§ 235. Metritis, hysteritis, inflammation of the uterus.

Metritis is either acute or chronic. We distinguish metritis parenchymatosa, or inflammation of the parenchyma of the uterus; metritis micosa, or endometritis, inflammation of the internal mucous membrane of the uterus; and metrophlebitis, or inflammation of the veins and lymphatic vessels of the uterus.

Metritis parenchymatosa is characterized by the following symptoms: More or less violent aching, pressing, boring, throbbing, or sticking pains deep in the pelvis, towards the small of the back, extending into the round ligaments or to the labia, sometimes even down to the knees along the ischiadic nerve, and generally accompanied with a troublesome sensation of heaviness in the womb. The pains are aggravated by pressure, motion, concussion of the abdomen, efforts to urinate or expel the faeces, internal examination; they frequently exacerbate like labour-pains; the patient is most comfortable in a recumbent posture, with her limbs drawn up. When the pain extends over a large surface, the peritoneum is generally involved. The uterus can be felt as a round body, sensitive to pressure. The examination by the vagina and anus is generally very painful; the vagina and the vaginal portion of the womb feel hot, swollen, dry; the latter is higher up in the pelvis.

According as the anterior or posterior wall of the uterus is affected, the rectum or bladder is sympathetically involved; the evacuations and the emission of urine are painful; there is tenesmus, strangury, ischury; sometimes stinging pains in the mammae, headache, vertigo, buzzing in the ears, delirium, convulsions.

The fever sets in simultaneously with the local symptoms, transitory chilliness followed by heat, with full, irritated, tight pulse, whitish coating of the tongue, violent thirst, red urine.

When a considerable portion of the peritoneum is involved, the pains extend over the larger portion of the abdomen, with meteorism, nausea, vomiting, small and intermittent pulse, disfigured features; in this case the disease runs a rapid course, and frequently terminates fatally. When the vaginal portion is alone inflamed, there is a deep-seated pain in the pelvis.

All these symptoms are less violent when the uterus of an unmarried female is the seat of the disease; they are more violent and lead to miscarriage in the impregnated uterus, or shortly after parturition.

§ 236. The disease runs its course in from seven to fourteen days; chronic metritis has an indefinite duration. Recovery takes place with the critical phenomena which usually occur in fevers, and abatement of the topical phenomena, particularly with critical discharges of blood or purulent mucus. Metritis may likewise terminate in partial recovery, exudation, suppuration, gangrene; both the latter terminations are fatal.

Causes: The uterus is most disposed to inflammation at the time of the menses, during pregnancy, childbed, at the critical age.

The disease may be occasioned by either of the following causes: Rude management during confinement; pressure and contusion during parturition; irritation of the uterus by drugs, such as turpentine, crocus, sabina; retention of the placenta, of coagula. suppressed menses: taking cold by exposure of the feet or abdomen; inflammations of adjoining organs; injuries and retroversion of the uterus; emotions at a period when the action of the uterus is intensely excited, etc.

The prognosis depends upon the state of the uterus, upon the extent of the inflammation, and upon the more or less complicated nature of the disease. The danger is very great when the impregnated uterus is inflamed and when the peritoneum is involved, when there is great prostration, recurrence of chills, distortion of the features, small, intermittent pulse, fetid discharge from the vagina.

§ 237. Nux vom. has, in my hands, proved a most efficient remedy in metritis, whether the fundus, neck of the uterus, the anterior or posterior surface of the uterus was the seat of the inflammation. In some cases, where the fever commenced with a violent chill followed by great heat, with frequent and tight pulse and violent thirst, I have given Aconite previous to Nux vom. This remedy is indicated by the following symptoms: Aching pain over the ossa pubis, aggravated by pressure and an internal examination, violent pains in the small of the back and loins, constipation, or hard stools accompanied by burning-stinging pains, painful micturition or retention of urine, stinging and bruising pain of the abdomen during motion, cough and sneezing; increased temperature and swelling of the os uteri, attended with pain in the vagina; exacerbation in the morning-hours.

Belladonna is indispensable when the sensation of heaviness and dragging in the abdomen, which frequently increases to a painful pressing downwards, is excessive, accompanied with a stinging-burning pain over the ossa pubis, with pains in the small of the back as if it would break, stinging pains in the hip-joints which bear neither motion nor contact. (Aconite and China may likewise prove serviceable for those symptoms.) If the inflammation should set in after parturition,and the lochia should be suppressed, with retention or attachment of the placenta, or if an ichorous, fetid fluid should be discharged from the uterus, with violent burning and feeling of fulness in the vagina, Belladonna is specifically indicated.

Next to Belladonna we ought to mention Mercurius solubilis, which is indicated by a sticking, aching, or boring pain. Rhus t. and Bryonia may likewise sometimes be useful.

An inflammation occasioned by violent chagrin, after parturition, yields most speedily to Chamom-lla. In such a case the lochia are generally more profuse, or, if white, change again to bloody, and even increase to metrorrhagia, with coagulated dark and black blood. For metritis occasioned by the abuse of Chamomile tea, Nux v., lgnat. and Puls, are the best remedies.

China is a distinguished remedy after heavy labor, if the patient should have lost much blood, or if an excessive quantity of milk should be secreted, occasioning great debility, and developing a metritis in consequence. A characteristic indication for China is the discharge of fetid, sanguineous, purulent matter, which corrodes the parts and debilitates the patient.

An unexpected joy, during confinement, sometimes develops a condition of things bordering on metritis; this is most easily relieved by Coffea.

If metritis be attended with metrorrhagia, one of the remedies indicated for metrorrhagia will be found useful; if puerperal fever should supervene, one of the remedies indicated for that affection will be found suitable. ,