REFLEX UTERINE AFFECTIONS.

BY J. H. WOODBURY, M.D.

Ir is a fundamental principle in Homœopathy, that in the selection of a remedy "we should be guided by the totality of the symptoms."

It is true that in practice the busy physician is very apt to content himself with a knowledge of the more obvious and superficial symptoms, and to form from these his "picture of the disease." It is equally true that he who does so, runs great risk of making an error in diagnosis and a failure in treatment.

Perhaps no class of cases requires more thorough scrutiny, more careful and exhaustive investigation, than those functional derangements arising from nervous irritation, as it is essential not alone to collect and record all the minor and apparently trivial circumstances and concomitants, but to ascertain, if possible, the origin and seat of the irritation.

This it is not always easy to do, and it is rendered in many cases especially difficult when the uterine nerves are the seat of the irritation, and displacement of the uterus the cause. This difficulty is greatly increased by the fact that the local symptoms may be very slight, in fact hardly noticeable by the patient herself, while the reflex and many times very distant affections are both very severe and persistent; and thus the symptoms of which the patient complains give no clew to the cause of the difficulty, nor any reliable indications for the selection of a remedy. Very frequently these reflex affections appear as cases of aphonia or of facial or temporal neuralgia, or a persistent cough or a dyspepsia, with constant and distressing nausea, aversion to food, and frequent attacks of vomiting.

Whatever form it may assume, if the primary cause be overlooked, the most elaborate treatment, the most accurate "covering of symptoms," will be of no avail. The patient will still lose her voice, or cough, or vomit, in spite of the "most (in) appropriately chosen remedy," inappropriately chosen beVOL. X. NO. I.

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cause, while it may have covered all the secondary and apparent symptoms, the primary condition, from which all these originated, has not been apprehended or taken into account. This constitutes the most important factor in the problem; and being overlooked, the result is sure to be a failure, and sometimes a most mortifying one.

I subjoin a few cases illustrative of what I have said.

CASE I. Aphonia. Miss T., brunette, æt. 26 yrs., of full, robust, habit of body, has suffered for more than a year from frequent attacks of severe, hacking, dry cough, resulting in a short time in that of aphonia. These attacks had latterly become more frequent and of longer duration, until finally she was never sure of her voice at any time, and the cough tormented her almost constantly.

She had been under treatment for the relief of the cough and aphonia for nearly the whole time. Her throat had been twice thoroughly cauterized. She had used inhalers and atomizers, and the throat had been counter-irritated by Iodine and vesicated across the lower portion with Cantharides. She had spent the latter part of the winter and the early spring in Florida, at the expense of great suffering upon the journey both ways, to escape the "Boston east winds," but all to no purpose. She was in no way benefited. She came to me about a year since, at the request of her uncle, for a laryngoscopic examination. This revealed nothing except the congested condition of the larynx and vocal apparatus due to the constant coughing. While questioning her as to her general condition she remarked that ever since the cough had troubled her she had suffered severely from dysmenorrhoea and obstinate constipation, while before that time she had been entirely free from these difficulties. This remark led to further questioning, and finally to a digital examination, which revealed the uterus decidedly retroflexed and hypertrophied. I at once attempted to replace it, but on account of the rigidity of the surrounding tissues and the hypertrophied condition of the organ I was unable to accomplish this until the following day, the patient then being fully under the influence of ether. The cough began to abate almost

immediately, and both it and the aphonia entirely disappeared in a few weeks, the patient meanwhile being restricted to very gentle exercise, and taking each day a sitz bath of the temperature of 70°.

The dysmenorrhoea ceased at once, after the replacement of the uterus, and the hypertrophy began gradually to lessen, and the retrograde metamorphosis did not cease when the uterus reached its normal size, but has continued, until the organ is now hardly more than infantile in its dimensions, a by no means uncommon occurrence in cases of resorption of hypertrophied uterine tissue.

CASE II. Mrs. T., Charlestown, applied to me, Aug. 6, 1873, for treatment for "indigestion, total loss of appetite, and so great a depression of spirits that she was utterly wretched, and unfit for anything." She was obstinately constipated, and her fæces, she said, were very small, hard, and constricted. This statement led me to make an examination of the rectum and vagina. I found the uterus in a state of extreme retroflection, and the ligaments so wanting in tenacity that on the withdrawal of the finger or sound, after its replacement, it would at once fall back again into its old position. I replaced the uterus and introduced a Hodge's pessary to keep it in position. The patient began to improve almost immediately in every respect. Three weeks after, she reports that "her appetite is good, and the indigestion not at all troublesome, though not wholly gone; the constipation very much better, and I have not felt so happy and light-hearted for the past three years as since the operation." She continued to improve steadily, and was able in December to take a trip to New Orleans, travelling almost constantly for six weeks. March sixth the pessary was finally removed, the uterine ligaments having recovered sufficient strength to retain the organ in position. She took little or no medicine, and there has been no return of the displacement.

CASE III. I was called August 25th to see Mrs. M. She had one child three years old, and had never miscarried. At the birth of her child her labor was very severe, and she was

finally delivered with forceps. Since that time she has never been very strong. For the last four months she has suffered greatly from nausea and occasional vomiting, and has been pronounced pregnant by two allopathic physicians, who had each attended her for a time. When I first saw her she was troubled with almost constant nausea, loss of appetite, and indigestion, great depression of spirits and general weakness, disinclination to any exertion, and great exhaustion after a short walk or going up-stairs. She had a constant pain in the back and thighs, constipation, and painful passage of the stools. Physical examination revealed very nearly the same condition of the uterus as in the last case. It would not remain in position for a single moment, but tumbled back into the recto-uterine fossa the instant the support was removed or the patient assumed the upright position.

The uterus was replaced, and a mass of cotton saturated with glycerine applied to keep it in position till I could procure a proper pessary. Two days afterward I saw the patient, when she reported that there had been no return of the nausea, nor had she suffered but very little from the gastric irritation. A pessary was now introduced and worn without interruption until November 26th, when it was removed, and up to this date, December 15, there has been no return, either of the gastric symptoms or the retroflexion, and the patient appears perfectly cured. This patient also took very little medicine after coming under my care (a few doses of Nux vom. and Sepia during the first two weeks), and I deemed the improvement wholly due to the replication of the uterus, and the consequent removal of the cause of these reflex symptoms.

These cases are sufficient to illustrate my observations, that in cases of reflex uterine irritation, "if the primary cause be overlooked, the most elaborate treatment will be of no avail"; and also, if this primary cause be detected and removed, very little further treatment will be required.

These cases are by no means solitary, but only specimens of large numbers of similar ones which come under the eye of every physician of any considerable experience in the treatment of diseases peculiar to women.

GASTRO ENTERITIS AND DYSENTERY,

BY S. M. CATE, M.D.

THE forms of disease of the stomach and bowels are so various, and the complications so many, that nosology seems often at loss to designate by some single term the cases that occur in practice. In diseases of children this is peculiarly obvious. Thus, we often meet with dysentery with symptoms that leave no doubt of inflammation of the rectum and colon, but in some cases vomiting from inflammation of the stomach, and in other cases vomiting from reflex action upon the sympathetic and pneumo-gastric nerves. Other cases of dysentery show that the inflammation of the rectum and colon is accompanied with inflammation of the ilium and jejunum; in others, again, the brain and spinal nerves suffer by the reflex action from the inflamed surfaces; and in still other cases disease of the brain is developed, and adds to the difficulties of the case. In many such cases it is difficult to designate the diseased action by a single medical term.

Dysentery complicated with gastritis is of frequent occurrence in children, and sometimes fatal. The following case is given, with some detail, in the hope that the report of it may be of some use to the profession.

August 21st, 8 A. M., I was called to the daughter of I. J. P., aet. 2 years. She had light skin and hair, and blue eyes. Had been usually well, and had good flesh and a full habit. She was taken the night before with diarrhoea, and vomiting came on at 3 A. M. Now the head and body are hot, with coldness of the hands and feet; face red; pulse 140, full and sharp. Frequent jumping and jerking, as though convulsions were imminent. The discharges from the bowels are greenish, watery, and slimy, and run away without warning, as though the sphincter muscles of the rectum were paralyzed. Very thirsty; very sleepy and stupid; breathing quick and short. Aconite and Belladonna, each in the 30th, were given in solution, a dose each hour alternately.

6 P. M. She has had five discharges since morning,-greenish