after its removal
from the thorax. The only motive agency left to it then, so
far as we know, is that furnished by the sympathetic ganglia
which are imbedded in its substance. The influence of these
centres of nervous action is neither continuous nor occasional,
but rhythmical-that is, periodic. The uterus resembles the
heart in also possessing numerous sympathetic ganglia im-
bedded in its walls, and in being wholly independent of the
cerebro-spinal system in its movements. Furthermore, the
recent researches of Goltz and Freusberg* seem to show that
there exists in the lumbar portion of the spine a nervous
centre for the sexual functions. These facts and investiga-
tions may afford a clue to the explanation of the persistence
of sexual appetite and functional activity of the generative
organs after the destruction by disease, or removal of the
ovaries—although in these organs undoubtedly originates
the primary impelling force which sets this complex sexual
machinery in motion. But whatever may be the nature or
exact seat of this force, I believe that its action must be
* See Dr. Duncan's Address, Obstet. Journ., Great Britain and Ireland,
1875, p. 361.
INTRODUCTION.
37
persistent and, in a sense, continuous, although some of its
results be ryhthmical. A pendulum may be set in motion
by a single forcible impulse, and for a time it will continue
to swing; but unless the application of the force be con-
tinuous or repeated, the arc described by the moving body
will become shorter and shorter, until finally the motion will
cease wholly.
"According to the light thrown upon the subject of men-
struation by the latest researches, we are perhaps justified in
propounding the following as embodying the main facts:
"The reproductive organs of the female, including the
ovaries, Fallopian tubes, uterus, and vagina, receive their
vascular and nervous supplies from the same sources. Prior
to the age of puberty, all these organs are in a state of com-
parative quiescence, and the uterus of a girl of eleven or
twelve years is scarcely larger than the organ in infancy.
Notwithstanding the fact that ova undergo some degree of
development and are discharged from the ovaries from early
childhood onward, their growth proceeds slowly, and, so to
speak, unperceived by the nervous system. At or about the
fifteenth year, the uterine mucous membrane attains a high
degree of development, and, at the same time, the erectile
tissues of the other genital organs, external and internal,
arrive at their structural completion. Like a wound-up
clock, with its needed touch to the pendulum, these organs
now only wait for some sufficient impulse to arouse them to
functional activity. This is afforded by the next recurring
period of ovulation. By the advancing growth of one or
more vesicles, an irritation of the ovarian nerves is produced;
the effect of this upon the sympathetic, and, by reflex action,
upon the vaso-motor nerves, is an increased hyperæmia in
the uterus and other genital organs. The uterine congestion
thus produced especially affects the lining membrane of the
organ, for the reason that, structurally, it is more liable to
vascular turgescence than the parenchyma. This vascular
activity is followed by a corresponding increase of nutrition
and hypergrowth-this latter consisting both in multiplica-
tion of the cellular elements of the parts and development of
those already existing. The superficial vessels of the mem-
brane are greatly enlarged around the glandular orifices, as
38
ON STERILITY.
are also the glands themselves. The entire membrane is so
thickened and convoluted that the uterine cavity seems
scarcely large enough to contain it. This process-called
'nidation' by Aveling-takes place in order to supply the
possible needs of an impregnated ovum, and should such a
one reach the uterine cavity, the developed membrane be-
comes its future nidus. But if not, a retrograde metamor-
phosis now takes place. The supergrown parts of the
uterus, consisting, as already stated, chiefly of the mucous
membrane, lose their excess of blood-supply and die of starva-
tion. The first elements which suffer death are the epithe-
lial cells which line the mucous membrane; next, the new
cells of the connective-tissue stratum below; and, finally, the
vessels which are developing or may have developed from
this surface. All these parts become infiltrated with fat, the
new formations are carried off, the vessels open, and there
results the active hæmorrhage which constitutes the men-
strual flow. This process is repeated at regular intervals
corresponding to the periodic life of the individual, and
varying somewhat in different cases.
"In the sense and to the extent just indicated, I regard
ovulation as necessary to menstruation; it furnishes to the
structurally completed uterus, through the medium of the
ganglionic nervous system, a needed hyperæmia to originate
the menstrual discharge. In order to do this, it is not neces-
sary that a follicle should burst (Ritchie), although it may
do so. Indeed, I have no doubt that a follicle may pass
through several periods without discharging its contained
ovule. Doubtless, the pelvic congestion of the menstrual
period greatly stimulates the maturation of the follicle, just
as does the excitement of sexual intercourse, and to a much
greater extent, probably, because of its longer continuance;
and a follicle which has been subject to these successive
periods of excitement eventually matures and bursts, with,
perhaps, an occasional exception. The increase in its fluid
contents, the thinning of its walls, and its near approach to
the surface of the ovary, all conduce to its easy rupture;
and such rupture may occur at any time, although it is
clearly more likely to do so during the menstrual conges-
tion, the excitement of intercourse, or, when on the point of
INTRODUCTION.
39
bursting, from a blow on the abdomen (Schroeder). Such is
probably the usual course, although, as already intimated,
not an invariable one; for all authorities admit that some
follicles never attain full devolopment, but after arriving at
a certain stage of growth, cease to enlarge and finally shrink
and disappear.
"Menstruation, with its phenomena of regularly recurring
development and disintegration of the uterine mucous mem-
brane, once established, proceeds side by side with the pro-
cess of ovulation. The two, while accompanying and aiding
each the other, are yet mutually independent; and menstru-
ation, instead of being an effect of ovular maturation and
dehiscence, is rather, in a certain sense, their cause. In men-
struation, the organ chiefly, and the only one essentially em-
ployed, is the mucous membrane of the body of the uterus;
the other pelvic organs, that is to say, the uterus proper, the
ovaries, Fallopian tubes and vagina, have no part in the pro-
cess beyond their share in the attendant general pelvic con-
gestion (Beigel).
"There are many facts connected with menstruation which
are not satisfactorily accounted for by the ovular theory, and
I desire, in conclusion, to call attention briefly to a few of
them.
"(a) The first is that variety of the function known as
remittent, where the habitual type is changed to another in
which the flow occurs usually at shorter intervals—every
fortnight, for example. These cases are strongly antagonistic
to the received theory. Tilt* considers them as dependent
upon some perversion of the nervous force presiding over
the generative function, because those in whom the anomaly
is observed are generally of a delicate and nervous tempera-
ment,' and also because he has always succeeded in restoring
menstruation to the monthly type by the exhibition of qui-
nine, a remedy whose efficacy in controlling nervous derange-
ment of a periodical character is well known. Negrier,t
quoted by Tilt, after observing that several patients did not
* Uterine and Ovarian Inflammation, third Lond. ed., p. 203.
†This author believed that the ovaries alternated their action, one furnish-
ing an ovule one month, and the other the next. This is likewise the opinion
of Girdwood.
40
ON STERILITY.
suffer from fortnightly menstruation, says: 'I do not believe
that the ripening of the ovarian vesicles can take place in
less than a month; so, in these cases, I think it more natural
to suppose that the two ovaries might so progress monthly
that, for instance, the right would contain a ripe vesicle on
the first of the month, while in the left ovary a vesicle would
ripen on the fifteenth.' Does any one regard ovulation as a
process whose type of periodicity would be changed by the
administration of quinine?
"(b) Again, the ovular theory does not account for the
regular recurrence of menstruation after the removal of one
ovary. Ovariotomists are unanimous in the statement that
in cases where a single ovary is removed, a healthy one being
left, menstruation is not interrupted, or, at least, the func-
tion is no more deranged than it would be by any other
equally severe surgical operation.
'It is not known how the work of maturing ovules is
divided between the two ovaries. Mr. Girdwood, from
observations made in several cases, states that the number
of cicatrices found in the ovaries corresponded with the
known number of menstrual periods, and that they were
equally distributed between the two organs. Others think
that for many months in succession one ovary may furnish
all the ovules, and then remaining quiescent, that the other
assumes the work for an equal, or possibly an unequal length
of time. But it is plain that if either of these hypotheses be
accepted-if ovulation be regular in any manner, and its
periodicity depend upon the presence of both ovaries, it would
be interrupted necessarily by the removal of either of these
organs. In the first case it would occur only at intervals of
two months; and, in the second, according as the active or
quiescent organ, for the time being, were removed, we should
have an entire temporary cessation at once, or at the end of
its term of activity; and if menstruation were dependent
upon ovulation, a corresponding aberration of regularity
would be observed in it also. But this never takes place,
for, as already stated, single ovariotomy is, as a rule, followed
by no change whatever in the menstrual periodicity.
"It cannot be said, in answer to this, that, as in the case
of the kidneys or testicles, the removal of one gland is
INTRODUCTION.
41
followed by increased and compensating work by its fellow.
The ovary is not a gland, and the Graafian vesicle is not a
secretion. The office of the ovary is simply and only to
furnish a suitable place for the development of the primordial
follicles existent in its stroma from the beginning.
"(c.) The remarkable regularity in the ripening and dis-
charge of ovules, one after another, month after month,
which is assumed by the ovular theory, is combated also by
the frequent occurrence of a simultaneous discharge of two
or more ova.* Multiparous pregnancies can, I think, only
be rationally accounted for by the fact that the shedding of
ovules is an irregular function, proceeding in both ovaries
simultaneously and independently.
6
"(d.) The ovular theory wholly fails, too, to account for
the menstrual irregularities caused by mental influence.
Tilt says: I have patients in whom any unusual nervous
emotion or overexertion will bring on the menstrual flow,
with the usual menstrual symptoms, although they may
have only just recovered from this discharge. How can it
be supposed that an ovule can be ripened, and the dense
ovarian envelope suddenly perforated, by the fatigue of a
dinner-party, by hearing disagreeable news, or by an alterca-
tion with a servant?' It is well known that influences such
as those just mentioned may cause the discharge to appear,
and may equally check it when present; and it is likewise
known that these, or other similar disturbing causes, may
at once change the menstrual regularity; the flow appearing
after the usual interval, whether the last one occurred at the
right or wrong time. This sudden shifting of periodic ac-
tion is the special attribute of the nervous system; it shows
the menstrual flow to be impelled by nervous influence, and
explains how a strong emotion may repel it or alter the time
of its appearance.' (Tilt.)
"The argument which I have endeavored to make may
be thus summarized:
"1. Ovulation and menstruation may each occur inde-
pendently of the other.
* Ritchie, in a case reported by Cazeaux, found six ova in the uterus at
one time.
† Change of Life, p. 72.
4
42
ON STERILITY.
"2. Ovulation is the irregular but constant function of the
ovaries, while menstruation is the regular rhythmical func-
tion of the uterus (Kesteven).
"3. Ova are matured and discharged from the ovaries at all
periods of female life, from early childhood to old age, both
before puberty and after the menopause; hence the one can-
not be the sign of the other.
"4. Menstruation is the consequence of conditions estab-
lished by the structurally completed uterus, and depends upon
ovulation only for its origination.
"5. The mucous membrane of the uterine body is the only
organ essentially concerned in the menstrual act; the uterus
proper, the ovaries, Fallopian tubes, and vagina have their
functional activity increased, however, by receiving a share
of the general pelvic congestion which accompanies the pro-
cess.
"6. The menstrual congestion of the pelvic organs—of the
ovaries in particular-is, of all causes, the one most likely
to determine the ovipont when a Graafian vesicle is suffici-
ently mature, and hence ovulation and meustruation are fre-
quently concurrent.
"7. The theory that would make menstruation dependent
upon ovulation fails to account for the possible occurrence
of pregnancy at any and all times between the menstrual
periods; for multiparous conceptions; for the frequent per-
sistence of menstruation after the removal of both ovaries; for
the non-interference with menstrual regularity by removal of
one ovary, and for the menstrual derangements and the shift-
ing of menstrual periodicity from mental emotion.
"8. All the known facts in regard to both ovulation and
menstruation are consistent with the theory that, after the
latter is once established, the two functions proceed side by
side, but independently of each other, the former occurring
at irregular and the latter at regular intervals; while, on the
contrary, many of these facts are wholly inconsistent with
the theory that assumes a necessary ovular maturity and
rupture at each menstrual period."
CAUSES OF STERILITY.
CHAPTER I.
I WILL now proceed to enumerate the causes of sterility,
viewed in the light of the present physiological and anatom-
ical knowledge of the generative organs of woman.
With a full appreciation of the imperfections which it
contains, I submit the following arrangement or classifica-
tion.
I. CONSTITUTIONAL OR PREDISPONENT.
a. Obesity.
b. Chlorosis.
c. Scrofula.
d. Syphilis.
e. Mercurialization.
f. Twin birth.
g. Prostitution.
h. Inordinate sexual intercourse.
i. Change of climate.
j. Mineral waters.
k. Improper diet, clothing, and exercise.
II. PSYCHICAL.
a. Incompatibility.
b. Frigidity.
c. Erotism.
III. OVARIAN.
a. Atrophy of the ovaries.
b. Absence of the ovaries.
c. Imperfect development of the ovaries.
d. Inflammation-chronic-of the ovaries.
44
CAUSES OF STERILITY.
e. Degeneration of the ovaries.
f. Tumors of the ovaries.
g. Dropsy of the ovaries.
h. Dislocation of the ovaries.
IV. UTERINE.
1. Fallopian tubes.
a. Stricture.
b. Obstruction.
c. Inflammation.
d. Inflammation of fimbriated extremity.
e. Displacement of fimbriated extremity.
2. The Uterus.
a. Absence of.
b. Atresia; constrictions; occlusions of the
uterus.
Atresia; constrictions of cavity and
cervix.
Atresia; constrictions; acquired, con-
genital.
Imperfect development of uterus.
c. Atrophy.
d. Displacements.
Anteflexion, and anteversion.
Retroflexion, and retroversion.
Lateroflexion.
Prolapsus.
Elevation.
Inversion.
e.. Tumors of.
f. Inflammations, chronic.
Endometritis.
Endocervicitis.
g. Ulceration.
k. Leucorrhoea.
¿. Amenorrhoea.
j. Dysmenorrhoea.
k. Menstrual irregularities.
l. Abortions.
m. Areolar hyperplasia.
n. Abnormal shape of the cervix.
*
STATISTICS OF STERILITY.
45
V. VAGINAL.
a. Atresia.
Congenital.
Accidental.
b. Absence of vagina.
c. Non-retaining vagina.
d. Imperforate hymen.
e. Vaginismus.
f. Leucorrhoea.
VI. RECTAL.
a. Hæmorrhoids.
b. Prolapsus ani.
c. Fissures of the anus.
VII. MEDICINAL.*
Agnus castus.
Conium.
Mercurius.
Ruta graveolens.
Apis mel.
Cantharides.
Asarum.
Chimaphila.
Morphine.
Moschus.
Sumbul.
Senecio.
Baryta carbonica.
Ferrum.
Sepia.
Sabina.
Cimicifuga.
Iodine.
Phytolacca.
Secale cornutum.
Capsicum.
Iodide of Lead.
Phosphorus.
Trillium.
Caladium seg.
Kali brom.
Platinum.
Ustilago.
Lachesis.
Iodide of barium.
Caulophyllum.
Cannabis.
*The above enumeration of the medicinal causes is necessarily imperfect,
because much of the testimony relating to their sterility-causing power is
unreliable. Their claims will be separately considered in another place.
Plumbum.
Pulsatilla.
46
CAUSES OF STERILITY.
CHAPTER II.
STATISTICS OF STERILITY.
In general, it is stated by Sims and other authorities, that
about every eighth marriage is sterile.
This is certainly an astonishing statement. In no other
age of the world than this could such a state of things exist.
From what we can learn from ancient writers, both sacred
and profane, sterility was a very uncommon occurrence
among the Egyptians, Jews, Greeks, Romans, and the nations
of Europe. If all the other evidence was lacking, the fact
that sterility was considered a disgrace among the nations.
enumerated above would be sufficient to prove its extreme
rarity among their women.
20
In Dr. Duncan's work on Fecundity, Fertility, and Sterility,
we find that in the cities of Edinburgh and Glasgow, 15 per
cent. of all the marriages between fifteen and forty-four
years of age are sterile. Dr. Lever (Org. Dis. of Uterus, p. 5)
says: "It is found that th, or 5 per cent., of married
women are wholly unprolific." Duncan does not ascribe
much value to this estimate. Dr. Simpson (Obstetric Works,
vol. i, p. 328) says it has been observed that in some por-
tions of Sweden one barren woman is not met with for ten
fertile.
Frank asserts that only one marriage in fifty is unproduc-
tive, but he gives no proof of his estimate.
Thompson (Todd's Cyclopedia, vol. ii, p. 478) estimates
from a census of two large cities, Grangemouth and Bath-
gate, that 1 in every 10 married women were sterile.
The same author gives the analysis of 503 marriages in the
British Peerage, resulting as follows: Among 495 marriages
81 were unproductive, or 1 in 6 were without any family.
Dr. West (Diseases of Women, p. 3) states that he found
the general average of sterile marriages among his patients
at St. Bartholomew's Hospital to be 1 sterile marriage in
every 8.5.
STATISTICS OF STERILITY.
47
Dr. Duncan's tables show that about 7 per cent. of all the
marriages between 15 and 19 years of age, inclusive, are
without offspring. Those that are married at ages from 20
to 24, inclusive, are almost all fertile; and that, after that
age, sterility gradually increases, according to the greater
age at the time of marriage.
We have no means of ascertaining the exact proportion of
sterile women among the older nations. Even at this day
statisticians have been remiss in collecting, or unable to ob-
tain any reliable tables. Dr. Nathan Allen* reports to the
Social Science Congress that he has ascertained that in New
England the birth-rate of the strictly American class is
steadily diminishing.
From a careful examination of the census and registration
reports, as well as of town and city records, the following
facts were developed :
The average number of births to each married couple, and
the relative number of children to adults, with the present
generation of Americans, did not begin to compare with
what it was in New England one or two hundred years ago.
A census of Massachusetts, taken in 1765, reports almost
one-half of the population as under sixteen years of age;
whereas, from the best estimates that can be made, not more
than one-fourth, or, perhaps, one-fifth, of the present Ameri-
can population are under that age. An examination
of the records also shows that the average number of chil-
dren to each family, at the date above mentioned, was from
eight to ten; aud that from the second, third, and fourth
generations the average ranged from seven to eight; but
when we come to the fifth and sixth generations the number
of children diminished more rapidly, averaging only four or
five to each married couple; and that of the present genera-
tion, the number will not much, if any, exceed three children.
Now, if we take into account the known increase in nis
carriages from disease, as well as the greater frequency of
criminal abortions, we shall find that this decrease in the
birth-rate is due largely to the increase in the number of sterile
women.
* Psychological Journal, vol. ii, p. 214.
48
CAUSES OF STERILITY.
It must be borne in mind that many of the causes of mis-
carriage are also causes of sterility. A diseased condition
causing the former in one woman, will in another cause the
latter. The statistics of sterility are, therefore, closely con-
nected with those of abortion.
Now it is generally believed that miscarriage from causes
not designated as criminal is one hundred times more frequent
now than a few centuries ago; so we may safely assert the
same of sterility.
If, therefore, the present rate is one in eight, the ancient
rate would be nearer one in eighty.
The statistics of sterility, as connected with certain dis-
eased conditions, have been only partially arrived at. We
can, therefore, only give a few estimates.
As regards the statistics of sterility connected with uterine
displacements, Sims gives the following table, which shows.
the influence displacements of the uterus exercise on the
sterile condition:
Of 250 cases of natural sterility, 103 had anteversion; 68
had retroversion.
Of 255 cases of acquired sterility, 61 had anteversion, and
111 had retroversion.
Or out of 505 cases of sterility, 343 had uterine displace-
ments, or about two-thirds of the whole.
The statistics of sterility connected with fibroid tumors of
the uterus show that of 225 women who had once borne chil-
dren and then become sterile, 38 had fibroid tumors of various
sizes and variously seated, or 1 in 6.7.
Of 250 women who had never borne children, the cause of
sterility was found to be complicated with the presence of
fibroid tumors in 57, being at the rate of about 1 in 4.3.
In 100 virgins consulting for some uterine disease, 24 had
fibroid tumors, or 1 in 4.6. These latter would probably be
sterile.
66
Hewitt (Diseases of Women, p. 238,) gives the following:
Influence of acquired deformities of the uterus in producing
Sterility."
"Of the 296 cases 235 were married or had had children,
including 100 cases of retroflexion and 135 cases of ante-
flexion.
CONSTITUTIONAL OR PREDISPONENT.
49
"Of the 235 cases 81 were sterile, in the sense that they
had either had no children or had only had abortions.
"Of these 81 cases 57 were absolutely sterile, and 24 had
only had abortions.
"In a very considerable number of cases the patients had
had one or more children, but had been subsequently sterile.
These cases are not included in those just described, but
their importance is equally great, and the interference with
subsequent procreation of children was evidently connected
with the presence of a deformity of the uterus acquired
subsequently to the first pregnancies. An additional proof,
if such were needed, of the effect of the flexion in produc-
ing such secondary sterility' resides in the fact, presenting
itself on looking over these cases, that the symptoms lead-
ing the patient to seek for medical advice had very generally
existed since the birth of the last child.”
50
CAUSES AND TREATMENT.
CHAPTER III.
CAUSES AND TREATMENT.
I. CONSTITUTIONAL OR PREDISPONENT.
CHLOROSIS.-In actual chlorotic conditions conception
rarely occurs. If, with the chlorosis, amenorrhoea is present,
fecundation is still more difficult.
Treatment. Ferrum phos. is the preparation most valuable
in this condition. Phosphoric acid is sometimes more useful
than any iron preparation, especially when the chlorosis is
due to mental causes. China, if from loss of fluids, or from
latent malaria. Calcis hypophosphis is an excellent remedy in
many cases. Nux, Ignatia, and Strychnia are remedies which
powerfully stimulate the trophic nerves and thus affect the
processes of sanguification. Pulsatilla, Helonias, Cuprum,
Manganese, and Aletris are all useful in their sphere.
SCROFULA. Scrofulous women are oftener fruitful than
otherwise. There are cases, however, where the diathesis is
well marked, and the ovaries or uterus become the seat of
its local manifestations with resulting sterility.
Treatment.-A careful study of Hahnemann's Chronic
Diseases is essential to the proper selection of remedies for
scrofulosis. Among the most important are Ars., Calc.,
Hepar sul., Iodine, Cistus, Graph, Kali hyd., Ferr. iod., Merc.
iod., Oleum jecoris, Phytolacca, Stillingia, and Sulphur.
SYPHILIS. This malady is doubtless a frequent cause of
sterility. Whitehead* narrates a case of "sterility of fifteen
years," caused by secondary syphilis.
Treatment.--Syphilis in all its stages and manifestations is
readily controlled by a few specific remedies, namely, Mercury
com., Merc. iod., Kali hyd., Phytolacca, Stillingia. For many
years I have rarely used any other remedy than the Iodohy-
* Abortion and Sterility, p. 354.
CONSTITUTIONAL OR PREDISPONENT.
51
drargyrate of potassa, mentioned in the New Remedies, 4th
edition, p. 695, vol. ii.
MERCURIALIZATION.—There can be no doubt in the minds
of physicians who have closely studied cases of sterility, that
Mercury sometimes causes a difficulty of conception.
Treatment. Mercurial poisoning is successfully treated
and the poison eliminated by the judicious use of Iodide of
potassa, Hepar sulph., Kali chlor., Aurum, Nitric acid, Phyto-
lacca, Stillingia, and Sulphur.
OBESITY.—This condition is considered, both popularly and
by the profession, to be alike the cause and consequence of
sterility.
Some authorities doubt if obesity is opposed to fecunda-
tion. Why this condition should interfere with conception
has never been fully explained. The fact, however, remains,
and every physician in large practice has doubtless observed,
that sterile women are oftener obese than lean.
When a woman becomes normally sterile, i. e., after the
climacteric period, she is quite apt to become adipose. This
fact would seem to prove that there is some connection
between barrenness and adiposis. This connection is recog-
nized by all breeders of cattle and horses, who consider "fat-
ness" a decided obstacle to conception.
I have known many instances where a woman has had one
or two children, and then suddenly become increased in size.
and weight, with resulting barrenness. These same women,
a few years after, from some illness or other cause, would
become lean, and again bear children.
Treatment. Obesity and plethora cannot be safely treated
with drugs. In order to diminish the amount of fat or blood
in the system by drugs, great damage may, and generally
does, result to the general health. The safest medicine for
obesity is a decoction of Seawrack or Fucus. A rigid meat
diet, with active exercise, will generally diminish obesity.
True plethora, on the contrary, diminishes when a meat diet
is abandoned, and light farinaceous food takes its place.
(Consult Banting, " On Obesity," and Griffin's "How to Grow
Lean.")
52
CAUSES AND TREATMENT.
TWIN BIRTH.—“There is a popular belief among a certain
class that when a male and female are born at a twin birth,
the female will be henceforward sterile. It is probable that
this belief originated with the graziers, for it is stated as a
fact that when a heifer and bull twins occur, the heifer will
not conceive. Among cattle-growers this heifer is called a
'free-martin,' and so undoubted is this belief, that this free-
martin is either killed as a calf, or, if raised, is regularly
broken to the yoke, and worked like an ox. Many men of
intelligence have made this statement to me, and it may be
found in agricultural journals.”
Among cattle such may be the fact, although I very
much doubt it; but after a careful examination I am con-
vinced that such is not the fact in respect to the human race,
as I have known of numerous instances to the contrary, and
do not now remember ever hearing one statement in corrob-
oration of this opinion."*
Professor Simpson, of Edinburgh, who has made consider-
able research upon this subject, acknowledges the "infecun-
dity of free-martin cows to be a very general fact, but by
no means a universal one." He has also collected the facts
relative to the married history of 123 females born co-twin
with males, 112 of whom had offspring, and 11 none, al-
though married several years. In other words, the marriages
of the females born under the circumstances, were unproduc-
tive in the proportion of one to ten."†
PROSTITUTION.-Prostitutes are notoriously sterile. Any
one who will wade through the horrible and sickening
details of the effects of prostitution, as described by Sanger,‡
will be convinced that fecundation rarely takes place in
utterly abandoned women. To the moralist this seems to
be more a special providence than any physical results. If
it were not so, it would be terrible to contemplate the vast
increase of crime and misery that would result. According
to Sanger, prostitutes who reform and marry, even if not
affected with syphilis, are often barren, while others become
prolific.
* Gardener, On Sterility.
† Simpson's Obstetric Memoirs, vol. i, p. 294.
History of Prostitution.
CONSTITUTIONAL OR PREDISPONENT.
.53
INORDINATE SEXUAL INTERCOURSE. It is stated by some
authorities that this habit, equally with prostitution, may
be a cause of barrenness. It has been successfully recom-
mended in such cases, that, in order to insure conception,
coitus be indulged in only once during the ten days succeed-
ing the menses. In several cases of sterility I have found
this recommendation to be followed by pregnancy. In some
cases coitus should be prohibited for a whole month, to allow
the exhausted organs time to regain their tone.
CHANGE OF CLIMATE.-According to Casanova, "change of
climate will produce sterility, as it has been observed in
women born in the region of South America which lies be-
tween the rivers Amazon and Nepo. When such women
leave their native home to reside in some of the limiting
States, they will surely (like many plants, when transplanted
from one climate to another) become, if not absolutely bar-
ren, at any rate less prolific than in their own native land."
This may be so, but the fact is equally apparent that
change of climate often cures sterilty. I am informed by
the physicians of Cleveland, Buffalo, and New York that
women, sterile for years, have conceived. while on a visit to
the Upper Great Lakes, or a few months' residence at Mack-
inaw. I have known the same result to follow in cases of
ladies from Chicago, who supposed themselves sterile until a
visit to Mackinaw or a trip to Lake Superior resulted in a
pregnancy. A visit to Europe or the West Indies is often
recommended to sterile women, and with good results.
Women sterile in New England become prolific in the
West, and women who have never conceived in any part of
the country east of the Rocky Mountains become pregnant
soon after reaching California.
Baudelocque mentions the case of a high personage who
could not have any children by his wife. During an absence
of two years from France his wife became pregnant, aud
gave birth to a boy. After this his wife remained sterile for
four years.
After another absence from France, she had
another child. The change of climate was evidently the
cause of some favorable change in the condition of the repro-
54
CAUSES AND TREATMENT.
ductive organs. This same couple, by making annual visits,
became the parents of eleven children, five boys and six girls.
MINERAL WATERS."Long residence near chalybeate
springs, and the abuse of drinking or bathing in their
waters, have been observed, on the continent, to produce
sterility in prolific women." (Casanova.) This author be-
lieves this result to be due to the iron contained in the water,
and floating in the air. He accounts for the cure of sterility
by Ferrum on homœopathic principles. Sterile women are
often sent to mineral springs for the cure of barrenness, and
it is asserted that some springs are noted for their good
effects on this condition.
Among the springs most noted for the cure of sterility
are the "Sweet Springs," in Monroe County, West Virginia,
and several in Europe.
IMPROPER DIET AND WANT OF EXERCISE.-It is well known
to all practical men that the diet has much to do with fecun-
dity in the human subject, also in animals and plants. One
of the best writers on this subject-Mr. Doubleday—says:
"It is a fact admitted by all gardeners, as well as botanists,
that if a tree, plant, or flower be placed in a mould either
naturally or artificially made too rich for it, a plethoric state
is produced, and fruitfulness ceases. In trees, the effect of
strong manures and over-rich soils is, that they run to
superfluous wood, blossom irregularly, and almost or entirely
cease to bear fruit. In flowering shrubs or flowers the first
effect is that the flower becomes double, and loses the power
of producing seed; next, it ceases almost even to flower.
On the other hand, when a gardener wishes to save seed, he
does not give the plant an extra dose of manure, but he sub-
jects it to some hardship, and selects the fruit that is the
least fine-looking, knowing that it will be filled with seed;
while the finest fruit will be nearly destitute.
"In the animal kingdom, fecundity is totally checked by
the plethoric state, while it is induced and increased by the
deplethoric or lean state. Rabbits, swine, sheep, and horses,
when overfed, will not reproduce; put them out of con-
dition, and they instantly resume their fertility. Tame
PSYCHICAL.
55
pigeons, sheep, mares, and numberless sorts of other ani-
mals, when they are stuffed to satiety, do not want to, or do
not care to raise, or are incapable of raising others."
Mr. Doubleday's theory is that "the increase of popula-
tion is connected with the food of the people." In other
words, and the truth of the deduction is evident to all ob-
serving men,—if the diet of women is composed of articles
in which fatty constituents or carboniferous abound,-such
as sugar, sweetmeats, nuts, and all the rich delicacies which
are found on the tables of the rich and luxurious, they
will become plethoric, adipose, and sterile.
If, with this rich and unnatural diet, we find lack of exer-
cise, an absence of outdoor life, and a condition of physical
indolence, we have the two causes combined which as
much if not more than all others conduce to render the
female population of our large towns and cities unproduc-
tive and sterile. If we contrast this sterile class with the
hard-working, hardy, plainly fed, and plainly clad portion of
the population, the Irish, German, and English,—we shall
see at once the difference which exists between the two
classes in the capacity for bearing children.
Hippocrates was well aware of these facts, for he says:
"The want of fruitfulness arises from sedentary life, in-
dulgence in riding in carriages, want of exercise, profuseness
in living, fatness, and muscular laxness in the female sex."
Aristotle says:
"The condition most favorable to procrea-
tion is a habit of body inured to labor.”
Lord Bacon says: "Repletion is an enemy to generation."
Herbert Spencer, one of the profoundest writers and ob-
servers of the age, has the same opinions.
It is to be hoped that the renewed interest of the present
generation in athletic outdoor exercises will have a favor-
able effect on the organizations of women, and in time undo
the evil caused by a century of false fashion.
For a further consideration of this subject, so important
as a cause of sterility, I refer the physician to that excellent
paper on The Law of Human Increuse; or Population based
on Physiology and Psychology* by Dr. Nathan Allen, of
Lowell, Mass.
* Quarterly Journal of Psychological Medicine, April, 1868, vol. ii, p.
209.
56
CAUSES AND TREATMENT.
CHAPTER IV.
II. PSYCHICAL CAUSES.
THAT there are causes of sterility which exist solely in the
mental constitution of women, no close observer will deny.
The annals of medicine and jurisprudence abound in cases of
this character. Among the psychical causes of barrenness
may be enumerated:
INCOMPATIBILITY.-There have been many instances known
where, in spite of perfect development of all the organs of
generation, together with a normal healthfulness of func-
tions, in both husband and wife, conception did not occur.
The reason why such marriages were unfruitful is said to be
some antipathy or antagonism in the mental sphere. Goll-
man* mentions such instances, and calls them relative causes.
of sterility. He says:
"Such causes are, for example, antipathy or antagonism
between the married parties; extreme differences of age,
constitution, and temperament, as when a very old man is
married to a very young wife, or vice versa, a very old
woman to a very young husband; or when a cold and
phlegmatic husband has a wife of a very ardent tempera-
ment. Such causes are quite frequent, although it is not
always easy to find them out. There are instances of ster-
ility of five, ten, or twenty years' standing, and when, after
this period, conception took place in consequence of a change
in the outward relation of the married partners."
Several cases have come under my own observation, where
husband and wife have lived together for ten or twenty years
without the occurrence of conception. These parties became
divorced, each married again, and had children. The case
of Napoleon and Josephine is in point. The Emperor had
children by his second wife, and Josephine's first marriage
was fruitful.
"We frequently see trials of divorce," says
* Diseases of Urinary and Sexual Organs, p. 248.
PSYCHICAL CAUSES.
57
Casanova, "reported in the newspapers, brought in by hus-
bands against their wives for adultery, when the latter had
been unfruitful during a number of years of matrimonial life,
and became pregnant by other men. Infidelity in such cases
was generally found to be the result of ill-treatment from
their cruel husbands; consequently their wives could not
possibly have had the least degree of love and affection, and
therefore no power of reproduction during such behavior."
This last sentence embodies the doctrine taught by this
singular author in his unique, but illogical work,* hereto-
fore referred to.
FRIGIDITY.-Coldness, or an absence of sexual desire, was
once supposed to be a cause of sterility; but the most emi-
nent physiologists of this century do not teach that such a
condition is a cause. Absence of sexual feeling may arise
from some malformation of the external genitals, while at
the same time the ovaries perform their functions properly.
The consideration of this delicate question lies in the do-
main of psychology.
Treatment. When no organic cause is discovered, the rém-
edies are: Kali brom., Agnus castus, Conium, or Baryta in the
high attenuations; or Phosphorus, Helonias, Cantharides,
Sumbul, Moschus, Ergot, or Nux in the low attenuations.
EROTISM.-Excess of sexual excitation or enjoymeut in
one or both, especially in hysterical and passionate women,
is stated by some authors to be a cause of sterility. This,
like the foregoing, is a subject which I do not propose to dis-
cuss in this work. I prefer to adhere principally to the
more practical details of the pathological causes of sterility.
Treatment.-Erotism, or erotomania, is best removed by
Cantharis, Phosphorus, Nux vom., Platina, Lilium, Origanum,
Moschus, Sumbul, Cannabis ind., in the higher potencies; or,
Kali brom., Lupulin, Camphor, or Ferrocyanuret of potassa in
the low attenuations, or massive doses.
* Contributions to Physiology.
5
LO
58
OVARIAN.
CHAPTER V.
OVARIAN.
ABSENCE OF THE OVARIES.-Congenital absence of the ova-
ries has been observed in a few instances. The persons so ab-
normally constituted possessed some of the characteristics of
woman, but were more masculine than feminine in their ap-
pearance. They may menstruate, but they cannot conceive.
IMPERFECT DEVELOPMENT.-This condition, which consists
in a persistence of the foetal condition of the ovaries, is not very
rare. It may exist on one side only, though it generally
affects both. As in the case of absence, a certain conclusion
is not easy; and, as in that case, also, we draw a presump-
tive conclusion from want of development in the other or-
gans of generation, absence of the usual signs of the men-
strual crisis, and lack of general constitutional vigor and
development.
Prof. Thomas* gives three cases of this condition which
came under his own observation. Their ages were respec-
tively 24, 18, and 30. Each showed a want of development
of the uterus, vagina, and external organs of generation.
The first two never menstruated, the latter very scantily.
Treatment. In imperfect development the treatment should
consist in administering the remedies homeopathic to the
condition, namely: Conium, Iodine, Chimaphila, Helonias,
Ferrum, Phosphorus, Calc. phos., Baryta carb., Senecio, and
the Hypophosphite of lime.
The action of these medicines may be aided by careful and
judicious irritation of the uterus by means of slippery elm
tents introduced at or near the probable menstrual periods.
Electricity has been successfully employed in such cases. It
acts by arousing the dormant forces in those organs. One
pole of a battery should be placed on the spine, and one over
* On Diseases of Women.
CAUSES AND TREATMENT.
59
1
the ovaries; or one pole in contact with the cervix uteri, and
one over the ovaries.
These means, together with proper bathing, exercise in
the open air, a nutritious diet, etc., will be apt to arouse the
undeveloped organs.
ATROPHY.-Aside from the normal atrophy which occurs at
the change of life, the ovaries may become atrophied at any
age. It may result from acute ovaritis, pelvic cellulitis, and
peritonitis. If both ovaries are affected in this manner, ster-
ility will of course be absolute.
Treatment.—If the atrophy be not too far advanced, it may
be arrested by the same means recommended for undeveloped
ovaries.
An excellent paper on this subject will be found in the
North American Journal of Homeopathy, vol. ii, p. 192,* in
which the treatment is considered quite extensively.
INFLAMMATION.-Acute inflammation of the ovaries may
cause such an amount of suppuration and disorganization as
to destroy forever their functions; or it may end in chronic
inflammation, resulting in destruction of the capability of
elaborating healthy ovules. If only one ovary be diseased,
sterility will not result.
Treatment. The specific remedies for ovaritis are: Aurum,
Apis, Cantharis, Conium, Lachesis, Clematis, Pulsatilla, Rho-
dodendron, Platina, Lilium, Thuja, Sabina, and Phytolacca.
In very severe cases with high fever, Aconite, Veratrum vir.,
Gelseminum, and Belladonna must be given.
DEGENERATION of the ovaries may result from acute or
chronic inflammation. When the disease has reached this
stage, no treatment is known that will restore their integrity;
and if both ovaries are affected, permanent sterility must
result.
TUMORS of the ovary are not uncommon. They may be di-
vided into: (1.) Those which are solid. (2.) Those which
have cavities, more or less large, in their interior; dropsical
tumors. (3.) Cancerous (scirrhous). The remedies recom-
* On "Atrophic Ovarian Amenorrhoea."
60
UTERINE.
mended are: Apis, Arnica, Belladonna, Conium, Graphites, La-
chesis, Lycopodium, Zincum, and Lilium. Some remarkable
cures have recently been made by means of electricity. Ova-
rian tumors of large size have decreased notably, and in some
instances apparently disappeared, under the use of Chlorate of
Potassa, Kali bromatum, and Chimaphila. Dr. Guernsey has
collected a number of cases supposed to be cured by homoeo-
pathic remedies (Hahnemannian Monthly, Dec. 1877).
DROPSY.-Ovarian dropsy is but a form of ovarian tumor; a
local disease, and not dependent on disorder of the kidneys.
CAUSES AND TREATMENT.
61
CHAPTER VI.
UTERINE.
Fallopian Tubes.
ANY abnormal condition of the Fallopian tubes sufficient
to prevent the passage of the ovum from the ovary to the
cavity of the uterus is a cause of sterility. It matters not
whether impregnation takes place in the ovary or the uterus,
normal conception cannot occur unless the ovum attaches it-
self to the internal wall of the uterus.
Among the diseases of the Fallopian tubes, causing ster-
ilty, may be mentioned,
(a) STRICTURE. It is said by several European writers
that stricture of the uterine end of the Fallopian tube may
occur as a result of previous inflammation. The occurrence
of a foetus being developed in the tube seems to prove that
such a condition may occur. Such an abnormality, however,
cannot be demonstrated during life, unless some unusual
dilatation or organic change in the os uteri coexist. "Theo-
retically," says Dr. Gardner, "there is little doubt of its
existence; but practically there is an immense doubt of the
possibility of recognizing it, save, perhaps, in some exceed-
ingly rare instances."
Treatment.--The recommendation of some recent English
writers, Tyler Smith, the originator, of passing a bougie into
the os and through the cervix, and thence into the Fallopian
tubes, and by a series of graduated instruments removing
the stricture, is itself so seemingly impossible that it is not
now seriously recommended. It has never been performed,
and doubtless never will be. Gardner gives cuts illustra-
tive of the method of performing this theoretical operation.
(6) OBSTRUCTIONS may occur anywhere in the course of the
tubes, but generally at the two extremities.
* Sterility, pp. 156-7.
62
UTERINE CAUSES.
Tyler Smith says: "I have repeatedly observed that in
cases where the Nabotbian bodies are met with, small cysts
are found in the course of the Fallopian tube, or at its fim-
briated extremities. Inflammation of the tube may result
in exudation into the tube, blocking up the canal, and ren-
dering it impervious. Catarrhal affections of the tubes may
cause obstructions of a more or less persistent character.
Polypoid tumors may also fill up the canal of a tube.”
Treatment necessarily obscure.
(c) INFLAMMATION of the Fallopian tubes may be discovered
during life, but its diagnosis from ovarian inflammation is
extremely difficult. The tube itself may be the seat of in-
flammation, causing stricture or obstruction; or the fimbri-
ated extremity may be affected, resulting in adhesions or
displacements.
(d) ABSENCE OR DEFECT OF THE UTERUS, in respect of de-
velopment, will cause absolute sterility.
"Complete absence of the uterus has been doubted by many,
because a more careful study of cases recorded as authentic,
rendered the presence of the rudiments of a uterus presum-
able or evident; and partly because cases of absence of a
uterus which are founded simply on examination of living
women do not seem sufficiently conclusive. Notwithstanding
this, it has been proved that the uterus may be entirely ab-
sent, and in such cases both the oviducts and ovaries, es-
pecially the former, may exist either in a rudimentary state,
or may be also wanting."*
Burggraeve relates cases where, with absence of the uterus,
both the ovaries were normally developed, with Graafian
follicles found in them; but the menstrual flow and sickness
were absent. Scanzoni speaks of extravasatious of blood and
formations of cysts, which cannot be imagined to take place
without ovulation. The breasts are frequently well developed,
the pelvis of the normal dimensions, and sexual desire not
absent. In this anomaly, as well as the rudimentary uterus,
described by Kolb, conception cannot occur. The absence of
the menstrual flow is, in such cases, a valuable diagnostic
symptom.
* Kolb, Pathological Anatomy of the Uterus.
UTERINE CAUSES.
63
ATRESIA of the uterus may be congenital or acquired. Of
the former, Kolb writes:*
"By congenital atresia we understand that arrest of de-
velopment in which the external orifice, or, at the same time,
a portion of the cervical canal, is either imperforate or en-
tirely absent. As the extremest degree of this anomaly, we
might consider that rudimentary form in which no cavity
has been formed. However, the term atresia is only applied
to the slighter anomalies just mentioned.'
وو
"The cervix of the uterus is, in rare instances, perfectly
imperforate, and forms a slender cylindrical body, consisting
of fibrous connective tissue, interspersed with muscular
fibres. In such cases the vaginal portion of the cervix is
either entirely absent or very imperfectly developed and
small, and the vagina is always rudimentary. In other cases
the atresia is limited to the external orifice; the occlusion
being also effected by muscular and connective tissue. In
such, the vaginal portion is generally small, but in some
instances it is found normally developed. Finally, we meet
with cases in which the vaginal portion and the cervix are
perfectly permeable, but the atresia is formed by the mucous.
membrane of the vagina passing over and occluding the ori-
fice of the vaginal portion."
Congenital atresia, in all its forms, is a very rare anomaly.
It may exist unperceived up to the years of puberty,
and acquire pathological importance only at the com-
mencement of menstruation. The menstrual fluid accu-
mulates in the uterine cavity, from which it cannot escape;
and, consequently, distending the uterus, it causes that con-
dition termed hamatometra, or retention of the menses. All
these forms of atresia cause sterility. A uterus affected
with atresia cannot be impregnated, yet after a successful
operation, not only conception, but maturity of the fœtus
and a normal delivery have been known to take place.
Acquired atresia, occlusions, or contractions of the uterine
cavity take place usually at its orifices; and as regards
frequency, those at the internal orifice are more frequently
observed than those of the external, whilst throughout the
* Pathological Anatomy of the Uterus, p. 32.
64
f
UTERINE CAUSES.
remainder of the uterine cavity, stricture or occlusion is
rarely found. Sometimes the entire uterine canal is dimin-
ished by concentric hypertrophy or atrophy.
Stricture of the uterine cavity may be caused by annular
contractions at a certain point; by the external pressure of fibroid
and other tumors; by partial or complete flexions of the uterus ;
thickening of the mucous membrane from catarrh; enlarge-
ment of the follicles, or from the growth of granulating tissues
resulting in a constricting cicatrix. The abuse of caustics,
such as Nitrate of silver, Chromic acid, and Potassa fusa, in the
treatment of ulceration and inflammation of the cervix, is
doubtless a frequent cause of occlusion. One such case came
under my observation, and required an operation for its re-
moval. In the treatment of ulceration during pregnancy,
proper caution must be used or the edges of the os may
unite. This has been known to occur when no local treat-
ment was resorted to.
Sterility may result from nearly every form of acquired
atresia.
Treatment.-- For complete congenital atresia of the uterine
cavity, no surgical treatment can be of avail. In those
forms of partial atresia, puncture or incision through the
occluded portions, with the usual precautions against re-
unions, will be attended with success.
(For the purpose of diagnosing contractious of the uterine
cavity, or atrophy of the uterus, Fitch's measuring-sound is
best.)
FIG. 1.
SUEPARD & DUDLEY N Y.

MANUALNE DIONNELMIAURINAMIRNET,
Acquired occlusions or contractions, if confined to the canal
of the cervix or its inner or outer orifices, may be success-
fully treated by the same surgical means. If from flexions
of the uterus, a proper pessary and tents will remove the
stricture. (Fee Flexions and Versions of the Uterus.) Tumors
may sometimes be removed by surgical operations, or the
persevering use of such remedies as Conium, Hydrastia, and
Iodide of arsenic. Simple occlusions from the adhesion of
UTERINE CAUSES.
65
the lips of the os can readily be removed by the uterine
sound, or in severe cases by the bistoury. Lacerations of -
the os and cervix should be watched for after miscarriage
and delivery. In closing up they often completely occlude
the os, and it is not ascertained until after the menses occur
at the close of lactation. Instances have been reported
where occlusion of the cervical canal has resulted from the
use of instruments used for the purpose of criminal abortion.
These causes should not be forgotten, and their results.
guarded against. If such a condition threatens to occur
from any of the above causes, the os and cervical canal
should be kept open by means of tents and bougies until the
danger is past.
cause.
IMPERFECTLY DEVELOPED UTERUS.-I have known of sev-
eral cases of sterility in otherwise healthy women from this
Such women are nearly always inclined to obesity.
Dr. Simpson* says he has seen a considerable number of
cases of short or imperfectly developed uteri in the living
subject. The imperfect development of the organ was as-
certained, on examination by the finger, by the small and
atrophied cervix uteri, and by actual measurement of the
length of the cavity by the uterine sound. Instead of being
two and a half inches in length, the cavity in such cases was
only two inches, or more frequently only one and a half or
one inch long. The subjects of this imperfect developement
were often well made and well formed in other respects. But
the malformation led to various functional defects, especially
to amenorrhœa and sterility. The amenorrhea was usually
persistent, and when a patient applied for medical relief who
was already twenty-five or thirty years of age, this malfor-
mation would in a large proportion of cases be found to be
the organic cause. In some such cases of amenorrhea, there
was great vascularity of the face, and occasionally a most
unconquerable form of acne. He has seen in some of these
instances the wearing of an intrauterine galvanic or zine
and copper pessary followed by the best results, and even
occasionally by the cure of the amenorrhoea. The uterus
* Obstetric Memoirs, vol. i, p. 258.
66
UTERINE CAUSES.
developed itself around such a foreign body when it filled
its cavity as it did around à fibrous tumor or an ovum.
Dr. Storer, in his note to this article, remarks that he has
often seen galvanic pessaries used by Dr. S. in ordinary
cases of amenorrhea which had resisted all the usual means
of treatment, and with perfect success.
Imperfect development will not only cause amenorrhea,
with sterility, but it causes that kind of difficult menstrua-
tion in which the flow is very scanty and sometimes delay-
ing. This condition is nearly always attended with sterility.
I do not think the imperfect development is always con-
genital, but oftener arises from a sudden check to the first
menstruation. I have now two such cases under treatment.
In both a severe cold checked the first or second menses,
which began profusely enough, but ever since that date
they have been scanty and delaying. Each has been married
thirty years, and never have been impregnated.
Treatment. No medicinal agent is of any service after the
condition has existed a few months. If Pulsatilla, Senecio,
or some remedy appropriate to the sudden suppression were
given immediately, the normal development would not have
been arrested.
ATROPHY of the uterus is an affection of mature age, and
generally commences simultaneously with puerperal involu-
tion, or it must be considered as marasmic degeneration of
the organ. In chlorotic women also, a sort of atrophy of the
uterus is sometimes met with, generally complicated with
displacements and derangements of menstruation. Besides
these causes, atrophy may result from pressure, or be due to
mechanical causes. As regards the extent of the affection,
we may distinguish between general and partial atrophy.
The latter affects either the body, fundus, cervix, or vaginal
portion of the uterus. As regards the cavity of the uterus, a
distinction has been made between concentric atrophy, with
diminution, and excentric atrophy, with dilatation of the
cavity. (Kolb.)
Concentric atrophy would doubtless be a cause of sterility;
but it is doubtful if atrophy with dilatation would be inimi-
cal to conception, although it might act as a cause of mis-
UTERINE CAUSES.
67
carriage. Concentric atrophy generally occurs as a sequence
to the puerperal state, and is probably one of the causes of
that form of sterility which occurs after the woman has
given birth to two or more children, and is often connected
with atrophy of the ovaries.
SENILE atrophy, occurring as it does after the climacteric
age, does not belong to the causes of sterility. Scanzoni
mentions as a cause of atrophy, imperfect innervation of the
pelvic organs consequent upon paralytic conditions of the
system (paralysis of the lower half of the body, followed by
amenorrhoea), and of which he observed several cases.
Treatment.—If the atrophy is from excess of puerperal sub-
involution or from a psoric miasm: Iodine, if there is a gen-
eral wasting of the body with great weakness of the joints.
Baryta carb., if there is an appearance of premature old
age, diminution of sexual desire, and the uterus feels hard
and is diminished in size; menses scanty or suspended.
Conium, if there has been swelling and soreness of the
mammæ, followed by wasting, with induration and atrophy
of the cervix uteri; sexual feeling abolished; menses scanty
or wanting.
Chimaphila, if the breasts have become atrophied and
flabby, without previous soreness; the skin is dry and hard;
and the urine deposits a profuse white sediment, like mucus
and chalk.
Graphites, Sepia, and Kali bromatum are indicated if the
menses are very scanty.
If it is caused or attended by chlorosis:
Iodide of iron, if with the Iodine symptoms there is waxen
complexion, bloated feet, etc. Ferrum, if the chlorosis is due
to deficiency in the red corpuscles of the blood.
Helonias, if there is chlorosis with dropsy or diabetes.
Bromine is an excellent stimulant of the ultimate cells of
the ovaries and uterus, and may avert atrophy of either of
these organs.
In atrophy from imperfect innervation, with paralysis of
the lower half of the body, the remedies are: Nux vomica,
Conium, Secale, Ustilago, and Phosphorus, or electricity.
68
UTERINE CAUSES.
OBSTRUCTIONS from stricture of the os and of the canal
of the cervix uteri, is of frequent occurrence, and often over-
looked by ordinary practitioners. On the other hand, sur-
geons who are always looking for stricture of the cervix
often mistake the effects of the various flexions of the uterus
for the former condition.
Dr. Simpson has an excellent paper on the surgical treat-
ment of this abnormality. He recommends incision, and
mentions several cases of sterility from this cause cured by
the operation.
Dr. Mackintosh recommends dilatation by long, straight
bougies of different sizes.
Dr. Sims prefers the bilateral incision of the cervix.
Dr. T. G. Comstock, of St. Louis, writes: "One case of
sterility I treated successfully by dilating the cervical canal
by means of the uterine probe, Atlee's dilator, sponge-tents,
and Simpson's graduated gutta-percha plugs. This opera-
tion, made in another case under treatment for a year past,
has entirely failed, although the stricture has been over-
For the last six months I have been experimenting
in cases of dysmenorrhea, from a narrowing of the cervical
canal, by relieving the stricture by incision; that is, divid-
ing it, making the bilateral section of the os and cervix uteri,
which is the operation proposed and performed successfully
by Drs. Sims and Simpson.
come.
"This operation I consider preferable to dilatation, and
the results of this practice I propose to make public at
some future period. I am acquainted with a physician who
claims to have performed this operation nearly fifty times,
without any accident or untoward results, and to have cured
many cases of sterility by it.
"Whether this operation is unwarrantable or not, it is
certainly worthy the attention of gynæcologists and surgeons
of our school.”
The July (1877) number of the American Journal of Obstet-
rics contains a paper by Dr. Pallen, entitled, "Incision and
Division of the Cervix Uteri for Dysmenorrhoea and Steril-
ity." In that paper are published a number of questions
addressed to Dr. J. Marion Sims, and relating to this oper-
ation and its results. Dr. Sims states that he has for sev-
UTERINE CAUSES.
69
eral years operated with the instrument figured in his work
on Uterine Surgery, and which has since been greatly im-
proved. With it he makes a bilateral incision up to the
cavity of the uterus, then dilating the canal by a dilator, and
introducing a plug of hard rubber to keep it from contract-
ing, and retaining the plug by means of styptic cotton. This
dressing is allowed to remain from two to six days. Great
care should be taken not to incise the cervix too deeply. The
incision should begin at the inner os, which need not be
opened larger than one-fourth of an inch. From this point
the incision can be carried deeper as the outer os is ap
proached, making the canal funnel-shaped.
Dr. Sims says he considers "the sponge and laminaria
tents more dangerous." He states that he has operated
nearly a thousand times and only lost two patients by it, who
died of peritonitis. He pronounces the use of tents, for the
purpose of enlarging and lengthening the cervical canal, as
utterly useless for the permanent cure of dysmenorrhoea or
sterility. I have found it so in my practice, for although it
may relieve the dysmenorrhoea for two or three months, the
stricture almost invariably returns. Incidentally, Dr. Sims
mentions the impropriety of treating any case of supposed
sterility without first ascertaining if the woman is really at
fault, or whether the fault lies with the husband. He says
be has met with many cases where the woman has been
treated uselessly for years by various physicians, when at
last the microscope demonstrated either that the spermatozoa
were killed in the cervical canal by the abnormal secretions
of the passages, or that they were dead or absent from the
seminal fluids. I have myself met with very many similar
cases, and I would advise every physician to examine the
seminal fluid before and after it has been placed in the gener-
ative passage of the woman. To omit this is to "work in
the dark," and allow the blame to rest where it does not
belong.
There are several instruments for division of the cervix.
Simpson's hysterotome, invented in 1843, was the first one
used for this operation, and by it that dintinguished surgeon.
gained a world-wide celebrity. It is single-bladed, the blade
concealed, and cuts one side at a time. It is still used very
70
1
UTERINE CAUSES.
successfully by many gynecologists. There are several double
hysterotomes, with two blades, cutting both sides at once.
Of these, Drs. Greenhalgh's, Stohlman's, and Skeene's are the
most popular. Dr. Skeene's instrument is perfectly safe, for
it can be set so as not to cut too deeply. I have operated
several times with Skeene's hysterotome, and afterwards in-
troducing a plug of slippery elm two inches long and one-
fourth of an inch in diameter, retaining it in place by a
small tampon of cotton wet in a solution of persulphate of
iron, introduced just within the lips of the os.
This is safer than Sims's formidable operation, an operation
which, however safe in the hands of such a master surgeon
as Sims, is one that the average practitioner should not at-
tempt. Moreover, Sims's operation cannot be performed
without using his speculum, which requires an assistant,
while the operation with Skeene's hysterotome can be per-
formed unaided and through any ordinary speculum with
movable or expanding blades.
There is another instrument, invented by Dr. Octavius
White, of New York, nearly fifteen years ago.
Q. NIEMANN CO.
FIG. 2.

This instrument is the safest ever invented, and incises the
cervix and inner os as much as is ever necessary, namely, one-
fourth of an inch. The instrument, when the blades are with-
drawn, looks like a long uterine sound. It has two small
semicircular or crescentic blades concealed near its point.
It is used with or without a speculum, and in any position.
the woman may assume. It is introduced up through the
os internum, the two blades are thrown out by an action
governed by a screw in the handle, and it is then withdrawn,
cutting an opening only one-fourth of an inch, the normal
size of the canal. I prefer to use this instrument through
NOTE: My speculum has many improvements besides those mentioned
above, but a cut of it could not be procured in time for insertion here. It
will be for sale by Boericke & Tafel.-HALE.
UTERINE CAUSES.
71
Jackson's speculum, for while it is nearly as convenient as
Sims's, it needs no assistant. This is a bivalve speculum,
the upper blade shorter than the lower-a very great im-
provement, as the practical operator will soon ascertain. I
have lately improved upon it by changing the shape of the
blades and inserting a small hook near the opening of the
upper blade, for the purpose of retaining in situ a tenaculum
similar to Nelson's, but stronger. The following cuts show
Jackson's speculum open and shut, with the tenaculum.
FIG. 3.

EH.SARGENT
After the operation of incision of the cervix it is neces-
sary to introduce some kind of a tent or plug to prevent
contraction during the healing process. Sponge tents or
laminaria are not always safe. I prefer the slippery elm.
FIG. 4.

EH.SARGENT
tent, carbolized, made of the proper size, as mentioned above.
This should be removed in twelve or twenty-four hours.
and a plug of firmer material substituted. I have used
72
UTERINE CAUSES.
Chambers's intrauterine stem pessary in some cases. They
are effectual if tolerated.
FIG. 5.
O o O o O o 90
Dr. Sims figures an instrument which has some advantages
over Chambers's, in that it is tubular and self-retaining. It
allows the secretions from the cavity of the uterus to pass
through it. It is about two inches long; it is introduced
with the wings drawn into a straight line by means of a
stilet, as shown in the figure. As soon as it is passed to the
requisite depth the stilet is withdrawn; the wings spring
back into the cavity of the uterus; the os internum grasps
the instrument at its bifurcation, and the lower end rests
outside of and against the os tincæ. It should be made of
vulcanite. It should be worn, if possible, through one men-
strual period.
CHA
FIG. 6.

Dr. Coghlan's plan of using a tube of sheet-lead answers
a very good purpose. Any physician of ordinary mechanical
tact can make one in a few moments, and thus possess at
hand a simple and inexpensive instrument.
DISPLACEMENTS OF THE UTERUS.-Any of the displacements.
of the uterus may be a cause of sterility. In the various
flexions of that organ, the bent condition of the cervix causes
a stricture at the point of flexion. This stricture may form
an obstruction to the entrance of the spermatozoa. (See Atre-
sia, Occlusion.)
In versions of the uterus the os uteri is often placed in
such situations that the seminal fluid cannot readily enter
into the cervical canal.
UTERINE CAUSES.
73
ANTEVERSION.-According to West,* anteversion or ante-
flexion of the uterus may be a cause of sterility, but not
more so than uterine diseases in general. Of thirty-three pa-
tients affected with this displacement, thirty were married,
of whom three were sterile. The remaining twenty-seven had
given birth to seventy-three children, and had had twenty-
one miscarriages; or, whose labors amounted to 2.7, their
miscarriages to 4.7 to a marriage; while one in 8.5 of the
total number proved sterile. "When anteflexion is so con-
siderable as to nearly obliterate the uterine cavity at the
point. of flexion, conception is rendered very improbable ;
but still it may take place if no structural occlusion or
atresia has recurred at the above-mentioned point, for there
may be space enough left to allow passage to the spermatic
fluid, and unless the uterus be held by false membranes, the
flexion may be lessened in a horizontal position of the pelvis
during coition by the weight of the fundus, and thus the
occlusion of the cavity be diminished, and the impregnating
fluid be allowed to pass. Considering, therefore, the fre-
quency of sterility in the females affected with anteflexion
(Moyer found 60 anteflexions in 272 sterile females), other
circumstances should be taken into consideration, especially
derangements of menstruation in the form of dysmenorrhoea
or amenorrhea; perhaps, also, the altered position of the
vaginal portion (the os uteri looking backwa:d) as well as a
certain amount of cervical catarrh." (Kolb.)
Treatment. The surgical treatment of anteversion is not
attended with much success. The use of pessaries generally
accomplishes but little in this displacement; but in excep
tional cases they are of benefit, and should be tried. They
act, not by rectifying the displacement, but by simply lifting
up the uterus, and diminishing pressure on the bladder.
Anteflexion is more apt to cause sterility than version. If we
have in view only the cure of sterility, I know of no better
means than Sims's operation, described by Thomas,† which
consists in cutting through the posterior wall of the cervix, thus
couverting a crooked into a straight canal, and affording a
passage-way for the seminal fluid. If this is objected to,
† Ib., p. 329.
* Diseases of Women, p. 168.
6
74
UTERINE CAUSES.
the use of the intrauterine pessary of Peaslee, Simpson, or
Detschy may be tried. If these can be tolerated, the canal
may be straightened. The use of intrauterine stem pessaries
is nearly abandoned by gynecologists. The recent discus-
sion in the American Gynecological Congress showed that
to be the case. I have, however, benefited several cases of
anteversion and flexion, by the introduction of Chambers's
intrauterine split-stem pessary, which is the most efficient in-
strument yet invented, and the least liable to cause irrita-
tion.
FIG. 7.

2
Better than any intrauterine pessary, however, is the
simple bougie, or tent, made of dry slippery elm bark, such as
is found in the shops. They are easily made with a pen-
knife, and smoothed by means of a piece of glass or fine
sand paper. They are very easily introduced after they
have been soaked in water a few minutes; a mucilaginous.
substance oozes out of them, and in this condition they will
slip into the flexed uterus without difficulty. I usually
make them about two inches long, and of such size as
seems best suited to the cervical canal. The point should be
tapering, the outer end blunt, with a strong thread attached.
This end can also be fixed in a ball or button, so as not to
irritate the vagina, but it usually suffices to place a cotton
ball (with string attached) under the end. These bougies
are to be placed in situ every few days, and removed in six
or twelve hours, or sooner if they cause pain. The thread
attached allows them to be removed by the patient. It
requires two or three months to cure an ordinary case of
anteflexion by these tents. To cure an anteversion requires
a longer time, and the simultaneous use of one of Thomas's
anteversion pessaries. Dr. Byford, of Chicago, speaking of
the bougies, says: "The modus operandi of this instrument
UTERINE CAUSES.
75
is different from the sponge, or sea-tangle tent. It dilates
the cervical canal a little, but not forcing. It produces an
influence upon the nervous vascular condition of the mucous
membrane of the cervix which assists in removing the
pathological state. I have succeeded in curing several cases.
of sterility due to anteflexion by the use of Dr. Thomas's
latest anteversion pessary. It lifts the fundus from off the
bladder, and allows the cervix to assume its proper position.
If the cervix has not acquired a permanently bent condi-
FIG. 8.

Thomas's anteversion pessary.
tion, a cure of the sterility will result. It may be necessary,
however, to incise the cervix after the version has been
remedied."
RETROFLEXION AND VERSION OF THE UTERUS may cause
sterility.
According to Kolb, a retroflexed uterus may frequently
conceive. Still Meyer records 36 cases of retroflexion in 272
of sterility.
"Retroversion," says Dr. Simpson, "is a cause of sterility,"
as shown by impregnation taking place after the displace-
ment is rectified.
With reference to the influence of retroversion or flexion
on fecundity, West says: "Of twenty-three affected with
this displacement, four gave birth to live children after the
womb had been misplaced, one had five children in spite of
a retroversion of fifteen years. In one of the above four,
pregnancy was preceded by the replacement of the organ;
but in the other two, not only was the womb misplaced at
the time of conception, but was ascertained to continue so
after delivery. Four having given birth to living children,
miscarried after the development of symptoms of uterine
76
UTERINE CAUSES.
displacement, and in one of the number miscarriage had
twice occurred, while fourteen, having previously given birth
to one or more living children, had passed more than a year
since the commencement of the symptoms without conceiving.
In three of this number, however, though still within the
childbearing age, conception had not taken place for two
years in one instance, and for four years in the other two,
previous to the commencement of the symptoms of the mis-
placement of the womb."
My own observation goes to show that retroversion and
flexion is oftener a cause of niscarriage than sterility. I have
several patients in whom the uterus is permanently retro-
flexed; the structural changes are such that no permanent.
straightening of that orgau can be effected, yet conception.
occurs readily; but in spite of all the precautions used to
keep the womb from retroverting, miscarriage usually occurs
between the second and third month.
Treatment. I have had considerable experience in the
treatment of this form of displacement, and the result is
that the mechanical treatment of retroflexion, when we wish
to cure sterility from that cause, should consist in:
(a) The straightening of the uterus at its point of curva-
ture by means of Chambers's stem pessary or the Slippery
elm tent, allowing them to remain in the canal of the cervix
only a few hours a day; or
(b) The continuous use for several months of Dr. Albert
Smith's pessary, Dr. T. G. Thomas's improved double lever
FIG. 9.
TIEMANN-CO
FIG. 10.


Thomas's retroversion pessary..
Albert Smith's pessary.
pessary of hard rubber, or Dr. A. R. Jackson's soft rubber
pessary of the same shape as Thomas's,
framework left open at top and bottom.
but with the wire
When the uterus
UTERINE CAUSES.
77
FIG. 11.
cannot be replaced by the fingers and position alone, use the
sound,* or Whitney's elevator.
G. TIEMANN-Co
FIG. 12.
J.REYNDERS-CO
Sims's Sound.
Gardner's Elevator.
Sims's Elevator.
Simpson's Sound.
* I prefer Sims's Sound on account of its lightness, and also that it is less
liable to cause irritation. The above cuts will show the difference.
FIG. 13.
LBEYNDERS—CO
FIG. 14.

78
•
UTERINE CAUSES.
(c) The administration of those specific remedies which
have the power to remove some of the morbid conditions
upon which the flexions depend. According to many excel-
lent authorities the chief cause of flexions is inflammation
or congestion of the parenchyma of the uterus. If this con-
dition predominates in the posterior wall, retroflexion occurs,
if in the anterior, anteflexion. I believe this theory to be
true in the large majority of cases. There are medicines.
which correspond to this causative condition, the most im-
portant of which are Sepia, Murex, Belladonna, Cimicifuga,
Helonias, Lilium, Podophyllum, Æsculus, Platinum, Palladium,
and Ustilayo. If the retroflexion or version is of long stand-
ing, the aim of treatment is to remove the abnormal deposit
in the parenchyma of the uterus, and impart tone to its
weakened ligaments. This can generally be done by the ad-
ministration of Aletris, Hydrastis, Ferr. iod., Ferr. brom.,
Ignatia, Nux vomica, and the use of an appropriate pessary.
In this case the persevering use of Sitz-baths of a moder-
ately cool temperature for fifteen minutes daily will greatly
aid the other medicinal measures, as will also the use of the
electrical current.
It will often occur that a sterility will be cured by the
pessary alone if it is worn during coition. I observed this
fact many years ago, before Sims's work was published. I
have treated several ladies for retroversion, who objected to
the use of the pessary for the reason that "if it was worn
pregnancy would result;" and several have preferred to en-
dure the pain and trouble of a retroflexion than to wear a
pessary, for this same reason.
Sims relates two cases of obstinate retroversion with
sterility in which no sort of pessary could be worn except
cotton; without the cotton pessary the uterus in each was
turned back to an angle of more than 100° from a normal
line; but with this pushed snugly up into the cul-de-sac the
organ was comfortably sustained in position. Each of these
patients conceived during the time of using this support.
They were taught to apply the cotton pessary (a wad of cot-
ton-wool of the proper size, tied in the middle with a strong
thread, 8 or 10 inches long) on rising in the morning, and to
remove it on going to-bed at night.*
* Uterine Surgery, p. 286.
UTERINE CAUSES.
79
FORCIBLE AND RAPID DILATATION.-When treating of the
surgery of stricture of the cervix, I unaccountably omitted
the method recently adopted by Dr. John Ball, of Brooklyn,
N. Y. I refer to the rapid and forcible dilatation of the
cervix by means of bougies and dilators. He thus describes
his method of operating:
“First evacuate the bowels very thoroughly beforehand,
so as to prevent all effort in that direction for two or three
days. I then place the patient upon her back, with her hips
near the edge of the bed, and when she is profoundly under
the influence of an anesthetic, I commence by introducing
a three bladed self-retaining speculum,* which brings in view
the os uteri, which I seize with a double hooked tenaculum,
and draw down towards the vulva, when I introduce a metal
bougie as large as the canal will admit, followed in rapid
succession with others of larger size until I reach No. 7,
which represents the size of my dilator. I then introduce.
the dilator and stretch the cervix in every direction, until it is
enlarged sufficiently to admit a No. 20 bougie, which is all
that is generally necessary. Then I introduce a gum-elastic
uterine pessary of about that size, and retain it in position by
a stem, secured outside of the vulva, for about a week, in
which time it has done its work and is ready to be removed."
Dr. Ball says, "The operation is not only applicable to all
cases of constriction of the cervix uteri, but its crowning
glory consists in the complete and radical cure of flexions,
for which there had previously been no really satisfactory
treatment."
In cases of flexion the relief is obtained
by the straightening of the canal, which is produced by a
change of the muscular tissues of the cervix from an abnormal
to a normal condition. In the rapid dilatation of the parts,
the constricting fibres are of course lacerated to some extent,
and in healing up around the pessary must necessarily con-
form to their new relation."
Dr. Ball in his pamphlet gives several remarkable cases of
cure, illustrative of the value of this method. He says he
has never seen any dangerous symptoms result from this
operation. I certainly would advise a trial of this method,
in preference to Sims's method of incision of the cervix. He
* My improved Jackson's bivalve speculum is better.—Hale.
80
UTERINE CAUSES.
also enthusiastically recommends this operation in endocer-
vicitis and conical cervix.
LATEROFLEXION of the uterus may cause sterility in the
same manner as the before-mentioned displacements.
Inclination of the uterus to one or the other sides never
attains a high degree; the fundus is inclined either to the
right or left, whilst the vaginal portion takes the opposite.
direction.
Lateroversion is often combined with obliquity of the
uterus. This displacement may be congenital or acquired.
The latter form may be the result of metritis. I have ob-
served that it occurs some time after labor or a miscarriage,
when the woman persisted in lying all the time on one side.
It may be caused by tumors in the body of the uterus, ova-
rian tumors, or disease of the round ligaments.
Treatment. The medicines must be selected by the char-
acteristic symptoms of the case. Mechanical treatment by
pessaries is of doubtful utility. I think I benefited one case,
and partially removed the flexion, by placing between the
cervix and the vaginal wall an air-filled rubber disc pessary
of about two inches diameter. The fundus was first pushed
up as far as possible. The patient was directed to lie alto-
gether on the side opposite to that occupied by the fundus.
uteri.
PROLAPSUS UTERI.-Unless the prolapsus is attended by
other morbid alterations in the uterine tissues, and is so com-
plete as to constitute procidentia, it does not become a cause
of sterility. A partial prolapsus may, indeed, favor impreg-
nation, by allowing the spermatozoa a more ready entrance.
Whenever the cervix uteri passes through the mouth of
the vagina we call it a procidentia, whether it be to a slight
or a great extent. A procidentia may be complete or incom-
plete; complete, when the vagina is inverted and protruded
externally; incomplete, when the cervix uteri alone projects
between the labia for an inch or two, and remains thus sta-
tionary for a long time; usually it goes from bad to worse,
till it eventually passes entirely through the vulva, forming
a tumor of great size, which, at its most depending part,
presents the os tincæ often ulcerated and bleeding. Some-
UTERINE CAUSES.
81
times the whole body of the uterus protrudes from the
vagina; at others, the cervix, greatly hypertrophied and
elongated, is the protruding portion.
Treatment.*—The medicinal treatment of prolapsus con-
sists in the administration of those remedies which will re-
move the pathological condition upon which it depends.
This is generally chronic congestion of the uterus, and, unless
of too long continuance, will yield to Aurum, Belladonna,
Sepia, Nux vomica, Platinum, Murex, Lilium, Cimicifuga,
Aquaphobin, Ustilago, Secale, Podophyllum, Esculus, and
Helonias.
No remedy or support will be of value unless the woman
dress properly. The use of tight corsets and heavy skirts
must be abandoned, for the pressure on the abdomen will
prevent any remedial measures from effecting a cure. The
internal support which I prefer to all others is the soft
rubber elastic pessary of Dr. Jackson, in which the copper
wire which is inside the rubber is open at the top and bot-
tom from half an inch to an inch, the widest opening to be
placed upward. It should be bent or moulded by the fin-
gers into a shape approximating the retroversion pessary of
Thomas or Hewitt: when in the vagina it opens of its own
accord, and the top, in which the wire is left out for an inch,
passes up behind the cervix, and affords a soft, elastic spring
for the fundus to rest upon, and also allows
the free passage of faces along the rectum.
The next best is the ordinary elastic ring,
or oval pessary, which has been in use for
many years.
FIG. 15.

Elastic Ring Pessary.
In providentia it is evident that no me-
dicinal means are of any value, unless the uterus can be re-
placed by pressure, and kept in position by simple mechanical
appliances.
In complete procidentia surgical treatment should be re-
sorted to. If the cervix is enlarged and elongated, the
operation of amputation is quite successful.
Dr. A. K. Gardner reports several cases, in one of which
the amputated cervix weighed nine ounces, two drachms
* An excellent monograph on the medicinal treatment of prolapsus uteri
has lately appeared from the pen of Dr. Eggert, of Indianapolis, Indiana.
82
UTERINE CAUSES.
and one scruple, "the largest on record as having been re-
moved during life." He says: "The organ drew up far
into the vagina after the portion was removed.”*
Dr. Sims says: "I amputate the cervix only when its
lower segment is too large and too long, and projects so far
into the vagina as to present a mechanical obstacle to the
retention of the uterus in situ when replaced."
This operation may cure a sterility by allowing a fruitful
coition, which is next to impossible when the cervix is hyper-
trophied, elongated, and protruding.
The so-called prolapsus uteri, without sinking of the fundus,
to which Virchow has called attention, may act as a cause
of sterility.
In this variety there is complete inversion of the vagina,
with the external orifice of the uterus situated at its extreme
end. The enormous elongation of the uterus affects chiefly
the cervix, the substance of which becomes dense and vas-
cular. In this condition of hypertrophy and elongation of
the cervix, the uterine cavity is sometimes narrowed, or
atresia of the internal orifice may be found.
The indications for treatment, aside from the elevation
of the uterus by mechanical supports, are to dilate the in-
ternal orifice by bougies or an operation, after which concep-
tion will readily occur if no other obstacle is present.
Dr. Sims's operation for the cure of complete procidentia
uteri consists in removing a portion of the anterior wall of the
vagina, bringing the edges together, and fastening them by
metallic sutures. This simple operation seems to prevent the
return of the uterus to its abnormal position.
For a com-
plete history of this successful operation see Sims's Uterine
Surgery. It seems evident that this operation is vastly
superior to the perineal operation as performed by Mr. Baker
Brown, Dr. Savage, and others.
In cases where this or any operation is objected to, we
may do something to alleviate the condition of the patient,
and, perhaps, bring the uterus into such a position as to be
capable of being impregnated. Dr. Sims says that in such
cases no pessary, except Zwang's, is of the slightest value;
while the best support is simply a large tampon of cotton,
Uterine Surgery, p. 294.
* Amputation of the Cervix Uteri.
UTERINE CAUSES.
83
wet with glycerin, which may be introduced in the morning,
to be worn all day.
It must be remembered that impregnation will occur
whenever the seminal fluid is brought in contact with the
cavity of the uterus, if the connection between that organ
and the ovaries is not disturbed. If the uterus is so far pro-
truding that the ovule cannot pass from the ovary into its
cavity, conception cannot take place, even if the semen is
thrown into its cavity.
ELEVATION OF THE UTERUS-This displacement, together
with its attending organic changes, may cause sterility.
By elevation of the uterus is meant a displacement of the
entire organ upward. The fundus ascends into the peritoneal
cavity, both peritoneal cavities thereby becoming shallow,
and the fornix of the vagina being so stretched as to cause
it to become cone-shaped. At the same time, the vaginal
portion disappears more or less, leaving merely a button-
shaped rudiment. (Rokitansky.)
The causes of elevation of the uterus lie either within or
are external to the organ itself. The causes that originate
in the organ itself are: an increase in volume of body and
fundus, unless the latter has been previously bound down by
adhesions in the pelvic cavity, in consequence of which, as-
cent of the uterus would be hindered; distension of the
uterine cavity by mucus or blood; formation of fibrous
tumors, etc.
To the class of external causes belong tumors of the broad
ligaments or ovaries, adhesions formed during pregnancy or
the puerperal state, previous to complete involution; also,
vascular tumors of the vagina, tumors of the pelvis, etc.
Slight degrees of elevation are found combined with flexions,
and always with anteflexions.
The effect of the elevation of the uterus, especially when
produced by other causes than tumors pressing from below,
is elongation of the organ, chiefly of the cervix, to sometimes
twice or thrice its normal length; this elongation being gen-
erally accompanied with diminution of its cavity and thinning
of its walls. The diminution of the uterine cavity by longitu-
dinal traction, is always more considerable near the internal
84
UTERINE CAUSES.
orifice. Even complete occlusion of the canal may take place.
In isolated cases, an obliteration of the canal at the above
point occurs in consequence of rupture of so-called Nabothian
glands, from the ruptured walls of which connective tissue
is produced, which ultimately leads to complete atresia of
the canal by agglutination. (Kolb.)
Mere elevation of the uterus will not cause sterility, for the
spermatozoa find no obstacle in distance, if the mucous mem-
brane is healthy and the cervical canal open. But if occlusion
or atresia occur with the elevation, sterility surely results.
Treatment. The removal of the causes of the elevation by
medicinal or surgical means constitute the indications for
treatment. If occlusion or atresia is present, the canal
should be opened by the operation recommended and prac-
ticed by Sims. After this is done, conception will occur as
readily as if the uterus was low in the pelvis. If large tumors
of the pelvis or uterus caused the elevation, their removal
by medicinal and surgical treatment should be attempted.
If this is impossible, and the tumors are so large as to offer
a probable impediment to childbirth, it is proper to advise
the avoidance of pregnancy, or the operation referred to,
unless a retention of the menses, or a dysmenorrhoea, render
it necessary.
INVERSION OF THE UTERUS.-This dangerous and infre-
quent form of displacement consists in the turning of the
uterus inside out. As the bottom of a bag may be pushed
through its mouth so that the inner surface becomes the
outer, so may that of the uterus. Inversion may be partial
and complete; partial, when the body has become depressed,
but has not passed through the os; complete, when the
uterus has been completely turned inside out, and the inverted
fundus and body hang in the vagina or between the thighs.
Inversion of the uterus generally occurs shortly after labor,
when the uterine tissues are relaxed. At such a time, undue
traction on the cord, to expedite the birth of the placenta,
coughing, sneezing, change of posture, straining at stool, etc.,
may cause the accident.
It is possible that inversion may occur at other times; and
UTERINE CAUSES.
85
3
there is evidence on record that a non-pregnant and undilated
uterus may become inverted.*
As this displacement may become chronic, it should be
placed among the causes of sterility, although Gardner does
not mention it. Chronic inversion may continue for many
years, giving very little annoyance; or it may render the life
of the patient miserable, on account of hæmorrhage and other
attending symptoms, and nevertheless last for years.
DIAGNOSIS.-Inversion may be mistaken for a polypus or
a fibroid tumor. For accurate differentiation of this dis-
placement from tumors, reference is made to Thomas, Sims,
Guernsey, Lee, and other authorities:
Treatment.—There are three plans of treatment:
1. To return the uterus to its place.
2. To leave it displaced, and adopt means preventive of
hæmorrhage.
3. To remove it by amputation.
For the cure of sterility depending on this displacement,
the first plan is the only one to be adopted.
In chronic cases, the second and third plans were consid-
ered the only means possible; but it has been demonstrated
by Dr. Tyler Smith, of London, and Dr. White, of Buffalo,
that even after the continuance of inversion for ten or fifteen
years, reduction is possible. Since these successful attempts,
the operation has been performed by Sinis, Thomas, and
many other obstetric surgeons.
The diagnosis having been clearly made, and reduction
determined upon, the bowels and bladder should be emptied,
and the patient put under the influence of an anesthetic, and
laid on her back on a strong table. The operator should
always be attended by three or four reliable counsellors, upon
whom he may call, not only for advice but physical aid.
Having thoroughly oiled one hand, the nails of which have
been pared, he should now slowly dilate the vagina so as to
introduce it, and grasp in its palm the entire tumor. The
other hand should be laid upon the abdomen, so as to press
just over the ring which marks the non-inverted cervix, and
* See Thomas's Diseases of Women, p. 339.
86
UTERINE CAUSES.
oppose the force exerted through the vagina, so as to pre-
vent too great stretching of this canal. In some cases, a
conical boxwood plug has been used.* For other methods
of reducing obstinate inversion, consult the authorities above
named.
After the reduction is effected, the patient should remain
in bed, with the hips elevated, for a week or more, and the
remedies indicated by the symptoms should be administered.
(Consult―Aletris, Belladonna, Caulophyllin, Cimicifuga,
Conium, Ferrum, Helonine, Ignatia, Mercurius, Nux vom.,
Podophyllin, Ustilago, Lilium, and Sepia.)
TUMORS OF THE UTERUS.-Sterility may be caused by any
of the varieties of abnormal growths known as tumors of the
uterus. The most common are the polypi, and those de-
nominated fibrous. They prevent conception, either by
blocking up the canal of the cervix, the cavity of the uterus,
or the orifices of the Fallopian tubes.
POLYPI.-Dr. Simst describes the location and character
of these polypi as follows:
1st. Those growing from or about the os tincæ.
2d. Those growing in the canal of the cervix.
3d. Those growing in the cavity of the uterus.
The first may be fibro-cellular or mucous.
almost always mucous. The third are almost always fibrous.
The second are
FIBROUS.—The uterus is particularly prone to the develop-
ment of fibroid tumors. They frequently prevent conception,
even when located in the parenchyma of the womb, but not
necessarily so. They are classed according to the manner of
their attachment to the walls of the uterus, as extrauterine,
intrauterine, and intramural.
EXTRAUTERINE fibroids, grow from any portion of the
external surface of the uterus, and may be pedunculated, or
they may be sessile, with a broad, immovable attachment to
its outer muscular tissue.
* See Thomas's Diseases of Women, p. 345.
Uterine Surgery, p. 67.
UTERINE CAUSES.
87
The INTRAUTERINE project into the cavity of the womb,
and, like the first, may be pedunculated or sessile.
The INTRAMURAL are so called because they are imbedded
in the walls of the uterus, being interlaced and overlapped
in all directions by its muscular fibres.
By reference to the statistics it will be seen that fibroid
tumors of the uterus were the cause of sterility in 95 out of
505 cases.
Treatment.—The surgical treatment of all polypi may be
summed up as follows: (a) Excision. (b) Torsion. (c) Liga-
ture. (d) Ecrasement. (e) Pressure by the sponge-tent.
Small polypi may be excised by the knife or scissors, if the
pedicle can be reached; but large growths are apt to bleed
profusely, and even dangerously, after the operation.
Dr. Sims, however, regards the hemorrhage as easily
managed by the use of perchloride or persulphate of iron.
Small, and even large tumors, may be twisted off with the
forceps, and the danger from bleeding is less than when
excision has been resorted to. In intrauterine polypi, when
it is necessary to expel them through the os, Ergot is gen-
erally used. If this agent fails, I can favorably recommend
the introduction of Slippery eim bougies, between the tumor
and the uterine walls, for that purpose.
(In a case occurring in my own practice, a small mucous
polypi, attached to the canal of the cervix, near the os ex-
ternum, was removed by one application of the solid nitrate
to the pedicle).*
The ligature, once so popular, is now rarely employed.
Ecrasement constitutes the safest and most expeditious of
all the operations.
Dr. Simpson has used the sponge-tent with singular suc-
cess in the treatment of polypi.
For minute directions for operating on polypi, refer to
Sims's Uterine Surgery, Thomas on Diseases of Women,
Baker Brown on Surgical Diseases of Women, and Franklin's
and Helmuth's works on Surgery. No homoeopathic physi-
cian should neglect to place these valuable surgical works
* See United States Medical and Surgical Journal, vol. ii, p. 235.
88
UTERINE CAUSES.
in his library, for cases may arise where his reputation and
that of our school in the locality of his practice may depend
on his successful surgical treatment of uterine tumors.
The medicinal treatment of polypi is not mentioned in
allopathic works, because no medicines are believed by them
to exert any curative action on such tumors.
"The cure of polypus by medicinal agency," says Leadam,*
"cannot be accomplished by the old school of medicine;
... but homoeopathy has rendered results which prove
the curative power of its remedies."
Staphisagria and Calcarea are those which have been recom-
mended principally to remove the state of dyscrasia upon
which the formation of polypi depends. The remedies which
are pointed out by Jahr† are too numerous to be quoted.
Guernsey‡ gives the characteristic indications in his peculiar
manner for the following medicines: Aurum, Cale. carb.,
Conium, Lyc., Mercurius, Mezereum, Nitric acid, Petroleum,
Phosphorus, Phosphoric acid, Platina, Pulsatilla, Silicia, Sta-
phisagria, Teucrium, and Thuja.
These remedies are also recommended for all varieties of
tumors; but as the indications are mainly theoretical, but
few clinical cases having verified them, we may consider
their value in polypi, or fibroid tumors, as quite problemat-
ical.
The surgical treatment of fibroid tumors is thus summed
up by Thomas, who seems to have consulted almost every
surgical work:
(a) Absorption. (b) Excision. (c) Ecrasement. (d) Enu-
cleation. (e) Sloughing. (f) Gastrotomy. Thomas doubts
if their absorption can be excited by any medicine (allo-
pathic). Scanzoni says he does not know of a single case
where medicines caused a complete cure. Sims believes that
pressure, by means of sponge-tent or sea-tangle, may cause
absorption. The treatment by excision or the ecraseur
is fully described by the last-named author. Enucleation
has been successfully practiced by Amussat, Atlee, West,
* Diseases of Women, p. 274.
Obstetrics, p. 99.
† Ibid., p. 224.
2 Diseases of Women, p. 407.
UTERINE CAUSES.
89
Ludlam, Danforth, Adams, Helmuth, Franklin, Beckwith,
and others. Sloughing, once recommended by Dr. Baker
Brown, has been abandoned. Gastrotomy, or removal of the
tumors, and with them the uterus, is a rare and dangerous
operation. According to Dr. H. R. Storer, who has written
the history of such operations, there have been 21 opera-
tions, with 18 deaths. The medicinal treatment of fibroids
is not very satisfactory. In allopathic practice, Dr. Chan-
ning, of Boston, claims to have cured many by internal medi-
cation. Dr. Simpson seems to have great faith in the long-
continued use of bromide of potassium. Dr. Sims says he has
never seen the slightest effect produced on such tumors by
internal medication. In homoeopathic practice no clinical
experience has yet been published showing the effects of our
remedies in this disease. Guernsey recommends the same
medicines as for polypi. I have a case of intramural fibroid
tumor which appears to have slightly diminished in size
under the use of iodide of arsenic 3d, continued for two
months. I would suggest the protracted use of hydrastis and
turpentine. Within a few years the therapeutic measures for
the treatment of uterine fibroids have been greatly increased
by the discovery of the curative power of the persistent use
of ergot. It has been found that, in a large proportion of
cases, the tumors decreased under its use, and in many cases
they nearly or altogether disappeared.
ERGOT, to be of value in such tumors, must be administered.
in large doses, large enough to institute and keep up its pri-
mary action, viz., a contraction of the uterine arteries and the
uterine muscular fibres. By this action it cuts off the nutri-
tion of these tumors, and they cease to grow, or shrivel away..
because they are no longer fed by the blood.
The Bromides undoubtedly act in the same manner. Also
Ustilago, which is a very near relation of ergot. If either
Ergot or Ustilago is given by the mouth, the dose must be
from 15 to 60 drops three times a day. But sometimes the
stomach will not tolerate ergot, and it must be administered
by hypodermic injection. From 10 to 30 drops of Squibb's
aqueous extract, or an aqueous solution of ergotin, is injected
into the cellular tissues of the abdomen or thigh, once a
day. Hildebrand injected about 3 grains at one injection,
7
90
UTERINE CAUSES.
daily, of the aqueous ext. His formula was, 3 parts aqueous
ext. Ergot, 7½ of Glycerin, 7½ of Water. Ustilago might be
used in the same manner, and in the same doses, if we had
an aqueous extract.
The Iodide of barium is a powerful remedy against abnor-
mal growths, and may become useful in removing uterine
fibroids. The continuous current from a powerful galvanic
battery of 20 to 60 cells has been found effectual.
Diet in the Treatment of Uterine Fibroids.—In a recent
number of the American Journal of Obstetrics (October, 1877),
Dr. E. Cutter has a very interesting paper on the treatment
of uterine fibroids by means of a peculiar diet. He says he
got the idea from Dr. Salisbury, of Cleveland, who regards
these growths as generally due to excess of carbohydrates,
starches and sugar, fermentable food, in the diet; that they are
usually caused by disorders of nutrition, and that by feed-
ing patients on a diet composed of animal food, the condition
which was most active in bringing on the diseased condition
is removed, and the system is enabled to right itself by its
own recuperative power. Dr. Cutter reports eight cases in
which women with uterine fibroids were placed on such diet;
all were greatly improved and some were cured. The follow-
ing were the articles permitted and prohibited:
PERMITTED.
Beef in all forms.
Tripe, veal.
Calves' foot and head.
Pork, fresh, salt and cured.
Sausages and ham.
Mutton.
All kinds of game.
Milk, butter, eggs.
Cheese, cream.
Vegetables, without or with
little starch.
Fish, fresh and salt.
PROHIBITED.
Starches and sugars.
Common white flour, in all
and every form.
Bread, biscuits, crackers.
Cakes, doughnuts, puddings.
Rice.
Potatoes in any shape.
Sugar, candy.
Corn-starch, arrowroot, etc.
If the strict diet becomes very repulsive, a mixed diet can
be allowed for a short time, of whole wheat, Graham bread,
oat-meal, rye-meal, and corn-meal.
UTERINE CAUSES.
91
INFLAMMATION OF THE UTERUS.-Acute and chronic inflam-
mation of the uterus usually result in sterility; not only by
the changes produced in the density of the tissues affected,
but in the changes effected in the secretions from the dis-
eased surfaces.
The inflammatory affections of the uterus causing sterility
are:
(1.) Endometritis (inflammation of the lining membrane of
the uterus). (2.) Endocervicitis (inflammation of the lining
membrane of the cervix).
ENDOMETRITIS has been described under the names of
uterine catarrh, uterine leucorrhoea, and internal metritis.
Its location extends from the os internum to all portions of the
uterine cavity, or fundus. (A variety has been described by Dr.
Routh, as fundal endometritis. In this variety, the inflam-
mation is located in the fundus, occupying only a small
spot.)
As endometritis is a frequent cause of sterility, it will be
well to devote a space to its consideration. Its chief symp-
toms are: (a) Leucorrhoea. (b) Menstrual disorders. (c) Pain
in back, groins, and hypogastrium. (d) Nervous disorders. (e)
Tympanites. (f) Symptoms of pregnancy. (g) Sterility.
Treatment.--No mention is specially made of endometritis
by Marcy and Hunt, Leadam, Gollman, or Mintern. Jahr*
treats of it in his own peculiar manner. Ludlam and Guern-
sey† give the only good description we have in any work in
our school. Jahr's remedies are: Alumina, Calcarea, Kreoso-
tum, Mercurius, Pulsatilla, Sepia, etc., for which he gives the
symptomatic indications. Guernsey gives the characteristic
or key symptoms of seventy-two remedies, among which,
Arsenicum, Bovista, Calcarea, Conium, Graphites, Lachesis,
Kali bi., Kali hyd., Mercurius, Muriatic acid, Nitric acid,
Platina, Podophyllum, Pulsatilla, Sabina, Sepia, Sulphur, and
Zine, are the most useful, and especially adapted to the chronic
form of the disease.
In addition to the above medicines, I have found Cimici
* Diseases of Women.
† Obstetrics, p. 128.
Y
92
UTERINE CAUSES.
fuga, Gelsemium, Hamamelis, Helonias, Hydrastis, Myrica,
Lilium, Phytolacca, Senecio, Trillium, and Xanthoxylum, use-
ful in some cases.
CIMICIFUGA is especially indicated for the nervous symp-
toms accompanying the disease, also when the pains in back,
loins, etc., are present.
GELSEMINUM is superior to all others in the acute or sub-
acute stage.
HAMAMELIS when the discharge is "rusty," or the menses
continue nearly through the month; (also Trillium, Erigeron,
and Senecio.)
HELONIAS for chronic albuminous leucorrhoea (uterine),
with great debility.
MYRICA when the discharges are offensive, bloody, and
corrosive; (also Arsen. iod)
PHYTOLACCA for nearly the same symptons, especially if
syphilis is present.
HYDRASTIS if the discharge is ropy, thick, yellow and
tenacious, with great debility. There are many points of
resemblance between these and the older remedies, which
may be studied to advantage.
I believe I have cured cases of sterility from endometritis
by means of the persevering use of Calcarea, Conium, Mer-
curius, Nitric acid, Sabina, and Sepia; also Cimicifuga, He-
lonias, Lilium, Phytolacca, and Hydrastis. Some of these
remedies I have used topically, by injecting a solution into
the cavity of the womb. One case, in particular, is worthy
of mention: A lady who had borne one child, had been
sterile seven years. She had the most profuse, thick, tena-
cious leucorrhoea I have ever seen. The vagina was also af
fected with chronic inflammation, and the os abraded. The
two latter were cured; the former by injections of Hydrastis,
the latter by a few applications of Nitrate of silver. The
uterine discharge, however, still continued; a thick rope of
mucus constantly hung from the os. With a small syringe,
having a long, slender tube, I injected, once a week, 3ij of a
solution of Muriate of hydrastia* into the cavity of the
* R. Muriate of hydrastia, gr. v; Glycerin, ss.; Water, iss.
UTERINE CAUSES.
93
uterus (the cervical canal allowing its return). After six
injections she became pregnant, and went her full time.
Molesworth's is the safest and best intrauterine syringe,
for it allows the fluid to return from the cavity.
FIG. 16.

Molesworth's double canula and bulb syringe.
Another instrument, quite as safe, but less convenient per-
haps, is Nott's double canula catheter, through which the
medicated injection is thrown by an ordinary syringe. The
arrows denote the course of the current.
FIG. 17.

G. TIEMANN & CO.
Nott's double canula catheters-two sizes.
The remarks of Sims on the surgical treatment of this
disease are so important that I quote them: "The first
great principle to guide us is that of insuring a very free
exit from the cavity of the uterus for the secretions therein
generated. The second is that of appropriate local applica-
tions to this cavity, for the purpose of modifying or healing,
as it were, the diseased surfaces. When the canal of the
cervix is contracted, I have freely divided it, as in cases
of dysmenorrhoea dependent upon mechanical obstruction,
and this with great relief. The uterine secretions must not
remain pent up in its cavity. With a patulous cervix, one
may use medicated injections, etc." For intrauterine appli-
cations, use small cotton tampons, to which a string is at-
tached, medicated with one of the following preparations,
94
UTERINE CAUSES.
and applied by means of my intrauterine applicator, or
Wylie's cervical protector.
FIG. 18.

SHEPARD-DUDLEY, NY.
In using Wylie's instrument, wrap cotton
around the rod, medicate it, and insert it
into the tube, which has been passed into
and through the cervical canal. Push the
rod up to the fundus and move it from side
to side a few times, then withdraw both
rod and tube.
For these intrauterine applications I have
found the following the most efficacious:
Merrill's fluid hydrastis, 3j to Glycerin Zj.
Sulphate of hydrastia,
gr. x
Muriate of
(
gr. v
Tinc. calendula,
"
thuja,
""
((
grindelia,
cubebs,
copaiva,
Carbolic acid,
Kali bich.,
(6
((
zij
gr. v
OG ON ON ON ON EN EN.
"
"
แ
แ
པ
เ
"
((
པ
པ༷
แ
(6
(C
Wylie's cervical protector.
My applicator can be used in the same manner, and is a
much cheaper and more convenient instrument. (See page
102.)
Dr. Sims has met with several cases of fundal endome-
UTERINE CAUSES.
95
tritis, and thus gives its diagnosis: "Place the patient in the
left lateral semi-prone position; introduce the speculum;
hook a tenaculum slightly into the anterior lip of the os
tincæ; draw this gently forwards, pulling the os open, so as
to be able to look right into it; then pass the sound, previ-
ously warmed, gently along the cervix, using no force what-
ever, but almost letting it go by its own gravity, as it were,
to the fundus. This is attended by no pain whatever till the
sensation point be reached, when it produces the most intense
agony a pain that does not cease sometimes for hours after
the experiment."
In this disease there is little or no discharge, but generally
pain in one or the other hip, generally the left, in the in-
guinal region, groin, ovary, and even mammary region.
Dr. Sims relates one very severe case, which he cured in a
few weeks, by dilating the cervix, and simply injecting into
the cavity of the uterus a few drops of glycerin, twice or
three times a week. In the course of a year, this patient
became a mother, and has had three children since.
In another similar case, he says: "A single sponge-tent,
followed by the injection of half a drachm of the officinal
tincture of iodine produced almost complete relief at once.
A repetition of the same, ten or twelve days afterwards,
produced a perfect cure." Medicated injections into the
cavity of the uterus are not always safe, even if the cervical
canal is dilated.
There are four other methods of applying medicinal sub-
stances to the internal cavity of the uterus (the endome-
trium), which are preferable to the use of injections, namely:
(a) The brush or swab. The brush is made of pig's bristles,
and should be not over one-fourth inch in diameter. The
swab is simply a bit of "absorbent cotton-wool," or clean,
white cotton-wool, wound around the end of a flat probe or
applicator to the length of one or two inches, and one-quarter
or one-eighth inch thick. The cervix should be previously
dilated. When the brush or swab is used it should be passed
quickly up to the fundus uteri, and moved from side to side
or rotated, so as to bring it in contact with the whole surface
of the cavity.
(b) The cloth-tent, first introduced by Dr. Taliaferro, of
96
UTERINE CAUSES.
Columbus, Georgia, and into our school by Dr. E. W. Beebe,
of Wisconsin,* although they have been used for centuries,
even by Hippocrates. The following is the method of their
manufacture, as described by Dr. C. Leonard:
"To make one, you need but a strip of linen, six inches in
length by three-quarters of an inch in width, a piece of hair
wire four inches long, and a few inches of common thread.
Roll one corner of the linen strip lightly between the thumb
and finger, then unroll and place the centre of the wire at
the corner so rolled, and then roll the cloth at this corner
over it (spirally, just as you would go to work to make a
paper lamp-lighter), till you get almost to the other corner of
the same end, then bend the wire upon itself (double it, in
other words), so that the two extremities will point to the
unwound portion of the linen; this done, continue rolling
the linen, in a spiral manner, about the doubled wire till
exhausted, then tie with the thread the last spiral turn about
the wire. You now have a tent about two and a half inches
in length, and one sufficiently firm to enter any normal uterine
canal, and almost any abnormal one. You can bend it to
any curve you choose to facilitate its introduction.
"It has still another advantage over all other tents, in that
you can leave it in situ (as I frequently do, for twenty-four
hours) with no danger to your patient, as it is inexpansible,
and hence no excitor of metritis, though a stimulator (from
its very slight mechanical irritation) to the endometrium.
By so doing you can get a prolonged action of a medicament
upon the lining membrane of the uterus, which is impossible
to get by any other method of application. Further, you
need not use such energetic local applications, and you may
be sure that they reach the whole uterine cavity; something
you cannot do with our intrauterine applicators, unless you
are a very skilful manipulator. The shape of the fundus
cavity is au anatomical proof of the great difficulty of making
a complete application with the common metal applicators;
whereas the cloth-tent, by meeting with resistance at the
fundus, immediately doubles upon itself, thus occupying the
whole cavity.
* American Homeopathist, November, 1877 (Dr. E. W. Beebe).
UTERINE CAUSES.
97
"You can make them of any size, and of any degree of
stiffness, by increasing the thickness of cloth, and the size
or number of doublings of your wire. I have them of all
sizes, from those suitable for an ante-puberal uterus to one
as large as your index finger.
"I use them now for cleansing the uterine tract previous
to an application of astringents or other medicaments thereto,
and find they clean away the tenacious mucus much better
than a syringe or a wisp of cotton on Emmet's applicator.
Indeed, it is invaluable in many ways. By leaving the thread
without the vulva, the patient can as easily and safely re-
move it at her residence as can her physician. You have
only to remember to tie a string (or a colored thread) to the
cotton pledget you leave in the vagina, so that she may be
made aware which to remove (pull) first.”
Dr. E. W. Beebe claims for them substantially the same
advantages as those above mentioned. I have frequently
used them, made extempore, without the wire, when the
cervical canal is open enough to permit their introduction,
or after I have dilated the passage by means of laminaria
tents.
(c) Packing.—This method has been used by many gynæ-
cologists and by myself for years. It has lately been highly
recommended by Dr. Carr,* of Galesburg, Ill. It consists of
taking narrow strips of clean white linen or cotton, one-
quarter inch by six or ten inches long. Saturate this in the
medicinal solution, and folding one end over an applicator,
push it gently up to the fundus; then, withdrawing the appli-
cator or probe, push up another portion, and so on until only
a short portion is left hanging in the vagina. It can be
removed in a few hours.
(d) Slippery elm bougies, made of the proper size, and
soaked in the appropriate medicinal solution, or powdered
over with the drug.
In all cases the drug selected should be that one which
corresponds in its topical action to the diseased condition of
the mucous membrane. This method is as strictly according
to the law of similia as if the drug was given internally by
* American Homeopathist, February, 1878.
98
UTERINE CAUSES.
the mouth. The curative action exerted by these local
applications is "homeopathic," "alterative," or "substi-
tutive," as we prefer to call it.
The following are the most useful agents for the above
methods:
Comp. tine. iodine, Tinc. ferr. mur, Conc. sol. carbolic
acid, Ext. pinus canadensis, Nitric acid, Chromic acid, and
all those mentioned in the list given above.
Those mentioned in both lists, all but nitric and chromic
acids, can, in old, intractable cases, be used diluted one-half
glycerin. Nitric and chromic acids should be diluted one-
half with pure water.
The bougies should be introduced up to the fundus (first di-
lating the cervix with a sponge or laminaria tent if necessary),
and allowed to remain there three or six, and even twelve.
hours, if they can be borne. If they cause continued pain, the
patient should be told to remove them. They should be
repeated every four or six days. It rarely requires more than
two or three months to cure the most obstinate case, and
conception can occur as soon as the mucous membrane is
restored to a healthy condition. If the medicated bougie can
not be borne, suppositories niedicated with the same reme-
dies act well; they soon melt, and cause little or no irrita-
tion.
I have been successful with medicated suppositories, after
the plan of Simpson and Sims. These are an inch and a
quarter long, and small enough to pass along the cervix,
and medicated with various remedies, so as to bring these
into permanent contact with the diseased surface. I know
that suppositories medicated with Conium, Calendula, Hy-
drastis, Iodine, Sanguinaria, Iodoform, Carbolic acid, Tannin,
etc., act very favorably in cervical induration or hypertrophy.
The best forceps to use in introducing these suppositories
into the cervical canal, or dressings to the os, is Bozeman's.
Suppositories, for intrauterine use, are made of cocoa-but-
ter, with which are incorporated certain medicinal agents.
The chief objection to their use is that they are very brittle
and difficult of introduction, unless the cervical canal is open
and straight. I have lately been using flexible bougies made
of gelatin, which melt in the uterine cavity in an hour or
UTERINE CAUSES.
99
two, and are much easier of introduction.* My favorite
formula for the suppositories or bougies are, to each one,
SHEPARD & DUNLEY-
FIG. 19,

Bozeman's dressing forceps.
one-eighth inch thick and two inches long, Carbolic acid,
one grain; or Muriate of hydrastia, two grains; or Iodo-
form, two grains; or solidified Copaiva, two grains. These
are pushed up with dressing forceps, and a cotton tampon
placed against the os to prevent their extrusion.
ENDOCERVICITIS is known to us by the synonyms of cer-
vical catarrh and cervical leucorrhoea. It is a chronic inflam-
mation of the mucous membrane, extending from the os
internum to the os externum, and over the vaginal portion
of the cervix uteri.
Dr. Sims (Uterine Surgery) gives the following reasons
why cervical leucorrhea is a cause of sterility:
"It is almost always of albuminous consistence, and very
difficult of removal. Under the microscope it presents all
the characteristics of muco-pus. Sometimes it is merely an
exaggerated secretion, without any abnormal qualities. It
interferes with conception in two ways, mechanically and chemi-
cally: mechanically, by blocking up the canal of the cervix, and
preventing the passage of the spermatozoa; chemically, by poi-
soning or killing them. I have frequently seen conception.
happen while using the nitrate of silver for granular erosion
of the os and cervix uteri. Unless there is some special
reason for it, I never interdict sexual congress during the
treatment of ordinary cases of cervical engorgement. When
conception has taken place under these circumstances, I am
*They can be ordered of A. Arend, 179 Madison Street, Chicago.
UorM
100
UTERINE CAUSES.
satisfied that sexual intercourse must have occurred within
ten or twelve hours after the use of the remedy, or at least
before its eschar began to separate, which is always attended
with a secretion of muco-pus, that would be fatal to the
spermatozoa.
"If I were asked what, next to mere mechanical obstruc-
tion of the cervix uteri, constitutes the greatest obstacle to
conception, I have no hesitation in saying that it was an
abnormal secretion from the cervix. We often see the cer-
vical mucus in such large quantities that its mere abundance
will mechanically prevent the passage of the semen to the
cavity of the uterus. Sir Joseph Oliffe has informed me of
the case of the wife of a medical man, who had been sterile
for many years, and whose cervix uteri had always presented
a little mass of ropy mucus hanging from the os, that ob-
structed mechanically the canal. At last the doctor had the
rational surgical idea to exhaust the cervix of its inspissated
mucus; and sexual congress with his wife, immediately
afterwards, was followed by conception.
"I am now satisfied that the cervical secretion is often
poisonous to the spermatozoa, even when it would seem to
be almost normal in appearance. This must depend upon.
some other quality than mere alkalinity, for I have often
found all the spermatozoa in the cervical mucus dead, while
it manifested no unusual degree of alkalinity when tested
by litmus-paper; but when placed under the microscope, it
showed an uncommon number of epithelial scales. This
demonstrated an abnormal action in the glandular apparatus,
that gave rise to this secretion, which seemed to kill the
spermatozoa more by its density than by its chemical action;
for I have noticed that they lived longer in that portion of
the mucus that had the fewest number of epithelial scales,
and, vice versa, died quicker in that portion that had the
most, and that, too, when litmus-paper showed no difference
in the chemical character of the two."
Professor Meigs, of Philadelphia, adds his testimony to
the effect of cervical leucorrhoea in preventing conception.
That author observes* that some cases of sterility are caused
* On Diseases of the Uterus, p. 56.
UTERINE CAUSES.
101
by a plug of viscid lymph filling the canal of the cervix, so
obstructing the passage as to render it apparently impossible
that any spermatozoa could obtain access to the uterine
cavity. "Certain it is," he says, "that some sterile women
are always affected with this excessive albuminous produc-
tion. Surprise has often been expressed on observing that
married women, after years of sterile cohabitation, have sud-
denly become fruitful. In these instances, the want of
fruitfulness could not depend on failure of the ovulations.
May it not be that the spontaneous cure of a protracted and
subacute inflammation, of the kind herein treated of, may
have restored the health, and so given power to take away
the woman's reproach ?"
Treatment: Guernsey gives the characteristic indications
for seventy-two remedies, the same as recommended in uter-
ine catarrh.
I have found most useful the medicines which were men-
tioned in endometritis. I have also used topical applica-
tions of some of the remedies to the canal of the cervix, with
Sims's applicator, or my intrauterine and cervical applicator;
FIG. 20.

Sims's cervical applicator with cotton attached by a thread.
or placed them in apposition to the os uteri, and with the
effect of hastening the curative process. I adopted this plan
several years ago, and I am every year better satisfied with
its usefulness. It has been thought, and is still believed by
many of our school, that topical applications to the cervix,
by any method, could be productive of but little benefit.
But no one who has tested them thoroughly can doubt their
efficacy. Remedies thus applied act by osmosis, and produce.
not only a local but in some cases a constitutional effect.
Dr. W. H. Holcombe, one of the most logical thinkers of
our school, believes in this method of applying properly
chosen remedies.*
*Nature and Limitations of the Homoeopathic Law.
102
UTERINE CAUSES.
My applicator, as figured in the cut, is made of hard
rubber, with a whalebone rod, ten inches long. The tube,
c d, is the size of a No. 7 catheter (Eng.), which carries
the rod a b, extending two and a half inches beyond its
FIG. 21.

d
a
0000000
Hale's cervical and intrauterine applicator.
extremity, represented by the space d b. The rod is flat-
tened from d b, and terminates in a rounded blunt end. In
using it the cotton is wrapped around the exposed portion
of the rod, with a strong thread attached (as in Sims's ap-
plicator). This cotton is saturated with the medicinal agent
selected, and if the application is to be made to the cavity of
the uterus, the cotton is drawn back into the tube before it
is introduced, when it is protruded and left in the uterine
cavity, or withdrawn after applying it to the endometrium.
If the application is to be made to the cervical canal, the
cotton is wrapped as above, medicated, and introduced up
to the end of the tube. The tube is then pushed, by means
of the ball or ring near the handle, until the cotton is
pushed off, when both the tube and rod can be withdrawn,
leaving the medicated cotton lying in the canal to be re-
moved in a few hours.
In both applications, the cervical canal may have to be
previously dilated by means of sea-tangle tents.
This instrument will be for sale by Boericke & Tafel.
If Sabina, Conium, Hydrastis, Senecio, or any other remedy
is indicated by the symptoms, the nature of the discharge,
and the pathological state, give the remedy internally by
the mouth, and apply the same to the os uteri, or even the
whole length of the cervical canal.
I have had patients who could distinctly taste argentum
nitrate, iodine, and other medicines, when thus applied to
the cervix. Dr. Sims says his patients complain of the taste
گر
UTERINE CAUSES.
103
of tannin a few minutes after its application to the cervix
uteri.
ABRASION, EROSION, ULCERATION.-Although these lesions
of the os and cervix uteri are generally considered causes of
sterility, they are not by any means invariably so.
Whitehead, Gardner and Sims enumerate ulceration as a
cause of sterility, but admit that it is oftener a cause of mis-
carriage. Nevertheless, women do often conceive, and go
through the full period of pregnancy, with the os and cervix
more or less the seat of one of the varieties of ulceration. It is
only when the engorgemeut, poisonous discharge, or occlu-
sion of the os, which sometimes attends ulceration, prevents
the spermatozoa from passing into the uterine cavity, that
sterility results from this condition.
According to Donne, the spermatozoa live in pus and
blood. Sims says he "has frequently seen conception to
happen when the cervix uteri was in a state of profuse sup-
puration, so that pus, per se, was no hindrance to this."
In the early years of homeopathy, it was a dogma of that
school that no application whatever should be made to a dis-
eased surface. Consequently, in all the old text-books of our
school, no topical application to a diseased uterus was men-
tioned, unless with disapprobation. The immediate followers
of Hahnemann failed to see that an agent may act according
to the law of similars even when applied to the diseased
surface externally. I regret that there are a few anti-
quated members of our school who still cling to this absurd
notion. To deny that a weak, mild application of nitrie or
chromic acid to an ulcerated surface is not homeopathic, is
to deny the truth of the homeopathic law, which is not
limited, but universal in its application.
During the first ten years of my practice, I followed faith-
fully the dogma above referred to, and although I faithfully
prescribed the carefully selected remedies then known to our
school, I never cured a case of ulceration or erosion of the
os uteri. Even when I supplemented the internal medica-
tion with vaginal injections of water, pure or medicated with
Calendula and other medicines, my success was but little
better. Afterwards I had better success when I touched the
4
104
UTERINE CAUSES.
diseased surface with glyceroles of Calendula,* Hydrastis,
Thuja, etc.
Not content with this treatment, which failed in a ma-
jority of cases, I took the rational ground of applying certain
agents which I knew would cause similar conditions of the
surface if applied in strong solutions, or the crude substance.
I commenced with the nitrate of silver, at that time the
best known and most generally used of all the eschorotics.
At first I used solutions of varying strength, and with them
made my first satisfactory cures. I soon learned, however,
that this agent was not suited to all cases.
The sphere of action of argentum nit. is confined to those
cases where the cervix has a deeply congested, red, and angry
appearance. The redness is so intense as to be livid, and
presents a velvety appearance. It bleeds readily, and dis-
charges a muco-pus, although often no discharge occurs
The menses are too frequent and profuse; there are sharp
quick stitches in the cervix and vagina. The vagina is often
intensely red and eroded, and an irritating, corrosive leucor-
rhoea is present.
In such cases, a sponge moistened with a solution of five
or ten grains of the crystals to 3j of water, applied lightly
every four or five days, will often act very happily. The
solution should be strong enough to coagulate the albumen
on the surface (after all the mucus and pus has been care-
fully wiped off). But I now adopt the following methods:
(a) I rarely use the solution of nitrate of silver, but
prefer, in nearly every case, to touch the erosion, abrasion,
or ulcer with the solid stick. The application should con-
sist of light, quick, delicate touches of the blunt rounded
stick. Never use the pointed stick, and never allow it to
remain in contact with the surface more than a second.
Before the nitrate or any other drug is applied, the sur-
face should be wiped dry of all secretions adherent to it.
(b) Instead of lint as a dressing to the ulcerated surface,
cotton saturated with pure Glycerin (diluted 1), medicated
* The best and only proper preparation of Calendula off, for topical use
should be made as follows: Calendula flowers, 3j; Water, Ziv; place in
an open-mouthed bottle and allow it to stand in a warm place six hours,
then add giv of glycerin, and macerate several days; strain or filter.
UTERINE CAUSES
105
with the remedy indicated by the condition. To prepare a
dressing to apply to the ulcerated surface, which has or has
not been touched by the nitrate, take some fine cotton,*
made into a ball, with a strong thread passing through it, im--
merse it in tepid water, and squeeze it gently under the water
till it becomes perfectly wet; then press all the water out of
it, and saturate with pure Glycerin, or a medicated glycerole.
To do this, lay the moistened cotton in the palm of the hand,
spread it out circularly for an inch and a half in diameter,
more or less, as may be needed, scooping it out in the centre;
then drop half a teaspoonful of Glycerin on it, thus held,
and rub it into the cotton with the point of the finger, then
pour a little more Glycerin and rub it in, and so on until
the cotton becomes saturated. When finished, the cotton
should feel soft and pulpy, should be about an inch and a
half in diameter, and about half an inch thick. This dress-
ing should be applied immediately after the application of
the nitrate, and before the speculum is removed. When I
use medicated Glycerin, it is usually of the proportion of
one drachm of the mother tincture to one ounce of Glycerin. For
dressing after the nitrate, the Calendula glycerole is best;
Hamamelis glycerole when there is a varicose condition of
the cervix with bleeding. Hydrastia mur. glycerole is often
very useful. (See list of preparations on page 94.)
There are other agents, however, which I now prefer to the
nitrate. In fact, I rarely use that caustic in my practice, pre-
ferring in nearly all cases Chronic, Carbolic, and Nitric acids.
Chromic acid is superior to all others in granular erosions,
which are very irritable, bleed readily, cause swelling of the
os and cervix, bloody purulent leucorrhoea, frequent and pro-
fuse menses, sometimes as often as every fifteen or eighteen
days. In all cases it should be applied strong enough to cause
the diseased surface to assume a yellow color. A solution of
five grains to 3j of water will suffice. In severe and more ob-
stinate cases, thirty grains to 5j must be used. Apply with
a bit of cotton closely wound on the end of a flat silver appli-
Touch lightly only the diseased surface, which has
been thoroughly wiped off. After it has dried, apply the cotton
cator.
*There are now two elegant preparations of cotton, far better than the
ordinary cotton-wool, namely, "borated cotton," and "absorbent cotton."
8
106
UTERINE CAUSES.
tampon moistened with a Calendula or Hydrastis glycerole.
Once in seven days is often enough to apply this agent.
Nitric acid is indicated when the granulations are intensely
red, livid, and irritable, or where actual ulcerations exist.
The ulcers are round, well defined, with sharp edges, and a
lardaceous bottom. It is equally useful in the fissured ulcer.
If the ulcers are syphilitic it is quite efficient, although it
may have to be superseded by the acid nitrate of mercury.
Carbolic acid is called for when the ulceration is superficial
and spreading; when the granulations are large, flat, or
pointed, but pale and flabby. The discharge from the dis-
eased surface is purulent, fetid, and often sanious. The
strength of the solution should vary with the intensity of the
disease. If recent, and the granulations small, a solution of
ten grains of the crystals to 5j of water will suffice. In older
cases, 5j of the acid to 5v of water will have to be used. The
best dressing to follow the application of carbolic acid is
Kennedy's Ext. Pinus canadensis, 3j.
Glycerin, ziij.
Apply on cotton, to be removed in twelve hours. This
dressing alone will cure some mild, recent cases of erosion or
abrasion. There are many other agents which are excellent
applications, when applied on the cotton tampons, namely:
Nitrate of bismuth, grains 60, to Glycerin, 3j.
Tannin 3j, to Glycerin, 3j.
Tinc. iodine, 3j, to Glycerin, 3ss.
Nitrate of sanguinaria, grains v, to water and Glycerin, of each, Zj.
Muriate of hydrastia, grains x, to water and Glycerin, of each, 3ss.
Merrill's fluid hydrastis, 3j, to Glycerin, 3j.
Tinc. thuja, ss, to Glycerin, ss.
Tinc. eucalyptus, 3ss, to Glycerin, 3ss.
Chloral hydrate, grains x, to water and Glycerin, of each, 3ss.
Tinc. Grindelia, 3j, to Glycerin, 3j.
If Glycerin is inadmissible, owing to some idiosyncrasy
of the patient, Cosmoline or Vaseline can be substituted
with advantage for it.
Kali bichromicum (1 gr. to 5j), in deepseated ulcerations,
with a red margin and fungous appearance. Many others.
could be named, but the physician must carefully select the
medicine which is indicated by the condition and symptoms.
(c) When these acids are used, they should not be applied
oftener than every five days. The medicated dressings should
UTERINE CAUSES.
107
Fro. 21.
be used once a day. The patient can be instructed to apply
them in the morning, and remove them at night on going to
bed, or vice versa. When these dressings are used no injections
are needed for cleanliness; for, as remarked by Dr. Sims, the
Glycerin "seems to set up a capillary drainage by osmosis,
producing a copious watery discharge, depleting the tissues
with which it lies in contact, and giving them a dry, clean,
and healthy appearance. When such a dressing is applied to a
pyogenic surface on the cervix uteri for a few hours, and
then removed, the sore will be as clear of
pus as if it were just washed and wiped dry."
Dr. Sims gives a cut illustrating an instru-
ment, the "porte-tampon," which he says.
any woman can use with ease. The tampon
is placed in the open cavity, the door shut,
the instrument introduced as far as possible,
the tampon pushed out by the piston, and the
porte-tampon withdrawn. There are now
several new instruments for this purpose. A
Fergusson's speculum may be used and the
tampon pushed up through it by means of a
stick the size of a lead-pencil.

*
LEUCORRHEA in general cannot be consid-
ered as a cause of sterility. Such a general-
ization is not in accordance with the spirit
and scope of modern scientific investigations
into uterine pathology. Leucorrhœa may be
said to consist of three varieties:
(1.) A discharge from the cavity of the
fundus uteri. (Endometritis.)
(2.) A discharge from the canal of the cer-
vix. (Endocervicitis.)
(3.) A discharge from the mucous mem-
brane of the vagina. (Vaginitis.)
The first variety has been considered in
another place, namely, in the preceding par-
agraph, relating to Endometritis.
The second variety has been treated of Sims's Porte-tampon.
above, under the head of Endocervicitis.
* Uterine Surgery, p. 295.
108
UTERINE CAUSES.
The third variety will be considered under the head of
Vaginal Causes of Sterility.
DYSMENORRHEA.--This condition, as a cause of sterility,
will also be found treated of under the heads of "Stricture or
Occlusion of the Cervix," "Uterine Displacements," "Uter-
ine Tumors," and "Inflammation of the Uterus."
Dysmenorrhoea is divided into six varieties: of these, two
only are constant causes of sterility; namely, the obstructive
and the membranous. The other four are only exceptional
causes; namely, the neuralgic, spasmodic, congestive, and inflam-
matory.
Treatment.--Anything like a thorough consideration of
the treatment of these varieties of dysmenorrhoea, would oc-
cupy too much space in this volume. A brief enumeration
of the most useful remedies will have to suffice:
I. For neuralgic dysmenorrhoea, Aconite, Agaricus, Bella-
donna, Cimicifuga, Ferrum, Gelseminum, Pulsatilla, Platinum,
Senecio, Scutellaria, Xanthoxylum, Zine, Viburnum, etc.
II. The congestive requires Aloes, Aletris, Belladonna, Cimi-
cifuga, Borax, Sabina, Hamamelis, Lilium, Murex, Secale,
Sepia, Ustilago, etc.
III. The spasmodic requires Caulophyllin, Cannabis ind.,
Nux vomica, Ignatia, Viburnum, Secale, Cimicifugu, Ustilugo,
Iodoform,* etc.
IV. The inflammatory, Aconite, Belladonna, Gelseminum,
Veratrum viride, for acute, and a host of remedies, too nu-
merous to mention, for chronic.
The so-called pseudo-membranous has beeu cured with Bro
mine, Guaiacum, Borax, and a few other remedies. Guernsey
gives the characteristic, or key symptoms, of ninety medi-
cines, for the cure of all the varieties.
AMENORRHEA.--The pathological conditions resulting in
amenorrhoea may cause sterility, but not the amenorrhoea
itself.
"I do not know," says Dr. Sims, "that conception has ever
occurred previously to the menstrual flow. . . . Many women
* See Cincinnati Medical Advance, 1878; also Therapeutics of New
Remedies.
UTERINE CAUSES.
109
conceive without menstruating, but it is always during men-
strual life." There are on record cases of conception occur-
ring after the change of life has been passed ten or fifteen
years. It may sometimes occur during a temporary amenor-
rhoea of a few months. (See Jackson's paper on Ovulation,
at the beginning of this work.)
If amenorrhoea arises from a failure in the function of
ovulation, conception cannot occur. (See "Atrophy of the
Ovaries," and other ovarian disorders)
If it results from phthisis, or serious chronic diseases, ster-
ility is an accompaniment. If from an atonic or torpid con-
dition of the ovaries or uterus, the resulting sterility may be
cured by remedies homoeopathic to the condition; such as
Sabina, Cantharis, Bromine, Aletris, Cannabis indica, Phos-
phorus, Helonias, Ruta, Agnus custus, Conium, etc.
If the retention of the menses result from some mechanical
cause existing in the cervix or vagina, consult the paragraph
treating of stricture, occlusion, etc
MENSTRUAL IRREGULARITIES.-It sometimes happens that
certain irregularities in the quality, quantity, and time of
appearance of the menses, are the only symptoms attending
sterility which we are permitted to know. Cases will now
and then occur, when no examination by the touch or specu-
lum will be submitted to, and we are compelled to prescribe
for the symptoms as related to us. The chief remedies for
menstrual irregularities are:
For scanty menses,-Conium, Agnus castus, Caladium,
Aletris, Cocculus, Secale, Subina, Graphites, Natrum mur.,
Senecio, and Sepia.
For profuse menses,-Sabina, Erigeron, China, Ipecac, Cro-
cus, Platinum, Nux vom., Hydrastis, Trillium, Murex, Senecio,
Ruta, Secale. (See the indications for the hundred or more.
remedies, in Guernsey's Diseases of Women.)
Too frequent and profuse menses are generally controlled
by Calcarea, Senecio, Platinum,Crocus, Sabina, Ustilago, Secale,
Lilium, and Xanthoxylum. When this condition is unat-
tended by any lesion of the uterus the Bromide of Ammo-
nium, 5 grains 3 times a day will regulate it.
110
UTERINE CAUSES.
For delaying menses,-Pulsatilla, Senecio, Aletris, Natrum
mur., Graphites, Helonias, Cimicifuga, etc.
Nearly all these irregularities depend on some pathological
condition of the generative organs. It will be necessary,
then, when possible, to ascertain the nature of the causes,
and consult the treatment of the conditions in the preceding
pages.
AREOLAR HYPERPLASIA OF THE UTERUS. *This disease of
the uterus, once known as chronic parenchymatous metritis,
is one of the most intractable with which we have to deal.
The great pathologist Kolb defines this condition of uterine
areolar hyperplasia as "a diffuse growth of connective tissue
which constitutes the so called induration, hitherto consid-
ered as a result of parenchymatous inflammation of the
uterus. . . . The whole uterine connective tissue sometimes
proliferates, either without accompanying increase of the
muscular substance, or if this does occur, the connective
tissue predominates to such an extent that the muscular
tissue is comparatively of little account."
This condition has also been designated as "uterine hy-
pertrophy," "enlargement of the cervix," and "subinvolution
of the uterus" (Simpson), also "chronic engorgement of the
uterus and cervix."
No morbid condition has given gynecologists so much
trouble. Allopathists and homeopathists alike find it obsti-
nate and intractable.
I will not attempt to describe the appearance and symp-
toms, but refer the physician to the exhaustive and graphic
description given by Thomas, Diseases of Women. I will,
however, quote his condensation of the causes, symptoms,
etc., namely:
Predisposing Causes.
A depreciation of the vital forces from any cause.
Constitutional tendency to tubercle, scrofula, or span-
æmia.
* This paper was presented to the Massachusetts Surgical and Gynæco-
logical Society, at the June meeting, 1878. With some additions I have
incorporated it into this work.-H.
UTERINE CAUSES.
111
1
Parturition, especially when repeated often and with too
short intervals.
Prolonged nervous depression.
A torpid condition of the intestines and liver.
Exciting Causes.
Overexertion after delivery.
Puerperal pelvic imflammation.
Laceration of the cervix uteri.
Displacements, endometritis, neoplasms, cardiac disease.
Abdominal tumors pressing on the vena cava.
Excessive sexual intercourse.
Symptoms.
If the cervix alone be affected there are:
Pain in the back and loins.
Pressure on bladder or rectum.
Disordered menstruation.
Difficulty of locomotion.
Nervous disorder.
Pain on sexual intercourse.
Dyspepsia, headache, languor.
Leucorrhoea.
If the body of the uterus is affected there are:
A dull, heavy, dragging pain through the pelvis, much in-
creased by locomotion.
Pain on defecation and coition.
Dull pain beginning several days before menstruation, and
lasting through that process.
Pain in the mammæ, before and during menstruation.
Darkening of the areola of the breasts.
Nausea and vomiting.
Pressure on the rectum, with tenesmus and hæmorrhoids.
Pressure on the bladder, with vesical tenesmus.
Sterility.
Physical Signs.
If cervical hyperplasia exists, there will be:
Sinking of the uterus in the pelvis.
112
UTERINE CAUSES.
Large, swollen, and sensitive cervix.
Normal uterine axis changed, the fundus tipping forward
or backward.
If corporeal hyperplasia exists, there will be:
Uterus enlarged, heavy, and sensitive.
The uterine cavity enlarged.
Sensitiveness of the internal uterine surface.
Uterine hyperplasia can only be confounded with:
Pregnancy.
Neoplasms, fibrous growths in uterine wall.
Periuterine inflammations.
Treatment.-Putting aside the treatment of the various
causes and complications connected with this condition, and
confining ourselves to the special treatment of the areolar hy-
perplasia, what medicines are indicated in that pathological
state? We must first know what the pathological condition
really is which obtains in this disease. It is divided into two
stages, and although the same remedies may be indicated in
both, the dose and method of administration will differ.
The first stage is characterized thus: The hypertrophied
areolar tissue is congested, containing absolutely more blood
than normal, and the whole of the affected part, neck, body,
or entire uterus, is greatly increased in size and weight, and
the cavity increased in size. This stage may last months, or
even years, but as time passes the second stage supervenes,
and an opposite state of things is set up. The large, red,
soft and engorged uterus decreases in size and becomes
small, contracted, hard, white, and anæmic, and the cavity
decreased in size.
Kolb thus describes advanced cases: "The parenchyma on
section appears whiter, or of a whitish-red color, deficient in
blood vessels from compression of the capillaries, by the con-
traction of the newly-formed connective tissue, or from par-
tial destruction or obliteration of the vessels during the
growth of tissue. The firmness of the uterine substance is
also increased, simulating the hardness of cartilage and
creaking under the knife." This constitutes a true sclerosis
of the uterus.
Now, in order to select the appropriate remedies, the prac-
UTERINE CAUSES.
113
titioner must possess an extensive and thorough knowledge
of Materia Medica, such as only studious members of our
school can possess. He must not only have a knowledge of
the symptoms of drugs, but the pathological conditions they
are capable of causing in the uterus or analogous organs.
No medicine can be useful in areolar hyperplasia, unless it
causes the first stage as well as the second, and the first stage
(of congestion, etc.) must have preceded the second. In other
words, the history and order of sequence of the medicinal disease
must be similar to that of the natural one.
I believe there are cases of this disease when the second
stage I have described may have been the only recognizable
stage, as in those cases of "morbid excess in the involution
of the uterus after parturition," described by Simpson. But
these cases are rare, and require peculiar treatment.
The medicines which are useful in this disease are those
which are capable of causing both stages of the pathological
condition. They must first cause:
Congestion of the uterus, or
Inflammation "
Enlargement"
Edema
66
66
Sensitiveness "
t
Increased weight of the uterus.
66
capacity
66
66
Painfulness of the uterus.
Too frequent and profuse (or scanty) menses.
With the various concomitant or reflex sufferings which
accompany this stage.
They must also cause the following conditions:
Anemia of the uterus.
Edema
Selerosis
66
66
(6
Hard, small, and contracted uterus.
Scanty and delaying menses.
Together with the various pains and sufferings attendant
on such a condition of the uterus.
Thomas and other prominent authors do not appear to lay
114
UTERINE CAUSES.
down any treatment for this second stage, either because
they consider it not amenable to treatment, or because there
is no necessity for any treatment. I propose to give such
treatment for the second stage as the materials of our Materia
Medica permit, because it causes one condition, namely,
sterility, which we are often called upon to treat, and with
such indifferent success.
The medicines generally indicated for the first stage of the
disease are the following (those italicized are the most im-
portant.):
Apis.
Asurum.
Cauloph.
Cimicifuga.
Podoph.
Platinum.
Aurum.
Calc. carb.
Ruta.
Ammonium carb.
Erigeron.
Sanguinaria.
Argentum nit.
Ferrum.
Sabina.
Arsenicum.
Hamamelis.
Sepia.
Esculus.
Helonias.
Secale.
Belladonna.
Lachesis.
Trillium.
Borax.
Lilium.
Terebinth.
Cantharis.
Merc. cor.
Tanacetum.
Cannabis ind.
Murex.
Thuja.
Cocculus.
Nux vom.
Senecio.
Crocus.
Nux mosch.
Ustilago.
Cactus.
Pulsatilla.
Sulphur.
All these medicines, by their primary action, cause the
following conditions of the uterus:
Irritation.
Congestion.
Inflammation.
Enlargements.
He
NOTE. Prof. R. Ludlam (U. S. Medical Investigator, Nov. 1877) recom-
mends Tartar Emetic 3x in "corporeal cervicitis, with concentric hypertrophy
due to effusion of serum into its tissues." He says he has used it successfully
for ten years, yet he does not mention it in his "Diseases of Women."
also asserts it to be one of the best internal remedies for "catarrhal inflam-
mation of the glandular portion of the cervix." The conditions for which
he recommends it are not exactly "areolar hyperplasia," although they may
be precedent or concomitant conditions. The first might be called "œdema
of the cervix," for which, on page 118 of this work, I have advised Apis, Ars.
iod., Polymnia, etc. From some recent experience, I am inclined to believe
that Antimonium iod. or Antimonium ars. will prove more useful than Anti-
monium tart., especially in chronic cervicitis with œdematous enlargement.
UTERINE CAUSES.
115
Attended by:
Sensitiveness and tenderness of the uterus.
Increased weight
(6
capacity
66
66
66
(6
(6
Painfulness
Too frequent menses (with menorrhagia), or,
Too scanty menses.
Dysmenorrhoea.
With all the reflex symptoms belonging to such condi-
tions.
These remedies should be carefully selected by the symp
toms, and also by the "genius" of the medicine.
They should be prescribed in the attenuatious from the
6th to the 30th, and not too often repeated.
Many of them may be applied to the uterus on cotton
tampons, by diluting them to the strength of 1x or 2x, using
glycerin as a vehicle.
There are a few exceptions to this rule, namely, in cases
of subinvolution after parturition or miscarriage, when, if the
carefully selected remedy does not bring about a rapid change,
we should resort to those medicines which act in material
doses in such a way as to contract the blood vessels of the
uterus, and thus cut off the nutritive supply, and at the
same time contract the muscular fibres to decrease the size
of the engorged and soft parenchyma. There are but few
medicines capable of such action, namely: Bromides of po-
tassa, ammonium, lime, soda, etc., Cuulophyllin, Secale, Usti-
lago, and perhaps Gossypium and Viscum alb. These should
be given in the following manner :
66
66
Bromide of potassa, etc., 5 to 10 grains every six hours.
Caulophyllin,
Secale,
Ustilago,
Gossypium or
Viscum album, I
to 1 grain
5 to 30 drops of a good extract
every six or twelve hours, or 10
grains of the 1x trit. of ergotin
every four hours.
5 to 10 grains of the 1x trit. every
two or four hours.
5 to 10 drops every two or four
hours.
116
UTERINE CAUSES.
In the treatment of the first stage there are certain very
important auxiliary measures which must be prescribed, for
without them medicines can do little.
(1) In severe cases rest in the recumbent posture for a few
hours each day, with a few hours' walking or riding in the
pure open air. The removal of all pressure from the abdo-
men from tight corsets, heavy skirts, etc.
(2.) The use of plain, non-stimulating food and beverages,
and an open state of the bowels.
(3.) Nearly complete abstinence from sexual intercourse;
at most, a few times midway between the menstrual periods.
(4.) Enemas of hot water of a temperature of 100° to
110° F., and in quantity not less than a quart, or more than
three or four gallons. This should be thrown in a steady
stream against the cervix uteri, by means of an ordinary
pump syringe, or a fountain syringe; the latter is the best, as
no labor of the hand is required, and the reservoir can be as
large as required. It can be used once a day-at night-or
in obstinate cases, twice daily. Those who have never tried
this method will be surprised at the change in size and color
-a diminution of both-which will take place after the use
of the hot water for a week or two. It is now the standard
and popular practice of all the best gynecologists.
(5.) Local depletion by means of leeches, or the scarifi-
cator. In the early years of my practice, I closely adhered
to the teachings of the leaders of our school at that time
(1850 to 1865). But my success in treating uterine disease
was neither satisfactory to myself or my patients. I then
resolved to adopt the modern teachings of those eminent
gynaecologists, who, while they discarded the general deple-
tions, painful caustics, and other horrible measures of the
allopathic schools, imitated nature's processes as far as possi-
ble.
Nature causes a congested uterus to bleed to relieve
the engorgement, or contracts, by means of vaso-motor nerves,
the dilated blood vessels. The application of a single leech to
the os uteri relieves the local engorgement, and allows our
remedies to act better than they could possibly do before.
Scarification of the os and cervix does the same.
But I pre-
fer to either the spear. This little instrument, first introduced
to notice by Dr. Buttles, bears his name. Its sharp, delicate
UTERINE CAUSES.
117
16
point is thrust into the enlarged and congested cervix, about
the of an inch, and given a single turn before it is renioved.
Six or eight punctures will cause a flow of from half to one
ounce of blood, according to the severity of the case. There
are certain indications for the use of local depletion, and they
FIG. 22.

Chapman's scarificator.
should be closely followed, namely: When the woman com.
plains of sensations of fulness, weight, soreness, and aching in
the uterus, it should be used. Now these sensations gener-
ally occur every week or ten days, during the intermenstrual
periods, and denote recurring congestions. They always
precede the appearance of the menses, which may occur every
two or three weeks.
It has been my practice for several years to use the spear
whenever these symptoms are complained of, and the relief
given to the patient is always gratifying.
FIG. 23.
Buttles's spear-scarificator.
By this means I have regulated the appearance of the
menses, that for years had occurred too often. It prevents
profuse menorrhagia, and causes the too scanty and painful
menses to be natural in quantity. The uterus in this disease
may be so congested as to bleed too much (menorrhagia), or
so engorged as to bleed too little, or not at all (suppression
of the menses).
In either case if we relieve the local congestion, we remove
the cause of the abnormal menstrual flow. This cannot be
done by medicines alone, unless absolute rest be adopted, and
then it requires a long time. It must be noted that I do not
refer to other conditions of the uterus, or ulceration, atouy,
etc., but only to the first stage of areolar hyperplasia.
118
UTERINE CAUSES.
Local Depletion as a Cure for Sterility.-But the most
valuable and important result which often follows the use of
local depletion, is the restoration of the ability to conceive.
Long before I adopted its use, I was acquainted with
numerous cases, several of them former patients of mine,
who after a few applications of leeches, became pregnant,
much to their surprise. Some of these patients had never
before been pregnant; others had not borne children for
many years. One case in particular impressed me profoundly,
a lady, married fifteen years, who had never been pregnant.
She had been treated by eminent men of both schools. She
was under my care nearly a year; there was no abnormal
appearance visible except enlargement and chronic conges-
tion. The menses were delaying, very sranty, and very pain-
ful. After she left my care she was advised by an English
nurse to apply a leech to the uterus about the time the
menses ought to appear. She became pregnant after the
second application. Three years afterwards she suffered
from a return of her old troubles; leeches were applied, fol-
lowed by another pregnancy; and this occurred the third
time! This patient informed other sterile women of this
fact, and some of them tried it with success. I have the
records of several cases where the use of the spear-scarificator
was soon followed by pregnancy in women who had been
sterile for several years.
Another method of local depletion which should not be
neglected, is by means of tampons of medicated or pure
Glycerin. I have already given the uses of these in another
place; also the method of their application. It remains only
to point out the condition requiring them.
In many cases the cervix presents a swollen, puffy, and
pale appearance. It looks odematous, and is in fact œdema-
tous. It is engorged with serum instead of blood. A punc-
ture with the spear brings but little blood, but a watery exu-
dation. I have seen cases in which the cervix actually pitted
on continued pressure. The medicines indicated in this con-
dition are Apis, Aquaphobin, Arsenicum, Cantharis, Hamamelis,
Iodine, Lachesis, Naja, Murcx, Merc. cor., Phytolacca, Sepia, and
Sulphur. The action of Glycerin when applied continuously
to such a cervix is to cause profuse drainage, or exosmosis
1
UTERINE CAUSES.
119
of water from the oedematous tissues. It should be applied
undiluted, night and morning. The addition of one-tenth
orth part of Iodine, Iodide of potassa, Hamamelis, Can-
tharis, Merc. cor., or Phytolacca, also Polymnia,* greatly
increase the value of the Glycerin in removing the oedema-
tous enlargement. If the whole body of the uterus is be-
lieved to partake of this dropsical condition, a small medi-
cated tampon may be placed in the uterine cavity by means
* Polymnia uvedalia (Bearsfoot) belongs to the genus Compositæ, of the
tribe Heliantheœ. It is an erect herb, roughish, hairy, stout, 4 to 10 feet high,
leaves broadly ovate, angled and toothed, nearly sessile, the lower palmately
lobed, abruptly narrowed into a winged petiole, outer involucral scales very
large; rays 10 to 15, linear oblong, much larger than the inner scales of the
involucre; flower yellow. Grows in rich soil west of New York to Illinois,
and southward. The flower and whole plant exhale a strong odor; they look
like a small sunflower.
This remedy was introduced into eclectic practice by Dr. Pruitt, of Missouri
(?), who found it useful for enlargement of the spleen. He recommended
that it be applied externally in the form of an ointment and given internally.
It was found so efficacious in this disease, that it was tried in other enlarge-
ments, of the joints, glands, etc., and finally in enlargements of the uterus.
I
have used it in two cases with success-in uterine hypertrophy (areolar hy-
perplasia) in the first stages, before condensation and contraction set in. The
dose is 10 drops of the tincture or 1x, three times a day, or oftener, and its
use continued for months; at the same time apply a glycerole (1 part of the
tincture and 2 parts glycerin) in cotton tampons every night, except during
the menses. In my two cases the uterus decreased in size fully one-third in
two months.
Dr. Scuddera gives the following as his experience, with an estimate of the
power of this new remedy.
"Let me again say that U vedalia is the straight remedy for those en-
gorgements of tissue depending upon an enfeebled circulation. The sensation
given to the fingers is a want of elasticity and tonicity, sodden, doughy,
atonic.
I use the Uvedalia ointment freely, and think of rubbing away a hyper-
trophied uterus, or an enlarged joint, as much as I would an enlarged spleen
or ague-cake. Recently I had occasion to use it in chronic ovaritis and me-
tritis, the cavity of the uterus measuring four inches. The organ was reduced
to normal size in four weeks.
Internally it has not gotten to be such a favorite, but this is because I
have not tried it so often. I am satisfied that in many cases of chronic dis-
ease it will be found a most valuable remedy, as it very certainly is in chronic
ague with enlarged spleen.
"I am sure those who have used it will feel much obliged to Dr. Pruitt
for his efforts to bring it to the notice of the profession."
&
Eclectic Medical Journal, February, 1878.
120
UTERINE CAUSES..
of a proper applicator. I have several times seen excellent
results follow their use, in addition to the external tampon.
Dr. Thomas (Diseases of Women), after giving all the vari-
ous methods of treatment, general and local, thus sums up
by candidly giving his own experience and its results:
"The best local alterative is the compound Tincture of
Iodine, which by means of a brush of pig's bristles should be
carried up to the os internum, or even to the fundus, should
endometritis exist, and over the cervix; then, waiting for a
complete drying, this process should be repeated. After
these applications a wad of cotton, to which a string has
been attached in such a way as to leave its surface flat, should
be saturated with glycerin and laid against the cervix.
This acts as a local hydragogue and disgorges the tissues.
These local applications should be repeated once a week, but
others should be made oftener by the patient herself, by
means of vaginal injections, by which the drug just men-
tioned may be brought in contact with the cervix.
“Mild and lacking in vigor as this course may appear,
let
any one test it side by side with the plan of using the acid
nitrate of mercury, potassa fusa, potassa cum calc., and the
actual cautery, etc., . . . and unless his experience greatly
differs from mine, he will feel that in the former he has reached
a resting-place for his faith in the treatment of the most im-
portant of all the forms of uterine disease. He will see
proof daily spring up before him that his capacity for bene-
fiting his patients has greatly increased, while his liability
to injure them has greatly diminished."
Treatment of the Second Stage.-The second stage of areolar
hyperplasia is the stage wherein sterility is sure to occur,
even if it did not occur during the first.
But it is possible, by the use of carefully selected remedies
and appropriate auxiliary measures, to restore the organ to
a condition in which conception is possible.
The same medicines mentioned as useful in the first stage,
are also useful in the second, but they will not be successful
in arousing the torpid energies of the uterus unless they are
prescribed in the lowest attenuations, or in material doses.
In proof of this may be cited the want of success which has
attended their use in such cases when given in high poten-
UTERINE CAUSES.
121
cies, and the positive success which has followed their use
when given in appreciable doses, by members of our school,
and of other schools of practice. Thus Cantharis, Cannabis
indica, Moschus, Sabina, Phosphorus, Cimicifuga, Sanguin-
aria, and others have been successfully used in quite large
doses, and have cured sterility due to atony, atrophy, and
paretic conditions of the uterus and ovaries.
They cure, by increasing the flow of blood to the shrunken
and poorly nourished organs of generation, and by imparting
to them a normal supply of nervous energy. It is generally
necessary to continue their use a considerable period of time,
and aid their influence by the action of electricity, appropri-
ate diet, change of climate, etc.
There is another class of medicines, however, which are
capable of bringing on a condition similar to the second stage
of areolar hyperplasia, or sclerosis, by their continued pri-
mary action. They are:
Arnica.
Aletris.
Aurum mur.
Ammon mur.
Argentum mur.
Arsenicum iod.
Baryta mur.
Bromine.
Culc. mur.
Calc. iod.
Cuprum.
Carbo veg.
Chimaphila.
Ferrum iod.
Iodine.
Kali brom.
Kali iod.
Kali carb.
Lachesis.
Lapis alb.
Lycopodium.
Magnesia mur.
Manganum mur.
Merc. iod.
Morphinum.
Natrum mur.
Nux vom.
Plumbum iod.
Phytolacca.
Pieric acid.
Polymnia uvedalia.
Platinum mur.
Palladium.
Silica.
Sepia.
Sulphur.
These remedies should be prescribed in the medium atten-
uations and continued a long time.
The muriates correspond to a condition wherein the scle-
9
122
UTERINE CAUSES.
rosis is the predominant condition. The uterus is con-
tracted, hard, and sometimes atrophied.
The iodides are useful in a similar condition, but the atro-
phy and hardness are not as well marked, the tissues are sof.er
and the sclerosis does not predominate.
Arnica, when the original cause was of a traumatic nature.
Arsenicum, when there is threatened tissue degeneration.
Cuprum and Ferrum in deficiency of red blood-globules,
with loss of energy in the spinal trophic nerves (also Nux,
Ignatia and Phosphorus).
Lycopodium, Kali brom., and curb., Natrum mur., and
Plumbum, when the menses have grown gradually less in
quantity, until they have nearly ceased.
Phytolacca, Chimaphila, Conium, and Iodine when there is
atrophy of the mammæ.
In this stage the menses are usually very scanty and infre-
quent. The uterus is nearly in the same condition as after
the "change of life." The ovaries may still carry on the
manufacture and extrusion of ovules. The ovules may even
become impregnated, but owing to the paretic condition of
the uterus, they do not make a lodgment therein. The
object of treatment, then, is to stimulate that organ to
healthy nutrition. Should this stage appear in unmarried
women, marriage, by giving the uterus its natural physio-
logical stimulus, will often remove the condition. It is pos-
sible that the careful but persistent use of Ulmus fulva
bougies, with tampons of cotton medicated with Cantharis
3d, Sumbul 1*, or l'hosphorus 2x, or Bromine 3*, would im-
part the necessary physiological life.
Electricity. It is in this condition that the use of the
stimulating Faradic current ought to be productive of great
and lasting good. It should be applied by one who thoroughly
understands the modus operandi, aud applied directly to the
cavity of the uterus. In these cases, also, the intrauterine
galvanic pessary, once recommended by Prof. Simpson and
lately by Dr. Thomas, may be found very useful.
Nutritive Treatment.-The most careful selection and ad-
ministration of internal remedies, as well as the most judi-
cious use of topical applications, will sometimes fail to cure
UTERINE CAUSES.
123
cases of chronic endometritis, endocervicitis, or chronic metritis
(areolar hyperplasia), because of the general constitutional de-
bility or acquired fault of nutrition, assimilation, etc. IIomo-
opathic physicians are more apt to neglect the nutritive and
restorative (tonic) treatment, than are the members of the
opposite schools. The senseless "diet rules" which, until
lately, were followed by the stricter homeopathists, had
much to do in inducing this neglect. Many suppose to this
day that if the perfect medicinal similimum is found-i
one whose symptoms correspond closely to those of the dis-
ease or the patient-nothing else was necessary to bring
about a cure. This is not, however, the case. It is as much
the duty of the physician to prescribe the exercise, the diet,
and the bathing and other hygienic agents, as it is to pre-
scribe medicines, or make use of surgical means.
e
These considerations impel me to make the following ob-
servations:
"
The general condition of the patient should be examined
and looked after. If the woman is obese, lymphatic, with
superabundance of fatty deposit, we should prohibit all
starchy foods, fats, vegetables, etc., and direct her to adopt
nearly the diet laid down on page 90, by Dr. Cutter, to pre-
vent uterine fibroids. Under this regimen the patient will
grow stronger, and the disappearance of obesity will allow
her muscular system to become more developed by active
exercise. The habitual use of mineral waters-Kissingen,
Vichy, Seltzer, Hawthorn, or Sheboygan, and other foreign
and native springs-will greatly facilitate the cure.
If the patient is thin, emaciated, debilitated, and the vic-
tim of some chronic cachexia, with all the functions of vege-
tative life in an atonic condition, with defective nutrition
and deficient vitality in general, we should add to our specific
remedial treatment the injunction to eat the most nutritious
and easily digested and assimilated foods. Advise chalybeate
waters, sea-bathing, exercise in the open air, the removal from
a malarious climate, or from unhealthy houses. Order the
use of pure wines, porter, ale, or, better than all, that purest
of all stimulants and beverages, Kumyss.
This Kumyss or Koumiss is a veritable "wine of milk,"
1
124
UTERINE CAUSES.
and contains in itself all that is necessary to build up an
anæmic, atonic, and vitiated constitution. It restores diges-
tion, favors the assimilation of other foods, imparts phos-
phates and other valuable constituents to the system, and is
at the same time a food, a beverage, and a tonic.
Kumyss (Vinum lactis, Lac equinum fermentatum) is pre-
pared by the fermentation of mare's milk. The fermenta-
tion of milk-sugar produces alcohol, carbonic acid, and
lactic acid, and to these products the action of Kumyss
seems to be chiefly due.
It has now been well-established that the milk of the cow
is equal, if not superior, to mare's in the production of
Kumyss. In fact, the milk of all animals is convertible into
this beverage by one and the same method. Kumyss is
now manufactured in Paris, London, New York, Cleveland,
Chicago, and, I believe, St. Louis. In order to give the
reader some idea of its constituents, I quote the chemical
analysis as given by the best authorities:
New or fresh Kumyss, when a few days old, has a sweetish,
acidulous taste and a sparkling effervescence, and looks like
rich milk. It contains alcohol, 1.65 per cent.; fat, 2.05;
milk-sugar, 2.20; lactic acid, 1.15; solids, 6.80; casein, 1.12;
carbonic acid, 0.785; salts, 0.28.
Old Kumyss is not as white, has a stronger acid taste, is
very sparkling and exhilarating. It contains alcohol, 3.23
per cent.; fat, 1.01; sugar, 0.00; lactic acid, 2.92; casein
and salts, 1.21; carbonic acid, 1.86; solids, 5.04. All the
sugar is now converted into alcohol. It is interesting to
compare this with the analysis of wines and beer.
Claret wines contain from 7 to 12 per cent. of alcohol;
champagne contains from 10 to 13 per cent.; cider, 5 to 9 per
cent; ale and porter, 4 to 7 per cent.; small beer, 1.28.
Kumyss stands midway between small beer and the weakest
ales or lager beer.
Patients can drink with advantage from one to three bot-
tles daily. I have had patients so debilitated from chronic,
exhaustive uterine diseases, and with such impaired diges-
tion and complete loss of all appetite that inanition seemed
imminent, rapidly restored to health by the persistent use of
UTERINE CAUSES.
125
Kumyss alone for weeks or months, or until they had suffi-
cient appetite and digestion to subsist on ordinary foods.*
Next in value is the extract of malt, now so much used in
this country. The liquid or granulated malt extract is com-
bined with other nutrient or medicinal agents. Among the
most useful I esteem the following:
Extract of malt with Pepsin.
"
()
Hypophosphites.
Iron.
Cod-liver oil.
The experience and judgment of the physician will enable
him to advise the preparation most suitable to the particular
condition of each patient. These preparations will not inter-
fere with the special, specific medicinal treatment which may
be instituted.
In certain strumous or scrofulous patients the use of Cod-
liver oil is almost indispensable. It will enable us to restore
to health patients who would otherwise be absolutely incur-
able. As stated in my Therapeutics of New Remedies, besides
the fatty food, Cod-liver oil contains many remedial agents
in minute quantities, which our school values very highly,
namely: Iodine, Bromine, Calc., etc. It need not be given
in the large, nauseous doses advised by the opposite school,
but will cure in very small doses, 15 to 60 drops three times.
a day, if used for a considerable time.
When the patient, whether anæmic or not, has a feeble,
or irregular and weak circulation, the use of Digitalis or
Digitalin, combined or alternated with the specific tonic or
nutritive remedy, will greatly increase its restorative power.
Digitalis increases the force and vigor of the heart's action,
and thus aids the curative force. I recommend Digitalis 1,
5 drops, or Digitalin 2, 2 grains, three times a day.
ABNORMAL SHAPES OF THE OS AND CERVIX UTERI.-We
often see cases of sterility when there is no symptom of dis-
ease, so far as physical suffering is concerned. We may
even find the uterus of proper size, in normal position, and
* Mr. A. Arend, a chemist, of Chicago, is the originator of Kumyss in this
country. After many years of experiment, he has discovered a method of
making it from cow's milk, so that it nearly resembles the original Tartar
beverage made from mare's milk.
126
UTERINE CAUSES.
with a straight cervical canal, but the cervix may be of an
unnatural shape. There are several abnormalities men-
tioned by Sims, namely:
(1.) Normal shape, with "pinhole os."
(2.) Conical cervix, with or without "pinhole os."
(3.) Crescentic-shaped os.
(4.) Too close apposition of the lips of the os.
(5.) Destruction of one lip of the os.
(6.) Overlapping os; curving of the os, etc.
These modifications of the shape, size, and relations of the
os tincæ may all become causes of sterility by preventing
the entrance of the spermatozoa, and require surgical opera-
tions for their removal. Dilating with tents, bougies, etc.,
do no good; the knife is the only trustworthy remedy.
(1.) A pinhole os can be readily changed to an open one of
normal size by the bistoury cutting slightly each way.
(2.) A conical cervix may be treated in the same manner,
but it may sometimes be necessary to amputate the terminal
portion, or make deep bilateral incisions.
(3.) In crescentic-shaped os, Sims cuts out a triangular por-
tion, removing the offending lip altogether.
(4.) Closed os fron apposition requires a bilateral incision
of the circular fibres of the cervix, with such after treatment
as will prevent their closure.
(5.) In destruction of one lip there is generally a dense
fibrous condition of the cervix. This requires the same op-
eration as for constriction of the cervix, the bilateral incision
as far upward as necessary, and its subsequent dilatation.
(6.) Overlapping cervix requires the cutting off of the over-
lapping lip, which straightens the canal and opens the door
for the entrance of the spermatozoa.
I have treated several cases of Nos. 1, 2, 4, and 6, and in
all but a few cases the slight operations performed resulted
in curing a sterility of several years. A portion of these cases
were congenital, others acquired, or were caused by severe
local treatment.
One case, similar to the case described by Sims, page 181,
Uterine Surgery, where the os closed by a fibrous band, and
the menses and a intrauterine catarrh of a sanious irritating
character escaped through two small orifices about half an
UTERINE CAUSES.
127
inch apart. This band was cut from one orifice to the other,
the cervical canal dilated by means of a sea-tangle tent, and
the woman, who had not been pregnant for six years, aud
had suffered intense agony from dysmenorrhoea, became preg-
naut before the next menstrual period.
I might add another variety to the abnormal forms of the
cervix mentioned by Sims. It might be called the "smashed
hat" cervix. It looks like a silk hat that had been sat upon.
At the vaginal junction it is of the normal shape and size,
but from this point to the os it enlarges, the end of the cer-
vix is flat, the edge of the circumference sharp and high,
like the base of a cone, while the cervix is corrugated. In
the three instances I have observed the os was not larger
than a pin's head, and the women were sterile.
The best instrument for these operations on the os for the
purpose of enlarging the orifice, is that known as Skeene's Hys-
terotome. When closed the blade is shut against a probe, like
FIG. 24.

Skeene's hy terotome.
a sound, and is thus introduced into the cavity of the cervix.
The blade is then opened as much as is considered necessary,
and rapidly withdrawn. It is again introduced, and the
other side incised in the same manner. The outer os should
be made at least one-fourth of an inch wide. The cut sur-
faces should be touched with persulphate of iron, and a cotton
tampon wet with Calendula-glycerole, be placed against it.
This instrument may be used in place of White's hystero-
tome, but it is not quite as safe or exact.
Another very useful and safe instrument for incising the
os and cervix, is Peaslee's Uterotome. The probe-point is in-
troduced up to the os internum, and the lancet-shaped knife
is pushed up, incising both sides of the os and cervix equally.
In a large proportion of cases of deformed cervix with con-
128
UTERINE CAUSES.
tracted os, I have found a tortuous canal. This, besides being an
additional obstacle to the entrance of the semen, is an obsta-
cle to the ready outflow of menstrual blood, and thus a cause
FIG. 25.

HAVANINZGO
Peaslee's Uterotome.
of dysmenorrhoea. This condition is readily removed (after
enlarging the os) by the use of the laminaria or ulmus-fulva
tent, worn a few hours at a time, and placed every three or
four days during the ten days previous to the menses. The
patient should not walk or ride during the time the tent is
worn. If she does she is liable to bring on hæmorrhage or
inflammation.*
Conoidal Cervix.-One of the simplest methods of treat-
ing unimpregnated os uteri with conoidal cervix and pinhole
os is that recently proposed by Dr. E. L. Drake, of Fayette-
ville, Tenn. It consists in placing some foreign body in the
vagina so that the os uteri will rest upon or against it. A
soft rubber or glass pessary, a cotton ball covered with rubber
"dam," or a small, soft sponge, similarly covered, will have
the effect, says Dr. Drake, of "bringing about sufficient
dilatation of the os to admit the tip of the finger. Further,
when the uterus, from overweight or laxity of support,
presses against the perinæum, or from other displacement.
the os is fretted against the vaginal wall for some time, char-
acteristic changes are set up, namely, a hypersecretion of
mucus, a softening of the tissues, and a considerable degree
of dilatation. Thus nature in these cases overcomes a
stenosed cervix and contracted os with considerable cer-
* In even the slightest operations on the generative organs of women,
especially on the uterus, the temperature of the body should be carefully
watched. The use of the clinical thermometer is now considered indis-
pensable in all surgical procedures, and its use should never be neglected.
If the temperature in the axilla or under the tongue is above 98.6° or 99°, no
operation should be performed until the temperature becomes normal. If
after any operation the temperature rises above normal, give immediately,
Veratrum viride, 1 or 7th of a drop every hour or two.
No other remedy so
surely prevents inflammation.
† American Journal of Obstetrics, April, 1878, p. 366.
UTERINE CAUSES.
129
tainty, and thereby promotes a free menstrual discharge,
unless too much obstruction exists from a flexure at the
internal os. The pressure of any foreign body against the os
will stimulate the menstrual flux, and so become available
in the treatment of amenorrhoea, which is often only a form
of dysmenorrhoea." Dr. Drake recommends this simple
method in place of rapid dilatation, incision, or amputation.
The pessary should be worn for two weeks in the intermen-
strual period. He claims that it will also dilate the inner
os, for he has observed that the sound passes more readily
to the funduș after the use of the pessary. He prefers the
concavo-convex rubber or glass instruments.
1
FIG. 26.

ones.
Conical cervix (alter Sin 8).
The following case reported by Dr. Drake appears to sub-
stantiate his claim: "It was a typical case of couoidal cervix
and pinhole os. The patient's sufferings were intense, last-
ing nearly through the intermenstrual period, and leaving
her in a wretched condition to withstand the succeeding
The sympathetic disturbance was great, manifested
in sympathetic cramps of the stomach and torturing head-
ache, which were barely held in abeyance with excessive
doses of Chloral and Morphine. She had been a sufferer for
years, dating from an abortion. I used with her a small
glass concavo-convex pessary, and have had no occasion to
visit her for months; whereas before, my visits were re-
quired regularly at her periods. The last time I examined
her the os would admit the tip of the finger."
Dr. Mundé, in commenting on this method, quotes a curious
case in point, related by Dr. Thomas, in his Diseases of Women,
where a globe pessary had gradually dilated the os and
130
VAGINAL.
cervical canal, and migrated into the uterine cavity, where
it remained for some time, causing obscure uterine symp-
toms, until it was detected and removed by Dr. Sayre.
My own observations corroborate Dr. Drake. I have
known the constant wearing of the cotton ball, changing it
every twelve or twenty-four hours, moistened with dilute
glycerin, to flatten out a conoidal cervix and enlarge the os,
and increase decidedly the usual scanty menses.
I once
placed in the canal of the cervix a Chambers's intrauterine
stem pessary, for the purpose of removing a flexion of the
cervix. The os was very small, the menses scanty, but after
wearing the stem, the menses increased, and the os dilated to
a normal size.
V. VAGINAL.
ATRESIA VAGINA." This of course forms an obstacle to
the ingress of the seminal fluid. It may be congenital or
accidental, more frequently the latter, and oftener the result
of a tedious labor, followed by sloughing."--(Sims.)
The vagina may be imperforate at the vulva, or in the
course of the canal. The closure may be complete or partial:
the former resulting in complete retention of the menses;
the latter causing a painful scanty flow, mistaken sometimes
for dysmenorrhoea.
The following causes may be enumerated as productive
of it:
Arrest of development. Prolonged and difficult labor.
Chemical agents locally applied. Mechanical injuries. Slough-
ing from impaired vitality. Syphilitic or other extensive.
ulcerations.
Congenital atresia, or arrest of development of the vagina
in the fœtus, is a rare anomaly. Aristotle, Celsus, Heister,
and Amussat, speak of congenital atresia. Sims says he has
seen but one case which might be called congenital. Drs.
Helmuth, Franklin, Adams, Danforth, and Comstock in-
form me they have met with cases. I have met with two
cases, occurring in infants: one in a child two years of age,
the other a girl of eight years. Both cases I believe to have
been caused by arrest of development during fœtal life. The
VAGINAL.
131
vulvæ were well developed, with a deep sulcus between, but
no opening to a vaginal canal could be discovered.
Accidental or acquired occlusion, from any of the above
named causes, may occur at the mouth of the vagina, or we
may have contraction or closure of the middle portion (of
which Meigs and Sims give illustrations); or the upper part
of the vagina and the neck of the uterus may be agglutina-
ted together in one dense mass of fibro-cellular tissue, while
we may occasionally find a complete obliteration of the
canal, from the neck of the bladder quite to the os tincæ.
Treatment.—In partial atresia, the menstrual fluids may
escape, with much suffering and pain, and the difficulty may
never be discovered. Cases are on record in which this con-
dition, occurring in maiden ladies, and even the married, was
not discovered for many years, or during life. The abnormal
condition may not attract any attention, until an examina-
tion for the cause of sterility reveals it.
Complete atresia is generally discovered before the woman
is married, but not always. The treatment in all cases is to
restore the canal, if possible, and keep it open, by the use of
a glass dilator, till the newly expanded surfaces are covered
with mucous membrane.
Partial atresia is best treated by pressure, or tearing with
the fingers, preceded, if necessary, by incisions with scissors.
It is best not to use a knife, if it can be avoided, as subse-
quent contraction and inflammation are more apt to occur
than when the tearing process is adopted. Sometimes a car-
tilaginous band seems to close up the canal. If this cannot
be broken by dilatation, the knife must be resorted to. Sims
gives some interesting cases.
I have known of two cases, one of congenital occlusion of
the vagina, the other a partial occlusion. In the former case,
no trace of a vagina could be found, and the operation per-
formed was a delicate one, requiring the most perfect ana-
tomical knowledge. It resulted very successfully: a vaginal
canal was made, offering no impediment to coitus, pregnancy
resulted, and the woman was safely delivered.
The other case, reported by Dr. W. H. Holcombe, occurred
in a married woman aged 35. During an abortion, vaginitis
occurred, with almost complete closure of the vagina. When
132
VAGINAL.
the case was examined three years after the accident, there
was a shallow sulcus between the labia, and a very small
orifice at the bottom, into which a uterine sound could with
difficulty be introduced. A canal was found extending sin-
uously up to the os uteri. The woman had become pregnant,
the spermatozoa passing up through this sinus. This wo-
man was safely delivered by Dr. Holcombe, of New Orleans,
aided by an eminent surgeon of that city, who operated at
the commencement of labor.
CONGENITAL ABSENCE OF VAGINA, according to Scanzoni,
rarely, if ever, exists without a simultaneous absence of the
uterus and rudimentary development of some of the external
organs of generation. If an obliterated vagina be present,
it may generally be recognized as a hard fibrous cord, by
one finger in the rectum and a sound in the bladder. Should
deformity of the external genitals exist, the uterus not be
discoverable, and no signs of distress at menstrual epochs
show themselves, it may be concluded that the case is one of
absence of the vagina, and not of complete atresia. Sims
says he has seen five cases of congenital absence of the va-
gina, and in all of them there was no uterus.
Treatment.—If we diagnose the case as one of absence of
the uterus as well as vagina, no treatment can be insti-
tuted for the removal of the cause of the sterility. Cases
may occur, however, in which the uterus may be present.
Amussat reported one to the French Institute, in 1835; and
this same bold surgeon has demonstrated that an artificial
canal to the uterus might be made.
NON-RETAINING VAGINA.-Dr. Sims was the first surgeon
to call attention to this cause of sterility. "It has been only
about three or four years," he says, "since I found out that
some vaginas would not for a moment hold a drop of semen.
There are no two vaginas alike. They differ in length, in
their various diameters, in their relations with the bladder
and rectum, in their course with regard to the pelvian axes,
and in their relation with the axis of the uterus. They
sometimes refuse to retain the semen when they are very capa-
cious; again when they are too short." Sims relates a singu-
VAGINAL.
133
larly interesting case,* where the forcible "reaction of the
distended vagina ejected all the semen that did not at once
regurgitate in the very act of ejaculation." This he demon-
strated to be the case, by inspection of the vagina a few mo-
ments after intercourse, when he found that "the vagina
did not contain a drop of semen.'
""
In another class of cases, Sims says: "Sometimes the va-
gina does not retain the semen, even when it is of large pro-
portions. When this is the case, we almost always find the
uterus retroverted. I have now but little doubt that, in
many cases of retroversion in which I have seen pregnancy
follow the rectification of the malposition, the sterile state
was due to the fact that the vagina did not retain the semen."
Dr. Sims relates several cases illustrating the non-retaining
power of the vagina, with retroversion of the uterus, and ex-
plains the modus of this abnormal action of the vagina.
Treatment. In the first-mentioned instance, the treatment
consists in instructing the parties to so conduct sexual in-
tercourse that a portion of the semen must be left in the
vagina; in other words, the semen must not be ejaculated as
far as usual into the canal of the vagina. I have several
times advised successfully the use of a ball or tampon of
cotton to be placed in the vagina immediately upon the con-
clusion of the act of coition, before the vagina can expel
the semen. It is singular that Sims never seems to have
thought of this simple device.
In case of retroversion with non-retention of semen, the
uterus must be placed in normal position, and kept in situ
by a properly adjusted pessary, which must be worn during
coition, as directed in the treatment of retroversion of the
uterus. Even in this case, the cotton tampon should be ad-
vised, as also in cases where the vagina is too short.
IMPERFORATE HYMEN.-Medical literature contains the
records of many cases in which the hymen was so tough as
to resist all reasonable efforts at penetration; and very many
in which it has been found completely occluded, with reten-
tion of the menstrual flow. Sims says he has never met
*Uterine Surgery, p. 342,
134
VAGINAL.
with an example of these conditions. He admits, however,
that the hymen may be hermetically sealed, so as to cause
retention of the menses and sterility.
Treatment.—All surgeons, at present, caution against the
operation, simple as it seems, of opening the hymen by
"crucial incision," i. e., if there is more than an ounce or two
of retained fluid in the uterus.
The operation should be performed by an exploring needle,
leaving the gradual evacuation of the fluid to nature and
time. The object of this is to allow the uterus time to con-
tract, as its contents slowly ooze away. If there is not more
than an ounce or two of imprisoned fluid, Sims does not
think it makes any difference whether we evacuate it sud-
denly or slowly. If the uterus and vagina hold six or eight
ounces, Sims directs to give Ergot,* until its specific action
is produced on the uterus, and then make a small pune-
ture in the hymen. Dr. Hewitt, one of the latest and best
authorities on diseases of women, directs the opening to be
made obliquely in the obstructing membrane, giving it a val-
vular character, so that the fluid will be evacuated guttatim.
An abdominal bandage should be worn till the fluid is all
evacuated.
In cases where the hymen is so nearly closed as to admit
the escape of the menses drop by drop, and the orifice so
small as to prevent the entrance of the semen, it had better
be ruptured by pressure, if possible, than by any cutting
instrument, as in occlusion of the vagina.
VAGINISMUS.-This singular affection is much oftener a
cause of sterility than has been supposed. It was first pointed
out by Dr. Burns, of Glasgow, and more lately, by Simpson,
Scanzoni, Sims, and others; also by our own Helmuth,† who
first called attention to it in our journal, and reported a case
treated successfully.
Definition." By the term vaginismus I mean an exces-
sive hyperesthesia of the hymen and vulvar outlet, asso-
ciated with such involuntary spasmodic contraction of the
* Caulophyllin, perhaps, and would be as good. (II.)
† North American Journal, 1864, p. 64.
VAGINAL.
135
sphincter vagina as to prevent coition. This irritable spas-
modic action is produced by the slightest touch; often the
touch of a camel's-hair pencil, or fine feather, will produce
such agony as to cause the patient to shriek out, complain-
ing at the same time that the pain is that of thrusting a
sharp knife into the sensitive part. This is worse in some
than in others. In a very large majority the pain and spasm
conjoined are so great as to preclude the possibility of sexual
intercourse. In some instances it will be borne occasionally,
notwithstanding the intolerable suffering; while in others it
will be wholly abandoned, even after the act has been re-
peatedly, and, as it were, perfectly performed" (Sims).
The recognized causes are: The hysterical diathesis; ex-
coriations or fissures at the vulva; irritable tubercle of the
meatus; chronic metritis or vaginitis; pustular or vesicular
eruptions on the vulva; neuromata.
Diagnosis.-There is no other affection with which it can
be confounded. All that will be necessary to decide con-
cerning it will be whether it is an idiopathic or symptomatic
disorder.
Course and Duration.-In its course it may be unlimited.
Cases are recorded in which it lasted for twenty-five or thirty
years. In some rare cases it may be removed by medicines
acting on the nervous system, or pass away without treat-
ment.
Prognosis.
"From personal experience," remarks Dr.
Sims, “I can confidently assert that I know of no disease
capable of producing so much unhappiness to both parties.
to the marriage contract; and I am happy to state that I
know of no serious trouble that can be so easily, so safely,
and so certainly cured."
Treatment. The surgical treatment is given for this affec-
tion by Dr. Franklin and Dr. Helmuth, in their works on
Surgery.
Guernsey ignores the disease altogether, or includes it
in the chapter on "spasms, cramps, constrictions, and neu-
ralgia of the vagina," although he does not therein describe
the true vaginismus of which we are treating. With char-
acteristic boldness he asserts that "these strictures of the
vagina may be cured without artificial dilatation, by the aid
136
VAGINAL.
of the homoeopathically indicated remedy." This assertion,
however, is not supported by a single clinical fact.
The rational treatment of vaginismus should be conducted
as follows: First ascertain, if possible, the cause of the affec-
tion, and whether it is idiopathic or symptomatic.
If it arises from the hysterical diathesis, those remedies.
indicated in hysteria, and possessing the general and local
symptoms, should be selected. Among these the most useful
are: Platina, Belladonna (or Atropin), Conium, Asafoetida,
Hamamelis, and Gelsemium.
The introduction of suppositories of cocoa butter, medi-
cated with Conium, Belladonna, Chloral, Atropin, Iodoform,*
or Gelsemium, as they are indicated, will aid the internal
administration of the remedy. At the same time a glass
tube, known as "Sims's vaginal dilator," should be gently
inserted into the vagina and kept there for as many hours a
day as practicable. Its presence tends to benumb the nervous
sensibility, and produce a tolerance of foreign bodies. During
the treatment the patient should live apart from her hus-
band.
If excoriations, ulcers, or fissures at the vulva are present,
Nitric acid, Ignatia, Graphites, and Sulphur, may be given
internally, but the best results will be gained by applying
the fuming nitric acid to the fissures or ulcers.
One of the former remedies may be alternated with one of
the latter with good effect; at the same time the Graphites
cerate, Culendula, Glycerin, or Glycerole of aloes, may be ap-
plied locally. The Aloes glycerole is superior to any other
known remedy in the treatment of irritable and obstinate
rhagades, or fissures, occurring anywhere. An ointment of
Chloral hydrate or Iodoform, will also give relief (gr. x to
Vaseline 3j).
If an irritable tubercle of the meatus or vagina exists, a
surgical operation is the only resort. It should be hooked
up with a tenaculum and cut out, and immediately the pecu-
liar sensitiveness of the part will disappear.
* A suppository, made of equal parts of Tannin and Iodoform, is almost
destitute of the abominable odor of the latter, but may not act as well in
this disease.
VAGINAL.
137
Dr. Baker Brown reports many cases of vaginismus cured
by excising the enlarged and irritable clitoris. (See obser-
vations on that disease below.)
Pustular eruptions of the vulva require the use of Tartar
emetic, Sabina, Croton tig., Arsenic.
Vesicular eruptions call for Rhus tox., rad. or ven., and
Euphorbia. Urticaria of the vulva requires Apis mel., Urtica
urens, Graphites, Arsenic. Neuromata require to be removed
by the knife or curved scissors.
I have recently read the report of a case of vaginismus
cured by the same process which has been adopted success-
fully in the treatment of fissure or irritable ulcer of the
rectum, namely, forcible dilatation. The reporter stated that
he introduced his thumbs into the vagina, and forcibly
stretched it as much as possible, this operation was repeated
once or twice a week, and resulted in a cure in six weeks.
As his patient was not under the influence of an anesthetic,
the case could not have been a severe one.
I would suggest
that the use of Barnes's dilators, or the inflatable pessary,
or my expanding speculum would give better results.
Before describing the surgical treatment of vaginismus, it
ought to be mentioned that several cases are on record where
coition was performed while the wife was under the influence
of chloroform or ether, and that conception resulted from such
intercourse. In some of these cases the vaginismus disap-
peared after confinement; in others no improvement resulted.
Dr. T. G. Thomas, of New York, related to Dr. Sims a
case in which pregnancy followed coition under the above
circumstances.
Dr. Sims relates a case in which two conceptions occurred
in a state of complete anesthesia, followed by a labor at full
terin, and a miscarriage, but without curing the vaginismus.
Treatment. The treatment consists in the removal of the
hymen, the incision of the vaginal orifice, and subsequent
dilatation. The last is useless without the first two, but is
essential to easy and perfect success with. "I usually make
two operations, but it may be done at once."*
"The patient being under the influence of ether, and placed
* Sims's Uterine Surgery, p. 326.
10
138
VAGINAL.
on the back upon a table, the remains of the hymen are
entirely excised by a pair of curved scissors. The slight
hæmorrhage resulting from this will soon cease under the
application of a compress wet with ice water, or a solution
of persulphate of iron.
"The index and middle fingers of the left hand are then
passed into the vagina, so as to put the fourchette on the
stretch. By means of a scalpel, a deep incision is then made
on the right of the mediau line, terminating at the raphe of
the perinæum. A similar incision is then made on the other
side, the two being united at the raphe, and extended to the
perineal integument, and through its upper border. Each of
these incisions will extend from about half an inch above
the upper border of the sphincter to the perineal raphe, thus
passing across the muscle, and measuring nearly two inches.
They should pass over the sphincter muscle, but not entirely
through it.
"After this, the vaginal dilator is placed in the canal,
either immediately or in about twenty-four hours, and worn
for two hours in the morning, and three or four in the even-
ing, according to the tolerance for it which is manifested.
The vaginal dilator is three inches long, slightly conical,
open at one end, and closed at the other, and varying in size
from an inch to an inch and a half in diameter. This instru-
ment is kept in place by a T bandage, and should be worn
for two or three weeks."
LEUCORRHEA (VAGINITIS).—Vaginal leucorrhoea is always
the result of acute or chronic vaginitis. It may be specific,
arising from gonorrhoea, catarrhal, or caused by various
kinds of irritation.
"I do not know," says Sims, "that vaginitis, properly
speaking, is absolutely opposed to the vitality of the sperma-
tozoa. It appears to be the character, and not the quantity,
of the vaginal secretion, that kills the spermatozoa.
"The secretion from the vagina should be slightly acid;
if it is very acid it kills the spermatozoa instantly. I have
seen many cases in which they were all dead within five or
six minutes after coition. In all these cases, the vaginal
mucus was by no means abundant, but the surface of the
VAGINAL.
139
vagina always had a reddish look, and its papillæ were prom-
inent. By simply inspecting the surface of the vagina, and
testing the degree of acidity with litmus paper, I have some-
times been able to say that the vaginal mucus would poison
the spermatozoa. The blue litmus should be slowly turned
to a faint pink, when the secretion is normal; but when it
is abnormal, the litmus-paper turns quickly to a deeper pink
color."
Treatment. The treatment of leucorrhoea or vaginitis, in
cases of sterility, should be chemical or medicinal, or both.
The chemical consists in so changing, temporarily, the
abnormally acid condition of the secretion, that it will not
be fatal to the life of the spermatozoa.
"I have seen," says Dr. Sims, "conception twice (occur)
when the vaginal mucus poisoned the spermatozoa. One was
remedied by slightly alkaline washes, used before sexual
congress. In the other it occurred in this way: A lady,
aged twenty-eight, was married six years without issue. She
had a contracted os. It was incised, but she did not con-
ceive. She had indurated cervix, the consequence of cystic
disease. For this she was under treatment nearly two
months. It was cured, and her husband came to take her
home. Wishing to see the character of the semen, I ex-
amined the vaginal mucus four or five hours after coition.
The spermatozoa were all dead. On the next day, I examined
them in five or six minutes afterwards, and could not find
one alive. I then placed in the vagina a small tampon,
moistened with a little glycerin, which held in solution some
of the bicarbonate of soda (20 grs. to 5j). This application
was repeated on the next day. The cotton was tied with a
string, for its removal. This was worn from about two
o'clock P.M., till eight the next morning. Its removal was
followed by connection. Living spermatozoa were afterwards
found in the greatest abundance; indeed, there were no dead
ones at all. Conception dated from that moment, being just
two days before the expected return of the menses, which,
however, did not occur. There had been no sexual inter-
course for nearly two mouths before."
According to Kolliker, the phosphate of soda is peculiarly
favorable to the movements of spermatozoa; and this would
140
DISEASES OF THE CLITORIS.
probably be superior to the carbonate as an application in ex-
tremely acid conditions of the vaginal mucus.
The medicinal treatment of acute vaginitis is best con-
ducted by the internal administration of Aconite, Cantharis,
Copaiva, Cannabis sat., Clematis, Pulsatilla, Mercurius, Thuja,
and Sabina. For chronic vaginitis: Merc. cor., Sepia, Cal-
carea, Arsenicum, Senecio, Kreosotum, and Sulphur. Besides
the remedies mentioned, I have found from recent experi-
ence, that in acute vaginitis, with local heat, etc., enemas of
Gelsemium, Grindelia or Hamamelis, together with their in-
ternal use, are capable of removing the inflammation sooner
than any other treatment.
In chronic vaginitis, my experience is strongly in favor of
the use of tampons of cotton, saturated with dilute Glycer-
oles (5j to 3j) of Calendula, Muriate of Hydrastia, Myrica,
Grindelia, Bismuth, Chloral, or Borax.
DISEASES OF THE CLITORIS.
That some congenital and acquired diseases of the clitoris
indirectly cause sterility is placed beyond a doubt by the in-
vestigations of Baker Brown, whose success in curing not
only sterility but insanity, epilepsy, catalepsy, and hysteria,
should have prevented the senseless folly of the members of
the "London Obstetrical Society," who expelled him from
that Society for reasons which will be utterly inexplicable
to future surgeons and physicians.
In Dr. Brown's Surgical Diseases of Women he devotes a
chapter to "Irritation and Hypertrophy of the Clitoris,
and writes:
66
Enlargement of the clitoris, sometimes accompanied by a
degree of induration approaching that of cartilage, at others
by a relaxed, flabby state of the tissues, and always attended
by abnormal irritability, is a condition of more frequent
occurrence, I believe, than the majority of medical men sus-
pect, and is for the most part brought on by self-abuse. The
radical cure of the habit is, however, fortunately in our
hands. Long-continued irritation of the clitoris figures
among the causes of sterility, for, besides its constitutional
effects, the habit acts locally on the functions of the womb,
DISEASES OF THE CLITORIS.
141
either in the same way, we may presume, as does excessive
venery, or by inducing displacement of the organ."
The following symptonis are noted by Brown as being
pathognomonic of this habit and condition: "Melancholy;
restlessness; excited and retiring; listlessness, and indifferent
to social influences and domestic life; strange fanciful appe-
tite, dyspepsia; pain in head and down the spine; pains more
or less constant in the small of the back, or on either side in
the lumbar region; wasting of the face and muscles gener-
ally; skin dry and hard, or cold and clammy; pupils dilated ;
hands clammy; often a hard cordlike pulse; irregularity
of the uterine function; amennorrhea, or too frequent
menses; dysmenorrhoea, and leucorrhoea. If married the
woman has distaste for marital intercourse, and very fre-
quently either sterility, or a tendency to abort in the early
months of pregnancy.
'On examination of the external genital organs there will
be found a straight and hirsute growth, a depression in
the centre of the perinæum, a peculiar follicular secretion,
an alteration in the structure of the parts, mucous membrane
taking on the character of skin, and muscle having become
hypertrophied and generally tending toward a fibrous or car-
tilaginous degeneration.”
Surgical Treatment." When I have decided that my pa-
tient is a fit subject for surgical treatment, I at once proceed
to operate, after the ordinary preliminary measures of a warm
bath and clearance of the portal circulation. The patient hav-
ing been placed completely under the influence of chloroform,
the clitoris is freely excised either by scissors or knife. I always
prefer the scissors. The wound in then firmly plugged with
a graduated compress of lint, and a pad well secured by a T
bandage. A grain of Opium is introduced into the rectum,
the patient placed in bed, and most carefully watched by a
nurse to prevent hæmorrhage by any disturbance of the
dressing. The diet must be unstimulating, and consist of
milk, farinaceous food, fish, and occasionally chicken. The
strictest quiet must be enjoined, and the attention of relatives,
if possible, avoided, so that the moral influence of the medical
attendant and nurse may be uninterruptedly maintained."
(Brown.)
142
DISEASES OF THE CLITORIS.
-
Dr. Brown says: "A month is generally required for the
healing of the wound, at the end of which time it is diffi
cult for the uninformed or non-medical to discern any trace
of any operation. The rapid improvement after the opera-
tion is most marked. The woman soon recovers excellent
health, mentally and physically, and a healthy pregnancy
results. He asserts that this operation no more unsexes
the woman than an operation for piles. On the contrary,
healthy and natural sexual appetite and pleasure take the
place of the abnormal appetite."
(
Medicinal Treatment.—It is a very hazardous and delicate
matter for a physician to propose this operation, be it ever so
necessary, owing to the popular and even professional preju-
dice. We are, therefore, driven to our local and internal
medicinal remedies, by which we may hope to accomplish
results approximating excision.
Abnormal irritability of the clitoris may, however, be due
not to any pernicious habit, but is often a congenital dis-
order of the pubic nerve which supplies that organ. We
may not be enabled by medicinal influences to perma-
nently remove abnormal irritability of the clitoris when it
has been acquired, or when that organ has become enlarged
or otherwise changed in structure; but we may be able to
palliate the irritation to such an extent that conception can
take place, and we may also be able, by the use of appropri-
ate remedies, to carry the pregnancy to a final termination.
In cases of congenital irritability, remedies have a nuch
more permanent effect, especially if masturbation has not
been contracted, and the clitoris remain normal in structure.
In such cases pregnancy usually arrests the irritability, and
after childbirth it disappears altogether.
There are but few medicines upon which we can rely in
this disorder, and in order to be successful with them we
must prescribe them in material doses until their primary
physiological effects are established.
These medicines are (1) the Bromides, especially the
Monobromate of camphor, (2) Pieric acid and Hydrobromic
acid, (3) Conium, (4) Ferrocyanuret of potassium and Bro-
mide of iron.
Monobromated camphor has a prompt and decided action as
'
LISEASES OF THE CLITORIS.
143
a sedative to the pubic nerve and the vaso-motor nervous
system generally. It not only calms the general nervous
system, but those of the genital organs especially. I have
used it with such success for several years that I can confi-
dently recommend it.
ILLUSTRATIVE CASE.
Sterility, Congenital Abnormal Irritability of the Clitoris
Cured.-Was applied to by Mrs. for the removal of
sterility. Had been married six years, without concep-
tion. She was a woman of large physique, bilious tempera-
ment; had internal hæniorrhoids, and chronic constipation,
dysmenorrhoea, and leucorrhoea. Examination showed some
follicular inflammation of os uteri, chronic vaginitis, and
some vaginismus. The vulva was rough, and the parts pre-
sented the appearance described by Dr. Baker Brown, above.
quoted, except that the clitoris was not enlarged. It was,
however, highly irritable as accidental touching showed.
Although I suspected something abnormal, from the spas-
modic contractions of the vagina, and the excessive trans-
parent mucous secretion poured out by the cervical glands
and those of the ostium vaginæ, I did not, from motives of
delicacy, ask any questions on that point. Treatment for a
few weeks removed the follicular ulceration, the vaginitis,
and the constipation. In a conversation with her husband,
he asked me if a state of almost constant sexual excitement
would not induce sterility. I answered in the affirmative,
when he requested me to consult with her on that subject.
On personal inquiry she related that she had been the sub-
ject of abnormal irritability of the external genitals since her
earliest childhood, "as long ago as she could remember any-
thing." To get relief she was obliged to resort to rubbing
and friction, and this would bring on orgasm. This led to
the habit of masturbation, which continued till she was
married, when she hoped it would cease, but was disap-
pointed, for her husband could not satisfy the unnatural
irritation. She had vainly striven to control it, and although
she was evidently a woman of strong mind and good princi-
ples she failed because the mind was not at fault. When she
resisted successfully during waking hours, she involuntarily
144
DISEASES OF THE CLITORIS.
1
X
produced orgasm by rubbing during sleep. She suffered much
from occipital headache, extending down the spine; had wild
and unpleasant dreams, and a "wild feeling in her brain that
alarmed her." Gelsemium 1 was prescribed with but little
effect, as also was Bromide of potassa, which only gave her
better sleep. I then gave her capsules of Camphor mono-
bromide each containing 2 grains, of which she took three
a day. In a few days she reported herself much better in every
respect, and in three weeks the pain in the head had ceased,
and sexual functions were about normal. The next month
she missed her menstrual period, the first time in her life, and
soon found she was pregnant. During pregnancy she had to
resort occasionally to the medicine, but went to full term
and gave birth to a healthy child. She informs me that
since the birth of the child, now over a year, there has been
no return of the former unnatural excitement.
I have since used the Camphor monobromide in another
similar case with like result. With the Bromide of am-
monium I once cured a case presenting the above features,
with this exception, the abnormal irritation occurred only
before, during, and after the menses; the dose was ten grains,
three times a day.
Pieric acid differs from the above in being primarily
homœopathic to the above-mentioned normal condition,
when given in small doses; i.e., small doses cause sexual
erethism; large doses produce a morbid sexual depres-
sion. Dr. L. B. Couch* says he has cured several cases of
self-abuse by this medicine. In one case reported, the cure
was made by the 30th. This proves my theory of dose to
be true. In obstinate cases Dr. Couch says he should not
hesitate to give large doses (10 grains of the 1 trit.).
X
Hydrobromic acid is said to possess nearly all the proper-
ties of the bromides, and as it is very pleasant to the taste
made into a "lemonade," and never disagrees with the
stomach, it may prove a useful remedy. Drop doses, if pure,
should represent grain doses of the bromides of soda, lime,
and potassa. In cerebral congestion I get good effects from
15 to 25-drop doses.
* Homœopathic Times, April, 1878.
DISEASES OF THE CLITORIS.
145
Conium will be treated of in a chapter further on. I will
only say here that in abnormal irritation of the clitoris, I
have used Squibb's fluid extract of Conium, in doses of 5
to 15 drops once or twice a day with good effects, in a few
cases.
Ferrocyanuret of potassium and Bromide of iron will prove
excellent remedies in this affection, in chlorotic or anæmic
women subject to cardiac and intercostal neuralgia, when
the menses are pale and too frequent. They enrich the blood,
while they lower in a marked degree the sexual power aud
appetite. This is especially the case with the Cyanuret.*
NOTE.-The foregoing Chapter should have been numbered VII instead
of V.
* See vol. ii, New Remedies (Therapeutics).
146
RENAL.
CHAPTER VIII.
RENAL.
DIABETES." During the course of this disease," says Dr.
Morgan,*"the power and function of reproduction are more
or less suspended in both sexes, but returns as vigorously as
ever on the removal of the diabetes
Diabetes mellitus, and perhaps diabetes insipidus, may be
a cause of sterility, and not be recognized as such by the
physician, who may be treating some uterine trouble which
he supposes is the real cause.
Treatment. The most important remedies for this disease
happen to be at the same time some of our most valuable
remedies for sterility, viz.: Acidum phosphoricum, Mercurius,
Helonias, Arsenic, Baryta carb., Conium, Digitalis, Eupato-
rium purp., Kali carb., Uranium nitrate, Terebinth., Acidum
mur. (For the special indications for these and many other
medicines, see Dr. Morgan's work.)
X
I have cured two cases of diabetes in women with Helo-
nias, in both of which impotence and sterility were concom-
itants. After their recovery sexual power and desire re-
turned, and they soon became pregnant. The 1 dilution
was used, ten to fifteen drops four times a day. Those who
wish to consult the important clinical and pathogenetic his-
tory of this remedy will find it in my Therapeutics of New
Remedies, 4th edition.
Lycopus virginicus has been found curative in several cases
of diabetes.t
Secale has been used very successfully in polyuria (D. in-
sipidus) after the failure of many other medicines. It was
given in doses of fifteen to thirty drops of Squibb's fl. ext.
three times a day. It also cured the attending impotence.
* Diabetes, etc, by Dr. William Morgan, Hom. Pub. Co., London, 1878.
+ See August number North Amer. Journal of Homœopathy, 1878.
VESICAL.
147
CHAPTER IX.
VESICAL.
IRRITABLE BLADDER AND URETHRA.-These two distressing
and obstinate disorders may become very prominent causes
of sterility, by the reflex irritation transmitted to the uterus
and vagina.
I have found that vesical catarrh is nearly always attended
by vaginal and uterine catarrh, and the cystic disease may
have been the first to appear. The nervous irritation is also
transmitted to the uterus, causing spasmodic or neuralgic
dysmenorrhoea.
There are several varieties of cystic and urethral disease,
and a brief mention only will be made.
Chronic cystitis, or vesical catarrh, is one of the most painful
and annoying affections with which a woman can be afflicted.
It commences usually with a simple cystitis from a cold,
especially from exposure during the menses. At first the
discharge is simple mucus mixed with the urine, but as the
disease advances it may become bloody, and is attended with
severe dysuria, and lancinating, burning, and spasmodic pains
like tenesmus.
In the chronic stage the dysuria is intense, the urging to
urinate very frequent, attended by vesical tenesmus, the sleep
is broken by frequent calls to urinate, the urine is scanty and
high-colored, containing a large proportion of pus, muco-pus,
blood, epithelium, and in the worst cases, shreds of mucous.
membrane from erosion and sloughing. The region of the
bladder is sensitive to the touch; walking or riding is pain-
ful, and finally hectic fever sets in. In some cases the urine
is intensely fetid, owing to rapid decomposition, or excessive
quantity of phosphates, especially if the posterior wall of
the bladder becomes prolapsed, and pouches into the rectum.
Not only does this affection cause sterility by reflex irrita-
tion of the uterus, but it renders fruitful marital congress
148
VESICAL..
almost impossible, on account of the pain and irritation it
causes, and because of the necessity of getting up to urinate
immediately after the act, when the tenesmus of the bladder
is attended by sympathetic tenesmus of the uterus and vag-
ina, expelling the seminal fluid from those organs.
Not only is it necessary to cure the disease before concep-
tion can take place, but even should conception occur, the
woman would be in a very pitiful condition, for pregnancy,
if not cut short by a miscarriage (a common result), would
be a continued scene of indescribable suffering
Treatment. The diet of the patient must first be regu-
lated. All stimulating beverages containing alcohol should
be prohibited. All foods containing spices, pepper, mustard,
horse-radish, etc., should be avoided. Milk is the best article.
of food, with bread and meat. Walking and riding should
be indulged in with great moderation. Coition should be
very rare, if at all, until a cure is effected. The feet and
lower extremities should be dressed warmly. Damp feet
should be avoided by wearing woollen hose, thick shoes with.
cork soles, or voltaic in-soles.
The medicines most efficacious in acute cases are Cannabis,
Equisetum, Cantharis, Pulsatilla, Capsicum, Galium, Spirits
nitri dulc., etc.
In chronic cases the most successful remedies are Galium,
Chimaphila, Mitchella, Uva ursi, Pareira brava, Barosma,
Grindelia, Monobromate of camphor, Santonin, Benzoic acid
and the Benzoate of lithia, Thuja, Terebinth., Copaiva, and
Cubebs. With these medicines, if carefully selected, nearly
all cases of vesical catarrh can be cured. Some of them,
namely, Galium, Chimaphila, Mitchella, and Uva ursi, act
best when given in infusion, cool or warm, prepared in the
proportion of 5j to 5ss of the herb to a pint of water, a
wineglassful taken every few hours. Barosma and Pareira
act best in Syrup bal. Peru (5) to 3iv of the Syrup, a tea-
spoonful every few hours). Thuja and Terebinth. in the
2× dilution. The others in the 1 trituration, a few grains
every two or four hours.
The topical treatment of this disease is indispensable in
many cases. The medicines in filtered solutions should be
thrown into the bladder, by means of a syringe directly, or
VESICAL.
149
through a short or long catheter. As a preliminary to this
treatment the urethra will often have to be dilated. (See
Diseases of Urethra.) The best medicines for topical use
are Hydrastis, Grindelia, Copaiva, Terebinth., Thuja, Sali-
cylate of soda, Bicarbonate of soda, or Acidum muriaticum.
Hydrastis, when the sediment is tough, ropy, and muco-
purulent (5j of Merrill's fluid hydrastis, or gr. v of the
muriate or sulphate of hydrastia to a pint of warm water).
Copaiva, Terebinth., Grindelia, and Thuja, in the form of
medicated waters, made as follows: 5j or ij is rubbed up
with carbonate of magnesia, then added to a quart of water
and filtered. Inject half a pint or more daily.
It is best to thoroughly wash out the bladder before the
medicated enema, by injecting simply warm water, or very
dilute solution of muriatic acid if the urine is alkaline; if
the urine is acid, sode bicarb. Some cases have been cured
by injecting healthy urine taken directly from another per-
sou, and thrown into the diseased bladder. Salicylate of
soda, or Salicylic acid, used as enemas, have cured many
cases when the urine was intensely fetid and contained
vibriones.† (In cases of prolapsus of the bladder I have ap-
plied a Thomas's anteversion pessary with great success.)
The most intractable case I ever saw was cured by the
latter. The woman had been a victim of this disease for
years. She was married and childless. The only relief she
obtained was by injecting warm water several times a day.
She had adopted the plan of her own notion. I found the
urethra already dilated, so that I could introduce my index
finger. I prescribed the following:
R-Salicylic acid,
Glycerin,
Water,
•
·
31.
3j.
1 quart.
Four ounces of this was thrown into the bladder, previ-
* The addition of a grain of Morphia, or 7th grain of Atropin, is an ex-
cellent palliative of pain in very bad cases.
R--Salicylic acid,
Borax,.
Water,
R.--Salicylate of soda,
Water,.
gr. xx.
gr. XXX.
1 quart.
Or,
•
3ss.
1 quart.
150
VESICAL.
ously emptied and washed out with warm water, and re-
peated several times daily.
The next most successful cure was made by giving inter-
nally, in teaspoonful doses every four hours, a mixture of
equal parts of Tincture of Chimaphila and Syrup Balsanı
of Peru. She was cured in two weeks, after many of the
above medicines, even Chimaphila in drop doses of the tinc-
ture, had been used unsuccessfully. Both these women be-
came pregnant soon after the cure. (Since the above was
written I have cured a severe case with Grindelia robusta,
given internally, and applied topically, prepared as a “medi-
cated water.")
URETHRAL.
151
CHAPTER X.
URETHRAL.
IRRITABLE URETHRA, or CHRONIC CATARRHAL URETHRITIS
may become a cause of sterility, equally with the similar
affection of the bladder. In this disease the pain and suffer-
ing during and after urination and coition, are more intense
than in chronic cystitis. It so wears upon the system that
women become nervous, irritable, and almost insane from
the constant irritation, the loss of sleep, and the peculiar
sufferings. In cases of true irritability of the urethra, no
discharge is observed, and a close examination fails to detect
any abnormal growths in the canal or at its mouth. It seems
to be as purely a nervous affection as are some severe cases
of vaginismus. In catarrhal urethritis, which may arise
from repeated acute attacks, or from gonorrhea, structural
changes often occur, namely, thickening of the walls, fun-
gous growths, ulceration, occlusion, or paralysis.
Treatment.—The medicinal treatment is far less satisfactory
than for chronic cystitis, but the same remedies are indicated.
The topical treatment is the most important. In the neu-
ralgic variety, atropia* applied to the whole length of the
canal by means of a probe wrapped with cotton, or carbolic
acid† may be useful in some cases. But the most successful
treatment is by means of dilatation. This operation is
equally efficacious in nearly all diseases of the female urethra,
and is adopted by all our best surgeons.
This simple operation is so important and useful that I
will give the most approved methods now adopted. Sir Ast-
ley Cooper first proposed and practiced it for the purpose of
removing stone from the bladder, but he used the slow method,
by means of sponge, or sea-tangle tents. But this method
has recently been supplanted by the equally safe and thorough
* Atropia, gr. i; Glycerin, j.
+ Carbolic acid, gr. v; Glycerin, 3j.
152
URETHRAL.
and much less tedious method of rapid and forcible di'a'ation.
As regards the instruments used, Simon employs graduated
bougies or special bivalvular specula, first incising the border
of the meatus. Noeggerath dilates with graduated steel
bougies and the little and index fingers. Thomas with a
forceps similar to a dressing forceps. Munde says Good-
willie's wire-spring nasal speculum is a good instrument.
Dr. Ball's instruments, which he uses for forcible and rapid
dilatation of the cervix uteri, might be useful. Any of the
forcible dilators of the cervical canal will answer; in many
cases the finger alone will do the work, for the urethra is
often dilated somewhat by the disease. In all cases the dila-
tation occupies but a few minutes or seconds, and is never
followed by permanent incontinence of urine all operators
agree in this statement. Heath says the urethra splits from
beneath the pubis, and that the incontinence rarely lasts
longer than twenty-four hours. The operation is always
performed under anesthesia. The benefit is instantaneous.
The American Journal of Obstetrics, and other journals during
the last year or two, have contained many reports wherein.
this operation has permanently cured old and hitherto in-
tractable cases, and restored the patients to health.
CARUNCLES OF THE URETHRA.-This is one of the most com-
mon of urethral disorders in the female sex. Dr. Goodell* de-
scribes them as intensely vascular and exquisitely sensitive
growths, occurring more frequently in married women; they
do not appear to be due to gonorrhoea, uncleanly habits, or
frequent coition, but are usually accompanied, perhaps pre-
ceded, by uterine diseases. Although at times perfectly pain-
less, they are often the cause of the most excruciating pelvic
and vesical pains, and in the course of time bring about
alarming symptoms of general debility, nervousness, and de-
pression, apparently quite out of proportion to the size of the
tumor. The caruncles may occupy any portion of the urethra,
and are the most difficult of treatment when situated near
the bladder and sessile in their attachment.
Treatment.—It is possible that medicines may be useful in
some cases, but doubtful if they will more than palliate.
* Affections of the Female Urethra, Philadelphia Medical Times, 1874.
URETHRAL.
153
Thuja is the best indicated. Goodell advises their destruc-
tion by means of chromic acid, nitric acid, or carbolic acid,
applied full strength, or they may be removed by the scissors
(followed by the immediate application of fuming nitric acid,
or the actual cautery, to check the usually profuse hæmor.
rhage), or by the galvano-caustic loop, or its less expensive
substitute, a red-hot knitting-needle or hair-pin. Forcible
dilatation of the urethra will sometimes be found necessary
to prevent their return and effect a permanent cure.
GRANULAR EROSION OF THE MUCOUS MEMBRANE is a very
painful affection, but generally relieved by the application of
undiluted carbolic acid on a fine stick, once a week, followed
by the introduction of Olive oil or Cosmoline.
FISSURE OF THE URETHRA is a rare and obscure form of ure-
thral disease. It occurs near the neck of the bladder. It is
readily cured by hyperdilatation and touching with lunar
caustic or nitric acid.
VESICO-VAGINAL FISTULA is a cause of sterility. For de-
tails of the operation for its removal consult the standard
works on surgery.
VASCULAR TUMOR OF THE MEATUS.—“Few diseases of tri-
fling magnitude occasion more distress than a vascular ex-
crescence, varying in size from a large pin's head to a horse
bean, which is sometimes found growing from the female.
urethra. Its exquisite sensibility shows it to be as well sup-
plied with nerves as with blood vessels. The tumor some-
times arises from the projection which generally exists around
the orifice of the meatus, but it frequently grows from the
internal surface. The tenderness of the part is so great as not
to allow of sexual intercourse, and it may thus become indirectly
a cause of sterility." (Dr. Baker Brown; Surgical Diseases of
Women.)
Diagnosis.—An exquisite sensibility of the part is a lead-
ing symptom of the disease. The patient complains of ex-
cessive pain in micturition, in coition, and from the slightest
pressure on it. Upon separating the vulva there will appear
a small tumor, of a florid scarlet color, resembling arterial
blood. It springs from the orifice or just within the orifice
11
154
URETHRAL.
of the urethra. It easily bleeds on rough handling. Its
surface is somewhat granulated. There are sometimes
several of these tumors.
Treatment." Ligatures," says Baker Brown, " are useless,
as they cannot be made to include the whole of the diseased
mass, nor can they be tied with any degree of force, so as to
strangle it without exciting inflammation, as, in order to
effect a cure, some portion of the mucous membrane should
be included. The best practice is to excise the tumor with
a pair of scissors, taking care to remove not only the ex-
crescence itself, but also that small portion of mucous mem-
brane from which it grows, a fine pair of forceps being used
to take hold of it. To the wound thus made Nitric acid should
be applied on a piece of stick pointed like a pencil, the parts
around being filled with lint previously soaked with a strong
solution of Carbonate of soda." Dr. Brigham, however, says
that they are quickest cured by touching their extremity
with the actual cautery. I have cured small ones by means
of Persulphate of iron, and Nitrate of sanguinaria.
RECTAL.
155
CHAPTER XI.
RECTAL.
"DISEASES of the rectum," says Dr. Baker Brown, "will
produce sterility. The rectum and uterus are both supplied.
by vessels and nerves from the same source; and, therefore,
disease in one organ must interfere with the other. When
a female is suffering from bleeding hæmorrhoids during the
menstrual period, a diminished supply of blood is sent to the
uterus, and its mucous membrane will not undergo those
normal changes necessary for the reception of the impreg-
nated ovum. The same observations apply to prolapsus ani,
with loss of blood at every defecation."
In Volumes I and II of the American Journal of Obstetrics
appears a series of papers relating to the rectal causes of
sterility and uterine diseases, by Dr: H. R. Storer, of Boston.
They will amply repay perusal by the physician who desires.
to become thoroughly acquainted with this subject.
Prof. T. G. Comstock, of St. Louis, communicates the fol-
lowing case:
FISSURE OF THE ANUS CAUSING STERILITY.
"Mrs W., aged
31, married ten years, was never pregnant. Had suffered for
seven years with what she supposed was piles. She had
been treated by many physicians, who seem to have been
mostly in accord as to the diagnosis, they supposing it
to be internal piles. She had never allowed any examina-
tion by the speculum, until she came under my charge. I
gave her case a careful investigation, and selected the reme-
dies accordingly; but at the expiration of one month, she
had not improved at all, and then I insisted upon an exam-
ination, or, if she refused, intended to decline attending her.
She consented, and an examination by means of the anal
speculum at first gave me no insight into the difficulty ; but
with a fenestrated speculum, and by means of my fingers, I
detected an erosion in the centre of a fissure, situated half
an inch or more within the orifice of the anus. The sides
156
RECTAL.
or walls of this fissure felt thickened, granulated, and
hypertrophied, and she experienced so much pain from the
examination, that I gave her chloroform inhalations; but
previous to this, she said: 'Now you touch the spot where I
feel all my pains.'
"I immediately operated upon this fissure, using very
carefully a sharp-pointed curved bistoury, making a simple
incision through the mucous coat, so as to completely cut
through the fissure to its bottom, and extending it longitudi-
nally a little beyond its extremities.
"The patient was very irritable, hysterical, and unhappy,
and had longed for offspring. The husband was perfectly
healthy, and the only thing the wife had ever complained
of was the infirmity in question. She always had distress-
ing pains during defecation, and great suffering during
coitus. These unpleasant symptoms all disappeared as soon
as she recovered from the operation, which was within three
weeks; and six months after, she became pregnant, and was
safely delivered. The fissure of the anus was undoubtedly
the cause of her sterility, although it had not been previ-
ously suspected. This ailment has been often overlooked by
physicians."
FISSURE OF THE RECTUM.-In Dr. Baker Brown's classical
work on Surgical Diseases of Women he devotes a chapter
to "Diseases of the Rectum producing, or resulting from
Uterine Disorder."
In this chapter he says there are three distinct kinds of
fissure.
(1.) A small superficial ulceration just within the verge
of the anus.
(2.) A deeper ulceration in the same position, which goes
through the mucous membrane and into the muscular fibres
of the external sphincter.
(3.) A true fissure or crack, not discoverable by external
examination, as it is situated at least an inch from the anus.
Polypi usually accompany the two latter forms, and Dr.
Brown thinks they are caused by the fissure.
The first form of disease, according to Brown, causes
the most serious symptoms, referable to the bladder and
uterus, namely, frequent desire to urinate, painful mictu-
RECTAL.
157
rition, and incontinence of urine; also, dysmenorrhoea of a
most painful character, vaginismus, a localized pain, almost
constant, about six or eight inches up the bowels, great irri-
tation about the anus and vulva; but rarely the painful
de ecation set down as a symptom of fissure. This last is a
reason why the disease is often overlooked, and treatment
applied to the uterus and bladder, instead of the rectum.
This variety of fissure is often a cause of sterility, from the
irritation which it keeps up in the uterus and vagina.
Treatment.-Dr. Brown's treatment, which I have adopted
in several cases, is to draw a straight, blunt-pointed bistoury
lightly through the ulceration and contiguous skin without
the anus for about an inch. Curling, in bis admirable little
work, which should be in the library of every physician,
thinks that even in these superficial erosions, the muscular
fibres "at the bottom of the sore," and for some distance
each way, should be cut off.
In the second and third kinds a deeper cut, deeper than
the fissure, through the fibres of the muscles and for an inch
or two through the skin of the anus, is necessary.
These operations should be followed by a dressing of
borated lint or cotton saturated with Glycerole of calendula.
Before the operation the bowels should be thoroughly emp-
tied by a laxative, or injections, and not allowed to move for
a few days after.
In homeopathic practice some surprisingly favorable re-
sults have accrued from internal medication, where we are
able to select the true similimum. In Volume V of the North
American Journal of Homeopathy is an exhaustive paper by
Dr. Perry on this subject, in which the indications for the
following medicines are given, and several brilliant cures
have been made by them:
These remedies are: (1) Nitric acid and Ignatia. (2.)
Plumbum, Arsenicum, Sulphur, Lachesis, Natr. m., Phos-
phorus, and Sepia. Dr. Roth adds Nux to the list, as a most
important remedy. It seems, however, from some late ex-
perience, that Ratania ought to come after Nitric acid, as the
next most important medicine. In the May No. (1878) of the
North American Journal of Homœopathy, Dr. T. F. Allen gives
* Diseases of the Rectum, p. 12.
158
RECTAL.
a complete résumé of the powers of this drug, and reports a
case where he made a brilliant cure with Ratania. He
suggests Graphites, Poonia, and Silica as good remedies. I
have had good results follow the use of Esculus and Aloes.
Ratania, or any other indicated remedy, should be applied
topically as well as given internally, for they have cured
cases, when thus applied, when they were not given in-
ternally at all. Ratania is equally valuable for fissures or
cracks in the nipple, vagina, or lips, showing that like Nitric
acid it is generally useful, and that fissures are not always a
purely local affection, but depend upon some constitutional
dyscrasia.
Dr. Baker Brown believes that fissures, and other diseases
of the rectum, especially irritability, spasm, and neuralgia,
may be caused by the habit of "delection," or masturbation.
In such instances he practices excision of the clitoris, as
a means of cure, to be followed, if necessary, by the above
surgical procedures on the rectum and anus. He shows con-
clusively that vaginismus is often caused by the same per-
nicious habit.
THE MECHANISM OF CONCEPTION.
159
n
CHAPTER XII.
THE MECHANISM OF CONCEPTION.
A WORK on sterility would be incomplete if it did not men-
tion certain important facts relating to the seminal fluid,
and the processes which may be termed the "mechanics of
conception."
This subject will be discussed under three heads, viz:
I. The nature and properties of semen.
II. The method of its passage to the ovule.
III. The successful conditions for such passage.
I. THE SEMEN.
The seminal fluid is made up of the secretion of the testes,
mixed with that of the seminal vesicles, prostate, and Cow-
per's glands. It is composed of the liquor seminis, granules,
and spermatozoa.
Normal semen will drop from the end of a pipette or
syringe in drops as easily as water. A small quantity falling
into a glass of water is, by slight agitation, immediately dif
fused or dissolved in it. Abnormal semen full of mucus will
not leave the mouth of the syringe quickly or suddenly, but
ropes off for an inch or more before it breaks into a drop;
but when it falls into water it preserves its tenacity, and but
a small part of it is dissolved. It floats about in shreds, and
eventually settles at the bottom of the glass in the form of a
whitish sediment.
Semen destitute of spermatozoa has the usual sui generis
odor, but lacks the appearance of uniformity that belongs to
the normal secretion. When viewed by transmitted light,
we usually see little whitish flakes of mucus floating through
it. This is not always the case, however, for Sims mentions
two instances in which it had the color and appearance of
good semen, although wanting in spermatozoa. Abnormal
semen is insoluble in hot or cold water, and floats about in
160
THE MECHANISM OF CONCEPTION.
it in cloudy flakes like ordinary mucus. It is more translu-
cent than good semen, less milky, and less opaque. Under
the microscope it presents the appearance of ordinary mucns.
Good semen may, however, be loaded with mucus, which
probably comes from the glandular apparatus at the neck of
the bladder. The presence of a large amount of mucus is
not necessarily inimical to the life of the spermatozoa.
The fructifying power of the semen lies in the spermatozoa
alone, and not in the liquor seminis, or any fanciful "seminal
aura.”
*
Dr. Sims, who had paid special attention to the exami-
nation of the seminal fluid, says: "If we take a drop of
semen from the vagina immediately after sexual intercourse,
and place it under the microscope, we shall see the hurried
movements of seemingly thousands of spermatozoa. But this
is not the best way of studying the phenomena of their move-
ments. The best plan is to take a drop of mucus from the
caual of a perfectly normal cervix uteri some fifteen or
1.
FIG. 27.
2.
3
a

Spermatozoa (after Kolliker). 1. Magnified 250 diameters. 2. Magnified 600 diameters.
a. Viewed from the side. b. Viewed from the back. 3. Fragment, head and one-fourth ot
tail. Magnified 2800 diameters (after Richardson).
twenty hours after sexual intercourse. We shall then be
better able to examine the spermatozoa; for we shall see
them in the fluid that serves as the means of their finding
their way towards the ovumi.
* Uterine Surgery, p. 315.
THE MECHANISM OF CONCEPTION.
161
"We shall find them moving more slowly, more continu-
ously, if the term be allowed. Suppose we select any one
spermatozoon for observation, and note particularly its va-
rious actions and movements. It will swim first one way
and then another, or more in a straight line across the field
of vision, and perhaps turn abruptly to retrace the path
already traversed. If it encounters a large epithelial scale,
it stops, places its head against it, as though trying to push
it forwards, and when it fails to do so, it turns and moves
off slowly in another direction, perhaps to encounter another.
opposing obstacle, to pause a moment and make another
effort to overcome it, and then to turn again in search of
some new field of exploration."
One would suppose, after reading this graphic description
of the movements of the spermatozoa, that there should be
no doubt about their possession of animal life, yet Carpenter,
in his Physiology, writes: "Spermatozoa have no more claim
to a distinct animal character than have the ciliated epithelia
of mucous membrane, which likewise continue in movement
when separated from the body. They appear to be nothing
else than cell-germs, furnished with a peculiar power of move-
ment, by which they are enabled to make their way into the
situation where they may be received, cherished, and de-
veloped."
This statement would deny them all organization and life,
as if life could be begotten without life. But let us inquire
into the proofs of their possession of organization.
Loeuenhoeck, Gerber, Valentine, Dujardin, Wagner, and
other eminent microscopists, all testify to have discovered
traces of organization in spermatozoa. Valentine says: "The
spermatozoa of the bear have a mouth, anus, and stomach, or
a convoluted intestine." Commenting on this, Hassallt prop-
erly observes: "The determination of the fact that the sper-
matozoa are possessed of even the smallest amount of or-
ganization, would involve their classification in the animal
kingdom." He further says, concerning their motions. "All
the spermatozoa contained in a drop of semen which has un-
* Muller's Embryology, with illustrations, p 1475,
† Microscopical Anatomy, vol. i, p. 225.
162
THE MECHANISM OF CONCEPTION.
dergone dilution, will not start into motion at once; many
of them will remain for a time perfectly motionless, and then
suddenly, as it were by an act of volition, begin to move
themselves in all directions." Of their mode of progression,
the same writer says: "The motions of the spermatozoa are
effected principally by means of the tail, which is moved
alternately from side to side, and during the progression the
head is always in advance." It is said that the spermatozoa
of different animals move in a different manner, because they
differ very much in their form and structure. This would
not be the case if they were "nothing more than ciliated
epithelium."
Hassall also states, that in the varied motions executed by
the spermatozoa, they exhibit all the characters of volition;
thus they move sometimes quickly, at others slowly, alter
their course, stop altogether for a time, and then resume
their eccentric movements. These movements it is impossi-
ble to explain by any reference to any hydroscopic properties
which may be inherent in the spermatozoa, they appear to be
so purely voluntary. Dr. Morris Wilson* says: "Sperma -
tozoa when moving through a fluid turn readily out of the way
of any obstructions, but they have not the backward movement
of the vibriones." (Would ciliated epithelium avoid obstruc-
tions?)
Notwithstanding both Dalton and Draper in their works
on Human Physiology assert that spermatozoa do not possess
animal life nor organization, and affect to believe that the
appearances above quoted were due to optical delusions, we
feel confident that their distinctive animal nature will some
time be fully proven. It will be more in accordance with
true scientific modes of thought not to assert of spermatozoa
a want of life and organization because we cannot now dis-
cover and demonstrate it, but await the result of more min-
ute investigations.
Not only must there be living, moving spermatozoa in the
semen, but their motions must be normal and their life healthy,
or they cannot impregnate the ovum. Sims has shown that
these organisms may be diseased† or crippled by the un-
* Disease of Seminal Vesicles.
Uterine Surgery, p. 352.
THE MECHANISM OF CONCEPTION.
163
healthy medium in which they are ejected, or poisoned by
the secretions of the uterus and vagina.
It is important to know under what circumstances the
spermatozoa live longest and retain their healthy vitality.
Under favorable circumstances they live many hours, even
days; under unfavorable circumstances they die quickly. For
instance, any great variation of temperature is fatal to their
existence. In a temperature of 98° they will live a long time;
a variation of ten degrees may cause death.
Certain conditions of the secretions of the vagina and
uterus destroy their life. According to Donné, they live in
pus and blood, but I imagine the pus or blood must be
healthy. According to Wagner, they live in blood, milk,
mucus, pus, syrup, and very delicate saline solutions. Sims
says he has frequently seen conception happen when the cer-
vix uteri was the seat of profuse suppuration. But if the
secretions of the vagina be abnormally acid, it kills the sper-
matozoa instantly. The same may be said of the cervical
mucus if it possess acrid or unhealthy properties, or if it is so
thick and tenacious that they cannot move freely in it. (I have
alluded to this when treating of leucorrhæa, etc.) "They do
not exhibit any movements in pure semen, i. e., before mixed
with the fluids of the seminal vesicles" (Kolliker).
There are certain chemical and toxic agents that are poi-
sonous to the spermatozoa, and others that are favorable to
their vitality. Of the former are strong alkalies, acids, even
when very weak, astringents, salt, alcohol, opium and all
narcotic poisons, strychnia, and, indeed, all medicinal sub-
stances. They cannot live in urine and bile, or uterine mucus
strongly alkaline (Donné). Hassall says the spermatozoa
are devoid of life in persons who have died from the poisonous
effects of prussic acid. This may be the case in poisoning
with other diffusible poisons. In treating the causes of ster-
ility we should bear these facts in mind, and allow no me-
dicinal substances to be injected or used in the vagina and
uterus near the time of a coition which is desired to be fruit-
ful.
To the last class, or those favorable to the life of the
spermatozoa, are weak alkaline soulutions, especially the
phosphate of soda (Kolliker), or bicarbonate of soda (Sims).
164
THE MECHANISM OF CONCEPTION.
The strength should be about 5 grains to 3j, and the water
of the temperature of 98°. We may, therefore, use these
alkalies when we wish to neutralize the too acid character
of vaginal mucus. In healthy vaginal mucus spermatozoa
may live several days, and in it their power of locomotion
are certainly very extraordinary.
EXAMINATION OF VAGINAL AND CERVICAL MUCUS FOR SPER-
MATOZOA.-Dr. Sims* gives the following minute directions for
procuring and examining the secretion of the vagina and cer-
vix uteri for spermatozoa: "Suppose we wish to examine the
vaginal mucus soon after coition-say within an hour; we
direct the patient to empty the bladder before the act, and
to retain quietly the recumbent position after it. The dorsal
decubitus is the best. To remove a few drops of the contents
of the vagina, pass the index finger into it; press the pos-
terior wall downward and backward, just under the cervix
uteri; hold it so for a minute or two; the semen will neces-
sarily gravitate to the pouch made by the pressure; then in-
troduce the nozzle of the syringe along the finger; let it
project slightly over the end of the finger-nail, and it will
be easy enough to obtain what we want if there is any semen
in the vagina. I am thus minute in explaining this simple.
operation, because we may fail in it entirely, even when the
vagina contains large quantities of semen, if we neglect these
minutiæ; and in this way, if we pass in the syringe in a
haphazard manner and begin to draw the piston, the mucous
membrane of the vagina is sucked up into the end of the
tube, and thus it is possible to slide it around in various di-
rections without getting a drop of mucus of any sort. But
suppose we fail even with properly directed efforts; then the
left lateral position and my speculum will, in a moment, show
us the whole contents of the vagina, and we can, with the
syringe, remove what we want.
When we wish to examine the cervical mucus, we should
resort at once to the speculum and the proper position. It
is well enough, then, to sponge away all the mucus from the
vagina, and especially from about the cervix uteri, when
* Uterine Surgery, p 393.
THE MECHANISM OF CONCEPTION.
165
we pass the nozzle of the syringe just within the os tincæ,
and draw up a drop of its mucus To do this, it is necessary
to pull the cervix forwards, so as to be able to look into it,
and to see exactly what we are doing. If the cervical mucus
is very tenacious we may fail to get it away. Then it will at
the next attempt be necessary, after introducing the syringe,
and drawing up the mucus, to pass the left index finger to
the edge of the os tincæ, and slide the end of the syringe on
to the end of the finger without raising it from the surface
of the cervix, or breaking its suction power. This may
seem to be a little thing to describe so minutely, but really
it is a most important matter to know and to do, if we ex-
pect to be exact in our investigations. The nicety of this
manipulation renders it the more important for us to clear
away all the vaginal mucus before we undertake it, lest we
get some of this drawn up into the syringe, which would, of
course, mar the precision of our observations. Suppose we
succeed in this, then we may wish to pass the syringe up for
an inch into the cervix to get a portion of mucus nearer the
cavity of the uterus. This operation is quite as delicate and
quite as important as the first, and is to be conducted in the
same way. There is an object in having the end of the syr--
inge bulb-shaped. This bulb fills up the os or the canal of
the cervix, and prevents the air from being drawn into the
instrument, as sometimes happened with me when it was
slender and pointed.”
A drop of this mucus procured from either vagina or cer-
vix should be placed immediately under the microscope, for
the spermatozoa will soon die.
In performing these operations or any other, there have
been but two specula which could be used with convenience,
viz, Sims's and Jackson's. Sims's instrument, or rather
combination of instruments, requires an assistant in all cases
where the operator has to use both hands. Jackson's was
a great improvement on all other valvular specula, because
the valves can be separated throughout their whole length.
I have, however, designed an instrument much lighter and
more convenient than Jackson's. Through the kindness of
E. H. Sargent & Co., surgical instrument makers, of Chicago,
who manufactured the one I now use, I am enabled to pre-
166
THE MECHANISM OF CONCEPTION.
sent a cut of my speculum, of which the following is a de-
scription.*
The blades are concavo-convex; the upper blade is shorter
than the lower, and falls into it when closed. The upper
blade is slit, giving a long opening, through which the ure-
thral orifice can be seen and any operation on the urethra
or meatus performed. The upper blade, which comes under
the pubes, is elevated by two methods-one, by applying the
finger to the extension which projects upwards from its base,
elevating the inner termination, as in Storer's and all other
bivalves; the other, by means of a screw, which separates
the upper blade through its whole length from the lower or
longer blade. This last gives it the quality of Sims's spec-
ulum, viz., a wide opening, through which almost any opera-
FIG. 28.

SARGENT
Hale's Expanding Speculum.
tion on the uterus can be performed without the aid of an
assistant.
The small screw which is attached to the upper blade, and
projects through the lower arch, is used to fix the upper
blade in position after its inner extremity has been elevated.
In vaginismus, or small vaginas, the long screw which en-
larges the opening between the two blades at their outer ex-
tremities can rarely be used without causing pain. But in
cases where it is necessary to do so, it is much more power-
ful than Sims's, and can be left in situ, while both hands are
otherwise engaged. This speculum can be introduced in the
* This speculum can be procured of Messrs. Boericke & Tafel, No. 145
Grand Street, New York, or ordered from any of their Branch Pharmacies.
THE MECHANISM OF CONCEPTION.
167
!
dorsal or lateral position. I generally use it with the woman
on her back and with the lower extremities strongly flexed;
although I frequently find it more convenient to use it in
Sims's position, on the left side.
The foregoing excellent cut shows the mechanism of the
instrument very plainly.
There should be a small hook projecting from the left
side of the under side of the upper blade, to which a tenacu-
lum can be attached, but it could not be represented in this
cut.
II. THE PASSAGE OF SPERMATOZOA TO THE OVULE.
Usually in women with healthy organs of generation there
occurs during sexual congress, or sexual excitement, a pro-
fuse flow of thin, translucent mucus. This not only lubri-
cates the vagina and inner surface of the vulva, but flows
out upon the external parts. There are many facts recorded
which prove unmistakably that if healthy semen be de-
posited in, and mixed with this mucus, even at some distance
from the ostium vagina, the spermatozoa will, in a few mo-
ments, find their way through this secretion into the vagina
and cervical canal to the cavity of the uterus. Sims records
many cases which fully corroborate this assertion, and he
goes on to refute the vulgar opinion, even now taught by
some writers, that "to insure conception, sexual congress
should be performed with a certain degree of completeness
that would give an exhaustive satisfaction to both parties at
the same moment." "How often," he says, "do we hear
husbands complain of coldness on the part of wives, and at-
tribute to this the failure to procreate; and sometimes wives
are disposed to think, though they never complain, that the
fault lies with the hasty ejaculation of the husband. Both
are wrong."
The fact is that in either sex, neither passion or desire are
necessary to conception. They are of no value except as
incentives. "It matters not," says Dr. Sims, "how awkward
and unsatisfactory the act of coition may be performed, so
that the semen, with the proper fructifying principle, be
placed in the vagina at the right moment; and, on the con-
trary, it matters not how perfectly and satisfactory it may
168
THE MECHANISM OF CONCEPTION.
be done if the semen lacks the fecundating power." My ex-
perience agrees with Sims, that both parties may possess in-
tense passions and power of enjoyment and have no offspring;
while in other cases be almost destitute of both, yet have a
large family. Physicians, by teaching their patients the
facts in this matter, may do much to render them happier
in their domestic relations.
There are also some facts relating to conception which
have a medico-legal importance. Does conception occur
during intercourse, or soon after? Dr. Sims says: "If the
uterus is in a normal condition we shall always, as a rule,
find spermatozoa in the canal of the cervix immediately after
coition." If in the canal of the cervix, why not in the
uterine cavity? The spermatozoa certainly travel with con-
siderable speed. Sims mentions one instance where a sper-
matozoa had travelled three and one-half inches from the
surface of the hymen to the os tincæ in three hours! Con-
ception or fecundation may take place immediately after,
possibly during coition, if an ovum is in the cavity of the
uterus ready to be impregnated; or it may be hours or days
before impregnation occurs. Dr. S. R. Percy, of New York,*
reports a case in which he found "living spermatozoa, and
many dead ones," issuing from the os uteri eight and a half
days after the last sexual connection. Sims thinks that
spermatozoa never live over twelve hours in vaginal mucus;
but in cervical mucus he has found living ones after forty
hours. He knows of no reason why they may not live much
longer. In some of the female maminalia they have been
found in vaginal mucus eight days after copulation.
III. THE SUCCESSFUL CONDITIONS FOR SUCH L'ASSAGE.
It has been already stated that, after the semen has been
deposited in the vagina, the spermatozoa find their way into
the cervix, pass up into the uterus, and, if not finding the
ovum, pass still further into the Fallopian tubes or ovary.
Whenever and wherever they meet the ovum they enter it.
Contact results in conception. Some microscopists have found
* Amer. Med. Times, 1861. -
THE MECHANISM OF CONCEPTION.
169
the ovum transfixed by the spermatozoa, the head imbedded,
the tail protruding and moving. In rare cases, the ovum
after impregnation does not pass into the uterus, but remains
where it was impregnated. Then occurs ovarian or tubal
pregnancy. But the mechanism of their entrance into the
cervix uteri is now a matter of considerable discussion.
Gardner states (Sterility, p 48), that "popular opinion de-
clares that during copulation, and at the height of venereal
sensation on the part of the female, the mouth of the womb
opens to receive the semen, which passes into the cavity
of the uterus." Since this was written, Dr. Sims writes:
"I have over and over again examined the condition of the
uterus after coition-often in four or five minutes after it-
and I have usually found the following state of things: The
uterus presents signs of exhaustion, if I may be allowed such
an expression; for instance, if the uterus is in a normal posi-
tion, or even moderately anteverted, we shall find the upper
part of the vagina relaxed, and passively holding a large
quantity of semen, in which the cervix uteri is submerged;
the uterus itself seems to be fatigued, and drops by its
gravity down towards the rectum, where it lazily sinks to
the bottom of the little pool of semen." Dr. Sims believes
that, in a normal condition of the uterus and cervix, the
semen suddenly enters the cervical canal. His explanation.
of the process is: "The cervix is pressed forcibly against
the glans (penis) by a contraction of the superior constrictor
vagina; that this pressure necessarily forces out the con-
tents of the canal of the cervix; that the parts subsequently
become relaxed, the uterus returns suddenly to its normal
condition, and the seminal fluid filling the vagina necessarily
rushes into the canal of the cervix by a process similar to
that by which a fluid would pass into an india-rubber bottle
slightly compressed, so as to expel a portion of its contents
before placing its mouth to a fluid of any sort." . . . "From
this it will be seen that I believe the cervix uteri to be short-
ened in the erethismal climax of coition by pressure exerted
upon it in the direction of its long axis when its position is
normal, which is impossible in a greatly abnormal position."
This theory has an important bearing on the question of
sterility, showing how it may be caused by retroversion or
12
170
THE MECHANISM OF CONCEPTION.
anteversion. For instance, in retroversion, "the fundus sinks
still lower after coition than before, and this necessarily
elevates the os tincæ still further from the seminal fluid, if
any of it has been retained." In this case the spermatozoa,
to enter the cervical canal, are obliged to "climb up," so to
speak, on the cervix, and find their way into the canal. (It
is in this condition that the lateral or "spoon-fashion" pos-
ture during coition may be advisable.) "In anteversion,"
says Sims, "we do not find the spermatozoa in the canal
immediately after coition, because, with the os tincæ looking
in the direction of the hollow of the sacrum, the same act
and the same pressure would only force the anterior lip of
the os tincæ up against the posterior lip, creating no vacuum
and making no room for the newly introduced fluid" (In
this instance the reversal of the natural position of the sexes
during coition might remedy the defect.)
Dr. Montrose A. Pallen,* in a very elaborate and scientific
discussion of this subject, says that during coition, "the
posterior wall of the vagina is lengthened, and the engorge-
ment of the vaginal plexuses further increases its elasticity
and tension. When erotic excitement is at its height, the
intra-pelvic erectility of the female is equally as tense as is
the extra-pelvic erectility of the male organs, and the cavi-
ties of the neck and body of the uterus occupy a position
midway between the axes of the inlet and the outlet, in a
line corresponding to the centre of the upper portion of the
vaginal insertion upon the cervix. Therefore, when the
ejaculation of the semen takes place, it impinges upon the
cavity of the cervix, and in many instances passes directly
into the cavity of the uterine body. Many women contend
that they can tell the very moment of impregnation from a
peculiar sensation of sickening shock, not the excitability of
orgasm, but a sickish, sinking pain, and the probabilities are
that the germinating fluid is forcibly ejaculated to the very
fundus, producing a decided sensation, which, if happening
when there are none of the hyperesthetic sensibilities of
coition, would give rise to a very marked uterine shock or
* The Philosophy of Menstruation, Conception, and Sterility (A Lecture,
G. P. Putnam & Co.).
THE MECHANISM OF CONCEPTION.
171
colic."
All this may be true in women whose pelvic organs
are in a normal condition and position. But how many
women possess such organs? And when Dr. Pallen insists
(p. 67) that conception must always be attended by this pro-
cess, and warns us against believing that women are impreg-
nated during sleep, intoxication, or when anesthetized, he is
going too far. His theory of "generative fixation,” as he
calls it, will not stand against the facts of common experi-
ence; for, without doubt, the majority of conceptions take
place without any such process as he describes. Sims's theory
is much more tenable. There is no doubt, however, that
during sexual orgasm, the os generally opens or relaxes, and
that more or less secretion of transparent mucus flows from
the cervix, but that this is necessary to conception cannot
be proved. Sims says the semen is "sucked into" the uterus
after the uterine erection. Pallen declares it is propelled into
the uterus during the "erectile hypertrophy." I do not
believe either process is always necessary. If the cervix is
filled with normal mucus, neither too thick, or too alkaline,
or acrid, and the vaginal secretions are healthy, the sperma-
tozoa are capable of "crawling from the posterior vaginal
fornix over the infra-vaginal cervix into the uterine cavity,"
notwithstanding Dr. Pallen doubts their ability. There have
been cases of undoubted rape when conception resulted, and
to teach, as does Dr. Pallen, that conception without orgasm
"uterine fixation" was impossible, would be placing
many good and virtuous women who had been violated, in a
very painful position, and strip the law of all right to punish
such an awful crime.
ΟΓ
Uor M
172
ERRORS CAUSING STERILITY.
CHAPTER XIII.
HYGIENIC AND OTHER ERRORS CAUSING STERILITY.
THERE are many causes of sterility, in habits of life and
conduct, which cannot be classified among the diseases men-
tioned in the previous pages. They are of such vital im-
portance that to omit mention of them would greatly lessen
the practical value of a work of this kind. It will not
answer to pass over such errors of life and conduct in a cur-
sory manner. Each one must be pointed out and described
as minutely as professional delicacy will permit, but without
that false modesty which is out of place in medical works.
One of the most injurious of all habits and customs to
which the women of nearly all highly civilized nations are
addicted, consists in improper and injurious arrangements of
the clothing which they wear. This matter is so well writ-
ten up by Dr. T. G. Thomas* that I take the liberty of
quoting his entire section, entitled
IMPROPRIETIES IN DRESS
"The dress adopted by the women of our times may be
very graceful and becoming; it may possess the great advan-
tages of developing the beauties of the figure and con-
cealing its defects, but it certainly is conducive to the de-
velopment of uterine diseases, and proves not merely a
predisposing, but an exciting cause of them. For the proper
performance of the function of respiration, an entire free-
dom of action should be given to the chest, and more
especially is this needed at the base of the thorax, opposite
the attachment of the important respiratory muscle, the
diaphragm. The habit of contracting the body at the waist
by tight clothing confines this part as if by splints; indeed
it accomplishes just what the surgeon does who bandages
the chest for a fractured rib, with the intent of limiting
thoracic and substituting abdominal respiration.
Mol
* Diseases of Women, p. 46.
ERRORS CAUSING STERILITY.
173
"As the diaphragm, thus fettered, contracts, all lateral
expansion being prevented, it presses the intestines upon the
movable uterus, and forces this organ down upon the floor
of the pelvis, or lays it across it. In addition to the force.
thus exerted, a number of pounds, say from five to ten, are
bound around the contracted waist, and held up by the hips
and the abdominal walls, which are rendered protuberant by
the compression alluded to. The uterus is exposed to this
downward pressure for fourteen hours out of every twenty-
four; at stated intervals being still farther pressed upon by
a distended stomach.
"In estimating the effects of direct pressure upon the
position of the uterus, its extreme mobility must be con-
stantly borne in mind. No more striking evidence of this
can be cited than the fact, that in examining it by Sims's
speculum, if the clothing be not loosened around the waist,
the cervix is thrown so far back into the hollow of the
sacrum as to make its engagement in the field of the instru-
ment often very difficult, and that attention to this point in
the arrangement of the patient will at once remove the
difficulty. While the uterus is exposed by the speculum it
will be found to ascend with every respiratory effort, and
descend with every inspiration; and so distinct and constant
are the rapid alterations of position thus induced, that in
operations in the vaginal canal the surgeon can tell with
great certainty how respiration is being affected by the anæs-
thetic employed. Au organ so easily and decidedly influ-
enced as to position by such slight causes must necessarily
be affected by a constriction which, in autopsy, will some-
times be found to have left the impress of the ribs upon the
liver, producing depressions corresponding to them.
“No one will charge me with drawing upon my imagina-
tion, even in the remotest degree, for the details of the fol-
lowing picture, for a little reflection will assure all of its
correctness. A lady who has habitually dressed as already
described, prepares for a ball by increasing all the evil influ-
ences which result from pressure. Although she may be
menstruating, she dances until a late hour of the night, or
rather an early hour of the morning. She then eats a hearty
supper, passes out into the inclement night air, and rides a
174
ERRORS CAUSING STERILITY.
long distance to her home. This is repeated frequently
during each season, until advancing age or the occurrence of
disease puts an end to the process.
"A great deal of exposure is likewise entailed upon
women by the uncovered state of the lower extremities.
The body is covered, but under the skirts sweeps a chilling
blast, and from the wet earth rises a moist vapor, that comes
in contact with limbs encased in thin cotton cloth, which is
entirely inadequate for their protection. It is not surprising
that evil often results to a menstruating woman thus ex-
posed.
"To a woman who has systematically displaced her uterus
by years of imprudence, the act of sexual intercourse, which,
in one whose organs maintain a normal position, is a physio-
logical process devoid of pathological results, becomes an
absolute, a positive source of disease. The axis of the uterus.
is not identical with that of the vagina. While the latter
has an axis coincident with that of the inferior strait, the
former has one similar to that of the superior. This arrange-
ment provides for the passage of the male organ below the
-cervix into the posterior cul-de-sac, the cervix thus escaping
injury. But let the uterus be forced down as it is by the
prevailing styles of fashionable dress, even to the distance of
one inch, and the natural relation of the parts is altered.
The cervix is directly injured, and thus a physiological pro-
cess is insensibly inerged into one productive of pathological
results. How often do we see uterine disease occur just
after matrimony, even where no excesses have been com-
mitted.
"It is not an excessive indulgence in coition which so
often produces this result, but the indulgence to any degree
on the part of a woman who has distorted the natural rela-
tions of the genital organs.
"But this is by no means the only method by which dis-
placement of the uterus may induce disease of its structures.
It disorders the circulation in the displaced organ, and pro-
duces passive congestion and its resulting hypertrophy, pre-
vents the free escape of menstrual blood by pressing the os
against the vagina, creates flexion, causes friction of the
ERRORS CAUSING STERILITY.
175
cervix against the floor of the pelvis, and stretches the
uterine ligaments and destroys their power and efficiency.
"These facts should be carefully borne in mind by the
physician who attempts to relieve uterine displacements by
the use of pessaries. If he merely replaces the displaced
organ, and relies for its support upon a pessary, he will often
fail in accomplishing the desired result. He is striving at
great disadvantage with a short lever power against the
weight, not of the uterus alone, but of the superimposed
viscera pressed downwards by several pounds of clothing,
which add their weight at the same time that they constrict
the waist, and substitute abdominal for thoracic respiration.
Thus employed, the pessary will often give great pain, and
so injure the parts upon which it rests as to necessitate re-
moval, and the practitioner will find himself cast off from
one of his most valuable resources. Should he, on the other
hand, before employing a pessary, remove all constriction and
weight from the abdominal walls, apply a well-fitting abdom-
inal supporter over the hypogastrium, so as to aid the ex-
hausted abdominal muscles in their work, keep the displaced
and congested uterus out of the cavity of the pelvis by a
tampon of medicated cotton, or bring gravitation to his
assistance by the position of the patient, he will ordinarily
at the end of a week be able to employ with great advan-
tage the same pessary, which at first seemed to accomplish
evil and not good."
Another subject meutioned by Dr. Thomas, and I have
taken the liberty of quoting his remarks, is-
IMPRUDENCE DURING MENSTRUATION.
This is also a very prolific source of uterine disease.
Some women, through ignorance, many through reckless-
ness, and a few from necessity, go out lightly clad in the
most inclement weather during this period, and many suffer
in consequence from violent congestive dysmenorrhea, and
often from endometritis. Every practitioner will meet with
a certain number of cases of uterine disease which have this
origin, and run on for years, ending, perhaps, in parenchym-
atous disease, which may prove incurable.
176
ERRORS CAUSING STERILITY.
(6
During a period in which the ovaries and uterus are in-
tensely engorged, in which the surface of the ovary is broken
through by the escaping ovule, and the nervous system is in
an unusual state of excitability, ordinary prudence would
suggest that the body should be well covered, that the con-
gested organs should be left at rest, and that exposure to cold
and moisture should be sedulously avoided. I need not say
that these rules are commonly neglected, and in evidence of
the fact I will venture the assertion that, on this very day,
the thermometer 15° above zero, the skating pond of our
park contains scores of delicate and refined women, who are
showing a disregard of them by their presence there.
"The immediate result of exposure during menstruation
is most commonly inflammation of the mucous membrane of
the uterus. Such an inflammation once excited will go on
for years, and in time end in parenchymatous disease, entail-
ing in its progress dysmenorrhoea, sterility, pelvic pain, and
gastric disorders, which impair digestion and nutrition."
Passing on from these hygienic errors, I propose to men-
tion certain errors of conduct as likely to prevent conception,
namely:
EXCESSIVE VENERY AND ORGASM. Too frequent indul-
gence in sexual intercourse, and excessive enjoyment of it,
may both be causes of sterility. Dr. M. A. Pallen, in
his Clinical Lecture heretofore quoted, says: "A very fre-
quent cause of sterility is in excessive venery, producing a
constant nerve stimulation of the generative circle, a con-
stant congestion of the entire organism, which very decid-
edly interferes with normal and regular functioning. These
causes are not infrequent in young married females, who
failing to become impregnated during the earlier months of
connubial life, are either taken to task by the husband or
taunted by some more fortunate female friend, and as a con-
sequence they repeatedly urge the act in the blended hope of
offspring, and the fear of losing the respect and affection of
their husbands. The result soon tells upon them both, con-
stitutionally and sexually, and sterility is ingrafted upon a
deteriorated physique, seriously complicating the treatment
and prognosis." And again, he says, "The summum of
ERRORS CAUSING STERILITY.
177
orgasm intensity is rather predisposed against impregnation
in consequence of excessive uterine and vulvar glandular se-
cretions, which tend to wash out the seminal fluid from the
cervical cavity; besides, women as highly hypersthetic as
are those influenced by excessive orgasm, are usually affect-
ed by more or less of uterine catarrh, in consequence of the
hyperæmia engendered by repeated tense erections, which is
of itself one of the most prominent bars to conception.
""
Such cases as these are doubtless cases that would be
favorably affected by large doses of Conium, as recom-
mended and used successfully by Dr. Tully, or by the use of
Bronide of camphor (2 or 3 grs., three times a day), which
I have prescribed with good results in two cases.
Both
parties should, however, be acquainted with the bad effects
of the practice of excessive intercourse, and enjoined to be
temperate, and limit themselves to the recommendation of
Sims, namely: "Twice during the four days previous to the
menses, and three times during the six days after." I have
known several instances where this injunction has been
followed by impregnation.
IMPROPER TIME FOR COITION.-After reading Dr. Jackson's
paper on Ovulation in the introduction to this volume, it
must be evident that there is no arbitrary period to be fixed
for the time of a fruitful intercourse. A few years ago it
was an accepted dogma, that the period most favorable for
conception was the ten days after menstruation. It was then
announced that there was another equally fruitful period,
namely, the three days previous to a period. The Jews are a
very fruitful people, and their women are not allowed to
accept the visits of their husbands until after the expiration
of fourteen days after menstruation. Many persons who
desire to avoid couception, abstain from intercourse during
both these supposed fruitful periods, but while it lessens the
probability of the occurrence of conceptions, it is by no
means sure, as the many statements of my patients have
shown me.
Dr. Sims,* who has paid a great deal of attention to this
* Uterine Surgery, page 372.
178
ERRORS CAUSING STERILITY.
matter, says that he usually orders his patients who are very
anxious to have offspring, to have intercourse on the third,
fifth, and seventh days after the flow has ceased, and on the
fifth and third before its return, and but once on each day.
Dr. Naegele says in his chapter on sterility, that he has often
found that intercourse during the menstrual flow has re-
sulted in conception, when every other period had been tried.
I once advised a husband to have a single intercourse with
his sterile wife on the last day of the show, and conception
followed this one act. Conception has been known to follow
an intercourse on the firs' day of the menses, the flow ceas-
ing immediately after the act.
COITION DURING THE TREATMENT OF DISEASES OF THE
UTERUS.
There are certain diseases of the sexual organs of women
in which marital intercourse should be absolutely prohibited;
others when it may be permitted under certain restrictions,
and others in which it is not injurious, and may even be
beneficial.
sons.
Dr. Tyler Smith, On Leucorrhea, says: "In the treat-
ment of cervical and vaginal leucorrhoea in the married there
is one point which must be noticed, namely, the continu-
ance or absence of sexual intercourse. Absolute separation.
should never be advised except for good and sufficient rea-
In leucorrhoea intercourse should only be forbidden
in the worst cases. This is one objection to the use of caus-
tics in mild cases of leucorrhoea, because it is necessary to
enjoin separation while they are employed. When inter
course causes considerable pain and bleeding, or when the
os and cervix are secreting pus, it is out of the question,
but its moderate use is quite compatible with the successful
treatment of profuse mucous leucorrhoea. It may be ques-
tioned whether it does not relieve the uterus of states of
congestion which occur in the unmarried, and are probably
the cause of leucorrhoea in single women, or in the married
who live in separation from their husbands. In vaginal
leucorrhoea attended with epithelial abrasions, intercourse is
almost always painful and injurious, and it is often attended
ERRORS CAUSING STERILITY.
179
by such a state of spasm of the ostium vaginæ as to render
introition impossible" (vaginismus).
Dr. Graily Hewitt, Diseases of Women, writes: "Sexual
excesses predispose to chronic congestion of the uterus, inas-
much as they involve too frequently-repeated or too long-
continued engorgement of the uterus and other generative
organs. In young women recently married it is by no means
uncommon to meet with a condition plainly brought about
by excess of the kind here alluded to, and but little is re-
quired under such circumstances to produce a chronic en-
gorgement of the organ, and the further train of evils usually
following in its wake. It appears to be quite certain also
that unnatural excitation of the generative organs in women
leads to uterine mischief of various kinds, and promotes and
maintains a chronic congestion of the organ and of its ves-
sels, tending to give rise to various secondary disorders"
Dr. Montrose A. Pallen writing of chronic endometritis,
says: "She must live absque marito. She must avoid all ex-
citing causes liable to induce pelvic fluxions and congestions.
More harm is done a patient by marital congress in one night
than good can be attained in a month's treatment by the
gynæcologist. . . You will get better and quicker favora-
ble results with patients who come from a distance, or who
are in well-regulated hospitals, than with those who live at
home in conjugal harmony, and who are the recipients of
their husbands' erotic embraces."
I will add that it is easy enough in the majority of cases
to get the consent of the woman to abstain from intercourse,
but it is otherwise with most husbands. Many of them
have an utter lack of appreciation of the importance of
giving their wives rest from intercourse, or if they appreci-
ate the importance do not possess that control over their de-
sires which all men should possess. They complain of the
long time it takes to cure their wives, but will not assist the
efforts of the physician by the requisite temperance.
IMPROPER POSITION DURING COITION.-It may be asked what
is meant by improper position? That depends upon the
position of the uterus in the pelvis. There are cases where
the natural posture is not the proper one to conduce to con-
180
ERRORS CAUSING STERILITY.
ception. Such may be the case in anteversion or flexion,
when, as Dr. Thomas says, the os is crowded downward and
backward against the posterior wall of the vagina, and the
male organ strikes the cervix, but does not pass under the os,
as it should. I know of two cases which must have been of
this character, where conception occurred only when the
relative position of man and wife was reversed. A physician
once related to me a case of sterility cured by having inter-
course while lying "spoon-fashion" (retroversion ?). And
still another case is related by a prominent medical writer,
where a sterility of many years was cured by the direction
of a travelling quack, who advised the parties to have inter-
course in the standing position (elevation of the uterus?).
I am aware that these are somewhat repugnant matters to
treat of, but in giving explicit directions for the cure of
sterility, I feel it my duty to neglect nothing, even if it jar
the finer sensibilities of some persons.
Improper ConDUCT AFTER COITION.-Many women, purely
from motives of cleanliness, arise and bathe themselves about
the genitals immediately after coition. I have known sterile
women who habitually did this, who were exceedingly anxious
to have offspring. When informed that such a habit had
probably prevented conception, they expressed themselves
grieved and surprised. Notwithstanding Dr. Pallen's asser-
tion that in a fruitful coition the semen is impelled directly
into the open os, I do not believe it occurs in all cases, and
even if such is the fact, not all uteri are possessed of the
quick vitality to shut it in immediately. If, therefore, a
woman arises and walks about, or sits down to bathe the
genitals, the seminal fluid escapes from the vagina or still
relaxed os, and conception does not take place. I could
record many cases where the direction to remain after coition
in the recumbent position till morning, resulted in concep-
tion after years of sterility. For this reason, if a fruitful
coition is desired, the intercourse should take place just
before the hour of sleep.
MEANS USED FOR THE PREVENTION OF CONCEPTION.-Among
the most common of all the initial causes of sterility are the
ERRORS CAUSING STERILITY.
181
various methods adopted by men and women to prevent con-
ception.
It is incredible that people united in marriage should de-
liberately set about preventing the most holy and natural
result of love and the sexual union. I know well enough
that there are cases where, from incurable diseases of the
uterus, conception is uniformly followed by miscarriage and
its attendant dangers. But these cases are so very rare that
the dictum should lie entirely with the conscientious physi-
cian, and he alone should prescribe the method to prevent
conception. So, also, are there rare cases of pelvic deformity
where conception should be avoided; but, with all the im-
proved methods of artificial delivery, the cases are rare in-
deed where such precautions are really necessary. As for
those unnatural people who apply to physicians for prescrip-
tions to prevent conception, I ecause "it is not convenient,'
or because" their pecuniary circumstances are not suitable,"
or because they "wish to take a trip to Europe," I have no
patience with or respect for them. No respectable or con-
scientious physician will aid and abet such criminality, for
it is nearly as criminal to prevent a conception as it is to
destroy the fruits of one, unless the above-mentioned irre-
movable physical obstacles render it necessary.
Among the worst means used for this purpose are:
>>
(a.) The injection immediately after coition of cold water.
This is especially injurious, because the vagina and uterus are
flushed, congested, and bathed in mucus just after inter-
course, and the cold douche acts as a sudden shock, contract-
ing the full blood vessels, suppressing the mucous discharges,
and results in secondary abnormal congestion, and even in-
flammation. I have known many cases where the cold water
was thrown directly into the uterus, through the open cer-
vical canal, causing serious uterine colic, and in one case a
dangerous attack of pelvic cellulitis.
(b.) Strong solutions of sulphate of zinc, plumbum aceti-
cum, tannin, etc., are often used; and, even if used with
warm water, the results are equally injurious. They set up
in time congestion of the cervix, cervical leucorrhœa, etc., and
the result is, that when these misguided people wish for chil-
182
ERRORS CAUSING STERILITY.
dren, they are surprised to find it impossible. They have
brought on an acquired sterility very difficult of removal.
(c.) One of the most hurtful and abominable of all methods
is the use of a so-called "pessarie" of French manufacture.
(The French excel in such abominations.) It is a cup-shaped
contrivance, nearly two inches in diameter, made of hard or
soft rubber, which fits over the os uteri like a cap. It is not
always effectual, but always injurious. One of the worst
cases of chronic metritis with metrorrhagia in a beautiful
and otherwise healthy woman, who applied to me for the
cure of her sterile condition, was brought on by the per-
sistent use for years of this infernal contrivance. Her hus-
band had insisted upon the use of one made of hard rubber,
and the delicate tissues of the cervix had been bruised until
an incurable areolar hyperplasia had resulted.
Dr. Montrose A. Pallen, in his clinical lecture, says:
"When the erection of the uterus subsides (after coition) the
germinating fluid is imprisoned in the cavity of the body,
and there retained. Hence the folly of many women who
syringe themselves with cold water immediately after coition.
to prevent conception, unless the shock of the fluid begets
some sudden contractile uterine action which expels the
contained semen, a very rare occurrence indeed.
"The explanation why women who use cold water so rarely
conceive, is not in the washing they give themselves, but
from the fact that such an unnatural procedure had long
since rendered themselves sterile by developing cervical
catarrh in consequence of their having so frequently shocked
the distended and engorged organs, thereby producing re-
peated blood stasis and temporary congestions."
A BORTION.-A well-known gynecological writer says: "A
single abortion from any cause, either from disease, or drugs,
or instrumental interference, may induce sterility."
That this is true, the experience of every physician will.
substantiate. The pathological changes set up by the un-
natural expulsion of the embryo at any period of gestation,
are nearly always more or less persistent. After having one
miscarriage, and this after a first conception, many women
never become pregnant again. This occurs much oftener when
ERRORS CAUSING STERILITY.
183
instruments of any kind have been used to effect the purpose.
Many women who have applied to me for the cure of their
sterility, have tearfully confessed that a miscarriage caused
by their own hands, during the first year of their married
life, resulted in an entire inability to conceive. This result
occurs when no examination which we are at present capa-
ble of making discloses any morbid condition of the womb.
In these cases it is no stretch of the imagination to believe
that the sterile condition was a direct divine punishment
for the enormity of the sin committed.
I have known the most careful medicinal and topical
treatment continued for years fail utterly in curing this con-
dition with such antecedent cause. If this fact could be
known and appreciated by young women, there would be
much less of the crime committed; for, as a rule, women
are almost entirely ignorant of the serious consequences of
the act. Even when one or more miscarriages do not cause
inability to conceive, they generally set up pathological
changes in the uterus which result in repeated abortions,
which in the end undermine the health of the victim, until
complete sterility results.
Is it not time that, not only physicians, but clergymen and
all public instructors, should boldly teach the lamentable.
consequence of this constantly increasing crime?
181
GENERAL THERAPEUTICS OF STERILITY.
CHAPTER XIV.
GENERAL THERAPEUTICS OF STERILITY.
UNDER this head I propose to place those hygienic and
therapeutic measures which find no special mention in the
preceding pages. In examining a patient about to be treated
for the sterile condition, the first object should be to ascer-
tain the physiological, psychological, or pathological cause.
If such cause be ascertained, the treatment will be found
above; but cases will frequenly occur in which the cause
can not be satisfactorily ascertained. Either it is not appre-
ciable to the senses, aided by the various aids to diagnosis,
or it is not physical in its character. In either case, the
physician must base his treatment on general principles,
such as change of condition as regards climate, diet, exer-
cise, etc., or he must follow the directions of Hahnemann,
and select the remedy from the similarity of its symptoms
with those presented by the patient, taking into special con-
sideration the general sphere of action of the remedy (its
genius), as well as its characteristic or key symptoms, and
also its special or diagnostic symptoms. To further the
proper selection of remedies in cases of sterility, the claims
of certain medicines will be considered, and their charac-
teristic indications pointed out. This cannot be done with
absolute accuracy in this, any more than in other diseases or
morbid states.
By referring to the list of medicinal causes of sterility, it will
be seen that many of the same medicines are enumerated that
appear below as the curative agents in sterility. That this
should be so, is in accordance with the law of cure, which
asserts that only those medicines which cause diseases are
capable of curing similar ones. No medicine, therefore, can
cure sterility without being capable, either directly or indi-
rectly, of causing that condition.
This law is not confiued to the action of medicinal agents,
but extends to all others, such as climate, certain habits
of life, mental conditions, and the like. That the curative
GENERAL THERAPEUTICS OF STERILITY.
185
influence of climate, particularly, is homœopathic in its
action, is admirably demonstrated by Dr. T. K. Chambers.*
It is my belief that nearly all the medicines capable of
causing sterility, do so by their action on the ovaries. Medic-
inal agents may, however, by their pathological action,
cause cervical leucorrhoea, displacements of the uterus,
stenosis of the cervix, vaginismus, or the various other
uterine and vaginal causes of sterility. But the function of
ovulation is the central and all-important cause of repro-
duction. If this is interfered with, sterility results. Medi-
cines which act pathologically on the ovaries, interfere with
that function, and thus beconie sterility-causing agents.
The ovarian remedies for sterility are more especially:
Hamamelis.
Iodine.
Aurum.
Agnus castus.
Apis mel.
Bromine.
Iodide of lead.
Iodide of potassa.
Baryta carb.
Kali carb.
Capsicum.
Kali brom.
Caladium.
Cannabis indica.
Conium.
Lachesis.
Phytolacca.
Phosphorus.
Cantharis.
Chimaphila.
Platinum.
Ustilago.
The uterine remedies comprise a few of the ovarian, and
some others, namely:
Aurum.
Aletris.
Moschus.
Phytolacca.
Borax.
Ruta grav.
Cantharis.
Sabina.
Cimicifuga.
Secale.
Caulophyllum.
Sumbul.
Eupatorium purp.
Stillingia.
Gossypium.
Sepia.
Helonias.
Senecio.
Lilium.
Ustilago.
Mercurius.
Viscum album.
* See Monthly Hom. Review, March, 1868.
13
186
GENERAL THERAPEUTICS OF STERILITY.
CHARACTERISTIC INDICATIONS.-It is impossible in a work
of this size to give the general and special symptoms, as well
as the pathological indications for the use of the above enu-
merated medicines. Many of them have been mentioned in
the preceding pages in connection with the diseases causing
sterility. I have, therefore, thought it best to give only the
"characteristics" of the remedies as a guide to their selec-
tion
Aurum. This remedy is secondarily indicated in amenor-
rhea dependent on torpor of the ovaries, in scanty menstrua-
tion with chronic metritis; in sterility dependent on these
states, or due to "coldness," or female impotency with suici-
dal depression. (Doses, a few grains of the 2d or 3d trit.)
Gold is primarily indicated for symptoms similar to pla-
tinum, namely: profuse and frequent menses, congestion of
the uterus, increased sexual desire, and mental or emotional
irritability. (Dose, the 12th to 30th.) I prefer the Aurum
mur. or the Muriate of gold and sodium.
1
Agnus castus -A complete loss of sexual power and de-
sire; albuminous leucorrhoea; ovarian atony, or suspension
of the function of ovulation; amenorrhea; melancholy.
Aletris.-General debility; paleness; inability of the uterus
to retain the product of conception; sterility after abortion.
Asarum (Can. and Europ.)-Said to cause sterility.
Apis mel.-Chronic or acute ovaritis with stinging pains,
followed by ovarian enlargement.
In women who are
troubled with urticaria and pruritus pudenda, also dysuria,
with stinging pains during urination.
Borax.-" A female had been sterile for fourteen years, on
account of a chronic acrid leucorrhoea; she received, among
other remedies, Borax, after which she became pregnant,
and the leucorrhoea improved. Eusy conception during the
use of Borax observed in five women."-(Hahnemann's Chronic
Diseases, II.)
It is indicated when membranous dysmenorrhoea causes
sterility; also for abrasion or erosion of the os uteri, and
aphthous affections of the vagina and cervix.
Baryta carb.-Loss of sexual desire and power; very scanty
menses; general appearance of premature old age; catches
cold very casily. (Also Baryta mur. and iod.)
GENERAL THERAPEUTICS OF STERILITY.
187
Cantharis. Sterility with great sexual excitement, with
irritation of the ovaries (primary effect); or sterility from
the opposite condition, viz., loss of ovarian function (secon-
dary effect).* For the first-named condition give the 30th,
for the latter, the 1st. It has been used successfully by al-
lopaths. I have known several cases cured by doses of 5
drops of the tincture three times a day; it caused violent
dysuria, but conception resulted.
Capsicum. For fat women who are generally chilly, have
a masculine appearance; atrophy of the ovaries (?) with amau-
rosis.
Calcarea. Sterility in adipose women, who have profuse
and too frequent menses.†
Caladium.-Sterility with melancholy, faint feeling in
stomach, fetid urine, asthma, loss of sexual desire, coldness
and cold sweat of the sexual organs.
Cannabis.—Cannabis ind., is preferable.) "Great excita-
tion of the sexual instinct, accompanied by sterility." Pro-
fuse menstruation, with various urinary difficulties.+
Chimaphila.—Atrophy of the ovaries (?) and mammæ. The
urine is full of mucus; scaly eruptions on the skin.
Conium.-One of the chief remedies in sterility. Atrophy
of the ovaries and mammæ; albuminous or acrid leucorrhoea;
loss of sexual power and. desire; amenorrhea, or very scanty
menses; pain and swelling of the breasts before the menses.
Professor Tully (allopath) says: "In several cases, where
persons had been married eight or ten years without offspring,
I have known a thorough use of good extract of conium
employed by the party with whom the difficulty was sup-
posed to exist, result in the subsequent birth of one, two, or
more children. Again, when, in the course of a few years
after marriage, there had been one, two, or more children,
* Gardner on Sterility, p. 159.
t
† "Calc. (x) given against a copper eruption in the face, effected preg-
nancy in a woman who had not conceived for nine years past."-Ruckert's
Therapeutics.
‡ “Cannabis (1st) one drop, and afterwards merc. (3d). Giving both rem-
edies twice to husband and wife, effected pregnancy, after a sterility of six
years "-Ruckert's Therapeutics.
? Materia Medica.
188
GENERAL THERAPEUTICS OF STERILITY.
and then a suspension of childbearing for ten or a dozen
years, after a thorough course of good extract of conium,
taken by the party in fault, I have known one, two, or more
children born. I recollect prescribing extract of conium for
a lady who had ceased for a long time to bear children. At
the time of my prescribing for her, she had some chronic
difficulty, I forget what it was, though it could not have
been of long duration. I made several calls, at compara-
tively long intervals, and at each was informed that she was
better, and apparently continuing to improve. At last, at
one of my visits, her conduct was very petulant, to say the
least. She told me she had discontinued the medicine, and
should take no more of it; but I could not ascertain the rea-
son of her rejection and refusal of it. In the mean time, her
husband sat by, laughing. At last the lady left the room,
apparently quite angry. Her husband then informed me
that she had just become gravid, and at a time when she
considered that her previous children were too old, and at
what she considered too late a period of her life for child-
bearing, since she was a little past forty years of age. He
said she considered her existing condition as due to my medi-
cine. I answered that I thought she must, at least, divide
the blame between him and my medicine." (Tincture of
Conium should be made from the unripe seeds.)
Cimicifuga. Sterility with hysteria, spinal irritation, want
of vitality in the ovaries and uterus (congested cervix). She
is subject to melancholy, severe congestive headaches, chorea,
and acute rheumatism. (I have known many cases of ster-
ility cured by Cimicifuga when all other means failed.)
Caulophyllum-Sterility with spasmodic dysmenorrhœa ;
she is subject to rheumatism of the fingers and hands.
Eupatorium purp.-Sterility in women who suffer from
nervous exhaustion, have profuse flow of watery urine from
the least excitement; loss of sexual desire, uterine and ova-
rian atony; sterility from frequent abortions.*
Gossypium.-May prove of value in some cases of sterility.
Supposed to be useful in uterine atony from frequent mis-
carriages.†
* New Remedies, p. 369.
† Ib., pp. 475, 539.
GENERAL THERAPEUTICS OF STERILITY.
189
Helonias. Sterility, with chlorosis, debility, diabetes,
atony of the generative organs, female impotence, prolapsus
uteri, melancholy, anæmia.
Iodine.-Sterility, with emaciation, weakness, especially
in the knees; atrophy of the ovaries and mamniæ; goitre.
The testimony in favor of Iodine in sterility from allopathic
sources, is worthy of our attention. Professor Tully says:*
"A free and protracted use of Iodine is said to prove aphro-
disiac, i. e., to increase venereal appetite, and the power of
gratifying it. Valetudinarian women who have been mar-
ried a number of years without children, not infrequently
become gravid after a thorough course of Iodine."
In the latest pathogenesist the following recorded symp-
toms are found:
"A case is said to have occurred where the female became
barren soon after commencing the use of Iodine. Before
she commenced the use of Iodine, she gave birth to a child.
annually, but from the time of commencing its use to the
present, a period of eight years, she has never become preg-
nant."
(These symptoms were quoted from Dr. Rivers, American
Journal of Medical Sciences, 1831, p. 546.)
No clue is given by Dr. R., to the pathological conditions
of the sexual organs which it caused. My conviction is,
that the sterility was due to arrest of ovulation, but it may
have been uterine catarrh.
Bromine has an effect on the ovaries similar to Iodine.
Iodide of Lead.-In atrophic ovarian sterility. (See N. A.
Journal of Hom., vol. ii.)
Iodide of Potash.-(See Iodine.)
Kali carb.-A prominent medical author asserts that the
sterility of American women is, to a great extent, due to the
excessive use of carbonate of potassa in bread. (See Hahne-
mann's Chronic Diseases.)
The Bromides.-All the bromides cause extinction of
sexual desire, and a general paralysis of the reproductive
organs. They are primarily indicated in sterility from de-
* Materia Medica, p. 2.
† Encyclopedia of Materia Medica, vol. v.
190
GENERAL THERAPEUTICS OF STERILITY.
ficient ovulation and sexual inactivity; and, secondarily, in
excessive excitation of the sexual organs, erotomania, etc.
Lachesis.-Chronic inflammation and other destructive
diseases of the ovaries, also many diseases of the uterus,
leading to sterility.
Lilium tig. will doubtless prove a valuable remedy. (See
pathogenesis in New Remedies, vol. i, or Allen's Encyclopedia.)
Mercurius.-It has been observed that women under the
action of Mercury easily conceive.* It has the
It has the power of
causing sterility, as all authors attest. It cures sterility
from syphilis; also sterility from poisonous leucorrhoea.
Moschus.-This odorous drug is but little used in homo-
pathic practice, although it appears to have a sphere of
action nearly equal to many of our much-used agents. It is
a nearer analogue of Platinum than many suppose. Hahne-
mann says: "It compares with Asafetida, Crocus, Coffea,
Conium, and Stramonium. Its primary action on the genera-
tive organs is decidedly excitant, like Phosphorus, Cantharis,
and Platinum." The following symptoms recorded by Halme-
mann are proof:
"Violent sexual desire, with intolerable titillation; draw-
ing and pressing towards the sexual organs, as if the menses
would appear; menses too early by six days, and too profuse.
Menses appear even when merely smelling of the drug; re-
appearance of menses, which had stopped a whole year; vio-
lent drawing pains at the appearance of the menses."
This violent excitement of the ovaries and uterus must
necessarily be followed by impotence and sterility, from ex-
hausted vitality. Many lymphatic, obese, and hysterical
women present all the above symptoms of its primary
action, and are also sterile. In such cases Moschus in the
6th trituration ought to remove the condition. If the
secondary effects obtain, give the lower triturations.
Mangeti, writing in 1703, thus descants of the virtues of
Moschus in female sterility: "There may be various causes
of hindered conception, but that they lie very frequently in
an excess of cold or wet of the uterus, or an obstruction of
the uterine vessels and ducts is established; which fact Hip-
* Symptomen Codex.
GENERAL THERAPEUTICS OF STERILITY.
191
pocrates (sec. iv, Aphor. 62) expresses in these words: 'They
who have cold and crowded (down) wombs, do not conceive.
And they who have wet wombs do not conceive; for the
germ is extinguished in them.""
This choked state, Lud. (i. e. Louis) Mercatus (book iii,
chap. iii, on Affections of Women) thinks is the result of
abundance of thick or cold humors. But that wombs that
have been more hurried than was suited to their nature
should be dried, and that fumigation should be applied to
them. Hippocrates has shown (book i, on Affections of
Women): "From these considerations it is concluded that
Musk can relieve this evil, since it warms too cold blood and
serum, dissolves those that are too thick, properly dries off
too hurried parts, thins phlegm and mucus, and thus opens
obstructions, not only of the vessels, but also of the passages
and canals. Thus the virile semen may be not molested and
weakened, nor prevented from extreme penetration, but
nourished by moderate warmth, may be borne away from
impediments to the female ovary, and thus the eggs, being
fecundated, may in due time receive free transit into temper-
ate wombs. To this end, Dom. Leonus (in Medical Art,
book vi, chap. xiii, sec. 3) prescribes an electuary (confec-
tion), as tried on many, which is compounded with musk."
66
ť
John Bapt. Porta tells (Mag. Natur, book viii, chap. vii),
that he has found that a fresh-laid egg, with which a single
grain of Musk has been mixed, is, when swallowed (absorp-
tum) excellent to assist conception. A fumigation (or per-
fume) and a pessary with musk, are described in Roderick
Castentris, book iii, sec. 1, chap. ii."
It will be observed that the old physicians advised it for
the symptoms resembling its secondary effects. There may
be more hidden under this obsolete language than at first
seems. Sumbul, or Castoreum, may be equally useful, as they
are nearly allied to Musk.
Morphine.—Dr. Allen quotes (Encyc. Mat. Med.) Lerinstein
(General Effects of Morphine), who says, in relation to effects
on the female generative organs: "The amenorrhea of Mor-
phine is gradually developed from dysmenorrhea, or it oc-
curs suddenly. Conception has never been noticed in (these)
amenorrheic women, who had been repeatedly pregnant pre-
192
GENERAL THERAPEUTICS OF STERILITY.
vious to the use of Morphine. Therefore, it seems probable
that the cessation of the menses is dependent upon anoma-
lies of the ovaries. According to Pflugus's theory, in the am-
enorrhoea of Morphine the growth of the cells of the ovaries
cease from one period to another, and, in consequence, the irri-
tability that is transmitted by the ovarian cells, and causes,
on the one hand, bursting of the Graafian follicles, and, on
the other, determines the reflex condition of congestion of the
sexual organs, is wanting. As a consequence, Morphine
affects the ovaries as it does other secretory glands, namely:
it renders them unable to perform their functions. It is
most probable that menstruation ceases because ovulation.
ceases. The supposition that Morphine injections cause the
arrest of the functions of the organs of generation is justi-
fied by the fact, that after the cessation of Morphine these
organs recover their activity. The sexual desire is at first
increased by the habitual use of Morphine, but after the
graver symptons of poisoning have been developed it almost
entirely disappears.
"It is also noteworthy that women who have suffered from
fluor albus, are generally free from it during the prolonged
use of Morphiue; this reappears after the withdrawal of the
drug, often with labor-like pains."
The same author says Morphine causes impotency in men.
It would seem by this testimony that Morphine ought to
be a specific for some forms of sterility, namely: where it has
been preceded by undue sexual erethism (passion, erotism),
and where the excessive indulgence has weakened the virile
functions of the ovaries especially, and amenorrhoea occurs
from "lapse of the menstrual habit." In a late pamphlet by
Dr. Montrose A. Pallen, he contends that menstruation de-
pends not alone on ovulation, viz., "that menstruation is a
neurosis, indicating anatomical changes, hyperplastic action,
degeneration of tissue and reparation process;" but he does
not admit that menstruation ever can occur in congenital
absence of the ovaries, while "a bleeding, but not menstrua-
tion" may occur in cases of extirpation of the ovaries. (See
Jackson, On Ovulation.)
Morphine evidently does not cause atrophy of the ovaries
or paresis, but simply arrest of function, which returns when
GENERAL THERAPEUTICS OF STERILITY.
193
#
the drug is suspended. When, therefore, we meet with cases
in practice where we believe this condition exists in amen-
orrheic women, or women with very scanty menses and little
or no sexual desire, it seems probable that small doses of
Morphine (2 or 3×) might aid in restoring the functions of
ovulation and the ability to conceive.
Phytolacca may be useful in sterility from syphilis, or
from atrophy of the ovaries; uterine leucorrhoea, acrid, with
ulceration or erosion of the os.
Phosphorus. This remedy has probably a greater reputa-
tion for the removal of sterility than any other. It is used
successfully by both schools of medicine-by allopathists in
large doses, by the homeopathist in minute doses-cures
following its administration, whether used in massive or in-
finitesimal quantities. There must be some rational explana-
tion of this, else homeopathy is not the only true system of
therapeutics.
The action of Phosphorus on the healthy organs of genera-
tion consists of two series of effects, namely: a primary ac-
tion, during which it stimulates the ovaries to excessive
functional irritation, which often proceeds to hyperemia and
inflammation. This ovarian excitation extends to the uterus,
vagina, and clitoris, resulting in hyperemia and hyperæs-
thesia, with inordinate sexual desire, uterine spasms, albu-
minous leucorrhoea, menorrhagia, ulceration, and various
other morbid states; all causes of sterility. After the pri-
mary irritation has exhausted the vitality of these organs,
the secondary effects set in, marked by loss of ovarian func-
tion (deficiency or suspension of ovulation), various organic
diseases of the ovary, such as atrophy, tumors, etc., and a
consequent loss of tonicity in the uterus and other genera-
tive organs, resulting in loss of sexual feeling, scanty menses,
too pale and delaying, acrid, excoriating acid leucorrhœa, and
many others of the various conditions leading to sterility.
Phosphorus is, therefore, homeopathic to sterility by virtue
of its primary and secondary effects. Material doses will cure
sterility if the secondary symptoms are present. It is for
these symptoms and conditions that it is used successfully
in allopathic practice. In the middle and highest potencies
it will cure sterility presenting symptoms similar to those
194
GENERAL THERAPEUTICS OF STERILITY.
enumerated among its primary actions. Gardner* quotes
Dr. Mackenzie, who, before the Medical Society of London,
"recommended Amorphous phosphorus in certain affections.
of the uterine organs, attended with weakness and irrita-
bility of the nervous system, to be given in doses from 10 to
30 grains, diffused in water. It appears to act as a direct
tonic or stimulant to the uterine system." IIe has known
pregnancy to supervene upon its employment, after a length-
ened period of sterility subsequent to marriage.
It is more relied upon than any other remedy in the actual
impotence of men, i.e., from loss of power in the testicles to
secrete semen. Any remedy that will restore this power in
men, will restore the function of ovulation in sterile women.
In Ruckert's Therapeutics, we find the observation that
Phosphorus appears to be a distinguished remedy against
sterility."
66
Several of my colleagues have informed me that they have
known conception to occur in women supposed to be sterile,
while under the administration of Phosphorus in minute
doses.
I can recall several instances occurring in my practice,
when women who were taking this remedy continuously for
pulmonary disorders, unexpectedly became pregnant for the
first time in many years.
Phosphorus very closely simulates Cantharides in its action
ou the reproductive organs.
Phosphoric acid or the Hypophosphites may be used instead
of Phosphorus in some cases.
Platinum. This metal appears to act in somewhat a simi-
lar manner to Phosphorus, but its characteristic symptoms
differ from that remedy. Thus the sexual excitement of
Platinum is attended by melancholy, hysterical symptoms,
cramps, with coldness and torpor, while that of Phosphorus
is marked by joyous excitement, febrile heat, and nervous
erethism. Gollmant has Platinum indicated "when the
patient feels oppressed with anxiety, or feels very cheerful
one day and low-spirited the next."
*On Sterility, p. 160.
+ Disease of Sexual Organs, p. 251.
GENERAL THERAPEUTICS OF STERILITY.
195
It is indicated in subacute ovaritis, with pain as if beaten,
congestion of the uterus, induration of the cervix, menor-
rhagia, and albuminous leucorrhoea. (I prefer Plat. mur.
Murex is its nearest analogue.)
Pulsatilla.—Both species of Pulsatilla act on the organs of
generation of women in such a manner as to cause sterility.
Ovarian irritation, uterine, cervical, and vaginal leucorrhoea,
uterine congestions, etc., are the conditions generally cured
by them. For characteristic symptoms, consult their patho-
geneses. (Clematis is very closely allied to Puls.)
Ruta grav. causes abortion, followed by too frequent, scanty
menses, with corrosive leucorrhoea and sterility.
Sabina. This drug acts as a tissue irritant to the ovaries
and uterus; the latter, in particular, causing primarily in-
tense active congestion, inflammation, and disorganization ;
and, secondarily, passive congestion or anæmia, with torpor
and actual paresis. It is, therefore, homoeopathic to ster-
ility, with excessive uterine irritation, frequent and profuse
menses, acrid leucorrhoea, ulceration, as well as sterility from
uterine torpor, chronic congestion, ulceration, amenorrhoea;
very scanty menses or passive metrorrhagia. It is analogous
in action to Erigeron, Tanacetum, Trillium, Crocus, Senecio,
and Calcarea.
Sanguinaria and Stillingia both have aphrodisiac properties,
and may prove useful remedies in the conditions which lead
to sterility. Sanguinaria resembles Calcarea, while Phos-
phorus and Stillingia resemble Phytolacca and Iodine.
Secale.-Ergot has a different sphere of action from Sabina.
It is a uterine motor stimulant. In its primary action it can
excite the uterus to such spasmodic irritation that the ovule,
before or after impregnation, is thrown from the womb or
destroyed in its cavity. In its secondary action it causes an
actual uterine paresis, in which it is impossible for the im-
pregnated ovum to be retained or nourished. It will cure
sterility when prescribed in the medium or the lowest at-
tenuations, according as the symptoms resemble its primary
or secondary action. Guernsey says it is always indicated.
in "thin, scrawny women, with low vitality, subject to
hæmorrhage of thin, black blood, aggravated by the least
motion." This is a part of its secondary action, however.
196
GENERAL THERAPEUTICS OF STERILITY.
Sepia. This agent, by its profound disturbing action on
the generative organs, is capable of causing sterility result-
ing from a variety of diseased conditions. It is best indi-
cated iu torpid, chronic states of congestion, ulceration, and
degeneration of the uterine tissues.
For a correct appreciation of the genius of this remedy,
the physician should study its pathogenesis and the observa-
tions of our best authors.
Stilingia will remove sterility resulting from secondary
syphilis or chronic mercurialization. Its action in this respect
compares with Aurum, Phytolacca, Iodide of potassium, and
Corydalis.
Senecio. This new remedy is not sufficiently appreciated
by physicians. It is as important as Pulsatilla, Calcarea, and
Sepia in the treatment of the diseases of women. The con-
ditions indicating its use in sterility are: Frequent, painful,
and profuse menses, cervical leucorrhoea, irritable uterus,
subacute ovaritis (primary effects), or delaying and scanty
menses, dysmenorrhea, with scanty flow, ovarian torpor,
chronic mucous leucorrhoea (secondary effects). In these con-
ditions it will rarely disappoint us if we prescribe it in the
proper dose and persist in its use.
Ustilago. This remedy is likely to prove of value in the
treatment of sterility, as well as miscarriage. It appears to
be a near analogue of Secule, Cuulophyllin, and Cimirifuga,
but causes a more profound degeneration of the tissues and
nervous system, exceeding even Secule. The symptoms indi-
cating its use may be found in New Remedies, vol. i.
In addition to the above remedies the following are recom-
mended in the treatment of sterility. Gollmau mentions
Dulcamara, Sulphur, Cocculus, Ignatia, Arsenicum, China, Nux
vomica.
Jahr refers to Borax, Amm., Caust., Graph., Natrum,
Sulph. ac., Cicuta, Croc., Dulc., Ferr., Hyos, Nutr., and also
those already mentioned.
Hempel recommends Canth., Ferr., Plumbum, and Sabina.
Dr. Pulte, of Cincinnati, contributes his experience in the
use of the following remedies. "The remedies mostly indi-
cated in cases of sterility coming under my observation, have
generally been those known best under the name of uterine
GENERAL THERAPEUTICS OF STERILITY.
197
remedies, such as Belladonna, Sepia, Phosphorus, Calcarea,
Carb., Sulphur, etc. Of these I remember to have used
oftener Sepia than any other remedy, simply for this reason;
that the symptoms present indicated more frequently its use.
As the causes of sterility are so various and many, it is evi-
dent that a uniform treatment for its cure cannot be estab-
lished. Yet I have seen sterility disappear where the lady
had not been treated for that special purpose, but for other
ailments, which, however, were connected with it, as the
result showed. It is to be hoped that this subject will con-
tinue to engage the earnest attention of the profession, as a
more frequent removal of sterility will counterbalance the
evil effects of artificially but criminally instituted abortion;
it will be the means to bring happiness in households who
deserve to bear children."
MISCELLANEOUS THERAPEUTICAL AGENTS. - Galvanism or
electricity has obtained considerable reputation for the re-
moval of sterility. M. Rouband, in his recent work, states
that he "has had greater success than most in the treatment
of cases that I am now describing when no disease is ap-
parent." Indeed, he claims that, "in six out of ten cases,
particularly in those whose sterility is from sexual abuse or
prostitution, this treatment is followed by childbirth. The
application is made once or twice a week for several months,
during which time coition is suspended, and great simplicity
and regularity in all the details of life are to be rigorously
exacted.”*
Gollman recommends galvanism, and advises that it be
applied by placing one pole on the os uteri, the other on the
sacrum, or at various places along the spine.
In Braithwaite we find recommended,† in cases of defec-
tive ovarian action, an application of Professor Recamier's
galvanic poultices.
I have heard of a few cases where the so-called electro-gal-
vanic baths appeared to have resulted in the removal of the
sterile condition.
* Gardner on Sterility.
†
Part xxiv, p. 348.
198
GENERAL THERAPEUTICS OF STERILITY.
CARBONIC ACID GAS.-The topical application of this gas,
according to the method of Dr. James Johnson,* is said to
have exerted a remarkably powerful influence upon the re-
productive organs. "Females who had for years sighed in
vain for pregnancy, became fertile in a very short space of
time after this gas had been applied in douches to the uterus,
by means of a pipe introduced into contact with that organ
through the vagina. Cases in which this beneficial result
had followed its use were so numerous, that the subject
merited consideration."
GYMNASTICS.—The systematic adoption of gymnastic exer-
cises, and especially the "Swedish Movement Cure," or "new
gymnastics," will doubtless be of great value as an aid to
the physician in his treatment of sterility, when not caused
by any organic obstruction.
HYDROPATHY, or the systematic application of water, has
doubtless resulted in the removal of the sterile condition. As
an adjunct to homeopathic treatment, the water-cure pro-
cesses may be advised.
MAMMARY IRRITATION.-Dr. Marshall Hall throws out a
suggestion on the treatment of sterility, which may be tried
under some circumstances. "There is an extraordinary
sympathy between the mammæ and the uterus, so that a
functional condition of the former influences that of the
latter. This sympathy is partly nervous in its character,
partly vascular. As a reflex action, the uterus is made to
contract after parturition, by applying the newborn infant
to the mamma; as a vascular sympathy, uterine hæmor-
rhage and leucorrhoea occur from undue lactation."
In cases of sterility arising from a temporary suspension
of function, it is a question whether or not the uterus can be
stimulated so as to assume a healthy functional action in
the way suggested by Dr. Hall, who says: "My suggestion,
then, is, that when the mammæ are excited at the return of the
catamenial period, a robust infant be repeatedly and perse-
Braithwaite, part ii, p. 64.
GENERAL THERAPEUTICS OF STERILITY.
199
veringly applied, in the hope that the secretion of milk may
be excited, and that the uterine blood may be diverted from
the uterus and directed into the mammary vessels, and that
a change in the uterine system and a proneness to conception
may be induced. I would propose that the patient should
sleep for one week before, and during the catamenial period,
with an infant on her bosom." (Braithwaite, part ix, p.
202.)
Remarks. It is possible that the irritation of the mammæ,
as above recommended, would so change the condition of the
uterus as to cure sterility. In such cases, however, other
means of irritation might be tried, as an infant is not always
"convenient." Poultices or sinapisms might be applied, or
what would be better, an application of the leaves of the
Ricinus communis, or castor-oil plant. Dr. McWilliams
first published an account of the remarkable properties of
this plant, which, when applied to the breasts of virgins
even, will produce a profuse and natural flow of milk, suffi-
cient to enable them to act as wet-nurses. Dr. Tyler Smith
bears testimony to the efficacy of the leaves to produce this
effect. The whole account of the method of applying the
leaves will be found in the Lancet, 1850, p. 294, or Peters's
Diseases of Married Women, p. 129.
INJECTION OF SEMEN INTO THE UTERUS.-This method of
removing sterility is fully described by Dr. Sims in his work
on uterine surgery. It has been recommended by several
medical authorities, some of them very old. Dr. Sims thinks
it may be successful in some cases, and he gives a few in-
stances in which he tested the plan in his own practice, with
the desired result. When all other means fail, and the desire
for an heir is above all other considerations, this method can
be advised by the physician.
THE TREATMENT
OF
GENERAL AND SPECIAL
DISORDERS AND ACCIDENTS
OF
PREGNANCY:
ALSO OF
PAINFUL AND DIFFICULT LABOR.
14
PREFACE.
THE two chapters on Dystocia which I contributed to Dr.
Richardson's "System of Obstetrics," were so favorably re-
ceived, and awakened such an interest in the subject, that I
have rewritten them and made copious additions.
There are many reasons why the profession should pay
greater attention to the subject of Dystocia. They should
disabuse their own minds and that of the public of the false
idea that the sufferings of pregnant women must be borne
without relief.
When women become convinced that the sufferings of ges-
tation and the pains and anxieties of labor can be alleviated,
great good will be accomplished.
This belief will remove many of the incentives which lead
women to the crime of fœticide. It is the fear of suffering
and death which influences most women to desire to avoid
pregnancy, and thus to violate the purest instincts of ma-
ternity.
Free a woman's mind from such fears and anxieties, and
a favorable influence will be exerted by the mind of the
mother upon the spiritual and mental nature of the child.
If anything I have written in the following pages shall
prove of benefit to womankind, making her more happy in
her maternal relations, I shall feel amply repaid for all my
investigations and labor.
CHICAGO, 1878.
E. M. HALE.
DYSTOCIA.
CHAPTER I.
GENERAL DISORDERS OF PREGNANCY.
By Functional Dystocia is meant those forms of preter-
natural and painful labors which are due to abnormal con-
ditions of the generative organs, not structural in character.
The causes of Functional Dystocia may be divided into
three classes. Either class may interfere with the regular
processes of nature.
1. Those special disorders and accidents occurring during
pregnancy; also, those accidents which may occur during
labor, all of which may endanger the life or health of the
mother or her child.
2. Those labors rendered difficult, impossible, or dangerous,
by a deficient or excessive action of the expulsive forces.
3. Those rendered difficult, impossible, or dangerous, by
obstacles (non-structural) to the expulsion of the foetus.
The treatment of Functional Dystocia may be divided into :
1. Preventive, which includes those hygienic measures and
medicinal agents which may be advised during pregnancy
and previous to the time of labor.
2. Immediate, or those medicinal agents and auxiliary
measures to be adopted during the progress of the labor.
PREVENTIVE TREATMENT.-The adoption of a prophylactic
treatment for painful or difficult labor has not attracted
that attention from physicians that the subject demands.
It is a singular and suggestive fact that nearly all barbar-
ous and semicivilized tribes or nations do adopt some treat-
206
GENERAL DISORDERS OF PREGNANCY.
1
ment, to which pregnant women are subjected, and which
is supposed to have a modifying influence on their confine-
ments.
This treatment, in some cases, consists merely of certain
baths and ablutions; in others, of semi-religious or supersti-
tious rites, such as ablutions and alterations in diet; while
in some tribes, like the North American Indians, the treat-
ment consists almost wholly in the drinking, for several
months, weeks or days previous to labor, of the infusions or
decoctions of indigenous plants.
Some physicians affect to sueer at any medicinal measures
used to ward off possible abnormal conditions which may
render labor painful and difficult. But if these same phy-
sicians could know that any patron would, after a few weeks
or days, be attacked by a scarlet fever or rheumatism, would
they not prescribe some hygienic or medicinal measures to
mitigate the severity of such attacks?
Now, although labor is a natural function, and the re-
sources of the organism are usually sufficient for its accom-
plishment, yet there are a number of circumstances which
may interfere with the work of nature, and render the
process painful, difficult, and dangerous.
If, then, the physician can devise any means by which
these obstacles to a normal labor can be prevented or modi-
fied, it is his duty to adopt such means for the relief of those
who are placed under his care.
I do not believe that it is necessary, or normal, that all
pregnancies or labors shall be painful.
The process of parturition is purely a physiological one,
as much so as the process of urination and defecation. The
latter especially is closely allied to parturition in its mechan-
ism. I do not believe the one should be more painful than
the other.
Notwithstanding it has been asserted by travellers and
residents among aboriginal tribes, that the women of such
tribes do suffer from the "pangs of childbirth," I do not
believe that their so-called sufferings compare in nature and
intensity with those of women in a state of civilization.
The fact is, that there are very few tribes on the globe
which can be said to be now living in a natural state. The
GENERAL DISORDERS OF PREGNANCY.
207
slightest contact with civilization modifies their habits and
customs, and every slight modification tends to alter their
physiological functions.
I have received positive and trustworthy information from
those who have spent many years among our native tribes,
that they know of hundreds of instances where the process
of childbirth was not attended by other than painless ex-
pulsive efforts. And more: nearly every physician of large
obstetric practice has attended cases in which the woman
was confined in so short a time, and with so little suffering,
that the labor could be termed painless.
In my own practice I have known many instances where
pain, as properly understood, was not present. The labor
was attended by bearing-down, expulsive efforts, and some
vascular and mental excitement, nothing more.
Therefore
normal labor may be termed a painless function.
So long as the human race can never return to a state of
existence such as we picture as the ideal, so long will a
large proportion of women be subject to dystocia.
What are the elements to be taken into account in the
preventive treatment of functional dystocia?
If possible, we should first ascertain if any structural ob-
stacle exists. If we find none, we should then inquire into
the history of the patient.
If a p imipara, we should get her menstrual history, as
this may be some guide as to the probable nature of the
labor.
(6
'Some writers," says Cazeaux, "have attempted to estab-
lish a relation between the phenomena that precede or ac-
company the menstrual discharge in the non-gravid state,
and the activity or slowness of the contractions of the womb
during the labor; for they say, should the periodical flow be
difficult, laborious, and painful, and the patient be tormented
every mouth with violent colicky pains, either before or during
her terms, the irritability of the uterus, and the energy of
the contractions will almost invariably be excessive in the
hour of childbirth; but, on the contrary, there is reason to
anticipate the occurrence of slow and feeble pains when the
woman is advised of the return of her nienses only by the
208
GENERAL DISORDERS OF PREGNANCY.
appearance of blood, and when they pass off without suf-
fering."
There is much truth in this theory, for it has been observed
that those women who were the subjects of violent dysmen-
orrhoea, usually have very painful labors, especially the
first; and that the subjects of menorrhagia were more liable
to post-partum hæmorrhage. In the case of multipara we
may judge of the probable nature of the dystocia by the
history of her previous labors. In this way I have known.
of hundreds of cases where the sufferings of the woman
have been greatly palliated, and even almost prevented.
Not only should we inquire into the history of the previous
labors, in their relation to the uterus, etc., but into the con-
dition of the other organs at the time of labor.
If in previous labors or pregnancies, the heart, lungs, kid-
neys, or bowels were in an abnormal condition, we should
select our remedies to accord with the abnormal condition
of those organs.
In this connection it should be stated that the commonly
received notion among women, that the distressing and pain-
ful sensations occurring during pregnancy must be borne
without applying for relief, because they occur during preg-
nancy, should be abandoned, and it should be the duty of the
physician to disabuse the minds of his patients of this erro-
neous belief.
Normal pregnancy should not be attended by painful
symptoms; consequently all such are abnormal, and demand
relief, and the carefully selected homeopathic remedies will
generally give relief.
The principal medicines indicated for the disorders of
pregnancy, or as prophylactics of dystocia, are:
Arnica, Esculus, Aletris, Bromides, Caulophyllum, Cale. c.,
Cimicifuga, Collinsonia, Digitulis, Ferrum, Eupatorium pur-
pureum, Gelsemium, Gossypium, Helonias, Ignatia, Nux vomica,
Pulsatilla, Secale, Scutellaria, Trillium, Senecio, Sepia, Ustilago,
Viburnum, and Veratrum viride.
In order to have a clear understanding of the nature of
these remedies and their indications, we will consider the
various causes and conditions which relate to dystocia and
mention the remedies indicated for such conditions.
GENERAL DISORDERS OF PREGNANCY.
209
Arnica causes a depressed state of the nervous system, es-
pecially the cerebro-spinal and the vaso-motor, leading to a
stasis of the capillaries. When pregnant women complain
of soreness of the muscles, lameness, and weakness of the
limbs, and such weakness of the capillaries that discolored
spots appear upon the skin after slight pressure, the external
use of Arnica-water, and the simultaneous use of Arnica in-
ternally, is of great value in preventing painful and difficult
labors. It also prevents that extreme soreness and tender-
ness of the uterus and genital passages which occurs even
after normal labors.
Esculus will remove many of the symptoms of painful
pregnancy, particularly the lameness in the sacro-ischiatic
ligaments, but it is especially useful for the disorders of the
rectum, which often cause great discomfort and lead to dys-
tocia. It removes the tendency to hæmorrhoids if given in
time, and tends to prevent the occurrence of painful and
protruding piles after labor. Premature labor is often in-
duced by rectal irritation, and in such cases Esculus will
prevent that accident.
Aletris is a powerful tonic to the muscular system, and
the organs concerned in the process of nutrition. It is use-
ful if the woman is weak, cannot endure exercise, has loss.
of appetite, and a constant sensation of weight and pressure
downward in the pelvis. A few drops of a low dilution be-
fore meals will often restore the appetite and nutrition in a
brief time. If the liver is torpid in addition to the above
symptoms, and the woman has gastric catarrh, Hydrastis
will be useful.
The Bromides are very useful agents in the treatment of
the pregnant state.
Plethoric patients are often troubled with an undefinable
nervous erethism, accompanied by hallucinations, morbid
impulses, even sexual appetite in excess, horrible dreams, or
exceeding wakefulness. The ordinary household cares worry
them exceedingly, they are restless and sleepless, have rush
of blood to the head, vertigo, fainting, etc. In such cases I
have seen such excellent soothing results from the bromides,
with such an evident improvement in the general meutal and
bodily he: Ith, that I sincerely advise their use.
210
GENERAL DISORDERS OF PREGNANCY.
For the indications, consult the provings in "Symptoma-
tology of New Remedies."
For general use I prefer Bromide of soda, but if there is
decided intracerebral congestion, with pain in the occiput,
and hemicrania, the Bromide of ammonium is preferable,
while for purely mental aberration the potash salt is the
best. If the tendency to congestion of the brain is attended
by scanty urine, the Bromide of lithia acts promptly. When
hysteria, faintings, and tendency to spasms are imminent, the
Monobromated camphor is of great utility. The dose of
these preparations must be varied with the exigencies of the
case. I have never seen good effects from them in the high
attenuations.
From one to ten grains, repeated at suitable intervals (one
to six hours), will be found to remove the above-named mor-
bid manifestations.
In cases of threatened cerebral congestion, with cold hands
and feet, flushed face, distended carotids, vertigo, incoherent
speech, etc., I have often given twenty grains of the Bromide
of lithia, with the result, as I believe, of saving life or pre-
venting severe illness.
In the most violent cases of hysteria, and hysterical spasms,
from one to five grains of the 1 trit. of Bromide of cam-
phor often arrests them, if repeated every ten or fifteen
minutes. During the latter months of pregnancy some
women are so oppressed by cerebral congestion that puerperal
eclampsia is imminent. I believe this fearful accident may
be warded off by the bold and judicious use of the bromides.
Even if uræmia is present, the bromides are not contraindi-
cated, for they aid in the elimination of the poison, acting
as diuretics, especially when their use is associated with the
administration of Apocynum, Apis, Cantharis, Helonias, etc.
Caulophyllum is one of those indigenous remedies which,
from the earliest occupation of America by the whites, has
been known to be used by the aborigines as a preventive of
difficult labors. Nearly every tribe use this, or some analo-
gous plant, the woman drinking a weak decoction of it a few
weeks prior to expected labor. We have not yet anything
approximating a complete knowledge of its action on the
human body; the provings are meagre and unsatisfactory.
GENERAL DISORDERS OF PREGNANCY.
211
But from the large mass of clinical evidence, we deduce that
it acts upon the smaller muscles, the uterus, and perhaps all
other hollow organs. It appears to act on the muscular
fibres which engage in expulsive action. Its primary action
is to exalt the irritability of such muscular fibre, its second-
ary to depress. We may prescribe it in the absence of
special indications, in primipara, when the menstrual periods
have been very painful, from spasmodic action, and where the
pains of the dysmenorrhoea have been like labor-pains, and
the discharge small in quantity and short in duration. Or
in multipara when the previous labors appear to have been
violent, painful, the paius spasmodic, regular, but with rig-
idity of the os and soft parts. In very many cases I have
prescribed the Caulophyllum for these general indications,
and with the happiest results, the following confinement
being natural and comparatively free from pain.
During the last fifteen years I have published in the vari-
ous journals of our school many cases corroborative of its
power over dystocia. Many such cases have been reported
by physicians of our school in all parts of the world.
Besides its value in preventing excessively painful, tedious,
and slow labors, it has other powers equally useful. It miti-
gates, and often altogether prevents those annoying and dis-
tressing "false pains," so common to the women of our cities
and large towns. These pains are generally located in the
hypogastrium, they appear at nearly regular intervals, the
paroxysms coming on every night for weeks, and the pains
recurring every few minutes or every hour. They often
extend into the limbs, up the sides, and into the abdomen.
Some women are so irritated by these pains that premature
labor is induced by them. In these cases not only does the
Caulophyllum arrest the pain, and make the last few weeks
comfortable, but it gives an easy labor, and according to the
testimony of some of my colleagues, protracts by several
days or a week the duration of pregnancy.
The dose of Caulophyllum is an important consideration.
It is claimed that good effects have been obtained from the
third dilution, or the sixth trit. of Caulophyllin. In a few
cases I can verify these claims, but in a majority of instances
I prefer the lower attenuations. The violently spasmodic,
212
GENERAL DISORDERS OF PREGNANCY.
very painful effects of the drug are primary effects-the
atonic, paralytic effects, secondary. Therefore, while the
middle attenuations will act curatively in very painful, spas-
modic conditions, due to great irritation, the lowest prepara-
tions, even the crude drug, may have to be used for atonic
conditions. Physicians of the Eclectic school habitually
prescribe the tincture in five-drop doses, or the active prin-
ciple in doses of fractions of a grain, for weeks before confine-
ment, with no alleged bad results. I believe I have seen
dystocia, and painful symptoms during pregnancy, warded
off by the third attenuation; but I have also seen the hap-
piest effects from the 1, 2, and even drop doses of the
tincture, repeated every two, three, or four hours. It is well
to begin the use of Caulophyllum a month or six weeks be-
fore full term; or six or ten weeks, if the woman fears a prem-
ature labor at the seventh or eighth month-a dose to be
taken once or twice a day. It has been known to enable
women to carry children to full term, who habitually had
premature labors.
It may be well to mention a few practical hints as to the
methods of administration. Pellets may be employed if the
dilutions are used; large pellets will each absorb nearly a
drop of the alcoholic mother tincture. The tincture or first
dilution in drop doses often causes an unpleasant burning in
the throat. This may be avoided by prescribing it in simple
syrup or gum-water. The low triturations of Caulophyllin
have the same effect, which may be avoided in the same man-
An elegant method of administering a definite dose
of the active principle is in the form of a sugar or gum-
coated pellet or granule, manufactured by several firms in
this country. These granules contain quantities from the
1-10 grain up to 1 grain. The former is best for use during
pregnancy; the latter to facilitate labor.
ner.
Cimicifuga is a near analogue of Caulophyllum, but has
some notable differences in its method of action. 1. It acts
upon the cerebro-spinal system, giving rise to spasmodic,
neuralgic, and myalgic pains. These pains and spasmodic
motions are not symmetrical, but irregular, and tend to run
into choreic movements. 2. It affects specifically the large
muscles, and has the power of causing a variety of muscular
GENERAL DISORDERS OF PREGNANCY.
213
pains, such as rheumatic, myalgic, and spasmodic. 3. It
affects the brain and mind, causing congestive headache,
melancholy, and mania.
All these conditions above named are well known to be
concomitants of the pregnant state, and lead to the most
troublesome forms of dystocia.
Dr. Meigs (Obstetrics, page 260), asserts that a large pro-
portion of the cases of "false pains" occurring during preg-
nancy are due to uterine rheumatism. He gives a clear and
graphic description of such cases, and his opinion is very
valuable. I have observed that many pregnant women who
are troubled with "false pains," and who have very painful
labors and severe after-pains, have been subject to dysmenor-
rhoea, which was undoubtedly of a rheumatic character.
Now, of all remedies for rheumatic affections of the uterus,
none are of greater value than Cimicifuga. Its only rival is
Guaiacum, Salicin, or possibly Viscum Album.
In many instances of abnormal pregnancy it is superior to
Caulophyllum, because of its wider range of action and greatly
superior power. If the student will consult the latest full
pathogenesis of Cimicifuga, he will see the special indications
fully set forth. My records of cases contain many wherein this
remedy has removed profound melancholy, insanity, and a
condition simulating delirium tremens. These women might
have been immured in lunatic asylums but for its curative
power.
A frequent and distressing attendant of some pregnancies
is the well known "pain in the left side," under the left
breast. This pain may shift to the left ovarian region, or
upward to the left arm, and even change to the vertex.
All these pains promptly give way to a lower attenuation
of Cimicifuga. Many physicians, especially those of the Eclec-
tic school, value Cimicifuga more highly than Caulophyllum
as an agent for the prevention of dystocia. The Eclectics use
it on general principles; they claim that it brings about a
normal relaxation of the muscular structures, which if "rigid,"
would obstruct the progress of natural labor; that it gives
tone to those muscles which have an expulsive function; and
moreover, that it gives the nervous system that strength and
tone so requisite in such cases. When speaking of the imme-
214.
GENERAL DISORDERS OF PREGNANCY.
diate treatment of dystocia the indications for its use will
be more fully set forth.
As a general prophylactic of dystocia, it should be pre-
scribed to be taken several weeks before full term, or other-
wise, as set forth under Caulophyllum; the active principle,
Macrotin, can be given in the 2 or 3* triturations.
Collinsonia has many points of resemblance to Esculus.
It acts upon the same organs and tissues, but has in addition
a toning power, especially over muscular fibre. It will re-
move the obstinate constipation and hæmorrhoids of the last
months of pregnancy. It does this by restoring the nor-
mal irritability of the muscular coats of the intestinal canal.
It is well known that during pregnancy there occurs a nor-
mal or physiological hypertrophy of the heart, to compen-
sate for the increased demand for a more powerful circula-
tion. If the pregnant woman has a neurosthenic diathesis,
this hypertrophy will be attended with an increase of the
action of the heart far beyond its proper bounds. The pulse
will reach 120, but regular, when it should be 80 or 90. If
the conditions above named all occur together, during the
last month of gestation, dystocia would be sure to result, fol-
lowed by an unfavorable puerperal state. Collinsouia, in the
attenuations from the first to sixth, will be found effica-
cious if it is used patiently and persistently.
Digitalis is a far more potent medicine than the last named,
and in many pregnancies is absolutely indispensable. By its
judicious use a woman may be carried to full term, when
suffering from cardiac disease, when without it she might
not survive to reach the last months, or, if surviving, suffer
miserably.
1
If a woman enter upon pregnancy with a "weakened
heart," whether from functional or organic disease, the
physiological "strain," which it is called upon to undergo,
soon merges into abnormal conditions. In the so-called "ir-
ritable heart," when its action is irregular, intermitting, weak,
and excitable, no remedy compares with Digitalis in its con-
trolling power. The patient, who before its use could not
go up stairs, or take needed exercise, without distressing.
palpitations and dyspnoea, soon finds herself more comforta-
ble in every respect. Digitalis acts upon the heart as does
GENERAL DISORDERS OF PREGNANCY.
215
Cimicifuga upon the uterus, regulating irregular action and
imparting strength through its nervous supply.
A woman who goes through gestation with any organic
heart disease (except hypertrophy with thickening) is liable
any moment to exhaustion, and even death from cardiac
failure. But if the heart is kept supported by Digitalis, no
such accident will occur under ordinary circumstances.
A weakened heart implies irregular and generally deficient
blood-supply in every organ of the body. In the brain we
have anæmia or venous stasis, so also in the lungs, uterus, and
kidneys. The kidneys usually suffer most, for the irregular
blood-pressure in those organs lays the foundation for those
conditions known as Bright's diseases, and consequent uræ-
mia. Even if the heart is not complained of, and the patient
has irregularity in the quantity of urine, at one time scanty
and dark, at another profuse and watery, and especially if
oedema of the face or feet is present, Digitalis should be pre-
scribed. But it is useless to give Digitalis unless the proper
dose is selected. The exclusive high attenuationist will not
see any good effects from it in the above conditions, for they
all belong to the secondary effects of the medicine, and the scien-
tific law of dose calls for material quantities. As a rule, a
grain or two of the 1* Digitalis leaves, or the 2ª of Digitalin,
or two or three drops of a good tincture, repeated three or
four times a day, will bring about good results. In rare
cases the 2x will suffice. These doses can be continued
days and weeks with none other than favorable effects; no
"cumulative action "is ever seen from these doses, and in
these conditions. If anamin is present, and the patient fails
in obtaining good blood from food, the use of Ferrum should
always be associated with Digitalis. These two medicines
act very harmoniously in such conditions, the iron cures the
malnutrition, and soon enriches the blood, and the Digitalis
insures its normal distribution by means of a strengthened
heart. I prefer the 1 trit. of Ferrum met. or Ferrum lact.
to any other preparation. Give the Digitalis before meals.
and the Ferrum after. Digitalis will also prevent hæmor-
rhage after labor, when there is a predisposition to it. It
acts on the uterus as it acts on the heart, inducing firm con-
tractions.
X
216
GENERAL DISORDERS OF PREGNANCY.
Lycopus virginicus is a near analogue of Digitalis. It will
control a weakened, irregularly acting heart, with dyspnoea
and cough from pulmonary stasis. It has not, however, the
dropsical symptoms of Digitalis, nor the scanty urine. On
the contrary, the urine is profuse-a condition simulating
diabetes.
Helonias has long had a reputation as a true "uterine
tonic." The few provings made, seem to show that it re-
sembles Cimicifuga, Aletris, Ferrum, and Pulsatilla. Certain
it is, that all the generative functions when disordered, seem
to improve under its influence. Not only does it exert a
profound influence over the uterus and ovaries, but the kid-
neys are included in its sphere of action. It has cured many
cases of albuminuria and desquamative nephritis, and con-
ditions simulating Bright's diseases, and I predict it will be
found one of our most efficacious remedies against uræmia.
If a pregnant woman in the last months becomes enfeebled,
pale, anæmic, dyspeptic, with albuminous urine, excessive or
deficient in quantity, and has great depression of spirits, the
Helonias should be prescribed in the 2 or 6* dilutions (or
triturations of Helonin), several doses a day until her condi-
tion has decidedly improved, and then repeated less often, up
to the day of her delivery.
66
Gossypium is a medicine about which there is still an at-
mosphere of doubt and incredulity. Many physicians be-
lieve it to be a valuable uterine tonic, others deny its power
altogether. The provings found in " New Remedies" seem to
show that it has some action on the uterus. It is probable
that the fault lies in the difficulty of preserving intact the
virtues of the root in any discovered preparation. The fresh
root is certainly a uterine motor, and has been known to
bring on labor, or facilitate difficult parturition. It has been
used for the same purpose as Caulophyllum, as a preparatory
agent for the purpose of bringing about natural and easy
labor, and with alleged success. The dose is usually from
five to fifteen drops of the tincture daily.
Pulsatilla.-I have for many years been convinced that the
uterine affinities of this medicine have been greatly over-
rated. It may cause uterine blennorrhoea, venous congestion,
and neuralgia, but I do not believe it to be a uterine motor.
GENERAL DISORDERS OF PREGNANCY.
217
3
It removes many of the sufferings of pregnancy, such as
toothache, prosopalgia, vomiting, indigestions, intestinal de-
rangements, and anomalous nervous affections of the gener-
ative organs. In this way, if selected according to its symp-
toms, it may prove a remedy to ward off dystocia. In its
pretended power to change abnormal presentations of the
fœtus in utero, I have not the slightest confidence. We
know that spontaneous version is a common occurrence, and
that it happens apparently when most demanded, and at the
very time when Pulsatilla would most likely be given for
that purpose. Of its use during painful and difficult labor
I shall speak in another place.
Secale ought, by its undisputed power over the impreg-
nated uterus, especially during the last months of gestation,
to prove an efficient remedy against dystocia, when prescribed
previous to that event. I am not aware, however, that it
has been used as such, except in a few instances, and nearly
all of those in my own practice. These cases were all char-
acterized by the peculiar cachexia belonging to Ergot, in
which there is a strong tendency to failure of the vital
powers, a predisposition to hæmorrhage, and a lack of vitality
in the fluids of the body. If a pregnant woman becomes
feeble, emaciated, with dry shrivelled skin, cold hands and
feet, sensation of great weight in the uterus, and worrying
false pains, and feels as if she should be sick any day during
the last month, Ergot in small doses is the remedy, and
especially so if her previous labors have been slow, feeble, and
followed by hæmorrhage and long-lasting, fetid lochia.
This powerful uterine motor ought to prove one of the best
of all remedies against dystocia. It is necessary, however,
that we should have a correct understanding of its method
of action, in order to prescribe it successfully.
Primarily in large doses it causes violent, persistent, tonic
contractions of the uterus, with expulsive efforts, also vaso-
motor spasm of its blood vessels, but this is followed by a
corresponding depression of the motor power of the uterus,
with vaso-motor paralysis. Thus, secondarily we have uterine
atony with tendency to passive hæmorrhage. This gives us a
clue to its true curative action as a preventive of dystocia.
If we have reason to fear that the woman will be confined
15
218
GENERAL DISORDERS OF PREGNANCY.
prematurely from want of tone of the uterine muscular fibre,
or, if she goes to full term, only to have a slow, distressing
labor, with deficient pains, lack of expulsive power, tendency
to hæmorrhage from deficient contraction, and finally sub-
involution of the uterus, Secale, in a low dilution, may be
given every day during the last month, with every prospect
of success.
(The dose I advise in such cases is one to five drops of
Squibb's Fluid Extract three times a day, up to the day of
confinement, beginning ten or fifteen days previously.).
Be sure, however, that the preparations used are reliable, for
of all medicines Ergot is most likely to be inert. I prefer
Squibb's preparations, or the French Ergotin, and am sorry
to say that the tinture ordinarily sold cannot be trusted.
Ustilago. This fungus, although a near analogue of Ergot,
cannot be said to be identical in action. It has more control
over the unimpregnated uterus, and over the impregnated
in the early months. It is of more value as an anti-abortive
than as a preventive of premature labor. It is especially indi-
cated in a certain atonic condition of the uterus, when there
is a passive hæmorrhagic condition, the blood being black,
grumous, or muddy. There is but little pain attending this
symptom, ouly a sense of weight in the uterus and much
general prostration. During the last months of pregnancy,
these symptoms are sometimes annoying and give rise to
much anxiety. This anxiety is not without cause, for they
portend a slow, difficult, and dangerous labor, on account of
the atony of the uterus. During labor, hæmorrhage difficult.
to control, may occur, owing to deficient contractility. This
condition, however, may be prevented by giving the lower
triturations, several doses a day, for a week or more previous
to confinement.
Viburnum.-This medicine, which has of late become very
popular in the treatment of dysmenorrhoea and allied affec-
tions of the uterus, has been called by the expressive name
of cramp-bark, from time immemorial. I was, I believe, the
first in our school to call attention to the peculiar properties
of this medicine, although it has been used in domestic prac-
tice for a century. Its common name perfectly expresses its
remedial power. Its action on the nervous system gives it
GENERAL DISORDERS OF PREGNANCY.
219
a decided curative power over painful contractions of muscles,
particularly the flexors of the limbs, and those engaged in
expulsive actions in hollow organs. Like Caulophyllum,
Cimicifuga, and Helonias, it had a reputation among the
aborigines and early settlers of this country, as a preventive
of painful labor. An infusion of indefinite strength was drank
daily for a few weeks previous to expected confinement.
Empirical experience has enabled us to define its range of
action, and its curative power. It is indicated when the
patient has been the subject of exceedingly painful dysmen-
orrhæa, or uterine cramps, accompanied generally by cramps
in the limbs, abdominal muscles, or other parts of the body.
In such cases it is to be considered probable that the woman
will have a very painful labor due to cramplike contractions
of the uterus, with cramps in the limbs, etc. Associated with
these symptoms will appear excessive erethism of the nervous
system. All species of the Viburnum, which I have examined,
contain a large percentage of Valerianic acid, which gives it
great power over abnormal conditions of the nervous system.
It is especially indicated for hysterical women, and when we
have reason to fear that the labor will be complicated with
hysterical spasms Some cases of puerperal eclampsia are
purely hysterical, and may be prevented by the previous ad-
ninistration of the Viburnum opulus, or Viburnum pruni-
folium. The latter possesses great power in preventing mis-
carriage and premature labor, and its use should never be
neglected when painful cramplike pains attend any period
of pregnancy, especially the last months.
X
The dose found most efficacious varies from a teaspoonful
of the tincture, or fluid extract, to single drop doses of the
mother tincture, or the 1 dilution. These doses are per-
fectly harmless, for it is a uterine sedative, not a uterine mo-
tor-excitaut. It is the opposite of Caulophyllum, Ergot, or
Ustilago. These doses should be repeated several times a
day for weeks before labor, or every hour or two during the
pains.
Veratrum viride -My own experience and observation has
convinced me that this medicine is invaluable in some cases
of threatened and apparently inevitable dystocia.
In some constitutionally plethoric women the plethora in-
220
GENERAL DISORDERS OF PREGNANCY.
creases to a great extent during gestation, and this condition
is increased to a dangerous extent by the physiological car-
diac hypertrophy.
An enormous quantity of blood is manufactured, and the
body is not only fed to excess, causing great increase in its
weight, but all the important organs are engorged. In such
cases it may be expected that convulsions will occur upon
the slightest exciting cause.
Apoplexy, both of the brain and lungs, is a common occur-
rence in such an abnormal state It is well known that cut-
ting off the supply of blood-making food will not always re-
duce the plethora, and venesection being virtually abandoned
by the old school, is never seriously thought of by ours.
We have, however, in Veratrum viride a remedy which,
associated with a low diet, will, in nearly every case, arrest
the inordinate plethora. This it does by slowing the action.
of the heart, and lessening its abnormal force. Under its in-
fluence I have known the bodily weight decrease several
pounds a month, with general relief to the engorged head
and lungs. It also decreases the abnormal arterial pressure
in the kidneys, and is of great value in preventing serious
renal congestion. Its sedative action on the cerebro-spinal
system and the convulsive centre in the brain, tends to pre-
vent the occurrence of puerperal eclampsia, for which acci-
dent it is almost specific.
The proper dose varies according to the susceptibilities of
the patient, ranging from one drop of the first dilution (1)
to five drops of the mother tincture, repeated three or four
times daily. It should be given largely diluted with water,
and during its administration, strong tea and coffee, or spirits,
and animal food should be prohibited. The use of the alka-
line mineral waters, Vichy, Seltzer, or Kissingen, aids its ac-
tion.
Hydrotherapy —The careful and judicious application of
some of the measures used in the so-called water-cure system,
are very efficacious in removing many of the ailments of
pregnancy and thereby preventing dystocia.
Very many instances have come under my observation
wherein women who have failed to carry the child to full
term, owing to laxity of the uterine tissues, or irritability of
GENERAL DISORDERS OF PREGNANCY.
221
that organ, have been enabled to give birth to a child at full
term by means of the sitz-bath, etc.
Other cases I have known, where women have had tedious,
difficult, and dangerous labors, when a residence for a few
months in a Water-Cure establishment would seem to remove
all the abnormal conditions, and their next labor would be
easy and natural, nor followed by unpleasant sequelæ.
The home-treatment of pregnant women is not carried on
as successfully as at a "Cure," unless the patient has every
means at her command, and also possesses a persevering and
patient disposition. It is probable that the rest and freedom
from domestic care, the systematic exercise and the excellent
healthful diet, have much to do with the cure of such
patients. But when a residence in a "Cure" is not con-
venient, or feasible, the physician can give proper directions
for the home treatment.
The three most useful hydrotherapic appliances are: the
sponge friction-bath, sitz-bath and wet bandage.
In the majority of cases all three will have to be combined,
especially when there is general and local debility.
The sponge-bath, associated with smart rubbing or friction,
with the hand or brush, is a powerful tonic to the system,
providing the patient is strong enough to hear it. In cases of
feeble and delicate women it should be used with great cau-
tion, not repeated too often, or its use prolonged beyond a
few minutes. It is not necessary to expose and bathe the
whole body at once, but a portion at a time, leaving the rest
clothed.
Alcohol or spirits should never be put in the water, unless
they leave a warm glow, and a soft, supple skin.
In very much emaciated subjects, the use of oil instead of
water is a powerful means of nutrition, and should not be
neglected. It should be thoroughly rubbed into every por-
tion of the body, and repeated every day or two, with a
general water-bath once a week. Even dry rubbing by a
healthy person is a tonic to the muscular and nervous system
if it is agreeable to the patient.
The sitz-bath (hip-bath) is best adapted to relieve local con-
gestious and weaknesses of the sexual organs. Of all the
water-cure appliances this is the most popular among weak
222
GENERAL DISORDERS OF PREGNANCY.
and debilitated women. Properly used, it acts as a tonic to the
circulation of the pelvic viscera.
The modus operandi of the sitz-bath has been variously
explained. My views of its action may be briefly stated.
The very hot sitz-bath has nearly the same effect as the very
cold. Both primarily contract the external blood vessels and
determine an unusual flow of blood to the internal organs
of the pelvis. But these extremes are rarely useful. The
temperature of the water should rarely exceed 100°, or fall
below 60°. At this temperature they rather equalize the
pelvic circulation, and have a toning effect. They have doubt-
less a stimulating effect on other nerves than the vaso-motor,
as it is well known that hot or cold sitz-baths increase the
power of uterine contractions.
But leaving out all theoretical explanations of their value,
we know that the regular and persistent use of sitz-baths do
greatly assist in the cure of chronic uterine disorders, and
avert threatened miscarriage and prevent habitual abortions.
We also know that they are a great comfort to delicate
women in the last months of pregnancy, relieving false pains
and many other abnormal sensations. I have known many
feeble women use the sitz-baths daily all through pregnancy,
up to the very day of confinement, and more, I have known
them pass the hours of labor in a sitz-bath These women
had previously suffered intensely all through their pregnan-
cies, but they all declared that these baths prevented similar
sufferings, and even mitigated greatly the pain of labor.
The temperature of the water should be made to suit the feel-
ings of each patient. Let each be her own judge.
The duration of the bath may be ten or thirty minutes,
and this too may be generally left to the sensations of each
patient.
The depth of the water should be just sufficient to cover
the hips and rise to the crest of the ilia
The wet bandage is another method of applying water, pure
or medicated, that should not be neglected. There are patients
who are not able to use hip-baths, or are not pleasantly affected
by them, yet these patients suffer from some or all of the
following symptoms, namely: sensations of soreness, tender-
ness or sensitiveness of the lower abdomen, weight, dragging
GENERAL DISORDERS OF PREGNANCY.
223
#
and bearing down in the pelvis, constant tearing or burning
pains in the sacral region, heat and fulness in the uterine
region, and many other symptoms pointing to passive stasis
of the uterine circulation and weakness of its muscular
structure.
In such cases the regular use of the wet bandage every
night, and even day and night, is followed by the best results,
namely the gradual removal of all the above symptoms.
The bandage should be of light towelling, double or treble,
and covered by one thickness of flannel or cotton drilling,
and should be a foot wide. It should be wrung out in water
cool or warm to suit the feelings of the patient (cool is ad-
vised), and changed as often as it becomes too warm or dry.
The water may be medicated with Aconite, Arnica, Nux,
Hamamelis, or Cimicifuga, in proportion of one-half ounce to
a gallon.
*
224 DISORDERS AND ACCIDENTS OF PREGNANCY.
CHAPTER II.
SPECIAL DISORDERS AND ACCIDENTS OF PREGNANCY.
NAUSEA AND VOMITING In many cases of pregnancy, in-
tense nausea, or severe and painful vomiting renders the life
of the woman almost insupportable. Not only does it cause.
great physical discomfort, but it interferes greatly with the
general health and enfeebles the system, rendering the wo-
man poorly prepared for the exigencies of labor. Until
within a few years it was supposed that little or nothing
could be done by the physician to alleviate this symptom.
But with the advance of our knowledge of the pathological
conditions which may be incident to the pregnant state,
and the discovery of the law of similia and the pathogen-
etic qualities of medicines, much has been done to relieve the
above symptonis.
But, as in nearly all pathological conditions, we must as-
certain the cause of the vomiting or nausea before we cau
remove it. Until lately the theories which were put forth
to account for the presence of this vomiting, were vague and
unsatisfactory. The general belief, however, was that it was
caused by "reflex irritation," and that the source of irrita-
tion was to be found in the uterus; but as to the exact
condition of the uterus which caused this reflex irritation no
satisfactory explanation was given. The assertion that the
vomiting was caused by the presence of the impregnated
ovum, or growing embryo, or enlargement of the uterus, are
all untenable, because only a small proportion of pregnant
women have sufficient nausea to be unpleasant, and many
none at all. If either of the above conditions caused the
vomiting, all pregnant women would suffer from it. After
carefully analyzing all the most recent theories of the causes
of vomiting during pregnancy, I believe there are three
conditions only to which it is due, namely:
(1.) The presence of the impregnated ovum.
(2.) Flexions and versions of the uterus.
(3.) Constrictions of the cervix uteri.
DISORDERS AND ACCIDENTS OF PREGNANCY.
225
(1.) Many women assert positively, and many gynæcologi-
cal authorities place reliance on their testimony, that nausea
sometimes occurs immediately after a successful intercourse,
¿. e., an intercourse during which the semen effects an en-
trance into the uterus. * We also know that the mere pass-
ing of the sound into the uterine cavity, or the introduction
of a few drops of fluid, will, in some women, cause nausea and
vomiting. The ordinary nausea of pregnant women, how-
ever, usually occurs about the fifth or sixth week, at a time
when the embryo begins to exert by its growth some pres-
sure upon the parietes of the uterus ; but this ordinary nausea
usually passes away in a few weeks.
I ought to add that it is Dr. Hewitt's opinion† that not
only the severer forms of vomiting of pregnancy, but even
this supposed normal nausea of the early months, is due to
slight flexions of the uterus. He thus explains it: "It is the
fact that the patient generally experiences the symptom in
question on first rising in the morning, or while dressing.
Why is this? Is it not because the body of the uterus falls
a little downward in obedience to the law of gravity, there-
by producing a slight flexion and a compression of uterine
tissues at the seat of the flexion. During the first three and
a half months such a temporary flexion is possible, because
the uterus is still in the pelvis Generally after that time.
it rises out of the pelvis, and flexion to more than a very
slight extent is no longer possible (but version is of fre-
quent occurrence). Is it not the fact that for the most part
the liability to nausea and vomiting ceases at precisely this
period. It is also a fact, which will be confirmed by all who
make the experiment, that in ordinary slight cases of nausea
and vomiting, by ordering the patient to remain absolutely
in the horizontal position the symptom ceases." Dr. Hewitt,
perhaps, carries his theory too far, for it is well known that
by taking her breakfast in bed, or drinking a glass of cham-
pagne before rising, the nausea is ameliorated. Still it is a
suggestive fact, that the remedies most useful in flexions of
the uterus, namely: Sepia, Lilium, Nux, Puls., etc., are often
* See Pamphlet by Dr. M. A Pallen, heretofore quoted.
+ Disenses of Women, p. 436.
226
DISORDERS AND ACCIDENTS OF PREGNANCY.
our best remedies in this nausea, although Ipecac. is generally
very useful, for other reasons.
(2.) That the really severe and painful vomiting which
renders some pregnancies so distressing, is caused by flexions
and versions of the uterus, there is now but little doubt in
the minds of well-read physicians. We are chiefly indebted
to Dr. Grailey Hewitt, of England, for the discovery of this
fact. In a paper presented to the Obstetrical Society of Lon-
don, 1871, he propounded his views on this subject, which
are further set forth as follows in his Diseases of Women, page
429. Ilis argument is (a) that nausea and vomiting are as-
sociated with pregnancy. (b) Nausea and vomiting are asso-
ciated with disease of the uterus; (c) but nausea and vomit-
ing are not always present in cases of pregnancy, nor are
these symptoms always present in cases of uterine diseases.
(d) It is probable that the nausea and vomiting of pregnancy
and that from uterine disease, are both due to a similar
cause. (e) Nausea and vomiting are very common in flexions
of the uterus, especially when the flexion prevents the escape
of any fluid in the cavity of the uterus.
Dr. Hewitt arrives at the conclusion that "the sickness of
pregnancy is due to the combined effects of the increasing
distension of the uterus and an associated flexion of that
organ." He offers a large array of proof in support of this
theory, and I must say that the testimony which he brings for-
ward seenis indisputable, especially so in view of the fact,
that for many years my experience substantiates it. Dr.
Hewitt says: "Ilaving occasion to treat cases of sickness in
young unmarried women suffering from flexion, it has been
observed by me that when those patients marry and become
pregnant, the sickness observed is liable to be unusually
severe and troublesome." He also observes that "cases
which have come to me in the course of consultation prac-
tice, and when the symptoms of sickness have been still
more troublesome, I have always recognized an abnormal
condition of the uterus as regards its shape."
Treatment. In excessive nausea and vomiting from act-
ual flexions of the uterus, the treatment should be more
mechanical than medicinal. I do not think it possible that
any medicinal agent can restore the bent uterus to its normal
DISORDERS AND ACCIDENTS OF PREGNANCY.
227
shape, without the aid of posture and mechanical supports.
Says Hewitt: "Over and over again have I observed these
troublesome symptoms disappear at once on applying mechan-
ical treatment for the restoration of the uterus to its proper
shape, whereby the congestion and the irritating pressure on
the uterine tissues are removed. Mere attention to the posi-
tion of the body often suffices to relieve the patient. The
horizontal position on the back in cases of anteflexion, the
prone position in cases of retroflerion, unaided, give great relief,
a relief which is more effectual if conjoined by suitable in-
ternal appliances for aiding the restoration of the uterus to
the proper shape."
It may be interesting in this place to quote a few cases
confirmatory of this theory, reported by physicians of our
own school. The following are reported by R. N. Foster,
M.D., Professor of Obstetrics in the Chicago Homœopathic
College:
"CASE I.-Mrs.
aged forty, had advanced to the
fourteenth week of her second pregnancy. Had been preg-
nant for the first time just fifteen years ago, and had then
miscarried at the twelfth week-the miscarriage being due
to persistent and intractable vomiting. The history of this,
her second pregnancy, had thus far been an exact repetition
of the first. For ten weeks she had been confined to her bed
by frequent vomiting, which was made worse by sitting up
or by standing or walking Her appetite was good, but a
few minutes after eating any kind of food she vomited it.
"She had been under 'regular' treatment, but without
any mitigation of the annoyance, besides she was growing
weak and emaciated, and dreaded a second miscarriage.
“An examination detected the uterus lying, thoroughly
retroverted, in the hollow of the sacrum, which the patient
informed me had also been the case in her previous preg-
nancy. The retroversion was probably a consequence of the
increased weight of the womb, as the ready mobility of that
organ would indicate that the position had been recently
assumed. Moreover, the pelvis was well formed and roomy,
and the replacement of the womb was therefore free from
difficulty. It was accomplished by alternately lifting the
body and fundus up out of the hollow of the sacrum, and
228 DISORDERS AND ACCIDENTS OF PREGNANCY.
pushing the cervix back toward the coccyx. This was done
gently, and the organ thus gradually restored to its proper
position.
“To retain it there an inflated ring-pessary was introduced
and placed precisely as in cases of prolapse, i. e., so that the
os rested in the central opening of the pessary.
"The next day the patient resumed her household duties,
the vomiting having ceased at once, and she is now approach-
ing the fortieth week of pregnancy, and is in perfect health.
"In retroversion of the womb, when the condition is not
complicated by adhesions, the best repositor' is the index
finger, or, if this does not suffice, another inch of progress
may be gained by the introduction, within the vagina, of the
middle finger also. The elevation of the fundus ought im-
mediately to be followed by pressure on the anterior surface
of the cervix, directing that portion of the organ back toward
the coccyx. This latter manoeuvre will often succeed when
the former alone fails."
'CASE II.-Mrs.
6
primipara, had been married three
months; bad gone over her time' two weeks, a circumstance
by no means unusual with her, and therefore creating no
suspicion of pregnancy. But just at this time began an era
of terrible vomiting. If she ate anything she vomited; if
she drank anything she vomited; if she neither ate nor drank
she vomited. She retained her food long enough to obtain
some little nourishment from it, nevertheless in three weeks
she was reduced to a condition of positive danger from starva-
tion. She was pallid, weak, emaciated, with a pulse of 100,
daily growing more rapid, and occasional streaks of blood in
the substances vomited. Moreover, she was a delicate woman
of consumptive proclivities.
(
She had meanwhile been constantly under treatment,
dietetic and medicinal. She had numerous friends, and every
one of them had a new diet, which was tried, and each dis-
comfited friend retired to make room for the next. Her
treatment was somewhat mixed, ranging all the way from
Ipecac. to the Oxalate of cerium, in 'regular' doses. The
reader may take it for granted that I simply gave everything
"according to the symptoms,' and not according also, and
that my patient daily grew worse.
DISORDERS AND ACCIDENTS OF PREGNANCY.
229
"At length I asked for an examination. Everything in
the pelvis seemed normal, both as to condition and location.
The womb was no lower in the pelvis than is usual in per-
haps one-third of our cases examined, whether pregnant or
non-pregnant. Nevertheless I determined to introduce an
inflated ring-pessary, by which means I would at least alter
the position of the womb, and bring what little pressure
there was to bear on new points and in new directions.
Possibly an oversensitive nerve might thereby be relieved,
and this reflex irritation stopped.
·
"Therefore the pessary was introduced, and the vomiting
ceased immediately; occasional slight nausea was experienced
during the next two mouths, but not so as to cause the pa-
tient any real discomfort. The pessary was not felt by the
patient at all, and was retained for three months, when it
was removed She is now in her thirty-sixth week and well."
"CASE III.-Dr. A. W. Woodward lately reported to me a
case equally intractable with the two preceding, when I re-
lated to him this story of the two pessaries,' thereby in-
ducing him to try the same experiment. The result in his
case was a total failure, wherefrom we may reasonably con-
clude that inflated ring-pessary is not a 'specific' in this
disease, and indeed we do not as such recommend it. But
the second case suggests as one cause of the vomiting in
these cases a hyperesthesia of the uterine nerves, of such a
character and so located that simply altering the position of
the uterus may chance to settle the whole difficulty. The
pessary is therefore worthy of trial in such cases, especially
as the experiment, if not successful, is at least perfectly harm-
less. Besides, how can we by medication cure a case which
is of such a nature as to yield at once to this simple mechani-
cal method ?”
If Dr. Foster had used Thomas's, Ilewitt's, or Jackson's
pessary, I think he would have been more successful in
Case 3.
The following cases were reported by myself in the March
number of the American Homeopathist, 1878:
“CASE I.—A young, healthy married woman, whom I
had treated a year previous for retroversion, became preg-
nant, and about the fifth week was attacked with violent and
230
DISORDERS AND ACCIDENTS OF PREGNANCY.
almost constant vomiting. Her mother and friends dissuaded
her from calling a physician, because 'the vomiting belonged
to pregnancy, and there was nothing to be done.' About the
seventh week, however, the husband became anxious and
called nie in. From my previous knowledge of her history
I immediately suggested the probability of a retroflexion.
She was loath to have an examination, and her mother never
heard of such a thing.' I therefore gave Nux vomica, which
seemed indicated; but in a few days I was summoned again.
I then made an examination, and found the uterus retroflexed.
Dr. Thomas's retroversion pessary was placed in position,
which changed the retroflexion into the normal position of
the uterus. After this she had no vomiting or nausea, ex-
cept the ordinary morning sickness. Iitalicize the last phrase
in order to call attention to the fact that in the majority of
cases, where the vomiting or nausea grows worse as the day
advances, we may safely diagnosticate some uterine displace-
ment."
"CASE II.-Mrs. B., multipara, pregnant with her third
child. Four years ago she miscarried at three months, ‘from
excessive vomiting,' as her medical attendant said. She was
now about two months advanced, and vomited everything
she ate or drank. The empty retching was very agonizing.
When I was called it was for dysenteric symptoms, and
here I wish to make another point, namely, that when a preg-
nant woman, before the fifth month, complains of tenesmus, with
small mucous or watery evacuations, look for retroversion of the
uterus. In this case I insisted on an examination, and found
not only a retroverted but a very sensitive and inflamed
uterus. It was with difficulty replaced, and required a long
Jackson's retroversion pessary to retain it in its proper posi-
tion. The next day all but the morning nausea ceased, but
it required absolute rest, with side and face position in bed
for several days before the pain, soreness, and rectal irrita-
tion disappeared. The use of Arnica and Caulophyllum
proved valuable."
"CASE III was one of a more unfortunate character.
Mrs. C., married a few months, passed over her time' ten
days, when she was suddenly attacked with violent vomiting,
occurring from walking or riding, or when expelling a cousti-
DISORDERS AND ACCIDENTS OF PREGNANCY. 231
pated stool. I gave her Nux v., Cocculus, and Argentum,
which corresponded with the three above given causes; but
no benefit followed their use I had treated her before her
marriage for retroflexion, and I now suspected the same con-
dition. An examination proved the correctness of my opinion.
The uterus was pushed up, an Albert Smith pessary placed
under it, and the vomiting ceased. She wore the pessary
two weeks, then at her request I removed it. For ten days
all went well, when, after a long walk and climbing many
stairs, the vomiting again occurred, and continued two days,
or until a pessary was inserted. Again at the third month
the pessary was removed, and, notwithstanding the persistent
use of Sepia and Lilium, the uterus became retroflexed at
three and a half months, this time from straining at stool, she
thought. Again the pessary was inserted with prompt arrest
of the vomiting, which was this time so violent as to lead to
spasmodic retching and vomiting of bloody mucus. She
wore this last pessary two weeks, when, contrary to my ad-
vice, she removed it herself. I then cautioned her very im-
pressively against any severe exercise, such as going rapidly
upstairs or down, riding over rough roads, or straining at
stool. For about two weeks she was perfectly free from any
pain or discomfort, and everything bid fair for a perfectly
normal advance of pregnancy. At this time I visited the
Centennial Exposition, and then went abroad with my family.
A few days after my departure, she entertained at her house
some friends from California, and unfortunately felt obliged
to attend them to places of amusement, and on long rides
over the rough wooden pavements of Chicago. On one of
these rides, her husband informed me that she was attacked
with such severe pain in the back and lower bowels, with
extreme nausea, that he was obliged to place her on a street-
car and take her to his residence. After arriving home she
was attacked with violent retching and vomiting of watery
mucus mixed with blood. A prominent homeopathic sur-
geon of this city, now deceased, was called in, but from some
inexplicable reason did not recognize the cause of the trouble,
notwithstanding the woman's suggestion as to the nature of
the previous attacks, and the means I had taken to remove
them. She rapidly grew worse, the pain in the back and
232
DISORDERS AND ACCIDENTS OF PREGNANCY.
hypogastrium became agonizing, the vomiting became gru-
mous, and delirium supervened. At this juncture, the at-
tending surgeon, for an equally inexplicable reason, trans-
ferred the case to a neighboring physician, whose utter
ignorance of the pathological condition of the uterus, and
the cause of the attack, was manifested by his absurd symp-
tomatic treatment. In consequence of the total neglect of
the ordinary and simple treatment of this case, the poor
victim died on the fourth day, after expelling in her last
agonies a fœtus of nearly five months.
"These cases, especially the last, should serve as practical
lessons to all physicians, not to overlook the displacements
of the pregnant uterus, but to act promptly and decidedly,
and not to rely upon medicines to remove a condition only
amenable to replacement and mechanical support."
For general directions relating to the mechanical treat-
ment of flexions and versions of the uterus, by the use of
pessaries, refer to the chapter on that subje.t. I will only
add, that if the proper pessary is selected, and properly
placed, so that it does not cause irritation by being too
large, too small, or of improper shape, there is not the least
danger of inducing miscarriage, but, on the contrary, it will
do more to prevent that accident than any other means at
our command.
The medicinal treatment of the nausea and vomiting of
pregnancy may be arranged in three classes:
(1.) Those homeopathic to the flexion and congestion of
the uterus.
(2.) Those homeopathic to a localized gastric irritability.
(3.) Those homœopathic to abnormal reflex irritation.
To the first class belong Aletris, Belladonna, Cimicifuga,
Nux, Lilium, Sepia, Apis, Pulsatilla.
To the second class belong Antimonium, Ipecae., Iris, Nux,
Kreosote, Oxalate of Cerium, Pepsin, Bismuth, Columbo,
Veratrum, Pulsatilla, Sanguinaria, and Mercurius sol.
To the third class belong the Bromides of Potassa, Am-
monia, and Camphor; also, Chloral hydrate, Cocculus, Calabar,
and Jaborandi. Electricity has relieved many cases where I
have advised it, when all medicines failed. For the special
DISORDERS AND ACCIDENTS OF PREGNANCY.
233
indications for the above remedies I refer the reader to the
Materia Medica and special works on Obstetrics.
I will, however, add my own experience with some of the
medicines I have mentioned.
I have met with cases of vomiting during pregnancy, so
severe that the life of the woman was almost despaired of;
cases where not a drop of water or a particle of food could be
tolerated by the stomach, and where the uterus appeared to
be in a normal condition. In these cases there may have
been abnormal conditions of the uterus which could not bẹ
ascertained, such as fibrous tumors, presence of exudative
products, tumefactions of the uterine tissues, inflammations
of the placenta, decidua, and other membranes. In these
cases all the ordinary remedies proved unavailing. But I
have never failed to carry my patient through, although I
was obliged to resort to procedures which are not put down
in our text-books, namely:
In four cases I kept the women in the horizontal posture
for several weeks, giving meanwhile from 20 to 40 grains
of Bromide of potassa twice a day, in an enema of a pint
of milk, beef tea, or mutton broth, allowing nothing what-
ever to be swallowed, thus giving the stomach perfect rest.
I had every reason to be gratified by the result of this treat-
ment, for in a few weeks they became conscious of an ability
to retain food, and the trial was successful. In many cases,
two or three enemas of Bromide of potassa, 20 grains at
night, has completely arrested the violent moruing vomiting.
The same results have often followed the administration of
15 grains in an ounce or two of milk, Lefore rising in the
morning. I have used Chloral hydrate in the same manner,
and with excellent success, being led to its use by seeing its
good effects in sea-sickness. These remedies do not cure by
acting on the uterus or stomach, but by lessening and even
arresting altogether the hyperæsthetic condition of the reflex
nervous system, giving the stomach rest until it recovers
its tone.
Associated with the vomiting of pregnancy, there is often
a condition which may be designated as "extreme bilious-
ness." The tongue is foul, coated with a brown, dirty fur,
the breath is fetid, the complexion dirty-yellow, and consti-
16
234
DISORDERS AND ACCIDENTS OF PREGNANCY.
pation is obstinate. In this condition no remedy will relieve
so well as Merc. sol., Hahn., two or three grains of the 2*, or
even 1*, given every three or four hours until the tongue
cleans and the bowels are opened. Podophyllin 2x, or Euono-
min 1*, will often do as well, and should be used if the woman
has ever been salivated, or cannot bear mercurial prepara-
tions.
On several occasions I have verified both Hahnemann's
and Ringer's recommendation of the value of Ipecac. in ob-
stinate and continuous vomiting during pregnancy. I have
cured cases with the 6th dil., and have made equally good
cures with five-drop doses of the mother tincture, or the
wine of Ipecac. Kreosote and Carbolic acid in minute doses
have helped me out in some obstinate cases, while in those
cases where undigested food was invariably vomited, I have
seen the best results from Pepsin, iu the form of saccharated
powder, wine of pepsin, or lacto-peptin, a dose given before
each meal, even if the meals were taken every few hours.
Bismuth sub. nit, in doses varying from 1 to 5 grains of
the crude, taken before or after food was taken, often acts
magically in removing oppressive pain, eructations, and vom-
iting of food. Ferrum, especially the lactate, in grain doses
of the 1, is often useful in similar cases in pale, anæmic
patients. Digitalis 1 will often give surprisingly good re-
sults when, in persons of slow, languid, irregular circulation,
they complain of palpitation, sinking at the stomach, ver-
tigo, faintness, etc. Koumiss often arrests the vomiting of
pregnancy, and at the same time affords excellent nutrition.
1
100
I cured two cases with Cuprum acet., when with the vomit-
ing there were cramps in the stomach and suffocative par-
oxysms. In another case, where the womb was very painful
and sensitive, a Belladonna plaster on the hypogastrium
arrested both the pain and the vomiting.*
In several cases, where there was the most obstinate and
uncontrollable constipation, it, with the vomiting, were both
removed by 5 drops of tincture Calabar bean, given at night
for a week. In another case I was led to the use of Jabor-
* Cazeaux (Obstetrics) recommends as often successful, painting the cervix
uteri with Ung. bell, or applying a tampon moistened with the diluted
extract.
DISORDERS AND ACCIDENTS OF PREGNANCY.
255
andi 2*, by the excessive salivation which annoyed the pa-
tient. That medicine removed in a week both the salivation
and the distressing nausea.
The treatment of those cases of vomiting which occur after
the seventh month of gestation, depends on the nature of
the cause, which is supposed to depend on constriction of
the fibres of the os and cervix uteri. These instances are
not usually continuous with the vomiting of the earlier
months, but occur after a long interval of quiet.
In one case reported within a few years, the vomiting was
so violent and exhaustive that a sponge-tent was introduced
for the purpose of inducing premature labor, when, to the
astonishment of the physician, its removal the next day was
followed, not by labor, but by a complete cessation of the
vomiting. In another case of vomiting in the ninth month,
the attending accoucheur attempted forcible dilatation of the
os with his fingers, in the hope that premature labor would
occur, but instead a permanent cure of the vomiting resulted.
Since these cases were published, several reports have ap-
peared in American and foreign journals, confirming the
value of gentle dilatations of the os uteri in this late vomit-
ing. One such case occurred last year in my own practice.
All that is necessary is to carefully insert the forefinger in
the os, and press gently in all directions, so as to slightly
relax the constricting circular fibres
It is possible that some of the medicines kuown to exert
a relaxing effect on these muscular fibres, might be used
successfully for this form of vomiting. Belladonna, inter-
nally and topically; Stibium, interually; Gelsemium, Cimi-
cifuga and Cannabis indica. Recent observations seem to
prove that Morphia has this effect; it is said to relax the
os when its rigidity causes slow and retarded labor, and it
might be given in minute doses for the vomiting, for it is
certainly very homeopathic to vomiting of a reflex or sec-
ondary character.
Some singular facts have come to my knowledge relating
to the little understood and complex relations of the uterus
to other organs, and the exceptional great tolerance of the
uterus under certain circumstances.
(1.) During the meeting of the National Medical Asso-
236
DISORDERS AND ACCIDENTS OF PREGNANCY.
ciation (allopathic) in Chicago, in 1878, Dr. M. O. Jones of
that city informed Dr. J. Marion Sims that he had for years
arrested the obstinate vomiting of pregnancy by placing a
piece of lunar caustic, half an inch long, in the cervical canal,
allowing it to remain there fifteen or twenty minutes. Dr.
Sims seemed much interested in the relation, but made no
comments at that time. But afterwards, while in Europe, he
published an account of the procedure in the London Lancet,
and stated that he had tried the method in many cases with
success, and without causing miscarriage. This would seem.
to show that there was a point of irritation somewhere in the
cervical canal that caused the vomiting of pregnancy, and
perhaps the vomiting which sometimes occurs in non-preg-
nant women with uterine disease. The supposition is that
the "charring" of the cervical mucous membrane produced
a "sedative" effect on its nerves, and arrested the reflex irri-
tation. It would seem to show that flexion was not always
the cause of the vomiting, but some other irritating factor.
Of course miscarriage would be caused if the caustic was
pushed through the inner os. I cannot recommend the prac
tice, for I have never tried it. It should not be forgotten,
however, in those cases which seem to threaten life.
(2.) During the meeting of the Illinois State Society in
1878, Dr. G. C. McDermott, a delegate from Milwaukee, in-
formed me that Dr. Ford of that city recently had a severe
case of intractable vomiting in a pregnant woman, who had
suffered similarly in three previous pregnancies, in one of
which miscarriage was brought on, as it was deemed neces-
sary to save her life, at least such was the decision of a con-
sultation of eminent physicians. In this fourth pregnancy
a similar decision was reached after serious consultation. A
uterine sound was used, but could not be introduced; a
sponge tent was introduced, but doubtless only part way up
to the inner os. This arrested the vomiting for a week, and
on its return another tent was used with like effect, and this
procedure was repeated several times. In this case the
amelioration was not permanent; but if a flexion was the
cause, a retroversion pessary might have continued the pal-
liation to a permanent improvement. It is possible that the
DISORDERS AND ACCIDENTS OF PREGNANCY.
237
tent acted like the lunar caustic, and benumbed the sensitive
point in the cervix.
These cases are suggestive, and should lead to more care-
ful study of the singular anomalies of uterine disturbance.
ALBUMINURIA.
By albuminuria, it is implied that through the medium of the
kidneys the albumen is filtered off from the blood to a greater
or less extent, and discharged from the system in the urine.
When this occurs it is believed, also, that the kidneys fail in
some measure to depurate the blood by eliminating urea.
Albuminuria and uræmia are not identical terms, as either
condition may exist and the other be absent; but I suppose
that albuminuria cannot be developed to any considerable
extent without being accompanied by more or less uræmia
(Barker).
Albuminuria of pregnancy is not Bright's disease, for the
albumen of Bright's disease differs essentially from that
occurring in the temporary albuminuria of pregnancy, as can
easily be shown by its chemical reactions. The albumen of
the urine in Bright's disease when brought in contact with the
Oxide of copper assumes a beautiful reddish-violet color, and
produces a more or less abundant flocculent black precipitate.
The urinary albumen of pregnancy, when Bright's disease
does not exist, while it coagulates readily by heat and Nitric
acid, does not exhibit any such reaction with the Oxide of
copper. Robin has demonstrated that granular casts are not
characteristic of any particular morbid state or pathological
change of structure of the kidneys.
It is an accepted fact that in a large number of cases,
gestation develops a temporary albuminuria which may dis-
appear during or soon after puerperal convalescence. The
phenomena pertaining to this condition are rarely manifested
before the sixth month of pregnancy. Statistics seem to
prove that it occurs more frequently in first than in subse-
quent pregnancies. It has been supposed that there is some
close relation between albuminuria and convulsions during
labor; but when careful and repeated examinations of the
urine during gestation have failed to detect albumen in the
238
DISORDERS AND ACCIDENTS OF PREGNANCY.
urine, convulsions have occurred during labor, and afterwards
the urine has been found loaded with albumen. It is now
settled that mechanical obstruction of the circulation during
pregnancy, while it may be one cause of albuminuria, is not
always the cause. A sudden cold may develop the disease.
The presence of albumen in the urine has been regarded as
the cause of many of the pathological conditions occurring
during pregnancy and the puerperal state, when, in reality, it
was only an effect.
Albuminuria when present during pregnancy usually causes:
(1.) Headache, severe and persistent, usually associated with
sleeplessness, impaired vision, hesitation or embarrassment in
speech, and great nervous irritability. It may culminate
in delirium, coma, paralysis, hemiplegia and convulsions.
(2.) Edema, first of the face, worse in the morning; then
of the lower extremities and even general anasarca. (3.)
Gastric irritability; sometimes obstinate constipation, and
sometimes diarrhoea. (4.) Miscarriage or premature labor.
Treatment. There are three important indications for
treatment, namely:
I. To relieve the hyperamia or congestion of the kidneys.
II. To prevent the impoverishment of the blood which results
from the loss of albumen.
III. To prevent the various disturbances which often terminate
in paralysis or convulsions.
Before proceeding to the special therapeutics of albuminu-
ria, I deem it my duty to enter my serious protest against
the manner in which it is treated by our best homœopathic
text-books. In Guernsey's Obstetrics, the etiology of the
disease is very fairly given, but when it comes to that all-
important point, the treatment, what do we find? A careful
examination into the merits of medicines having a specific
action on the kidneys? Medicines capable of curing the
symptoms and pathological conditions accompanying the
disease? Not at all! Nothing but three pages of a "repertory,'
or an enumeration of medicines causing such symptoms as
relate to color, sediment, smell, and painful sensations in the
kidneys, bladder, and urethra. Nine-tenths of the medi-
cines mentioned are not renal remedies at all, and the symp-
toms they cover have very little, if any relation to the renal
دو
DISORDERS AND ACCIDENTS OF PREGNANCY.
239
functions, or the abnormal condition of the urine found in
albuminuria. He refers us to another section entitled "Uri-
nary Difficulties," in which thirty-three medicines are men-
tioned, and their supposed characteristics given. But out of
the thirty-three, only ten at most have any specific action
on the kidneys or the urine. And this is called the correct
homoeopathic treatment of albuminuria! To make matters.
worse, the senseless plan of enumerating the medicines in
alphabetical order is retained, instead of giving preference to
those which experience has found most efficacious. Further
comment on such so-called "treatment" is unnecessary. It
is like the "apples of Sodom"-
"Fair to the eye,
But turn to ashes on the lip."
I do not claim for the following treatment anything in-
fallible, for our knowledge of the specific treatment of al-
buminuria is still in its infancy. But I do claim that it has
a basis of common sense, and has in many hands besides my
own proved efficacious in many cases.
I. To relieve the hyperemic or congested kidneys.
If the woman is plethoric, and there is persistent redness
of the face, injection of the conjunctiva, hot skin, sharp
pains in the head, a hard labored pulse, denoting arterial
tension, and an elevation of temperature, there are three
medicines which are capable of removing the hyperemia by
lessening the abnormal blood pressure. In these cases, the
condition of the urine is of less moment than the threatening
constitutional, pathological state.
Veratrum viride by its secondary symptoms corresponds
exactly to this general hyperæmic condition. In the experi-
ments narrated in the "Therapeutics of New Remedies," after
the first stage of depression had passed, or even when a toxic
dose was given, the arterial blood-pressure rose enormously,
and every organ became congested-even the convulsive
centre in the medulla-and violent convulsions set in. Ac-
cording to my law of dose, which I believe to be as important
as our law of cure, Veratrum viride should be prescribed in
the lowest dilutions, or the crude preparation. I have suc-
ceeded best by giving one to five drops of the tincture or 1*
240
DISORDERS AND ACCIDENTS OF PREGNANCY.
every two hours, until the pulse, temperature, and other
symptoms showed that the arterial tension was normal.
It will not do to suspend the medicine at this point, but con-
tinue it at longer intervals, in order to hold the advantage
gained, and alternate with it some other remedy correspond-
ing to the special symptoms of the urine, etc.
Gelseminum corresponds to nearly the same general condi-
tion, but the pulse is not as large, hard, and heavy, nor is the
urine as scanty as under Verat. vir. The dose is, however,
nearly the same. There is moreover a tendency to stupor,
and a dimness of vision not found in Verat. vir.
Aconite is indicated when with a small, hard, wiry pulse,
there is great restlessness and anxiety, fear of death, scanty urine,
and acute rheumatic-like pains all over the body. The dose
will vary from five drops of the 1x to the same quantity of
the 2x dilution.
I have made no mention of albumen in the urine or dropsy
as indicating these medicines, because they are only indicated
in the first stage of the disease, or for dangerous conditions.
of arterial excitement, which may arise in the later stages.
If the constitutional symptoms are not of a nature to in-
dicate the above three arterial sedatives; if there is not gen-
eral increased blood-pressure or congestion to the brain, but
we believe the kidneys to be highly congested, with only
sufficient intracranial hyperemia to cause frightful dreams,
incoherency of speech, temporary attacks of delirium, etc.,
another class of remedies becomes necessary.
These remedies should have a specific influence, not only
on the kidneys, but the capillary circulation in general.
They need not be primarily homeopathic to renal hyperæmia,
but to general hyperæmia. One of the most important of
this class, I believe to be the Bromide of lithia. Its action in
albuminuria, and the conditions tending thereto, is as fol-
lows: (1.) It relieves the renal hyperemia by contracting
the arterioles of the kidneys. The blood-pressure in those
vessels being lessened, the urine increases in quantity, and the
elimination of urea is increased. It thus prevents an accu-
mulation of this toxic agent in the blood, and the tendency
to uræmia is lessened.
The action of this medicine can be favored and increased
DISORDERS AND ACCIDENTS OF PREGNANCY.
241
by the use of certain mineral waters, namely, Gettysburg,
Pethesda, Vichy, or Seltzer; if these are not readily ob-
tainable, pure soft water, filtered rain-water, or a weak solu-
tion of Bitartrate of potassa, or Citrate of potassa. No
active diuretics should be used in this stage of the disease,
for they all tend (in material doses) to increase the renal
hyperæmia. (In some cases the Benzoate of lithia may be
substituted, namely, when the appearance of the urine corre-
sponds to the indications found under Benzoic acid.)
The Bromide of lithia controls admirably the cerebral
irritation, the rheumatic pains, and many of the abnormal
mental phenomena. The dose which I have used and advised
most successfully, is five grains three or four times a day,
and if obstinate insomnia occurs, with nocturnal frightful
dreams, or delirium, I give an additional dose of fifteen or
twenty grains at bedtime. For this last purpose, however,
the Bromides of lime, soda, or potassa may be used.
Another class of remedies, more important for the radical.
cure of albuminuria, are those medicines which are primarily
homœopathic to the pathological condition existing in the
kidneys, viz.: Turpentine, Cantharides, Apis mel., Copaiva,
Erigeron, Equisetum, Nitrate of uranium, Phytolacca, Eupa-
torium purp., Helonias, Aurum muriaticum, Merc, corrosivus,
and Arsenic. These are the most important, and it is rare
that any others will be found more than palliative, because
their action is not powerful enough in the direction of the
real pathological state of the kidneys.
Turpentine is probably the closest similimum to both acute
and chronic albuminuria. Primarily it causes the acute
stage, secondarily the chronic. But the disease must be idio-
pathic, i. e, not originated by, or kept up by disease of the
heart. In the attenuatious, from the 3 upward to the 30th,
it is primarily indicated in active congestion of the capillaries,
the Malpighian tufts, and the glomeruli, with exudation of
albumen. It also destroys and expels the glandular surface
of the tubuli uriniferi. The urine contains blood, epithelium,
cylindrical casts, and coagula, and coagulates under the
action of heat and nitric acid. Its ultimate secondary effects
are complete denudation of the surface of the tubuli, of all
212 DISORDERS AND ACCIDENTS OF PREGNANCY.
of its glandular cells, paralysis of its nervous supply, passive
hæmorrhage, uræmia, and convulsions.
When the stage of acute congestion, or inflammation of
the kidneys subsides, and structural changes set in, the higher
dilutions of Turpentine are useless. When pus, disorganized
blood-corpuscles, fat-globules, and very scanty urine, loaded
with albumen, appears, then Turpentine should be given in
the lowest dilutions.
The action of Erigeron and Erechthites is closely analo-
gous to that of Turpentine, and may sometimes be substituted
for that drug.
Cantharides, next to Turpentine, is the closest similimum of
acute congestive albuminuria. When the patient seems suf-
fering from some feverish erethism, with scanty and frequent
urinations, irritation of the generative organs, burning or
scalding pains during micturition, and pain in the back,
Cantharis 3d or 6th will ward off impending albuminuria,
or arrest the disease even after albumen has appeared in the
urine. It is of little value after cædema has appeared, for it
causes not so much structural changes in the glandular ele-
ments of the kidneys as paralysis of its nervous supply. If
homœopathic to dropsy at all, it is a dropsy from renal
paralysis. If homeopathic to uræmia, it is from the same
cause. In allopathic practice it has warded off uræmic con-
vulsions with suppression of urine when given in material
doses The material doses acted curatively because the
paralytic condition was similar to the secondary action of
Cantharis.
Apis has many symptoms in common with Cantharis. It
causes both congestion and paralytic conditions in the kid-
neys with cerebral hyperæmia. But it differs from Cantharis
in its specific power of causing cedema of almost every organ,
and effusion of serum into almost every cavity. Very soon
after the renal irritation of Apis commences we find symptoms
of general dropsical effusion. Even ædema of the brain and
lungs sets in. Feverish symptoms are rarely present, but the
blood is soon poisoned, and this causes a condition known as
uræmic fever, which finds relief in eruptions on the skin
(urticaria, erysipelas, etc.). In this respect it closely resem-
bles the preparations of Arsenic.
DISORDERS AND ACCIDENTS OF PREGNANCY.
243
I
Copaiva is a medicine of much greater value in albuminuria
than is generally supposed. It is especially indicated when
the origin of the disease is a cold or sudden check of per-
spiration, and the affection of the uriniferous tubes are ca-
tarrhal as well as congestive. It has caused acute attacks of
albuminuria, with feverish symptoms, bloody urine, and all
the symptoms of acute congestion of the kidneys. In the
middle attenuations it will effectually remove these condi-
tions. It has been found singularly efficacious in dropsy
after all other remedies had failed, and when the urine was
almost entirely suppressed; but in these cases it was pre-
scribed in material doses (five to fifteen drops of the bal-
sam repeated every few hours). The dropsy of Copaiva
is a secondary effect of that drug, due to conditions of the
kidneys somewhat similar to those caused by Cantharis.
Equisetum is recommended by Dr. Marsden as having
proved curative in many cases of "painful dysuria with al-
buminous urine in pregnant women," but our knowledge of
its pathological effects is quite limited. (See Pathogenesis.
in Allen's Encyclopedia of Materia Medica.)
Nitrate of uranium seems indicated where an attack of
congestive albuminuria has set in after diabetic symptoms.
Helonias is indicated in the same condition, but it is a
much more useful remedy on account of its specific relation
to the uterus. Albuminuria is supposed by some to be due
to reflex irritations transmitted from the uterus to the kid-
neys. Helonias may be useful when this variety exists.
But it is also homoeopathic to acute albuminuria, for it has
caused that condition when taken in large doses. It is best
indicated when the blood is impoverished by the drain of
albumen, diabetes, or from failure of nutritive processes.
Eupat purp. closely resembles Helonias, but will be found
more useful when general edema is present. Here the low-
est dilutions or the tincture will have to be used in order to
restore the normal quantity of the urinary secretion.
Mercurius cor. has been found one of the most valuable
and trustworthy remedies we possess when albumen appears
in great abundance in the urine of pregnant women. Under
the use of the 3 trit. the albumen has rapidly disappeared,
and serious results been prevented. But I must warn the
244 DISORDERS AND ACCIDENTS OF PREGNANCY.
physician not to continue Merc. cor. but a few days in this
low trituration, as it may cause serious general disturbances
and a final aggravation of the albuminuria. I would advise
that as soon as improvement fairly set in to change the 3×
for the 3º, or the 6× trituration.
Aurum, Cuprum, Arsenicum, and Argentum are excellent.
remedies, but will be considered in the next section. I
ought to add that in all acute cases where congestion of the
kidneys is evidenced by pain and tenderness in that region, and
the urine is scanty, "smoky," and high-colored, that great relief
may be obtained, and the action of specific remedies favored,
by the application of dry cups over the lumbar region, or a
poultice of flaxseed meal, in which is mixed a spoonful of
tincture of aconite root. IIot "sitz" baths act in the same.
mauner, by attracting the blood to the surface capillary blood-
vessels, and thus lessening the amount of blood in the kid-
neys.
II. To prevent the impoverishment of the blood which results
from albuminuria.
Next in value to these medicines, which are strictly ho-
mœopathic to the morbid condition existing in the kidneys,
are those remedies which arrest the chloro-anæmia from
loss of albumen. The physician must not confound the
hydramia which often exists with the anemia, with true
plethora. Hydræmia is a kind of serous plethora, which
closely simulates true plethora, causing great disturbances of
the circulation and even serious local congestions.
The most valuable remedy for this condition of the blood
is Ferrum. Iron is purely homeopathic to many forms of
anæmia, chloro-anæmia, and even hydræmia, but it cures by its
secondary action, for the true plethora caused by large doses
of iron is often followed by unmistakable anæmia. It is
very important that we select the proper preparation of Fer-
rum. According to all trustworthy observers the Ferrum
muriaticum is the best. It not only acts by increasing the
red globules, but it also acts on the kidneys, increasing the
watery portion of the urine.
The large doses of Tincture of chloride of iron prescribed
by the opposite schools, have doubtless done great injury by
causing primary pathogenetic effects, which secondarily ag-
DISORDERS AND ACCIDENTS OF PREGNANCY.
245
gravated the chloro-anæmia. The 2 or 3* dilution of Tine.
ferr. mur. in 10-drop doses after each meal is amply sufficient
for all curative purposes. Next in value, I consider the Al-
buminate of iron, a few drops of the officinal syrup given in
the same manner.
X
The trophic spinal nerves which influence nutrition have
much to do in the production of anæmia. The condition of
the blood in albuminuria tends to paralyze these nerves.
When Ferrum alone does not seem to act favorably, Ferrum
et Strychnia citras 1 will be found an admirable remedy. If
there is deficient digestion of food, vomiting of ingesta,
lientery, give Pepsin or Lacto-peptin, 5 grains after each meal.
If actual hydræmia exists, with general adema, irregular
circulation, and congestive symptoms, Digitalis is a power-
ful curative remedy. The action of the heart in this con-
dition is one of excessive action, irregular, but with insuffi-
cient radical power. Digitalis, by imparting regular and
normal force to that organ, prevents the congestive phe-
nomena, and increases the favorable effect of restorative
medicines. Five to ten drops of the 1 dilution may be given
before each meal, and Ferrum after. A favorite preparation
of mine in hydræmia with weak and irritable heart is Digi-
talin 3 and Ferrum met. 1, equal parts, triturated together,
of which I prescribe two or three grains three times a day.
Should there exist an unnaturally profuse flow of the urine
with anæmia, instead of scanty flow, I have found Lycopus,
5 or 10 drops four times a day, to have a better effect than
Digitalis in regulating the irritable heart.
X
There are other medicines which should be consulted in
these cases, medicines which are eminently restorative in
their effects on the blood and the processes of nutrition.
Among the best are Metris, Helonius, Cule. hypophos., Vibur-
num prun., China, Hydrastis, Phosphoric acid, and Kali chlor.
They have also another action, especially useful in hydræmie
albuminuria and anemia, namely: to prevent miscarriage,
premature labor, or the death of the fortus. Nor should we forget
in such cases to resort to Cauloph., Cimicifuga, and Mitchellu.
Gallic acid should not be forgotten when we are selecting
medicines to prevent the chloro-anæmia due to loss of al-
bumen. It is not only powerfully palliative in albuminuria,
246
DISORDERS AND ACCIDENTS OF PREGNANCY.
but may prove curative in some cases. No medicine so
surely prevents the loss of albumen after scarlatina, and it
also arrests the loss of blood from the kidneys which some-
times occurs as a sequel to that disease.
If, during the obstinate albuminuria of pregnancy, other
medicines fail to arrest the loss, and the woman begins to
look pale, bloated, and anæmic, give her 5 to 10 grains of the
1* trituration of Gallic acid, watching the urine to observe
if the percentage of albumen is decreasing. Ferrum can be
given at the same time, the former before, the latter after
meals. So soon as the waste of albumen is arrested, change
from Gallic acid to some more radically curative remedy.
III. To prevent the nervous disturbances which often terminate
in paralysis or convulsions.
Medicines alone cannot be relied upon for this purpose.
We should advise and insist that all emotional excitement
should be avoided, and all overtaxing the physical powers in
any way. The digestive organs should be carefully watched;
the diet so regulated as to avoid indigestion, and, above all,
the patient should not become constipated. We should see
that the woman sleeps and lives in apartments which are well
ventilated and free from sewer-gas, or air impregnated with
carbonic oxide, for these two agents poison the blood in a
most dangerous manner, and serve to precipitate an attack of
uræmia.
If the woman shows signs of a mania in which fear of
death is the prominent symptom, give Aronite 6th or 30th, or
Arsenicum 6th or 30th. If a suicidal mania obtains, no rem-
edy is so efficient as Aurum, especially Aurum muriaticum, or
the "Muriate of gold and soda," as both these latter salts
have potent diuretic and eliminant properties, and are use-
ful in dropsy or uræmia. They should be prescribed in about
the 34 trituration.
A mania with melancholy is usually controlled by Cimirifu
ga, Helonias, or Hellebore. If violent delirium with insom-
nia occurs, it is of little use to select the medicine by the
ensemble of its merc symptoms. We must select that medi-
cine which will have the twofold action of calming the irri-
tated brain and rapidly eliminate the noxious poison in the
blood. I have already mentioned the value of the Bromide
DISORDERS AND ACCIDENTS OF PREGNANCY.
247
of lithia, and I cannot too strongly recommend that it be used
freely (twenty to thirty grains every four or six hours) until
the delirium is controlled.
The obstinate sleeplessness, which sometimes precedes the
mania, can be controlled by Scutellarin 1, Cypripedin, 1×,
or Caffein cit. 2. (A new preparation, the Bromohydrate
of Caffein, in the 2 trit., has acted promptly in a few cases
in my practice.)
There is a group of symptoms and conditions denoting
uramic poisoning, which may occur, and which demand the
promptest action if we would save life, namely, coma, paral-
ysis, general dropsy with suppression of urine, and constipation.
In this condition I have several times adopted the following
treatment with success. Mix two to four drops of Croton oil
with a little butter, and force it back upon the posterior
portion of the tongue. It soon dissolves and gets into the
stomach, causing very soon profuse watery discharges from
the bowels, which relieves the brain, nervous system, and
kidneys, and allows us to select the proper specific remedy.
10
In less grave cases, where the above condition is impend-
ing, and the danger is imminent, the patient's life has been
saved by the timely administration of th or th of a
grain of Extract of elaterium. This dose causes in four or
five hours very profuse watery evacuations from the bowels,
sometimes a quart at a time, followed by profuse diuresis.
Not only in the uramia of pregnancy have I warded off coma
and convulsions with this medicine, but I believe I have saved
life in the extreme dropsical conditions which occur during
the progress of organic diseases of the heart. The above
dose can be repeated three or four times during twenty-four
hours, until the patient is relieved.
X
If we fail, as in rare cases we may, in causing proper evac-
uations from the bowels or kidneys, we have in the new
remedy, Jaborandi, a drug which for its action on the skin
and salivary glands has no equal. Fifteen to thirty drops of
a good tincture, or a few grains of the 1 trit. of its active
principle, the Muriate of pilocarpin, will cause such profuse
sweating that the thickest bed-clothing will be saturated,
and such profuse flow of saliva that it has been known to
amount to twenty ounces in a few hours. Cases have been
248 DISORDERS AND ACCIDENTS OF PREGNANCY.
!
reported where, in dropsy with coma or convulsions after
scarlatina, or puerperal uræmia, the action of Jaborandi has
doubtless saved life by its rapid elimination of morbid mat-
ters and water through the skin.
CONVULSIONS.—If puerperal convulsions occur, even when
albuminuria has not been suspected, or from evident uræmia,
there are but few remedies which can control them. It is
useless to waste time in selecting from the list given in our
text-books. (Of the thirty-five mentioned by Guernsey only
three are of any value, Gels., Verat. vir. and Bell.)
Veratrum viride, when we have the violent tonic convul-
sions, tetanic, with turgid head and face, pulse large and
hard and bounding. Give large doses, five to ten drops every
half hour, until the spasms are arrested, and the pulse soft-
ened. In New Remedies many cases of fearful severity are
reported, cured by doses as large as twenty to forty drops,
repeated in an hour or two if necessary. So long as the in-
tense blood-pressure exists in the arterial system, even such
large doses are safe.
Ge'semium ranks next, but corresponds to a milder form
of spasms, with less pressure in the great arteries, but more
in the capillaries, a softer pulse, redder face, and suppressed
urine.
Chloral hydrate has been used very successfully in ante- and
post-partum convulsions. The dose is twenty to thirty grains,
repeated in two hours if necessary. (See New Remedies.)
Bromide of lithia (or any bromide) when the convulsion has
the characteristics of epilepsy or hysteria.
Cuprum acet. 2x, when the characteristic of the spasm is
the terrible suffocative phenomena, and the "beginuing in the
fingers and toes."
Belladonna, Agaricus, Cicuta, Solanum, Hyoscyamus, and
Stramonium may each be valuable in cases where these
symptoms closely correspond to those of the convulsive dis-
order, but I cannot recommend them in cases where the
blood poisoning is evidently the cause, while I believe they
may be promptly efficacious when the convulsions arise from
some other excitement of the nerve-centres than uræmia.
DISORDERS AND ACCIDENTS OF PREGNANCY. 249
CONSTIPATION is a far more important abnormal condition
than many writers would have us suppose. Many women
whose alvine evacuations are perfectly normal and regular
when not pregnant, become very constipated so soon as concep-
tion occurs. This fact would go to prove that constipation
is caused by some undiscovered cause, and not from mechani-
cal obstruction. It has generally been supposed that it was
due to the pressure of the growing uterus on the upper
part of the rectum. It is thus explained by Guernsey:
"The mechanical pressure exerted on the rectumn, by which
its calibre is diminished and its action paralyzed, and
the habits of inactivity in which some pregnant women
indulge, especially in cities, combine to produce costiveness,
and as a final result of the constipation, hæmorrhoids, either
blind or bleeding, appear in many cases.
And the very great
amount of vital force consumed in the womb may also tend
to draw away from the intestinal canal some of the energy
that might have sustained its regular and daily evacua-
tions."
This last sentence explains the cause of many cases of
constipation in pregnant women, and should be borne in
mind in our treatment. When constipation occurs at or
after the sixth week, I believe it is due in many instances to
retroversion, for I have found the uterus retroverted in such
cases, and the constipation was removed promptly by re-
placing the uterus and keeping it in proper position by a
well-selected pessary. But constipation may cause retrover-
sion both by the accumulation of fecal matter above the
uterus, and by the efforts in straining at stool which some
women improperly make. Besides this result, constipation
may cause headache, anxiety, giddiness, sleeplessness, dis-
tressing dreams, vomiting, fissure of the anus, swelling of
the veins of the legs, tedious labor, irregular and deficient
pains, obstruction to the passage of the child, and puerperal
fever. It may even produce febrile excitement, loss of appe-
tite, erratic pains in the bowels, simulating false pains. The
efforts of straining to relieve the bowels may also result in
abortion. I have met with cases where the pains were so
severe that it seemed as if retroversion or miscarriage must
occur,
but an examination would reveal a rectum enormously
17
250 DISORDERS AND ACCIDENTS OF PREGNANCY.
enlarged and obliterating the vagina, requiring copious and
repeated enemas, and even the use of small placental forceps
or the fingers to remove the hardened masses. Campbell
had a case in which the bowels were so overloaded that
after the birth of the child the attendant thought the
woman had another child to bear. The rectum was found
distended to the size of a quart bottle, and the woman died
of inflammation of the bowels. Fourteen pints of fecal
matter were removed after death from the small bowels,
after the colon and rectum had been relieved during life.
Churchill once attended a labor in which the hollow of the
sacrum was nearly filled up with a hard mass; but a more
careful examination proved it to be the lower bowel filled up
with hardened fæces, giving to the finger the sensation of a
large growth upon the bone. Great difficulty was experi-
enced in emptying the bowels, and not until then did labor
progress favorably. Ashwell mentions many similar cases.
Treatment.--It is evident that the constipation of preg-
nant women should receive judicious and effectual treat-
ment if we wish to avoid many of the sufferings of that
period, and also difficult and painful labor. The treat-
nient is to be based on somewhat different principles than
would guide us in prescribing for ordinary cases of consti-
pation.
When called upon to prescribe for a case, we should in-
quire into the diet, habits of life, and previous state of
health. We should advise active exercise, walking is better
than riding; also regulate the diet by advising coarse bread,
fruit, etc. If these means fail we may then select the med-
icine which seems appropriate. Out of the fifty-five medi-
cines recommended by Guernsey, only eleven are of much
value, namely: Alumina, Bryonia, Ignatia, Lycopodium,
Nux vom, Opium, Plumbum, Ratanhia, Se, ia, Sulphur, and
Verat alb. Of these I have succeeded best with Alumina
30th, Bryonia in five-drop doses, Ignatia 30th, Lycop. 6th
trit., Nux vom. 2x, Opium 12th, Plumbum 2, Ratanhia 3d,
Sepia 6th, Sulphur 1 trit. (See special indications in any
text-book.)
X
But there are other remedies which I value more highly.
Calabar bean (Physostigma) is very efficient when we have
DISORDERS AND ACCIDENTS OF PREGNANCY.
251
a lax, distended state of the intestines, with large quantities
of flatulence, fæces dry, hard, and very large. Five drops
of the 1× dil. four times a day will promptly remove the
inactivity, by contracting the half-paralyzed muscular coats
and restoring peristaltic action. I have seen better results
in some cases from giving ten drops of the crude tincture at
night, than from smaller doses repeated during the day.
Strychnia in the 6th trit. will often act favorably when
Nux or Ignatia fails.
Opium 2 trit. will often restore the action of the bowels
when the higher attenuations do not act.
Podophyllin is one of our most efficient medicines, but it
must be given in appreciable doses, for it secondarily causes.
constipation. It is indicated by the constantly furred tongue
(yellow or brown coating, the sallow complexion, anorexia,
and a tendency to piles, fissure, or prolapsus recti. I first
try the 2x trit., three or four doses a day. If this fails
give granules, each containing the th or eventh grain,
once, twice, or thrice daily, until free laxative effects occur;
then lessen the dose for a few days, when it will be found
that the bowels will remain regular. The alternation, or
even combination of Podophyllin with Physostigma or Nux
vomica, will often give better effects than either alone.
There will now and then occur cases so obstinate that all
the above remedies will fail, and we feel that we must use
some palliative measures. This fact has time and time
again been recognized by the best men of our school, and
even the most bigoted high-dilutionists have been forced to
use them. I cannot too highly commend Dr. Madden's ex-
cellent article on this subject in the British Journal of
Homeopathy, vol. vii, page 310.
In such intractable cases when the bowels must be moved
occasionally, we should select those laxative and aperient
agents which produce the least irritation, and do not run
counter to the idiosyncrasies of our patient.
I have generally succeeded with the Podophyllin above
mentioned. But some women cannot take it in sufficient
doses without "griping." A pill of Aloes, 1 gr.; Ext. Hyos.,
gr.; Soap, 2 grs., combined (one at night), is often very
252 DISORDERS AND ACCIDENTS OF PREGNANCY.
easy and effectual, but they should not be too long con-
tinued.
A powder composed of Sulphur, Seuna and Liquorice root
(from a formula found in the Prussian Pharmacopœia), is a
great favorite with many physicians and patients. It is
prescribed as "Comp. Glycyrrhiza powder-30 to 60 grs.
in a wineglass of water at night." It usually gives one or
two free evacuations the following morning.
In some cases in plethoric women, with rush of blood to
the head, feverishness, abdominal congestion, etc., a wine-
glass of Hungarian or German bitter-water, taken in the
morning before breakfast, acts very favorably, especially if a
glass of common water be drank afterwards.
In very acid states of the stomach, with sick headache,
a teaspoonful of Tarrant's Seltzer Aperient before breakfast
is very efficient.
Some non-medicinal substances will often act as excellent.
palliatives, namely: (1.) A tablespoonful of wheat bran,
mixed with milk and taken at night or morning. (2.) An
equal quantity of flaxseed or white mustard seed, taken in
the same manner. (3.) A dozen stewed prunes, taken at
night on going to bed, or in the morning before breakfast.
(4.) A teaspoonful of tamarinds mixed with a wineglass of
water, taken in the same manner. (5.) The eating of any
ripe fruit before breakfast--oranges, bananas, apples, pears,
berries, etc.
I trust that the importance of inquiring into the condition
of the bowels during the few days or hours preceding labor
will not be forgotten.
Nature usually attends to that matter by causing consid-
erable relaxation, with several free discharges the day before,
or just before the commencement of labor. Women should
be told of the importance of an open state of the bowels,
and advised to use enemas to bring about that result if na-
ture proves delinquent. The first question that the physician
should ask on entering the lying-in room and examining his
patient, should relate to the state of the bowels and blad-
der. If these have not been evacuated, it should be done.
immediately, else he may have to conduct a painful, pro-
tracted, and otherwise disagreeable labor.
MEDICATION OF THE FETUS IN UTERO.
253
CHAPTER III.
MEDICATION OF THE FETUS IN UTERO, CONSIDERED
AS A MEANS OF PREVENTING DYSTOCIA.
ONE of the most important questions now under discussion
by the medical professions is, "Can we influence the foetus
by administering medicine to the mother?"
The
The literature of this subject is exceedingly meagre
regular text-books on obstetrics merely give the physiologi-
cal theories of the placental circulation or gaseous inter-
change; not one of them (except Richardson's) refers to the
transmission of medicinal agents to the child through the
maternal blood. Schroeder alone mentions the experiments.
of Reitz, who, after injecting Cinnabar into the blood of a
pregnant rabbit, found the red particles of that chemical in
the blood of the fœtus particularly distinct in the capillaries
of the pia mater. Schroeder therefore considers the trans-
migrations of maternal blood-cells into the blood of the foetus
easily conceivable. The older journals contain only investi-
gations on the normal placental respiration, which leaves the
question more or less undecided. In later journals, all Ger-
man, occur a few papers on this subject. Gusserow injected
Tincture of iodine and a solution of Ferrocyanide of potas-
sium into the stomach of pregnant rabbits, guinea pigs, and
dogs, but was unable to find any traces of the drugs in the
liquor amuii and in the urine of the foetus, even when the
dose had been given five days before. On the other hand, he
was able to detect Iodine in the liquor amnii and in the
urine of the newborn infant after administering Iodide of
potash for some time (about two weeks) to the mother before.
her delivery.
Zwisfel, in 1874, claimed that in five cases where Chloro-
form had been inhaled during labor, traces of it were found
in the placenta and in the urine of the child. He claims
that the foetus respires through the placenta, and that "this
respiration is subject to the same conditions as that of the
animal after birth."
251
MEDICATION OF THE FETUS IN UTERO.
Benicke reported to the German Medical Association, in
1875, that he gave Salicylic acid to twenty-five women dur-
ing labor, and found it in the urine of the children imme-
diately after birth, the shortest time after its administration
being forty minutes. Ruge and Martin report precisely the
same observation with Salicylic acid; but Iodide of potash
was found by them only in small quantities after prolonged
use by the mother. Fehling failed to get any effects on the
fœtus by giving Woorara to the mother rabbit. He got no
effect on fœtal rabbits by giving Chloroform to the mother.
Fehling and Korman's observations seem to show that the
hypodermic injection of Morphine during labor does affect
injuriously the foetus before and after birth. In a number
of the American Journal of Obstetrics, for 1877, this subject
of poisoning the foetus by giving Opium or Morphine to the
mother, was discussed at length by many of the most promi-
nent obstetricians of this country. Dr. Paul F. Mundè said:
"With reference to the influence of medicinal agents on the
infant during pregnancy, there was not much to be said.
We all know that by giving the mother tonics and various
nutritious medicinal agents, we aid in securing a vigorous
and healthy offspring; we also know that by putting a syphi-
litic mother under specific treatment during her pregnancy,
we are preserving the child from premature death, or for a
time, at least, from venereal disease. But still we do not know
why the foetus in utero is not poisoned by a drug, given to
the mother in a dose, adapted to her, it is true, but large
enough to be fatal to the child after birth."
Dr. Fordyce Barker concluded his paper by laying down
the following proposition as his belief: "1. There is no evi-
dence which can be accepted in science that narcotic drugs
administered to the mother ever produce their specific effects
on the fœtus in utero." He says nothing about other medi-
cines, however.
Dr. Peaslee reasons from a very material ground, namely :
because the fœtus having no vascular connection with the
mother, derives no part from her of its blood-therefore:
mere solutions in the mother's blood of medicinal substances
are not absorbed into the fœtal blood in any appreciable
amount. His argument, however, disproves nothing, for
MEDICATION OF THE FETUS IN UTERO.
255
he would say the same of the administration of attenuated
medicines, and we know that in this his argument would be
fallacious.
Dr. Mundè, after listening to this celebrated discussion in
the New York Obstetrical Society, said: "It matters not if
in one hundred experiments the substance injected into the
maternal blood is not discovered in that of the fœtus in ninety-
nine, if it be so discovered in the hundredth, it shows that
such a thing is possible."
The homoeopathist will bear in mind that in all these ex-
periments and investigations crude medicines were used.
Now we know that attenuated or material medicines do not
depend altogether upon their mixture with the blood for
their action on the organism. Many medicines act as do
ernotions, dynamically. We all know that mental influences
affecting the mother during pregnancy or lactation, do cer-
tainly affect the fœtus in utero or the infant at the breast.
Surely the blood has nothing to do with the influence in such
cases.
I have watched closely the various papers and investiga-
tions, as well as the discussions going on in the journals and
societies of the allopathic school during the last few years,
and I have no hesitation in expressing the opinion that there
is no reasonable doubt that medicines of all kinds do affect
the child in utero when given to the mother. I think also
that we can entertain no doubt as to the specific action of
homeopathic medicines on the foetus in utero when admin-
istered to the mother. This leads to a discussion of
DYSTOCIA DUE TO THE FETUS.
In the previous chapters we have considered only those
causes of dystocia which belonged to the maternal organism ;
but there is a dystocia which is due to the fœtus, and the
causes may be classified as follows:
UNNATURAL OSSIFICATION OF THE SKULL.-A variety of
this condition is that known as complete ossification. Dr.
Joulin describes one kind as " the development of ossa Wor-
miana in the fontanelle, causing solidification." But all
the sutures may be united by ossification to such an extent
256
MEDICATION OF THE FETUS IN UTERO.
that the head is unyielding, and has to be forced through
the genital canals without undergoing any change. It is
probable that this condition may be amenable to treatment,
by so arranging the diet of the mother as to leave out all
or nearly all the earthy salts which go to make bony tissue.
(This will be treated of in another place.)
Another cause of dystocia is
HYDROCEPHALUS OF THE FETUS.-The hydrocephalic head
sometimes reaches an enormous size. Cazeaux says Meckel
has a skull of an infant whose transverse diameter is 16
inches, and its height from the occipital foramen to the vertex,
16 inches. Burns gives a case of hydrocephalus where the
circumference was 23 inches.
The management of a labor obstructed by a hydrocephalic
head is not within the scope of this work. It is possible
that we may be able to prevent this abnormal condition by
medicating the mother. If the mother has been delivered
of one hydrocephalic fœtus, she may give birth to another.
If we have reason to fear this, the treatment should consist
in placing the mother upon a diet of animal food almost ex-
clusively, a diet the opposite of that advised for too rapid
and complete ossification. We may also administer to the
mother such remedies as Sulphur, Calcarea, and Phos. (as
recommended by Grauvogl), also Apis and Arsenirum, in
the highest potencies, or Kali hyd., Merc. iod., and Cule. iod.,
in the lowest attenuations, or in nearly a crude state. The
treatment of ascites or hydrothorax in the fœtus should
consist of the administration of the same remedies.
TUMORS OF THE FETUS -Large tumors may
Large tumors may form upon the
body, or in the body of the fœtus. They may attain such
a size as to prevent delivery without mutilation of the child
or mother. It is possible that knowing the kind of tumors
affecting a previous fœtus we may give remedies to the
mother which may prevent their recurrence. Tumors are
sometimes hereditary, and when the mother is affected with
them it is possible that the persevering use of appropriate
remedies would prevent their appearance in the fœtus.
MONSTROSITIES.-The various anomalies which have been
described under this head are usually the result of two general
causes, namely: (1.) Some psoric, scrofulous, or strumous taint
MEDICATION OF THE FETUS IN UTERO.
257
in the blood of the parents, and (2.) Mental emotions, shocks,
etc., to which the mother may have been subjected. Homoeo-
pathic remedies have such a decided action over mental aber-
rations and emotional shocks, that there is good reason to
suppose that if Aconite is given to a pregnant woman imme-
diately after a fright, it might prevent an injury to the foetus
in utero. For the effect of any of the injurious mental
shocks, select the appropriate remedy recommended in our
Repertories, and we may succeed in arresting deficient or ab-
normal development.
Dr. Croserio, now dead, and a distinguished physician of
our school, wrote a small work entitled Homeopathic Obstet-
rics, the first of that kind which appeared in our literature.
He quotes "a distinguished physician" (name not given) as
having "just published a very interesting memoir upon this
subject," in which he recommends giving the mother, at
different periods of pregnancy, and at long intervals, Sulph.
30th, and Calc. carb. 30th, to purify the foetus from the psoric
(scrofulous) taint which it may have inherited from its
parents. Several homeopathic physicians claim to have seen
good results from such a procedure.
But Sulphur and Calcarea are not the only remedies to be
prescribed. The whole history of both parents should be
obtained, and, after a careful comparison of all the symptoms,
the specific remedy should be fixed upon, and given at least
once a week all through the pregnant state. Some mothers
invariably give birth to rickety children. To such should be
given Silica, Cale. phos., or Cale. hypophos., in the triturations
from the 3d to the 30th.
When tuberculosis is feared, give the mother Cale., Silica,
Kali carb., Iodine, etc.
The Hypophosphites of lime, soda, and potassa, in small
doses, using glycerin as a vehicle, are admirable prophylac-
tics of tuberculosis.
But of all remedies Oleum jecoris is probably the best, for
it contains all of the above remedies in an attenuated form,
and is more readily assimilated in the oil than in any other
way. It is not necessary to give massive and nauseous doses.
The 1* or even 3* trituration is efficacious, a few grains three
times a day. If, however, the mother was greatly emaciated,
258
MEDICATION OF THE FOETUS IN UTERO.
and her stomach would readily tolerate it, I would prescribe
a teaspoonful three times a day.
It is not best to rely on medicine alone. Advise the mother
to remain much in the pure open air, and live on an appropri-
ate diet, else all remedies may fail of preventing disease in
the offspring.
HARDNESS OF THE BONES OF THE FETUS.-One of the chief
obstacles to easy and natural labor is often the unnatural
size, the strength, and unyielding character of the osseous
structure of the child. A child weighing ten pounds can
be delivered easily through a natural pelvis and soft parts,
if the bones of the head are soft and yielding. The
head readily elongates and becomes smaller in diameter,
assuming a wedge or cone shape, permitting its easy expul-
sion. But if the bones are very unyielding, a long, tedious,
and painful labor results, with more or less injury to the
mother and child, even if the forceps are skilfully used.
It is said that this condition of the foetus can be remedied
and prevented by placing the mother upon a diet composed
of such articles as contain the least amount of bone-making
materials, namely: earthy salts, lime, silica, common salt,
etc. This diet is sometimes called the fruit diet, although
other articles than fruit may enter into the diet of the
mother. Drs. Lewis, Cummins, and Richardson have called
attention to this matter, and allege good results from its
use. The following is the history of the discovery of the
method, and the details of the method itself and its results.
Fruit Diet. In 1841, there was privately printed in Eng-
land, a small pamphlet of twenty-two pages, in which a
gentleman, who was a chenist, gave an account of an exper-
iment he himself tried in the case of his wife, whose labors
had been so excessively painful that there was much reason
to fear that she would not survive the next one. The result
was so favorable that he felt it his duty to publish it, with
his name and residence.
A few experiments were made in Boston and vicinity with
distinguished success, when the discovery of Ether rather
threw it into the shade. As, however, there are persons, es-
pecially out of New England, who do not use Ether, the
following extracts are made from the pamphlet in question,
MEDICATION OF THE FETUS IN UTERO.
259
which has now become very scarce, and indeed practically
inaccessible. It will be best to begin by stating the principle
of the system, with which the experimenter ends his account.
In proportion as a woman subsists during pregnancy upon
aliment which is free from earthy and bony matter, will she
avoid pain and danger in delivery; hence the more ripe
fruit, acid fruit in particular, and the less of other kinds of
food, but particularly of bread or pastry of any kind, is con-
sunied, the less will be the danger and sufferings of child-
birth.
"The subject of this experiment had, within three years,
given birth to two children, and not only suffered extremely
in the parturitions, but for two or three months previous to
delivery her general health was very indifferent; her lower
extremities exceedingly enlarged and painful; the veins so
full and prominent as to be almost bursting; in fact to pre-
vent such a catastrophe, bandages had to be applied, and for
the few last weeks of gestation her size and weight were
such as to prevent her attending to her usual duties. She
had on this occasion, two years and a half after her last de-
livery, advanced full seven months in pregnancy before she
commenced the experiment, at her husband's earnest instance;
her legs and feet were as before, considerably swollen, the
veins distended and knotty, and her health diminishing.
She commenced by eating an apple and an orange the first
thing in the morning and again at night. This was con-
tinued for about four days, when she took just before break-
fast, in addition to the apple and orange, the juice of a
lemon mixed with sugar, and at breakfast two or three
roasted apples, taking a very small quantity of her usual
food, viz., wheaten bread and butter. During the forenoon
she took an apple or two and an orange
For dinner she
took fish or flesh in a small quantity, and potatoes, greens,
and apples, the apples sometimes peeled and cut into pieces,
sometimes boiled along with the potatoes, sometimes roasted
before the fire and afterward mixed with sugar. In the
afternoon she sucked an orange or ate an apple or some
grapes, and always took some lemon-juice mixed with sugar
or treacle. At first the fruits acted strongly on the stomach
and intestines, but this soon ceased, and she could take several
260
MEDICATION OF THE FETUS IN UTERO.
lemons without inconvenience. For supper she had again
roasted apples or a few oranges, and rice or sago boiled in
milk; sometimes the apples peeled and cored were boiled
with the sago. On several occasions she took for supper
apples and raisins, or figs with an orange cut among them,
and sometimes all stewed together. Two or three times a
week she took a teaspoonful of a mixture made of the juice
of two oranges, one lemon, half a pound of grapes, and a
quarter of a pound of sugar or treacle. The sugar or treacle
served mainly to cover the taste of the acids, but all saccha-
rine matter is very nutritious. The object in giving these
acids was to dissolve as much as possible the earthy or bony
matter which she had taken with her food in the first seven
months of her pregnancy. She continued in this course for
six weeks, when much to her surprise and satisfaction the
swelled and prominent state of her veins, which existed be
fore she began, had entirely subsided; her legs and feet,
which were also swollen considerably, had returned to their
former state, and she became so light and active she could
run up a flight of more than twenty steps with more ease
than usual when she was perfectly well. Her health became
unwontedly excellent, and scarcely an ache or a pain affected
her up to the night of her delivery. Even her breasts, which
at the time she commenced the experiment, as well as during
her former pregnancies, were sore and tender, became en-
tirely free from pain, and remained in the very best condition
after her delivery also, and during her nursing.
"At nine o'clock on the evening of March 3d, after having
cleaned her apartments, she was in the adjoining yard shak-
ing her own carpets, which she did with as much ease as any
one else could have done. At half-past ten she said she be-
lieved her 'time was come,' and the accoucheur was sent for.
At one o'clock the surgeon had left the room. He knew
nothing of the experiments being made, but on being asked,
on paper, by the husband, two days afterward, if he could
pronounce it as safe and as easy a delivery as he generally
met with?' he replied, on paper, 'I hereby testify that I at-
tended Mrs. Rowbotham on the 3d iust., and that she had
a safe labor, and more easy than I generally meet with.'
On his asking the female midwife if she thought it as easy as
MEDICATION OF THE FETUS IN UTERO.
261
usual, she replied, Why, I should say that a more easy
labor I never witnessed. I never saw such a thing, and
I have been at a great many labors in my time.'
"The child, a boy, was finely proportioned and exceedingly
soft, 'his bones being all in gristle,' but he became of large size
and very graceful, athletic, and strong as he grew up. The
diet of his mother was immediately changed on his birth,
and she ate bread and milk and all articles of food in which
phosphate of lime is to be found, and which had been left
out before. She also got up from her confinement immedi-
ately and well. Mr. Rowbotham made a table of substances,
with the proportion of phosphate of lime in each, so that it
may be avoided in the food during pregnancy, and used after-
ward in nursing, when the bones and teeth of the child are
made.
(6
Beans, rye, oats, and barley, have not so much earthy mat-
ters as wheat. Potatoes and peas not more than half as
much; flesh of fowls and young animals one-tenth; rice, sago,
fish, eggs, etc, still less; cheese, one-twentieth ; cabbage, savoy,
broccoli, artichokes, coleworts, asparagus, endives, rhubarb,
cauliflower, celery, and fresh vegetables generally, one-fifteenth;
turnips, carrots, onions, radishes, garlic, parsley, spinage,
small salad, lettuce, cucumbers, leeks, beet-root, parsnips,
mangelwurzel, mushrooms, vegetable marrows, and all kinds
of herbs and flowers, average less than one-fifth; apples,
pears, plums, cherries, strawberries, gooseberries, raspberries,
cranberries, blackberries, huckleberries, currants, melous,
olives, peaches, apricots, pineapples, nectarines, pomegranates,
dates, prunes, raisins, figs, lemons, limes, oranges, and grapes,
on the average are two hundred times less ossifying than bread
or anything prepared from wheaten flour. Some articles, as
honey, treacle, sugar, butter, oil, vinegar, and alcohol, if
unadulterated, are quite free from earthy matter. But
still worse than wheaten flour is common salt, and nearly as
bad are pepper, cinnamon, nutmeg, cloves, ginger, coffee,
cocoa, Turkey rhubarb, licorice, lentils, cinchona or Peru-
viau barks, cascarilla, sarsaparilla, and gentian.
“With regard to drinks, no water except rain and snow, as
it falls, and distilled water, is free from earthy matter, and
every family should have a distilling apparatus; and perhaps
262
MEDICATION OF THE FETUS IN UTERO.
it would pay capitalists to form a company for the purpose of
distilling water on a large scale. Filtering water is not suf
ficient to purify it of earthy matter, because a filter can only
remove such particles as are mechanically mixed.
"An American lady, who usually suffered terribly in labor,
immediately procured the pamphlet and governed her diet
by it partially, and had the easiest labor she ever had.
Another who governed herself wholly by it from the first
moment she was aware of being pregnant, like the English
lady never experienced a moment's discomfort before de-
livery. She had taken nothing made of our grains, but cou-
fined herself to the best Indian ones, rice, sago, tapioca; and
taking a disgust to our summer fruits, subsisted largely on
oranges, tamarinds, marmalades, and also took a great many
lemons. At first the fruits made her bowels too loose, but
she did not abandon them on that account, but took mutton
broth with rice in it to correct this effect. She also took
fish and sardines, and the young of meats; for the older ani-
mals are the greater quantity of earthy matter is contained
in their secretions, and so it is even with milk. She had so
little thirst that she drank nothing but a little tea made
with distilled water. This lady and her husband were
neither of them very young, she was thirty-five and he forty
at the birth of her eldest child: and she had been an invalid
in her chamber from fifteen to thirty years of her life, though
very well at the time of her pregnancy, and for the first time
in her life taking much exercise in the open air. Conse-
quently, and because of her extreme nervous delicacy, she
did not escape pain in the labor the first time, and the pro-
cess was several hours. But in the two succeeding times, at
the last of which she was forty, the labors were very short
and not at all severe. In all the cases she rigidly adhered
to the diet without a single day's exception, and her three
children were perfectly splendid instances of large, healthy,
strong, and beautiful physique. The youngest of them is
now eighteen years of age."
A common error is, that during gestation the mother
needs to "eat for two;" that is, that more food is necessary
to support properly herself and her growing infant than at
other times. This is a thorough delusion. On this point,
MEDICATION OF THE FETUS IN UTERO.
263
and on diet during pregnancy generally, Dr. Bull, a very
sensible and experienced English physician, says:
"We habitually take more food than is strictly required
for the demands of the body; we therefore daily make more
blood than is usually wanted for its support. A superfluity
amply sufficient for the nourishment of the child is thus fur-
nished, for a very small quantity is requisite without the
mother on the one hand feeling the demand to be oppres-
sive, and on the other, without a freer indulgence of food
being necessary to provide it. Nature herself corroborates
this opinion; indeed, she solicits a reduction in the quantity
of support rather than asks an increase of it; for almost the
very first evidence of pregnancy is the morning sickness,
which would seem to declare that the system requires reduc-
tion rather than increase, or why should this subduing pro-
cess be instituted? The consequences, too, which inevitably
follow the free indulgence of a capricious, and what will
afterward grow into a voracious appetite, decidedly favor
this opionion; for the severest and most trying cases of in-
digestion are by these means induced, the general health of
the female disturbed and more or less impaired, and through
it the growth and vigor of the child..
"If the appetite in the earlier months, from the presence of
morning sickness, is variable and capricious, let her not be
persuaded to humor and feed its waywardness from the be-
lief that it is necessary to do so; for if she does, she may de-
pend upon it, from such indulgence it will soon require a
larger and more ample supply than is compatible with her
own health or that of her little one.
"If the general health before pregnancy was delicate and
feeble, and, as a consequence of this state, it becomes invigo-
rated and the powers of digestion increase, a larger supply
of nourishment is demanded, and may be met in such case
without fear; for instead of being injurious, it will be useful.
"Lastly, a woman, toward the conclusion of pregnancy,
should be particularly careful not to eat in the proportion of
two persons, for it may not only bring on vomiting, heart-
burn, constipation, etc., but will contribute, from the accu-
mulation of impurities in the lower bowel, to the difficulties
of labor."
264
MEDICATION OF THE FETUS IN UTERO.
A few figures given by Dr. Dewees, whose discussion of
this subject is exactly in harmony with Dr. Bull's, show very
clearly the absurdity of the idea that it is necessary to “eat
for two." They are in substance as follows:
"On an average, a new-born child, together with all the ac-
companying materials expelled at birth, weighs not more
than ten pounds, viz.: eight pounds for the child itself, and
two pounds for the placenta, etc. A table of 7077 births in
Paris gave an average of about two pounds less than this,
being for the child itself just six pounds. Now, a daily sup-
ply of less than three-quarters of an ounce, during the aver-
age of two hundred and eighty days of pregnancy, will
amount to this ten pounds; and this daily supply is de-
cidedly less than the average quantity of unnecessary food
which is usually eaten. Since, therefore, we almost always
eat too much, and since the ordinary overplus is more than
enough to supply the requirements of pregnancy, and par-
ticularly since the natural symptoms of that state usually
indicate less food rather than more, it is mere common sense
to conclude that pregnant women neither want nor need to
'eat for two. The fact is more likely to be the seeming
paradox that enough for one is too much for two; i. c., that
less food than usual, rather than more, is best during preg-
nancy.
Regularity in hours of eating is advantageous to the health,
and more care even than usual should be taken during preg-
nancy to observe this practice. Another, almost, or quite
equally important rule is, to eat nothing for four hours, or
at least for three hours before going to bed.
Eating should also be, as indeed it should always be, in
moderation. It should be deliberate, and it should be cheerful.
Deliberation is almost indispensable to moderation; for it is the
sense of satisfaction of hunger that tells us when to stop eat-
ing, and this sense is blunted and almost useless when the
food is swallowed rapidly and without thorough chewing;
and the appetizing effect and healthful stimulus of cheer-
fulness at meals are too well known to require any detailed
enforcement in this place.
"I once heard a physician object to the fruit diet on the
ground that it would not give enough strength to the preg-
MEDICATION OF THE FETUS IN UTERO.
265
nant woman to undergo the severe trial of parturition. But
if the trial be robbed of its severity, where is the need of
the extra strength? Again, what strength is imparted by
rich strong animal food, that is ejected from the stomach, or
else passes out of the system undigested and unassimilated?
Or, if this food be digested and assimilated, what is the re-
sult? Why, plethora, that most dreaded foe of the pregnant
woman, leading either to miscarriage or to a terrible con-
finement, in which the chances of death are greatly aug-
mented." (Dr. Cummings.-"Richardson's Obstetrics.")
Dr. Verdi says, in his advice to mothers:* "It will do no
harm to avoid what is repugnant to you, but it may be det-
rimental to your health to satisfy the longing for slate-pen-
cil, chalk, or other deleterious substances which sometimes
women in your condition crave.
"But above all, keep a cheerful mind and do not yield to
grief, jealousy, hatred, discontent, or any perversion of dis-
position. It is true that your very condition makes you
more sensitive and irritable; still, knowing this, control your
feelings with all your moral strength.
"If you believe that strong impressions upon the mother's
mind may communicate themselves to the foetus, producing
marks, deformity, etc., how much more should you believe.
that irritability, anger, repinings, and spiritual disorders,
may be impressed upon your child's moral and mental nature,
rendering it weakly or nervous, passionate or morose, or iu
some sad way a reproduction of your own evil feelings; and,
indeed, this is more frequently found to be the case than is
the physical marking of a child by its mother's impressions.
"If a woman needs culture and expansion, both of her per-
ceptions and conceptions of the beautiful, in order to pro-
duce a grand poem or painting and sculpture, or to conceive
noble measures for the relief of the sufferings of others, then
does she also need all these for that highest of all her
efforts, when it seems as every fibre of her being was put
upon the stretch to do its share in the grand donation to
love and to humanity of a child.”
* On Maternity. By T. S. Verdi, M.D.
18
266
MEDICATION OF THE FETUS IN UTERO.
SUMMARY. It appears then that painless parturition may
be secured by attention to the following points during preg-
nancy (besides correct previous bringing up, moral, mental,
and physical):
Moderate healthful exercise and avoidance of shocks,
fatigue, and overexertion.
Comfortable or at least quiet and patient mental condition,
avoiding all bad tempers.
Amusement and agreeable occupation as far as possible.
Judicious use of bathing, particularly of the sitz-bath.
The fruit diet, and avoidance of unsuitable food, and of
alcoholic, narcotic, and other stimulants.
Watchfulness and prompt treatment of the various ail-
ments of the situation, should they appear.
Cheerfulness on the part of the patient, and kindness and
indulgence by the husband and friends.-(Dr. Cummings.)
IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA. 267
CHAPTER IV.
THE IMMEDIATE TREATMENT OF FUNCTIONAL
DYSTOCI A.
By the immediate treatment is meant the application of
medicinal agents which have the power to control or modify
those conditions and symptoms which may arise during the
progress of labor, and tend to produce an abnormal mani-
festation of that condition.
EXTREME SLOWNESS OF THE LABOR.—A duration of eighteen
or twenty hours in a primipara cannot be regarded as an
alarming circumstance. But if labor is prolonged beyond
this period, some assistance is demanded. Assistance may be
given before, however, if certain symptoms arise. The first
stage of labor, that of dilatation of the cervix, may be pro-
longed without danger; but the second cannot pass beyond
certain limits without greatly endangering the health of the
patient, or the life of the child. It is found that the latter
is lost at least one time in four, when the head remains in
the excavation longer than seven or eight hours after the
complete dilatation of the os uteri and the rupture of the
bag of water; whilst it nearly always survives when the
first period is prolonged to forty, fifty, or even sixty hours.
(Cazeaux.)
The first stage of labor, even prolonged as above, rarely
presents any serious symptoms, except great fatigue, nervous
irritation, loss of sleep, depression of spirits, and alarm.
These symptoms may be met successfully by proper food,
gruels, and broths, and the use of Coffea, Cimicifuga, Ignatia,
Aconite, and Erythroxylon Coca.
It is during the first stage of labor that we meet with
those two conditions of the os and cervix, which cause great
trouble and anxiety, namely:
1. Rigidity of the cervix.
2. Spasmodic contraction of the cervix.
Rigidity is a passive force by which the fibres of the neck
of the uterus resist the dilatation they have to undergo.
$
268 IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
Spasmodic contraction is an active force by which the fibres.
contract and diminish the size of the opening, previously
exhibited by the mouth of the womb.
In rigidity the tissues seem dense and like a piece of leather
soaked in grease. The labor continues without dilatation of
the orifice, which retains a certain thickness, against which
contractions strive in vain, until the woman is exhausted
with her fruitless efforts.
Pain in the loins, according to Madanie Lachapelle, is a
diagnostic sign of rigidity of the os.
Spasmodic contraction may occur after the cervix has at-
tained considerable dilatation.
The orifice presents a thin cutting edge, and is warmer,
drier, and more sensitive to the fingers, and very irritable.
This extreme sensibility-tenderness-of the neck is often
the only symptom by which we can decide that we have a
spasmodic contraction to deal with.
These two conditions must not be confounded with a neck
which continues thick, simply because the contractions are
insufficient, badly directed, or lost against some mechanical
obstacle in the pelvis.
The obstetric authors of our school have always advised
the same remedies for both conditions. Nothing could be
more unscientific or irrational, for the conditions are oppo-
site.
In rigidity the true remedies are-Gelsemium, Lobelia,
Veratrum viride, Passiflora (or Curare), and Nux vomica.
Gelsemium, when the face is flushed, the woman is pleth-
oric, dull, and apathetic, the pains irregular in force and
frequency, and not in their proper place-passing from before
backward, or occupying one side of the uterus-and the os
is thick, sodden, but unyielding. The efficient dose is a drop
or two of the tincture or 1 every half hour until the cervix
relaxes. (Dr. Page asserts that it acts better when admin-
istered in hot water.)
Lobelia is next in value. It is indicated for the thick,
leathery, unyielding cervix, and the reflex symptoms which
arise from the obstruction,-the dyspnoca and nausea.
In some rare cases this medicine will have to be given until
it causes general relaxation, but no vomiting need be induced.
IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA. 269
However, I think I should not hesitate to give it until
vomiting ensued if the rigidity did not yield, for I should
only be imitating nature. In such cases vomiting often
occurs spontaneously, with immediate relaxation of a rigid
Dose usually the same as Gelsemium.
OS.
60
Stibium, in doses of th of a grain, or a few grains of
the 2 trit., will often act better than Lobelia, while the in-
dications are nearly identical.
Veratrum viride is useful in those cases where the old phy-
sicians considered "bleeding" absolutely necessary, i. e. when
the woman was very plethoric, the head and chest congested,
the pulse full and bounding, and eclampsia threatening. It
should be given in doses of one to five drops of Norwood's
tincture, repeated every hour. Usually three or four doses
bring down the great blood-pressure, the congestion, and the
cervix relaxes normally.
Passiflora or Curare are indicated if the rigidity seems
almost tetanic, with a general tendency to tetanic stiffness,
such as we will sometimes meet with in hysterical subjects.
The dose is, of the former, ten to twenty drops of the tinc-
ture every hour; of the latter, a few drops of the 1 or 2x
dilution.
Nur vomira is also indicated in the same condition, espe-
cially if the woman feels the peculiar pains in the "loins
and a constant urging to stool. Ignatia may better suit some
women.
A
These two last remedies being primarily indicated should
be prescribed in the tenth or thirtieth attenuations.
single dose is often sufficient.
I have induced the needful relaxation in some cases with-
out the use of medicine, by placing the woman in a hot
(100° F.) sitz-bath for half an hour or more, and injecting, at
the same time, warm water against the os.
I think I have observed that the internal administration
of the remedy, particularly Gelsemium, was aided by ap-
plying it topically. Saturate a tampon of cotton or soft
sponge, with a warm solution of glycerin and water, equal
parts, and pour upon it 15 or 20 drops of the medicine.
Apply this to the rigid os, and allow it to remain.
270 IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
33
Spasmodic contraction of the os and cervix requires the fol
lowing remedies:
Aconite, Amyl, Belladonna, Hyoscyamus, Solanum, Cactus,
Lachesis, Conium, Caulophyllum, Cimicifuga, Morphia, and
Viburnum. (Also Ether and Chloroform.)*
Aconite, when the patient has the usual restlessness, anxi-
ety, and fear of death, some fever, with fine, small hard pulse,
the vagina and os dry, hot, and sensitive. Here the 3* or
6* acts promptly-especially so if we apply it topically, as
above recommended.
Amyl Nitrite.-Although no cases are on record where this
agent has been used for the specific purpose of relaxing a
spasmodically constricted os, it has been used by some Eng-
lish and Continental physicians in "very painful labors,” and
with alleged good results. The most painful of all labors
are those in which there is spasmodic constriction of the os,
with spasmodic contractions of the uterine body.
The pathological condition is similar to that which obtains
in angina pectoris, or dysmenorrhoea from coustricted cervix.
The value of Amyl in both these conditions has been estab-
lished. It should prove equally useful in dystocia from
spasm of the os.
A few drops, not more than five, should be
poured into a small vial, on a little cotton, or upon a hand-
kerchief, and the patient be directed to inhale deeply eight
or ten times, or until the face flushes and the head throbs.
When this occurs, the constriction of the os will be observed
to relax, and allow the expulsive efforts of the womb to ac-
complish their purpose. Instead of inhalation, the Amyl
may be given internally, a few drops of the 2x dilution every
ten minutes. ·
Belladonnat has been alternately praised and denounced as
* The special indications, and contra-indications, for the use of Ether and
Chloroform, are to be found in all text-books on Obstetrics. They frequently
relax spasmodic rigidity of the cervix and os, when internal medicines fail.
† Atropin in Spastic Rigidity of the Cervix in the First Stage of Labor.—
In the July No. of the American Journal of Obstetrics (1878), appeared a
paper by H. L. Horton, M.D., in which he strongly advocates the use of
atropin when the os is spasmodically rigid, and the pains fail to cause any
normal relaxation. He applies it by means of a hypodermic syringe, having
a needle hooked at the end. After hooking the index finger of the right
hand into the anterior lip of the cervix, and drawing it slightly forward,
IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
271
a remedy in "rigid os." This conflict of opinion is explained
by Cazeaux, who writes: "The belladonna, so highly lauded
by some accoucheurs, is by others thought to be useless. It
seems to me that this difference of opinion has arisen from con-
founding simple rigidity with spasmodic contraction. Though
without action in the former case, I think it very useful in
the latter."
We have the same difference of opinion in our school, often
from the same cause, but generally on account of a want of
understanding of the relation of dose to primary and secon-
dary effects of medicine. In order to prescribe Belladonna
with any approach to scientific precision or curative effect,
we must know something as to its method of action; which
of its effects are primary and which secondary. The primary
action of Belladonna (also Conium, Hyoscyamus, Stramo-
nium, and Solanum) is to relax and paralyze the sphincters of
the orifices of hollow organs, but not the muscles of the organs
themselves. Its secondary effects are just the opposite, the
sphincters are affected with spasm and constriction, and the
muscular fibres of the walls of the organs themselves,
weakened.
Now according to the only law of dose known, Belladonna
should be given in a high potency when we have symptoms
simulating its primary effects, and in low attenuations when
the symptoms resemble its secondary effects. In cases of
spasmodic constriction of the cervix, Belladonna is seconda-
rily indicated, and no possible benefit can arise from its ad-
ministration in highly attenuated doses.* The low dilutions.
the needle is carried along the palmar surface of the finger, keeping the point
firmly pressed against it, so as to avoid wounding the maternal parts. After
carrying the point of the needle within the cervix, it is raised from the finger
and buried by slight traction somewhat deeply into the muscular structure
of that portion of the uterus. After discharging its contents, it is retained
in position a few moments, in order that the atropin shall be retained.
This injection should be done in the interval between the pains. He injects
gth of a grain, dissolved in 10 or 15 drops of water. It caused no unpleas-
ant symptoms in the eight cases reported; only a slight dryness of the
throat, flushed face, and dimness of vision, which soon passed off. Proba-
bly the th of a grain would be as effectual.
50
100
* No rational physician can believe that the 30th of Aloes or Podoph.
will purge, or the 6th of Ipecac. vomit, nor can we expect the 30th of Bel-
ladonna to relax a sphincter.
272
IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
X
must be used, and often the material substance itself. Give
internally the 1 or 3x, and apply to the cervix with the
finger a mixture of one grain of the solid extract, or ten drops
of the tincture, in a drachm of glycerin, lard, or cosmoline, or
a small ball of cotton can be saturated with the glycerole,
and placed against the os.
Conium has some reputation in spasmodic conditions of
the sphincters and circular-muscle-fibres. It has removed
laryngismus and oesophageal spasm. I cannot, however, sub-
scribe to the dogma that "any remedy will remove rigid os,
if its other symptoms correspond," for if it does have all the
other symptoms, it may not have that symptom of the os,
and cannot therefore be completely homoeopathic to the case.
Hyoscyamus and Stramonium both cause primarily paraly-
sis of circular-muscle-fibres, and if the patient has other
characteristic symptoms of these medicines, they may be
indicated instead of Belladonna. I once removed a spasm
of the cervix with Solanum (a close analogue of Belladonna),
selecting it for the peculiar occipital headache and amaur-
otic symptoms.
Cactus causes, primarily, a spasm of the circular fibres of
the heart, and has been successful in spasmodic dysmenor-
rhoa. If the woman has the cactus-heart-symptom, so well
known, I believe it would remove a constriction of cervix.
Perhaps it would be successful even if that symptom were
not present. The 6th would be indicated, or even the high
potencies.
Lachesis would be indicated, especially if its throat symp-
toms were present, and here the 30th, or the very highest
potencies, will be useful.
Caulophyllum irritates all circular muscles by its primary
action; the constriction is intermittently manifested. This is
precisely the condition of the cervix in the worst cases. The
uterine pains will be very severe, the contractions of the
fundus strong, but the cervix will also contract powerfully,
and neutralize the uterine contractions, and the head cannot
engage. In the 1 or 2 dilution (or trituration of Caulo-
phyllin), it will promptly remove this condition. Larger,
and often-repeated doses would aggravate; they are only use-
ful in general uterine atony.
IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA. 273
Cimicifuga has a similar action, but the pains are irreg-
ular, the contractions irregular, and the cervical constriction
irregular. One moment it would seem as if the os would
sufficiently expand, the next it is firmly closed by spasm.
Moreover, the patient is nervous, depressed in spirits, her
hands and legs tremble, her pulse is quick and weak, and
there is irregular twitching and choreic movements, and a
dull heavy headache in the brow and eyes. When these
symptoms occur, the attenuations from the 3* to 6x will be
found useful; they should be repeated every few minutes.
Viburnum, from its wonderful power over spasmodic dys-
menorrhoea, ought to prove very useful, and act very promptly
in spasmodic stricture of the cervix, especially so when the
patient has very violent pains, almost driving her distracted,
attended by uncontrollable nervous excitement, cramps in the
legs, thighs, and abdomen. It is primarily a uterine seda-
tive; its spasmodic effects are secondary. Empirically it has
acted best in appreciable doses. I have never observed it to
remove spasmodic pains when given in the attenuations.
above the 2, but have seen the most happy effects from
doses ranging from 10 to 30 drops of the tincture, or 1 di-
lution, frequently repeated. No aggravation need be appre-
hended, for it is harmless, and I have known much larger
doses used, with only pleasant results.
Morphia.-This medicine has been very successful in the
hands of many physicians of all schools in certain cases of
dystocia, but its sphere of action and the symptoms indicat-
ing its use have never been clearly defined. It has generally
been prescribed for "excessive pain and uncontrollable nerv-
ousness," and in certain cases it has been remarked that a
rapid and favorable termination of labor resulted from its
administration. Some of my professional friends claim to
get excellent effects from the 1 trituration. In several
cases I have been agreeably surprised at the favorable turn
of affairs following similar doses. Instead of the Sulphate
usually prescribed, I prefer the Valerianate of morphia, in the
1 or 2 trituration.
X
X
In the April number of the Eclectic Medical Journal, Prof.
Edwin Freeman has a paper "On Morphia as a Partus Ac-
274 IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
celerator," and his views appear so clear and logical that I
present them in full. He says:
'Eight or ten years ago I noticed in the Medical and Surgical Reporter of
Philadelphia, reports of cases of rigidity of the os uteri favorably affected
by the use of Morphine. A physician was called in the night to a case of
labor. An examination revealed a rigid os. He concluded that the labor
would be somewhat protracted, and that he might as well go home and en-
joy a night's rest in his own bed. A moderate dose of Morphine was given
to allay unnecessary pains, and he retired. In a very short time, however,
he was aroused in haste and summoned to the bedside, which he barely
reached in time to assist in the birth. He was led to regard Morphine as a
parturifacient, classing it with Ergot and other remedies of that kind. Sub-
sequent observers of a similar action have regarded it as directed to the
nerves supplying the lower parts of the cervix and os uteri, obtunding their
sensitiveness, and thus preventing their reflex action upon the muscular
tissues. This latter explanation probably approximates the truth, with the
exceptions to be hereafter mentioned, so that the agent is rather a partus
accelerator. Its action may also be referred to a lessening of the irritability
of the muscular fibre, which irritability in that region is often increased by
any unnatural condition of the part, such as previous cervical endometritis,
granular os, wearing an instrument to support the uterus, a highly nervous
and excitable temperament, too frequent examinations, etc. The muscular
fibres of the uterus are of the involuntary kind, consisting of transverse
fibres passing around the neck, acting as a kind of sphincter, and oblique
and longitudinal fibres continuous with those of the middle layer of the
muscular wall of the body of the organ. Involuntary muscular fibres are
excited to activity by mechanical agencies; those of the alimentary canal
by the contact of the contained alimentary material. They may be aroused
to activity, or modified in their action, through the sympathetic system, or
even through the cerebro-spinal system, but this is not the normal method.
In like manner they are excited to unusual activity when the contained ma-
terial is of an irritating nature, or when the canal itself is in a state of irri-
tability, arterial blood being in excess, they are excited by the presence of
ordinary material
"In the progress of the evolution of the foetus and the womb which con-
tains it, the muscular fibres having become fully developed, the sphincter of
the neck is gradually distended from above downwards by the gravitating
pressure of the fœtus and amniotic bag that surrounds it, until at last only
the external os remains to be loosed, and the uterus appears as a sac with an
os and without a neck. At this latter stage of utero-gestation at the com-
pletion of the above process, and as its result, the child sinks down below
its previous position low into the pelvis. The loosing of the transverse fibres
still goes on, the settling of the child making space above, upon which the
uterus contracts. The action thus set up in the body of the womb is con-
tinued to the oblique fibres of the neck, which, by then contracting, pull
upon or stretch the constricting fibres of the os, still further enlarging that
opening, until at last it is sufficiently open to allow the foetal head to pass.
*
X-
*
*
IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
275
"Now if these sphincter fibres at the os be unduly excited, they may
rigidly close it, or being less excited, they may seem relaxed, but as soon as
the expulsive effort forces the child against the margin of the opening, con-
traction is set up, and it grasps it as rigidly as before. This is evidently the
hyperexcited action of the non-striated muscular fibre, which ordinarily is
excited to action by mechanical pressure.
"The objections to the theory that these contractions are produced en-
tirely by direct reflex-motor action from the spinal cord, or even from the
sympathetic, are: 1st. The fourth sacral nerve from the spinal cord joins
the inferior hypogastric plexus of the sympathetic below where the uterine
branches are given off, while above that point the spinal fibres join only the
sacral sympathetic ganglia. 2d. The nerves distributed to the lower part
of the womb are from that plexus, accompany the arteries, and belong to
the sympathetic system, and their office is to regulate the functional activi-
ties of the womb by their influence over the circulation. 3d. There are no
striated muscular fibres at the mouth of the womb to be affected by fibres of
spinal nerves. Thus both these nerves and the sympathetic have, if any,
only an indirect action. Now what is the probable method of action of
Morphine? We give it or Opium in diarrhoea, and it lessens the peristaltic
movement of the bowels, not through the nerves, but through the blood by
direct action upon the fibres. So in the case of the uterus, its action is di-
rect through the blood, lessening the irritability. The action of the fibres
of the os are thus brought to harmonize with that of the rest of the womb,
when it again begins, and labor proceeds without the previous interruption.
I was called to a case of labor recently in which the os was soft to the touch,
but quickly contracted as the pain came on. The patient remarked that she
was a week in labor with her previous child. The waters' were coming
away since the previous day. I waited awhile after having her get up and
sit and walk a little, and then examined her, but there was no change, and
the pains seemed lessening, although I gave her a dose of flu. Ext of ergot.
I gave her then Morphine sulph. gr. granule, and left her with directions
to send for me as soon as the pains were severe. In an hour and a half I
was called and found the labor progressing well, and she was speedily deliv-
ered of a child without further trouble."
(
But the second stage of labor, if extended beyond ten or
twelve hours, presents symptoms which need attention. The
pains become irregular, both in frequency and intensity, the
fœtus seems to retrograde instead of advance, because the
pains are not expulsive. "This local disorder is soon fol-
lowed by violent trembling, the woman vomits bilious mat-
ters, she is uneasy and excited, and changes her position
every moment, the skin is hot and dry, the pulse runs up to
100 or 150 per minute, the tongue is dry, and sordes on the
teeth. The vagina and cervix are hot, sensitive to the touch,
and a yellowish liquid escapes from them, which occasion-
ally has a fetid odor, the pressure of the child's head on the
276 IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
neck of the bladder prevents the emission of urine.” (Ca-
zeaux.)
Be-
The above picture is one of an extreme case, a condition
which I cannot imagine could obtain in the hands of a com-
petent physician, for we have many remedies which can
prevent such an array of symptoms, the chief of which are
Aconite, Baptisia, Cimicifuga, Caulophyllum, and Pulsatilla.
This will be seen by a brief comparison of the symptoms of
these remedies with those of the abnormal condition.
sides these medicines I consider the sitz-bath to be of the
greatest efficacy. Should I find a patient in the second
stage of labor with the above serious symptoms, I would
immediately give her the remedy indicated, and have her
placed in a deep sitz-bath of a temperature of 100° F., and
kept there till she felt faint, or till the natural pains and
expulsive efforts came on actively. I would do this before
resorting to the use of forceps, because the patient and the
child would be better off for it.
But we will now consider the special causes that may bring
about the above abnormal second stage, namely: Slowness or
feebleness of the contractions.
This condition may occur at the very commencement of
labor, and persist to the end, unless the appropriate remedy
is given.
It is sometimes, but not often, due to general debility of
the muscular system, for it is a well-known fact that the
most feeble patients, as those in consumption, often have the
most powerful pains, and the most rapid labor.
When the feeble pains are due to general atony, words of
encouragement, small quantities of broth or beef-tea, or a
few spoonfuls of wine, or Elixir of Coca, frequently repeated,
are of great service.
Caulophyllum tincture in drop doses, or Caulophyllin, 1 or
grain pills, repeated every half hour, even before the os is
dilated, will have an excellent effect in increasing the natural
uterine action. This remedy seems to affect specifically all
the muscular fibres of the womb in a manner simulating
natural labor. This explains why it appears to relax the os
in cases of rigidity.
Cimicifuga is best indicated where the pains, besides being
IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA. 277
feeble, are irregular, and are not always in the same place,
now on one side, now on the other, now in front, then in
the back. The os does not relax, and the woman is depressed
in spirits, taciturn, and has jactitation of the limbs. The
lower attenuations are indicated.
Pulsatilla is indeated for these changing, erratic pains, but
the woman weeps, sco'ds, frits, and tosses about in bed, and is
very "fidgety."
China is of great value in such cases, but it should be
given in appreciable doses, namely, a teaspoonful of the wine
of Cinchona, repeated every hour or two. Its alkaloid, Qui-
nine, however, gives the best results. Many eminent obstet-
ricians believe that Quinine possesses parturient power sim-
ilar to Ergot, but I doubt its supposed excito-motor power
over the uterus. It causes natural uterine pains, because it
is secondarily homeopathic to muscular atony when due to
inefficient blood-pressure, and decreased nervous supply. In
many cases of general exhaustion, with cool sweating skin,
feeble quick pulse, and very feeble pains, I have seen almost.
magical results from the administration of half a grain or a
grain of Quinine every half hour. The pains begin imme-
diately to increase, the pulse is stronger, and the woman be-
comes greatly encouraged. The obnoxious taste of the drug
is readily disguised by mixing it with Syrup of glycyrrhiza
(gr. 1 to 1 drachm), or the use of gelatin-coated pills, of a
grain or a fraction of a grain each. In cases of alarming
prostration, five or ten grains at a single dose has often
seemed to rescue the woman from collapse.
This
I ought to add that the physician must not mistake the
condition of the womb in cases of feeble pains. Excessive
distension of the uterine walls often causes very feeble and ir-
regular pains. The uterine walls become so thin that they
are benumbed, and cannot contract while so distended.
condition may be diagnosed by an examination, when the bag
of waters will be observed not to bulge during the pain. In
such cases, if the os is not rigid, the remedy is to rupture the
bag of waters, and then, if good pains do not set in, give one
of the remedies just mentioned.
Slowness or feebleness of the contractions may depend upon
sanguineous engorgement or plethora of the uterine tissues.
278
IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
This condition may be diagnosed by the following signs:
The pains are at first quite energetic, but soon diminish, both
in frequency and intensity, the cervix uteri is soft, supple,
and non-resistant, but the presenting part of the child does
not engage during the pain, which latter is equally diffused
over the whole abdomen. The phenomena of general plethora
nearly always manifest themselves at the same time, the res-
piration becomes laborious, the pulse hard and full, and the
pains irregular both in force and frequency. In these cases
the old practice is, or was, to bleed, for it is very rarely re-
sorted to now.
We have remedies, fortunately, that will control this con-
dition without debilitating the system.
Gelsemium, if the face is flushed, the pulse full, but not
very hard, the head feels heavy, the senses apathetic, and the
pains feeble and irregular; it will soon remove the plethora
if administered in the low dilutions.
Veratrum viride is indicated in a higher grade of conges-
tive phenomena; when the head aches violently, the pulse is
very full, very hard and quick, and convulsions or apoplexy
threatens; and especially if the temperature of the patient
is high-103° or 105°.
Prompt results will accrue from two or three drops of the
tincture, or 1* dil., repeated every hour, or oftener.
Cactus will be useful if the heart is violently excited, and
there is a sense of constriction about it.
Bromide of soda (5 grains every half hour) has often re-
moved this plethoric condition, when actual fever was not
present, and there was great nervous erethism.
Aconite is not indicated, and should not be used unless the
pulse is small, hard, and quick, and there is great anxiety
and fear of death.
If the feebleness of the contractions be solely due to uter-
ine debility, a weakness of its muscular tissue, while the gen-
eral muscular system is healthy and strong, we must select
remedies which specifically cause this condition.
In such cases the woman will exert great strength; will
"bear down" very powerfully, and pull violently on the
hands of the attendants; but the physician will observe by
IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
279
66
touching" that the head does not advance, although no
obstacle to its progress is present.
Here we have admirable remedies in Caulophyllum, Cimi-
cifuga, Cannabis indica, Secale, Ustilago, and Phoradendron.
(See page 281.)
The same medicines are equally useful in sudden cessation
of the pains, either from exhaustion, or some unknown cause.
Caulophyllum is preferable where the pains are exceedingly
feeble and far apart, or when they have been very violent,
but intermittent, and then cease altogether. Give the tinc-
ture, ten to thirty drops every fifteen or twenty minutes, or
the Caulophyllin in one-tenth or one-fourth grain doses as
often, or until good pains appear.
Cimicifuga is superior to Caulophyllum, if the feeble and
inefficient pains are irregular, both in intensity and recur-
rence. The general system partakes somewhat of the same
aberration. It is a greater neurotic remedy than Caulo-
phyllum, and its power over the uterus depends on its action
through the spinal and sympathetic system. In cases of
sudden suspension of pain and expulsive efforts due to de-
pression of mind or nervous exhaustion, Cimicifuga is specific.
The most efficient dose lies between the tincture and second
dilution, in drop doses, or from the 1 or 2 trit. of macrotin,
in one-grain doses, repeated every fifteen or twenty minutes,
until the pains are efficient.
X
Cannabis indica in doses of five or ten drops of the tinc-
ture repeated every twenty minutes has been found to in-
crease inefficient pains, or bring back suspended ones. It
doubtless acts upon the enfeebled nerves which supply the
uterus, stimulating them to normal action.
Electro-magnetism properly applied has been known to act
well in such cases, after all medicines have failed. The posi-
tive pole should be applied to the lumbar region, the negative
to the os, in the vagina, and a mild current (induced)
should be applied between the pains, and suspended during
their continuance, or, if no pains are present, the current
should be applied for five minutes, with intervals of the
same duration.
Secale has been used by the dominant school for nearly a
century, for the purpose of inducing uterine expulsive efforts.
280 IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
At first its powers were not understood and it was given in
all stages of labor, when the pains were feeble or absent It
was found that in many cases its effects were unpleasant
and dangerous, or no apparent effects were observed. As its
action became better understood, it was found that if given
before the os was dilated or easily dilatable, it caused vio-
lent, persistent, painful contractions, which were not only
useless to expel the child, but were the means of its death.
The intense and unintermitting pressure cut off the foetal
circulation, and the child died of asphyxia in utero.
Even in cases where the os is dilated, the constant pres-
sure caused by Ergot will produce the death of the child be-
fore it is thrust into the world. Its use among the best ac-
coucheurs of the old school is now limited to those cases
where, after the os is dilated, labor does not advance, owing
to feeble expulsive power, the size of the child, or smallness.
of the passage. Many of the more cautious do not advise
it until just before the head escapes from the vulva, and then
only for the purpose of insuring a firm, final contraction,
in order to prevent hæmorrhage, open or concealed, or the
formation of an intrauterine clot. They prefer the use of
forceps, for the purpose of facilitating the labor. In this I
think they are judicious, for the safety of the child and the
integrity of the perinæum are greatly enhanced by their skil-
ful use.
If the pains are simply feeble and inefficient, the careful
application of the pocket-forceps (page 288), in such a man-
ner as to imitate the natural expulsive efforts, and aid the in-
efficient pains, is much more efficacious and desirable than a
resort to such a powerful agent as Secale. If, however, the
accoucheur has not the forceps with him (but he always
should have), and the pains are very feeble, slow, and ineffi-
cient, or altogether absent, and the os is dilated, the presen-
tation favorable, and perinæum distensible, Secale should be
administered. I must here protest against the absurd ad-
vice given by some writers of our school, of giving the 30th or
200th in such cases. As well might we expect to cause diar-
rhoea with the 200th of Epsom salts. Only appreciable, ma-
terial doses of Ergot will excite or originate uterine contrac-
IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
281
tions. Any observations to the contrary are based on a de-
lusion or coincidence.
There are several methods of administering Ergot in such
cases. (1) The old method of infusion-30 to 40 grains of
the powder in an ounce or two of hot water; a teaspoonful
every ten minutes, or all in three or four doses, half an hour
apart; (2) 15 or 30 drops of a fluid extract at similar in-
tervals; (3) a teaspoonful of the wine of Ergot, as above; or,
(4) Ergotin in gelatin-coated pills, containing three grains
each, one every quarter or half hour. (5) A hypodermic
injection of 15 to 20 drops of Squibb's, or any other good
aqueous extract, will act with greater certainty and prompt-
ness than any other method of administration. The drug
should be suspended on the appearance of strong bearing-
down pains.
Ustilago, or the Corn ergot-is supposed to have similar
properties as Secale, but it has not been sufficiently tested
to enable us to use it with confidence. The dose is the same
as Secale.
Gossypium, or Cotton-root, is praised by many southern
physicians as a good substitute for any of the above medi-
cines. In several cases of slow labor in the last stage, I have
given teaspoonful doses of the fluid extract. It appeared to
stimulate to more efficient expulsive efforts. It is said that
a decoction of the fresh root is the most efficient preparation,
but the use of this would be restricted to the localities where
the plant grows. We need further experience with Ustilago
and Gossypium to determine their real powers.
Viscum album.*-This new remedy has lately been intro-
duced as a partus accelerator. In my Therapeutics of New
* Since the appearance of Dr. Long's statement, Dr. E. S. Crosier has in-
vestigated the botanical relations of the Mistletoe used by Dr. Long, and
he announces in the Louisville Medical News, that it is not the Viscum
album, but the Phoradendron flavescens of Nuttall. Therefore the Viscum
album cannot be used for this purpose, although it may possess similar prop-
erties (see New Remedies, 4th edition), and resembles Cimicifuga in many
respects.
Dr. A. G. Hobbs, contributes to the same journal a report of three cases,
two of them obstetrical and one of menorrhagia, and says, "My experience
with this parasite is that it acts more promptly and more decidedly as an
oxytoxic than Ergot." (See also a case in Amer. Jour. Obstets., July, 1857).
19
282
IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
Remedies I refer to its use by Dr. Huber, of Germany. He
used it successfully in retained placenta, metrorrhagia, and
menorrhagia, and his cases appeared to show that the condi-
tion was that of uterine inertia. I have never tested it fully,
and therefore cannot give my favorable testimony. But I
will quote the testimony of Dr. Long, which seems con-
clusive.
(
"Dr. William H. Long, of Louisville, says that for ten years he has
used the Mistletoe as an oxytoxic, having been led to do so from observing
that farmers, in the part of the country where he formerly had practiced,
were in the habit of giving Mistletoe to such of their domestic animals as
failed to clean themselves,' or expel the placenta after the delivery of their
young. In 1857 he first used an infusion in the case of labor, in which the
second stage was delayed through inefficiency of the uterine action. Con-
tractions followed in twenty minutes. He has since used it in decoction in a
large number of cases, and does not recall an instance of its having failed to
stimulate the uterus to contract.
"He believes in its superiority to Ergot-
"1st. Because it acts with more certainty and promptness.
"2d. That instead of producing a continuous or tonic contraction, as Ergot
does, it stimulates the uterus to contractions that are natural, with regular
intervals of rest. Consequently it can be used in any stage of labor, and in
primiparæ where Ergot is not admissible.
"3d. It can always be procured fresh, does not deteriorate by keeping,
and is easily prepared.
"He has used Viscum in many cases of menorrhagia and bæmorrhage
from the uterus with gratifying results, and has taken pains in such cases
to give Ergot and Mistletoe a competitive trial, with the object of test-
ing their relative merits; he unhesitatingly pronounces in favor of the latter.
Indeed, cases in which Ergot given in powder, decoction, and fluid extract
failed to give any relief, the Viscum acted promptly.
"In post-partum hæmorrhage, the results have been no less satisfactory
than in labor and menorrhagia, firm contractions of the uterus being secured
in from twenty-five to fifty minutes after administering from one to two doses
of the Mistletoe.
According to Dr. Long, the remedy may be administered either as an
infusion, tincture, or fluid extract, but he considers the latter to be the
most convenient. The former he directs to be made by taking two ounces
of the dried, or four ounces of the green leaves; pour on these one pint of
boiling water, cover closely, and allow to stand until cool enough to drink.
Two or four ounces may be given at a dose, and repeated in twenty minutes
if necessary. The green leaves impart a disagreeable taste that is lost in
the process of drying.
"He has also used an alcoholic tincture made by taking eight ounces of
the dried leaves and saturating them with boiling water, and adding alcohol
to make one pint; but he does not think this as efficient as either the decoc-
tion or fluid extract. It should stand ten days before ready for use. Vis-
IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
283
cum makes a fluid extract of a dark-brown color, which possesses all the vir-
tues of the parasite.
"The best time for gathering the Mistletoe is in November, after a few
frosts have fallen, and before the sap freezes, though it may be gathered and
used at any period of the year. When gathered, it should be at once spread
out to dry, as it will mould in a very short time if kept in a box or sack. It
is best to dry it in the shade.
"Viscum abounds in the Western country, and is found in greatest quan-
tities on the walnut and elm trees, though it grows sparingly on a few others,
as the red and black locust, oak, etc. So far as Dr. Long is aware, there is
no difference in its properties or strength made by the kind of tree on which
it grows."
Sudden cessation of the pains may be caused by influences.
from without. Disagreeable impressions occurring during
labor-like the presence of disagreeable persons, the arrival
of a physician, especially if he be not the one expected-
may determine the cessation of the pains.
Aconite is the remedy if the cause is akin to fright.
Chamomilla, if the patient is vexed or made angry.
Other remedies may be selected according to the causative
influence, not because the medicine affects the uterus direct-
ly, but because it acts upon the mental or moral origin.
During the progress of labor acute pains in some other por-
tions of the body may occur and arrest the labor until the ex-
traneous pain is removed.
Violent vomiting may occur, and will require the adminis-
tration of Ipecac, Iris, Nux vom, Stibium or Verat. alb.
Lumbar pains, severe and sharp, may require Belladonna,
Cimicifuga, or Rhus.
Colic may require Chamomilla, Dioscorea or Colocynth.
Viol nt cramps in the thighs, legs or calves, so graphically
described by Prof. Meigs, may set in with such severity as
to totally arrest the uterine contractions. They are sup-
posed to be caused by the pressure of the child's head upon
the sacral nerves, and no remedy is capable of relaxing them
until the pressure is removed. Here the forceps should be
promptly used, and Chloroform or Ether given. Should the
cramps continue-as they sometimes do after the pressure is
removed-Arnica, Colocynth, Verat. Alb, or Viburnum are
useful.
Congestion to the head has been known to occur suddenly
during labor, with sudden disappearance of the pains. In
284 IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
such cases, nurses say, "The pains have gone to the head."
I have met with several such cases. The patient suddenly
puts her hands to her head-the pain is severe; there is
flushed face, vertigo, dimness of vision, throbbing, ringing in
the ears, pulse full, hard, etc.
One such case was soon relieved by ten drops of tincture
Verat. viride; and another by the administration of thirty
grains of Bromide of lithia, which effected amelioration in
thirty minutes.
In the former case Verat. viride was selected because the
pulse was very hard. In the latter the pulse was not hard,
but full and soft.
Solanum, Gelsemium, and Belladonna will be useful if other
symptoms call for them.
Violent pains in the uterus, or pelvis, from pressure of the
child's head, may be so intense that the woman cannot make
any effort, at a time when her efforts are necessary to the
termination of labor.
I have met with cases where the pains were so spasmodic,
cramplike, and agonizing, that labor actually came to a
standstill. In some cases a hot sitz-bath will give almost
immediate relief, so much that the woman will beg to be
allowed to remain in the water. In other cases there is
nothing to be done but to remove the child with forceps, or
give Chloroform to induce anesthesia. In a few cases I have
known medicine to allay these pains. In one instance a tea-
spoonful of tincture of Caulophyllum gave relief in ten min-
utes, probably by changing the position of the child's head.
In another case Viburnum opulus, in a similar dose, relieved
the pain after three doses half an hour apart. Theoretically
Secale 30th ought to relieve the agonizing, constant pain
which sometimes occurs.
Cases are on record where Hyoscyamus, Coffea, and Cham-
omilla are said to have relieved these unnatural pains.
Irregularity of the pains.-Under this head Cazeaux de-
scribes certain kinds of pains, which he also terms uterine
tetanic pains.
He mentions several varieties:
1. "There is not a complete and perfect interval between
them, they are continuous, and only interrupted by the parox-
IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA. 285
ysms, during which the intensity of the suffering is terrible."
This variety, as above stated, would call for Secale, accord-
ing to a strict application of the law of similia. Here, evi-
dently, Chloroform ought to be given, until the pains cease
or give way to natural ones. If Chloroform was not admis-
sible I would try Amyl, Calabar, or Chloral hydrate, either
of which, in proper doses, should, in a short time, ameliorate
the sufferings.
2. "The pains return, it is true, at intervals, but some-
times it is only the fundus, again one of the cornua, and at
others, some part of the uterine body, which contracts spas-
modically, while the remainder scarcely does so at all."
They have no effect on the progress of labor, except to
retard it. The hand on the abdomen notes the irregular con-
tractions of various parts of the uterus. The membranes do
not bulge, nor the head press down. In these cases the warm
hip-bath may do much good.
Cimicifuga may prove an excellent remedy if the woman
is nervous and depressed, the whole body jerks, and the
limbs twitch (choreic motions). (See Cannabis indica.)
Gelsemium has proved the curative remedy in several
such cases under my care; and recently Dr. Fauntleroy re-
ported a case to the Virginia Medical Society, which verifies
my experience. He writes: "I was called in consultation,
and the following history was elicited: In the three previous
confinements, from the exhaustive continuance, for two or
three days, of the inefficient contractions, marked by fre-
quent pulse, coated tongue, and mental wandering, the doctor
had been forced to relieve his patient by a resort to instru-
ments. When called upon, the labor had commenced, the os
uteri was partially dilated, not at all rigid, but the contrac-
tions evidently involved different planes of the uterine mus-
cular tissue, first in one part, then in another. The writer
suggested the use of Gelsemium. Eight drops of the fluid
extract were given every hour. After the second dose the
uterine contractions became more general, and when the pa-
tient had taken eight doses, she was delivered by the un-
aided forces of nature, of a large healthy child.”
Pulsatilla.-If this medicine is ever indicated in unnatural
labor, it is applicable in this variety. The genius of this
286 IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
remedy makes it applicable, not only for irregular contrac-
tions of the uterine muscles, but contractions which fly from
one set of muscles to another in the uterus, or from the
uterine muscles to those of other parts of the body. The
mental state of the patient affords valuable indications for
Pulsatilla. With irregular, inefficient pains the woman often
weeps, complains, is greatly agitated, and cannot be encour-
aged. Here Pulsatilla will be indicated.
Aconite will be useful if the patient has an uncontrolla-
ble anxiety and fear of death, the skin is cold, and the pulse
small and feeble (primary), or she becomes hot, feverish,
with hard small pulse, thirsty, delirious, and has slight con-
vulsive motions. (Secondary.)
Ignatia covers many of the symptoms of this condition.
Dioscorea may prove useful, especially if the uterine mus-
cular-cramps suddenly cease, and appear in the bowels, hands,
or feet. (See Symptomatology of New Remedies.) Before
closing this chapter I cannot omit to mention a remedy,
which under certain circumstances proves most efficient and
harniless in the treatment of false labor, or irregular uterine
contraction.
I allude to Opium and its preparations. They are not ho-
mœopathic to this condition, any more than Chloroform or
Ether, but act as palliatives, giving the tortured organ needful
rest, after which it takes up its normal action.
Cazeaux says: "Under the influence of Opium, given in
the form of enema (into the rectum), twenty or thirty drops
in a few ounces of water, the pains entirely disappear in the
course of half an hour. During this period the patient gen-
erally slumbers, and then the good pains, that is, the natural
and regular ones, come on, and the labor terminates happily."
In several cases of peculiar obstinacy, where neither the
homœopathic remedy nor Chloroform changed the unnatural
character of the pains, I resorted to an enema of twenty
drops of McMunn's Elixir of Opium, and the improvement
set in in less than half an hour, and after an hour or two of
sleep, natural labor commenced in earnest. In one case, two
doses, half an hour apart, of one-eighth of a grain of Mor-
phiæ acetas had the same effect. (See Dr. Freeman's obser-
vations on Morphia, p. 274.)
IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA. 287
Position. A woman in labor should not be obliged to lie
in one position, unless it is appropriate, and she desires to.
To confine a woman to the left-side position in all cases,
would be to greatly retard labor in many cases. In lateral
oblique positions of the uterus, or oblique presentations of the
head, the woman should lie on the side opposite to that of
the fundus uteri. This allows the uterus to fall to that side,
and changes the abnormal presentation of the head to a nor-
mal one.
In anterior obliquity, the proper position is on the back,
with the head as low as comfortable. This obliquity may
also be removed by a properly-adjusted bandage worn during
the last month of pregnancy, and also during labor. It
should be so applied as to hold the womb upward, and press
it backward. A finger hooked into the os, and drawing the
anterior lip forward will often remedy this condition.
In posterior obliquity (see Cazeaux, page 714), the woman
ought to remain seated or standing, or, if possible, reclining
a little forward. I have in two cases of this nature delivered
the woman while she was kneeling by the side of a bed or
chair, with the body bent forward. The hands of the ac-
coucheur, reaching from behind, and pressing on the child's
head just above the pubes, assists in aiding the head to en-
gage.
In all these obliquities the head is often greatly obstructed
by the rim of the cervix getting between the head and the
passages. This should be pushed forcibly back, between the
pains, and held there, if possible, during the pains, until it
will recede permanently.
Abdominal pressure, made by the hands of the physician
or nurse, or by means of a properly-adjusted bandage, will
often facilitate a slow and tedious labor. The external pres-
sure should be made during the pain, and, if possible, the
pressure should be maintained in the intervals to keep what
was gained by each pain. Many obstetricians of the present
day strongly advocate this method. Unfortunately, some
women cannot bear any pressure on the abdomen during
labor, unless they are under the influence of Chloroform,
Ether, or Chloral hydrate.
The Forceps.—I do not propose to mention those Forceps
288 IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
whose sole use in difficult or abnormal labor is to extract the
child by force, but shall briefly mention a variety which can
be used as a simple and valuable aid to the natural or defi-
cient pains.
My first experience with forceps was with Davis's, after-
wards with Simpson's, but recently I have used Comstock's
with decided satisfaction, especially when the head was high
in the pelvis. When the head has passed the brim and the
obstruction is below the promontory of the sacrum, unless
there is some very great obstacle to overcome, I prefer Roler's.
But from the first I was struck with the absence of any
instrument, which, without being a compressor, or powerful
tractor, would be an aid to the mother in the expulsion of
the head from the lower strait, or when it rests on the peri-
næum.
Every practitioner has had cases where the head comes
naturally down upon the perinæum, and then from some cause,
as fatigue or exhaustion of the mother, a head that would
not readily mould, rigidity of the soft parts or perinæum, or
dryness of the passage, refuse to progress with that celerity
which was desirable.
I hold with Dr. Goodell, of Philadelphia, that it is only
very rarely that there is any necessity for waiting hour after
hour in slow labors, when we can facilitate it by means safe
to the mother and child.
But must we always use the heavy and formidable instru-
ments which up to this time have been invented? The modern
tendency of all the instruments used by surgeons, has been to-
ward lightness and delicacy; not only in surgery, but in all
the arts, and in every department of labor where machinery
is used. Why has it not been so in midwifery?
It is only within a few years that Roler's light forceps were
introduced, and this has met with much opposition. Years
before I saw Roler's I had made a drawing of a small light.
forceps, which should be of the same shape as Davis's, only
shorter and very much lighter; but I shrank from intrud-
ing my idea upon the profession. However, when I saw the
extremely light and delicate forceps, having ouly a "scissors
handle," invented by Dr. Newman, of Denver, I hunted up
my old drawing, in which the handle was the ordinary club-
IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA. 289
shaped one of Davis's and Roler's latest. I then conceived
the idea of modelling the handle of my small forceps so that
it would resemble that found upon some of the older styles
of pistols. I finally adopted the following shape, as shown
by the accompanying cut.

CH.SARGENT
Hale's Forceps for Rotation and Extension.
I have named my instrument the "Pocket Forceps," and
a brief description is as follows:
Length of blades from point of crossing, six inches. Total
length, ten inches. Length of handles, three and one-half
inches. A gradual pelvic curve of two inches, beginning
near the extremity of the shanks. Breadth of the cephalic
portion averages one and one-half inches. The distance
across the widest part when the instrument is closed is two
and three-quarter inches, the points being separated one-half
of an inch. The branches fit easily in a "button lock."
The diameter of the closed handles is one inch. The fenestræ
are nearly elliptical; their length the same as most other for-
ceps. Total weight only five and one-half ounces. These
forceps are all nickel-plated.
*
[By way of comparison I give the relative dimensions of
* Since the introduction of my small forceps, many physicians of both
schools have urged me to enlarge them so as to give them more traction-
power. They highly approve of the shape of the handle as being the most
convenient ever introduced. I have complied with their solicitations, and
have designed a forceps which I have named Hale's Larger Traction Forceps,
of which the following is a description :
Length of blades, sir inches; total length, fifteen inches. Length of
handle, four and a half inches. Length of curve, and breadth of cephalic
portion and other measurements same as small forceps. The handle is placed
more at an angle with the blades than in the small forceps, and its diameter
is one inch near the lock, and one inch and a half at the butt. The shank
between the blades and the lock diverges as in Comstock's. The weight
about ten ounces. This forceps can be substituted for any one of the large
forceps, as it possesses traction-power equal to any one of them, and is much
more convenient on account of its peculiar handle. (Messrs. Boericke &
Tafel will supply either instrument to order.)
290 IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
my forceps, Comstock's, and Elliot's. The total length of
Comstock's is fourteen inches; weight, thirteen ounces. Total
length of Elliot's, seventeen inches; weight, twenty ounces.]
It will be seen that while I have followed the general out-
line of Roler's blades, I have increased their curve at the point of
divergence from the lock, giving an opportunity for the placing
of the forefinger as a guide and slight tractor. The shape
of the handle I claim to be altogether original. It affords
the best grasp for the hand, and does not interfere with its
free movement.
Its small size enables the physician to carry it in his
pocket. Its appearance is not in the least formidable. It
can readily be applied in nearly all the various positions in
which women place themselves during labor, and thus afford,
with but the slightest show of an operation, very important
assistance during the last stage.
It can be used to rectify those annoying oblique positions
of the head, which, even when the head is resting on the
perinæum, retards its progress. Here it is used as a lateral
lever, as recommended by Meigs. In cases where the head
is placed transversely to the lower pelvic strait it can be used
successfully to rotate the occiput under the pubic arch. In
face presentations, these forceps can be used effectually to
cause the chin to escape more readily from under the pubes,
or assist it in escaping from the perinæum.
In occipito-posterior positions this little instrument will
greatly assist in causing the chin to approach the breast, and
allow the vertex to escape more readily. Even in that most
natural phase of labor, the occipito-anterior, the attendant and
patient are annoyed and fatigued by the tendency of the head
to retrograde, or "slip back," at each pain, just at the time
when it seems as if it was about to escape from the vulva,
or reach a position where it could be grasped by the hand.
How often have we waited hours for the escape of the head
under these circumstances. We feel that all that is wanting
is a little harder pain. We know that if we only had one
hand on the head we could extract it, but just as we seem
able to grasp it it slides back into the pelvis. It is in just
such cases that these small forceps are a great assistance to
both physician and patient.
IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
291
I here wish it to be distinctly understood that I do not
recommend my forceps as an instrument for forcibly extracting
the child, but for guiding the head, for effecting rotation, flexion,
and extension, and assisting weak or even normal pains.
For the purpose of forcibly impressing upon physicians the
value of my short forceps, I quote from a recent lecture by
Dr. E. W. Sawyer, of Chicago, who claims for it great value
in saving the perinæum by effecting flexion at a certain period
of labor. He says:
"The remarks which I have to offer, relate to those labors in which the
vertex is in advance, and only to that stage of labor when the head has
almost passed through the bony portion of the obstetric canal, but is still
opposed chiefly by the woman's soft parts at the floor of the pelvis, and the
outlet of the canal.
"It will perhaps elucidate the point I hope to establish, if I may be per-
mitted to describe the manner in which the forces of the woman will com-
plete the expulsion of the head, if no interference is offered by the attendant.
"At the moment we speak of, the antero-posterior diameter of the fœtal
head approximately corresponds to the same diameter of the parturient
canal. In the great preponderance of labors, the back of the head looks
upward-the woman being upon the back. A little further advance brings
the vertex to look through the vulvar aperture, and the nape of the neck in
contact with the inner surface of the pubes; while that part of the occiput
just inferior to the protuberance, is lodged against the sides of the pubic arch.
The occiput is too broad to be received into the pubic arch as far as its sum-
mit, as one may convince himself by sweeping the tip of the finger between
the inferior border of the symphysis and the head, during the expulsion of
the latter.
"Till this time the foetal head has been in a state of flexion; but when the
occipital plane becomes arrested against the pubic arch, the frontal part of
the head receives the propelling force more directly, and is soon in advance.
The head is now made to describe a movement of extension, or evolution, by
which it becomes unfolded into the world, around the point of the pubic
arch, against which the occiput is lodged, as around a pivot.
"Two forces operate to produce this extension. The propelling power of
the uterus and its auxiliaries, the vis-a-tergo, advance the head until the
larger portion of the forehead looks over the margin of the perinæum.
When the soft parts become still further distended by the fœtal head, the
perinæum draws itself backward over the face, urging forward successively
the margin of the orbit, the malar prominences, nose, lips, and chin, the
part of the head to be freed last being that part which was lodged against
the pubic arch. This retraction of the perinæum is the second force which
extends the head.
"Such is an outline of the manner in which the head is delivered by na-
ture. A movement which, while it succeeds in its object, at the same time
jeopardizes the woman's soft parts. This is even more apparent when we
recall the successively increasing dimensions of the head which pass through
292
IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
the vulvar outlet. I have given the name pubo-facial diameter to that
axis, one end of which rests upon the highest part of the pubic arch, while
the opposite extremity is lost upon different parts of the face. Their names
indicate the limits more exactly. The length of these several axes show the
extent to which the vulvar aperture is opened to give exit to the head.
Thus the pubo-frontal, 4½ inches; pubo-malar, or nasal, 4 inches; pubo-
mental, 51 to 5 inches. I believe it practically impossible for the vulva of
the primiparous woman to be stretched to this degree without a rupture of
the perinæum occurring. I am aware that a primipara may be delivered of
a large child, and her perinæum be left intact, but this is because the judi-
cious interference of her attendant compelled the head to pass out in a shorter
axis than nature can do if left to herself.
"I have had an opportunity of an ocular demonstration of the moment
and manner in which the perinæum was torn. Just as the upper margin of
the orbits looked over the edge of the perinæum, the little fold of mucous
membrane known as the fourchette, or frænum, gave way; this tear was
continuously deepened by the malar prominences and chin. This is, I
think, the usual order. Writers have described, in exceptional cases, its
first giving way at the centre, but all agree that it tears on the median
line.
"I know some hold that it is the bis-acromial diameter, the shoulders,
which causes the tear. But I cannot believe that the perinæum, left abso-
lutely intact by the head, will be torn first by the shoulders, under the care
which the woman always receives. Such an accident can always be averted
by delivering the pubic shoulder first.
"The interference which I would recommend to anticipate the hazardous
stretching of the vulva is, in a word, of a nature to hold the head in a state
of extreme flexion, and force it to pass through the vulva in a diameter a
little superior to the pubo frontal, and which has a length in the full-grown
child of about four inches.
"I cannot assume that preventing the extension of the head at this time
is an original procedure; only that its significance is not generally under-
stood. Many practitioners interfere during this stage of labor, and really
Thus some hook the index
prevent the complete extension of the head.
It would seem at first
finger over the chin through the woman's rectum.
sight that they attempted just what we would prevent, that is, extension of
the head; but really they accomplish what we have recommended, for the
thumb of the same hand is pressed upon the perinæum, which is being bulged
out by the forehead. In this way, with the face held between the thumb
and finger, in easy cases, the sinciput is kept back.
"Others apply the hand to the perinæum in such a way that the commis-
sure between the thumb and finger corresponds with the posterior commis-
sure of the vulva. Judicious support continuously supplied is of the greatest
advantage, but the object to be attained by this palmar pressure is not always
understood, for I have often been told to hold the forehead back for a time
to allow the perinæum to become thin and the vulva more easily stretched.
Possibly this is accomplished, but the greatest advantage comes from the
flexion into which the head has, by this means, been forced.
"In addition to holding the sinciput back with one hand, others attempt
IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA. 293
to tease the occiput forward with the fingers of the other hand applied to the
head just in front of the symphysis pubis.
"Besides the objections to the introduction of the finger in the rectum, it
can be said against all these measures that they are not sufficient, in the ma-
jority of labors, to hold the head in a state of flexion.
"I am assured that this can be most certainly and easily accomplished
with the forceps. For a long time I have been using my short forceps for
this purpose with the most satisfactory results."
I will add that Dr. Sawyer's forceps are similar to my
short forceps, with the exception of the handle, which, like
Comstock's, has a hook to each half, which projects outward.
I consider the "pistol handle," as applied to obstetric forceps,
as one of the greatest advances in the improvement of that
instrument. When placed upon the large forceps, it will
give to them a strength, a convenience, and a facility for
manipulation which will render it universally popular.
Dr. Sawyer gives correctly the proper method of the use
of the small forceps:
"Let us assume that the forceps is to be used to flex the head, and to hold
it in a state of flexion. At this stage in the labor the woman is usually upon
the back. Her position need not be changed, only to have the limbs strongly
flexed in the lithotomy position. Nor is it necessary for the operator's body
to be in a line with the pelvic axis. The introduction and locking of the
blades is a matter of extreme simplicity. While the head is loosely held,
the handles should be elevated so as to nearly approach the symphysis.
Choose the interval of uterine action. Now clasp the head firmly in the
blades, and slowly depress the handles until the edge of the perinæum is
approached. The following diagram illustrates this movement of forced
flexion:

"C shows the forceps applied. The handle is to be depressed to D, when
the chin will recede to the dotted line.
294
IMMEDIATE TREATMENT OF FUNCTIONAL DYSTOCIA.
"It may be that one movement is not sufficient to flex the head; this is
the more likely to result if the operator is overtaken by a contraction of the
uterus. It is only necessary, in this event; to repeat the elevation and de-
pression of the handles, and the operator will have the satisfaction of feeling
the sinciput recede, when a moment before it was causing the perinæum to
bulge out in a most threatening manner.
"The most important step in the operation remains to be mentioned.
When the head has been flexed, the hold of the instrument should be re-
laxed, and the handles elevated to that degree that the general axis of the
handle is nearly perpendicular to the plane of the bed. It is in this position
that the head is to be held if the operator waits for the uterus to complete
the delivery; and it is in this direction only that the operator lifts the head
if he sees fit to make traction.
"If, in addition to this use of the forceps, the ends of the fingers of the
disengaged hand are placed upon the head in such a way that the convex
surfaces of the nails rest upon the edge of the perinæum, and during the in-
terval of uterine action gentle efforts are made to tease back this edge, and
to prevent it from being caught upon the advancing head, the operator has
by this conjoined manipulation given the soft parts the greatest possible
security.
"
Finally, in an exceptional case of posterior position of the occiput, which
refused to rotate forward to appear beneath the pubic arch, I was able, by
reversing the movement I have described, to lift the head into marked
flexion, and to deliver a primipara of a large child without injury to the
soft parts.
"As injuries of the soft parts, I have in the foregoing remarks alluded
particularly to those rents which are apparent upon an inspection of the
perinæum. But it seems reasonable that the liability to those not infre-
quent tears of the mucous membrane about the outlet would be lessened
by the same measures which would prevent the dangerous distension of the
perinæum."
INDEX.
Absence of uterus, 62
ovaries, 58
vagina, 132
Atrophy of vagina, 59
uterus, 66
Atresia of uterus, 63
cervix, 63
vagina, 130
Amenorrhoea, 65, 108
Anteversion of the uterus, 73
Anteflexion of the uterus, 73
Amputation of cervix, 81
Applicator, Sims' cervical, 101
Hale's intrauterine, 102
. Abrasion of os uteri, 103
Areolar hyperplasia of uterus, 110
Abnormal shapes of cervix, 125
os uteri, 125
Abortion a cause of sterility, 182
Albuminuria, 237
treatment of, 238
Bougies, slippery elm, 97
medicated gelatin, 98
Bozeman's dressing-forceps, 99
Bladder, irritable, 147
Causes of sterility, 43
Constitutional causes of sterility, 50
Change of climate, 53
Cervix uteri, stricture of, 68
occlusion of, 63
division of, 68
dilatation of, 68
rapid and forcible, 79
amputation, 81
elongation, 83
oedema, 114, 118
enlargement, 110
abnormal shapes of, 125
conoidal, 126
"smashed hat," 127
rigidity of, in labor, 267
Climate, influence of, 53
Convulsions, puerperal, 248
Chambers' intrauterine stem pessaries, 74
Cotton pessaries, 78
Cloth tents, 95
Cervical protector (Wylie's), 94
applicator, Sims', 101
Hale's, 102
hyperplasia, 111
Calendula glycerole, 104
Conical cervix, 129, 126
Crescentic os, 126
Coition, improper time for, 177
position during. 179
during disease, 178
conduct after, 180
Clitoris, diseases of, 140
enlargement of, 140
abnormal irritability, 142
Carbonic acid gas douche, 198
Cases of retroversion during pregnancy,
227
Case of sterility, 143
fissure of the anus, 155
Cystitis, 147
Catarrh, vesical, 147
Constipation during pregnancy, 249
Conception, 159
prevention of, 180
Diet, improper, as a cause, 54
in obesity, 51
Degeneration of ovaries, 59
Dropsy of ovaries, 60
during pregnancy, 244
Dysmenorrhoea, 68. 108
pseudo-membranes, 108
Dilatation, rapid and forcible of cervix,
79
Dressings, medicated, for ulceration, etc.,
106
Depletion, local, curing sterility, 118
| Diabetes, 146
Dress, improprieties in, 172
DISORDERS OF PREGNANCY, 201
DYSTOCIA, 201
preface, 203
due to the foetus, 255
fruit diet for, 258
Erotism, 57
Exercise, want of, 54
Elongation of cervix, 83
Elevator for retroversion, 77
Endometritis. 91
fundal, 94
Erosion of cervix and os, 103
Enlargement of uterus and cervix, 110
Engorgement, chronic of, 110
Enemas of hot water, 116
!
Eruptions in vulva, 137
296
Electricity in areolar hyperplasia, 122
in sterility, 197
Frigidity, 57
Fallopian tubes, stricture of, 61
Fundal endometritis, 94
Fitch's sound, 64
Flexions of uterus, 72
cervix, 79
INDEX.
rapid and forcible dilatation of, 79
Fibroid tumors, 86
ergot in, 89
diet in, 90
Forceps, Bozeman's dressing, 99
Hale's pocket, 280, 289
Fissure of vulva or vagina, 136
urethra, 153
anus, 155
Fistula, vesico-vaginal, 153
Foetus in utero, medication of, 253
Fruit diet in dystocia, 258
Galvanic pessary, 122
Granular os and cervix, 103
Galvanism in sterility, 197
Gymnastics, 198
Hæmatometra, 63
Hale's intrauterine applicator, 102
Hale's speculum, 71
forceps, 289
Hysterotomes. 69
White's, 70
Skeene's, 70, 127
Peaslee's, 128
Hypertrophy of uterus, 110
cervix, 110
Hot water enemas in metritis, 116
Hymen, imperforate, 133
Hysterical diathesis, 136
Hæmorrhoids, 155
Hygienic causes of sterility, 172
Hydropathy, 198
Hydrotherapy in dystocia, 220
Hardness of the bones of fœtus, 258
Illustrations, list of, 11
Inordinate sexual intercourse, 53
Improper diet, exercise, etc., 54
Incompatibility, 56
Inflammation of ovaries, 59
Fallopian tubes, 62
uterus, chronic, 110
vagina, 138
bladder, 147
urethra, 151
Inversion of uterus, 84
Irregularities, menstrual, 109
Irritable tubercle of vagina, 136
Imperfect development of ovaries, 58
uterus, 65
Imperforate hymen, 133
Intrauterine pessary, 74
stem, 72
Intrauterine tampons, 105, 107
packing, 97
syringes, 93
bougies, 98
suppositories, 98
applicator, 102
Iodine in areolar hyperplasia, 120
Incision of cervix uteri, 68
Kumyss, nutritive value of, 124
Lateroflexion of uterus, 80
Leucorrhoea, 107
vaginal, 138
Leeches in engorgement of the uterus, 116
curing sterility, 118
Local depletion in chronic metritis, 116
curing sterility, 118
Labor, slowness of, 267
Phoradendron in, 281
cessation of pains during, 283
vomiting during, 283
cramps in legs during, 283
congestion to bead during, 283
irregularity of pains during, 284
position during, 287
obliquity of uterus during, 287
forceps in difficult, 287
pains, cessation of, 283
irregular, 284
violent, 284
Medicinal causes of sterility, 45
Mercurialization, 51
Mineral waters, 54, 123
Menses, retention of, 63
suppression of, 108
irregularities, 109
frequent and profuse, 109
scanty, 109
delaying, 110
Metrorrhagia, 109
Menstruation, imprudence during, 175
Metritis, chronic, 110
Mammary irritation, 198
Medication of foetus in utero, 253
Neuromata of vagina, 135, 137
Neuralgia of vagina, 135
Non-retaining vagina, 132
Nutritive treatment, 122
Ovulation (introductory), 11
Obesity, 51
Ovaries, absence of, 58
imperfect development, 58
atrophy, 59
inflammation, 59
degeneration, 59
tumors, 59
dropsy of, 60
Edema of cervix, 114
Os uteri, abnormal shapes of, 125
INDEX.
297
Os uteri, "pinhole,” 126
crescentic, 126
closed, 126
Predisponent causes of sterility, 49
Plethora, 51
Prostitution, 52
Psychical causes, 56
Prolapsus uteri, 80
Procidentia uteri, 81
Packing the uterus, 97
Phoradendron in dystocia, 281, 282
Pessaries, intrauterine, 74
galvanic, 122
Chambers' stem, 74
Thomas' anteversion, 75
retroversion, 76
Albert Smith's, 76
Jackson's, 76
cotton ball, 78
for lateroflexion, 80
elastic ring, 81
Zwang's pessary, 82
in conoidal cervix, 129
concavo-convex, 129
Polypi of the uterus, 86
Polymnia uvedalia, 119
Porte-tampon, 107
Pinhole os, 126
Peaslee's uterotome, 128
PREGNANCY, DISORDERS OF, 200
vomiting of, 224
1
Slippery elm tents, 74
bougies, 97
Syringes, intrauterine, 93
Suppositories, medicated, 98
in vaginismus, 136
Scarificator, Skeene's, 117
Butler's spear, 117
Semen, nature of, 159
injection into uterus, 199
Spermatozoa, 160
examination for, 164
passage to ovule, 167
Special disorders of pregnancy. 224
Twin-births, 52
Tumors of ovaries, 59
of uterus, 86
of meatus, 153
Tampons, cotton, intrauterine,
in vaginitis, 138
in leucorrhoea, 139
Tenaculum, Nelson's, 72
Thermometer, clinical, 128
Temperature, 128
Tortuous cervical canal, 128
Therapeutics of sterility. 184
102
PAINFUL AND DIFFICULT LABOR,
201
Preface to Sterility, 3
ļ
Preface to Dystocia, 203
Retention of menses, 63
Retroversion and flexion, 75
a cause of vomiting in pregnancy,
226
Renal causes of sterility, 146
Rectal causes of sterility, 155
Rectum, ulceration of, 156
fissure of, 156
Remedies for sterility, 185
for dystocia, 208
Statistics of sterility, 45
Scrofula, 50
Syphilis, 50
Sexual intercourse, inordinate, 53
in uterine hyperplasia, 116
Stricture of Fallopian tubes, 61
uterine cavity, 63
cervix uteri, 68
vagina, 131
Subinvolution of uterus, 110, 115
Sound, Fitch's measuring, 64
Sims' and Simpson's, 77
Simpson's hysterotome, 69
Skeene's hysterotome, 70, 127
Sims' operation for stricture of cervix
uteri, 68
Speculum, Jackson's, 71
Hale's, 70, 166
Uterus, absence of, 62
atrophy. 66
imperfect development, 65
atresia, 63
displacement of, 72
anteversion, 73
flexions, 73
retroversion and flexion, 75
lateroflexion, 80
prolapsus, 80
elevation, 83
inversion, 84
tumors of, 86
polypi, 86
areolar hyperplasia, 110
hypertrophy, enlargement, etc., 110
subinvolution of, 115
erosions, 103
ulceration, 103
abrasions, 103
Uterine elevator, Sims' and Gardner's, 77
sounds, Sims' and Simpson's. 77
applicator, 102
pessaries, 74, 75, 76
Ulcers of vagina, 136
uterus and cervix, 103
Uterotome, Peaslee's, 128
Uræmia, 247
Urethra, irritable, 147
dilatation of, 152
caruncles of, 152
granular erosion of the mucous mem-
brane, 153
fissure of the, 153
vesico-vaginal fistula of, 153
vascular tumor of the meatus, 153
Urethral catarrh, 151
20
298
INDEX.
Vaginismus, 134
forcible dilatation for, 137
Sims' operation for, 137
Vagina, atresia of, 131
congenital absence of, 132
non-retaining, 132
Vaginitis, 138
Vesical causes of sterility, 147
catarrh, 147
salicylic acid in, 149
Vesico-vaginal fistula, 153
Venery, excessive, 176
51
.

LUBI O!