often the sooner the bowels are " locked up " by them, the better. But on the other hand, this locking up is as often a mischievous practice. You only check, as by an insufficient dam, the flow, to have it break out again more uncontrollable than ever. The decision hero as to the best course to pursue is generally very perplexing to the physician with his first patient. It is now, therefore, that a careful consideration of the causation and the nature of the diarrhoea has so much to do with the management of the flux, for success will depend more upon a proper judgment of how the trouble bi'gan rather than how it happens to continue.

Take, for example, the diarrhoea common with teething children. I have often suffered from toothache myself, with the invariable result of finding that an aching tooth can seriously disturb the stomach. It is not the pain alone whicli takes away the appetite, furs the tongue and brings on a qualmish dyspepsia, for the divisions of the trigeminus are allied through more than one branch with the gastric nerves, so that not only a frontal headache accompanies an irritated gastric mucous membrane, but, vice versa, a painful tooth will often in adults check the flow from the follicles in the stomach. It would seem, therefore, that we may infer correctly that the reflex irritation produced by one or by several teeth pushing their way through the narrow bony bed in the undeveloped jaw of infancy, may be severe enough to suspend the gastric secretion almost completely. Should this occur, the milk will soon be vomited with a very sour smell, and simultaneously with this symptom, you have plain evidence that something is producing pain and disturbance in the bowels. Irregularities of the local i temperature, the unfailing signs of radiated intestinal irritation, first manifest themselves. The feet and hands turn cold and contract.the head becomes hot and tlia face streaked, and soon the vomiting is succeeded by an evacuation which has the same kind of fermented odor which is perceptible in the matter ejected from the stomach. There are other characters besides the odor to be noted in the passages similar to what comes from the stomach, such as the collections of undigested casein, but we would direct special attention to the sour smell for this reason. The gastric juice is itself acid, and hence, some may think that the taking of mineral acids to relieve the dyspepsia of a sour stomach, or to act as astringents in diarrhoea, is somewhat after the Hahnemannic principle; but in reality it is just the reverse. Though the gastric juice is normally acid, nothing that it is mixed with should sntell \ sour; that is a certain indication of fermentative change caused by the deficiency, and not by the excess, of the proper acid. On the other hand the intestinal juice is alkaline, but still as effectual a preventive of fermentation as is the gastric juice, so that sourness of the digester is equally au evidence of a great deficiency in the normal secretions of the bowels, and due to the same cause, namely, arrest, through reflex irritation, of the functions of the digestive glands. The way to treat such a diarrhoea, therefore, will differ in several respects from the treatment of almost any case of diarrhoea in adults. The first thing to do is to put a 6top to the nerve irritation, and for this purpose we may adopt several different procedures. One of the oldest and most familiar is scarification of the gums, an excellent measure if done when needed, and that is, only when there is hyperemia of the gums. If they are swollen and hot, a few drops drawn from them by the prick of a lancet, relieves them greatly, on the principle that local bloodletting is one of the most effective vascular and nervous sedatives that we know

of. We are utterly without an explanation of this fact, but the child is quieted in just the same way that the dreadful spasmodic dyspnoea of a thoracic aneurism is sometimes marvellously quieted by the trivial bleeding from two or three leeches applied at the top of the sternum, or the pain of pericarditis by the same at tbeprecordium, or the irritable stomach in acute hepatitis by the same at the epigastrium, or the headache of meningitis, by the same applied to the mastoid processes. There is no support afforded by these clinical facts to the advocates of general bleeding, for the amount of blood taken in the case of anpurism, for instance, is too little to produce the slightest change in the sac or in its contents. But the cases where lancing the gums is called for are comparatively few. We should remember that the greatest aching usually accompanies the growing of the teeth through the bony canal, before they begin to encroach upon or irritate the gums at all, and hence, if the gums are neither red nor tumefied, you had better not attempt the operation, for it will be of little avail. The laity, and some physicians even, imagine that cutting the gums is for the purpose of making a way for the teeth to grow out; but a young gentleman, ambitious for a moustache, might as well prick holes in his upper lip to help the hairs appear, as the practitioner to think that a soft mucous membrane can really delay a growing tooth.

We have, however, in the bromide of potassium an agent which possesses an incontestable power of arresting reflex irritability. Its free administration lessens even normal reflex movements, as in winking; and if you are annoyed with excessive excitability in the fauces of patients whom you wish to examine with the laryngoscope, you can generally soon obviate this hj giving half a drachm of the bromide. While the mure the reflex irritability is morbid in its degree, the mure effective will this agent be found. It is not an anodyne in the usual sense of that term, for I doubt if it relieves pain at all; but it certainly can prevent, hy its paralyzing effects upon reflex processes, the toothache from disturbing travels to distant nerve distributions. Whether this theory, however, l>e correct or not, I nevertheless believe that I have found this drug exert a positive remedial action in the diarrhoea of dentition, given in five-grain doses every three hum's or so, and my only explanation therefor is, that the gastric secretory nerves are allowed by it to return to their own business through its freeing them from the influence of the dental irritation. I need only mention also, that it is of special use in those numerous oases where slight irritations are apt to induce infantile convulsions or spasmodic croup. Another effective agent for calming the nervous symptoms, and thus restoring the stomach and bowels, is cold to the head. 1 Ii»tc found the employment of Potters' hydrostatic hag, filled with enough ice-water to make a comfortable cushion for the child's head, act as nicely in checking restlessness and inducing sleep, as the most approved medicinal prescription. Cold water applied to the head directly, is objectionable for many reasons, so that if you cannot procure a water-tight receptacle like the one just mentioned, I would recommend your adjusting bottles of ice-water about the head, which should be protected first by a thin napkin or handkerchief. When you tnke into consideration the great disproportionate development of the brain and the nervous system in children, you will readily pereei" the need there is for early attention to the deranged central circulation which is so apt to supervene in them, and which soon of itself must react upon the gastric and intestinal disorder. The paralyzing effect on reflex action of immersion in warm water is doubtless also the explanation of the benefits found from' the use of the warm bath in these cases.

I am, however, in these remarks, anticipating the fulfilment of one indication which in most instances should take the precedence of all the rest. If you were | called to treat a case of poisoning by some irritant, you i would think first of freeing the stomach or bowels as | soon as possible of the material which is inflaming the mucous surface, before you would administer anything else. But food once fermented in the alimentary caual is unfit to stay there a moment beyond it is possible to get rid of it, because it not only acts as a local irritant, but by its presence it arrests any proper diges-1 tion of matters taken subsequently, as it induces fermentation in them also. The reason why even the briefest attack of the kind seems to tell so quickly upon the muscular tone, the color and the strength of the little patients, is doubtless because, for the time being, all real feeding is arrested. The alimentary canal appears to stop renewing the supply at once, and after one day's continuance of the trouble, as great a change manifests itself in the child's condition as if it had been actually deprived of nourishment for the same number of hours. I have, therefore, never seen cause to regret my beginning the treatment of such cases with the nursery remedy of castor-oil, though I have seen caise to regret not doing so from a mistaken confidence in the previous purging having disposed sufficiently of the offending matters. We are apt to be too much influenced by the activity of the diarrhoea towards stopping the flux at once, lest it exhaust the patient. But it is scarcely possible to irritate the patient's bowels with the oil, however given, in comparison with the irritation which fermented cheese is capable of producing; and so often will the whole trouble promptly subside after a single good operation by this medicine, that I am inclined to recommend your beginning the treatment of infantile diarrhoea with it very much as a routine prescription. After it has acted, you may rely on your other measures with much more confidence than you have reason to entertain without it

Another indication, present from first to last in the course of the complaint, is to supply the deficiency of the gastric juice by artificial substitutes. You cannot do any harm by pepsin and a few drops of muriatic acid; but you may be doing thereby just what is needed to prevent a repetition of the abnormal change in the food ; and when there is much gastric irritability, the common addition of bismuth to pepsin is certainly indicated. As the friends generally dread too many prescriptions, and we are being constantly warned by a public, which many of our own teachers labor to inform, that it has been greatly overdosed by our unen lightened predecessors, you had better say that pepsin is no " medicine" at all, but ahelp to digestion derived from calfs or pig's stomach. The derangement of the digestive processes of course demands also that for a time the stomach be allowed to do less work. The heat of the mouth and fauces (especially after vomiting) increases thirst, on the other hand, so much that the child is likely to be nursed or fed altogether too often. Drinks of cold barley or rice water therefore, in spoonful doses, or equal parts of cold milk and lime water, are very properly recommended in your text-books, for the reason that with no real appetite, the patient should be relieved with drinks which will tax the stomach the least; otherwise, your best prescriptions may wholly fail.

Should you now find, say on the second day after beginning with the measures recommended so far, that the diarrhoea continues, and that the discharges arc more watery or frequent, I would then begin with a

combination of familiar correctives which I have found best administered in the form of a prescription given by Dr. West in his book on children's diseases. I will have something more to say on the action of rhubarb with alkalies in the diarrhoea of adults, but I may remark, that having once held the children's class in one of our city dispensaries, I made and recorded the results of comparative trials of various reported prescriptions for diarrhoea. The attendance during the hot months became inconveniently large, and I adopted the plan of giving the patients alternately as they came in, West's rhubarb mixture, and one or other of the usual mixtures containing sulphuric acid and laudanum, chalk mixture, ipecacuanha or astringents, notes being taken of each, and a promise exacted to report again. After six weeks' experience, the superiority of the rhubarb prescription appeared to me so certainly demonstrated that it has influenced me in treating summer diarrhoea in young and old ever since. West's prescription is this: 1} Magnes. Sulph., 3 i.; Tr. Rhci. 3 ij.; Syr. Zingiberis, 3 i.; Aq. Mentha?, 3 ix. M. 3 i. ter die for children a year old. You will note that there is no opiate in this mixture, and you should bear this in mind, for if you can check a diarrhoea of this kind without this drug, by all means try to do so. Instead of thinking of opium first, ulways think of it last, when the bowel trouble has maldigestion as its beginning, because opium is invariably a hindrance in children to the proper secretion of digestive juices. The indication for opium arises only when the discharges not only continue profuse, but also are evacuated with a suddenness which betokens excessive peristaltic action. In such a case the addition of a drop of laudanum to each dose of this mixture will generally suffice, for I prefer to give the sedative only in this combination, as the one least calculated to neutralize its interference with the digestive secretions.

(To be continued.)

©ttninal Communications.

THE RELATION AND HEREDITARY TENDENCY BETWEEN INEBRIETY" AND EPILEPSY.

By EDWARD C. MANN, M.D.,

MEDICAL StTPEBIMTESDENT 8TATE EMIGRANT IXSANE ASYLUM, WARD'S ISLAND, MEW YORK.

(Bead before the meeting of the il American Association for the Curo of Inebriates," held at Philadelphia, Sept. 26, 187G.)

Vkry little attention has yet been paid to the relation and hereditary tendency existing between inebriety and epilepsy, although a very close relation undoubtedly exists between them. Careful examination reveals a large number of persons affected with epilepsy whose parents or ancestors have been addicted to intemperance. There is a very close analogy existing between the paroxysms of a dipsomaniac, where there is often a prodromic stage of nervous disturbance which may incapacitate the patient for mental labor, and the convulsions of an epileptic, whose paroxysms of intense nervous excitement are generally preceded by the "aura epileptica;" the difference being that in the former case the paroxysm lasts for weeks perhaps, while in the case of the epileptic it lasts hut a few moments. As we often see the two diseases existing in the same person, it becomes impossible not to infer a similarity of origin. We have in both instances accumulated and pent-up nervous force or irritation, which finally expends itself, in the one case in the unrestrained indulgence, in the irresistible impulse to indulge in alcoholic stimulants, and in the other in tli3 convulsive movements of epilepsy. There would seem beyond all doubt to be a correlation of force which results in the mutual convertibility of these two diseases. It is not an unusual case to rind in the various members of different generations of the same family different phases of the neuroses, such as insanity, epilepsy, phthisis, chorea, or inebriety, showing beyond all doubt correlation of morbific force in hereditary diseases. I believe most firmly that the morbid condi- | tion of nerve element, or morbific force induced by inebriety, is indelibly impressed upon or is transmitted to the ovum at the time of conception, and that this morbific force lies dormant in the system until developed by an adequate exciting cause, and that the hereditary neurosis thus often skips a generation, leaving no appreciable manifestation of its existence in the intermediate generation. When this morbific force does manifest itself, next to the transmission of the predisposition to inebriety comes unquestionably epilepsy. From my experience, the children or grand-' children, while infants, are generally affected with convulsions, which may prove fatal, but more often j tend to assume an epileptiform type, as the child ad- j vanccs in years. I have repeatedly noticed, in patients: who did not have complete epileptic seizures, epileptic' ■vertigo, which passed off almost instantly, butjwhich for tin time evidently abolished consciousness partially if not entirely. The brain of such children is often morbidly active, and too high pressure in education, or an unnatural forcing process during the formation period of childhood, often results, especially in girls, during the period of constitutional evolution—a time at which the organism is under physiological conditions that predispose to pathological states—in disturbances primarily of the organs of respiration, circu- | lation, and digestion; and secondarily, in the produc- I tion of hysteria and epilepsy by over-stimulating a 1 brain already morbidly active and predisposed to disease, upon the application of even comparatively trifling exciting causes. Again, consanguineous marriages may be the connecting link between inebriety and epilepsy. I have known cases in which the intermarriage of blood relations, where there was inebriety that had lain dormant for one or two generations, has resulted in the old hereditary neurosis reappearing in the form of epilepsy in the offspring. It is a curious fact, also, that the sons bom as the result of the union of cousins in marriage appear to have a strong tendency toward inebriety. The only explanation which I can offer of such cases is. that it is probably the development of the latent morbific force residing in th J constitution of the parents, who have a common ancestor, which has been lying dormant for one or two gjnerations, and which is developed in the offspring as the result of the consanguineous marriage. I think that such latent morbific force and hereditary disease is far more common than we generally suppose, and that in many cases both insanity and inebriety are only tin expression of latent disease, elicited by external, accidental causes, rather than as the result of mural or physical cames. to which they are attributed both by the laity and by the profession.

The epileptic convulsions occurring as the result of inebriety depend mainly, I think, upon a two-fold cause, which operates in the production of a morbid irritability of the medulla oblongata. Whether this be a transitory or a constant state, I think, is an open

question. I am inclined to think that it is a cmtttnut state, which may, however, for the production of tl\e epileptic paroxysm, require the additional stimulus of transitory cerebral irritation to be transmitted to the medulla oblongata, and perhaps the sympathetic. The two-fold cause which has appeared to me to operate in the production of what I take leave to term ahoholic epilepsy, consists, first, in hyperemia of the brain, which causes symptoms of irritation tine to increased excitability of the nerve filaments and ganglion cells of the brain, which, by transmitting to the medulla oblongata a morbid irritability, results in epileptiform convulsions. Second, a state of cerebral anaemia which also induces a morbid irritability of the medulla by causing arterial ana?mia. Finally, I believe that as a result of inebriety we may have epileptic convulsions occurring merely from the state of nervous irritation produced in the medulla and at the base of the brain, which excites the motor nerves, from the poisonous and improper character of the blood plasma produced by the presence in it of alcohol. This I believe is often the case without either very marked anremia or hyperiemia of the brain. This appears reasonable when we reflect upon the fact that the amount of blood going to the brain constitutes alimit one-fifth of the whole bulk of the blood. Consequently any poisonous or injurious change in the condition of the usual supply of blood must be very apparent in the encephalic condition, and produces cerebral irritation incompatible with the performance of healthy function.

There is in epilepsy, and more especially in epileptic insanity, a period which sometimes precedes and sometimes follows the epileptic paroxysm, in which often occurs an abrupt and complete change in the moral nature, so that we often witness the change from a sober, honest, and industrious to a dissipated, negligent, and lazy man. These attacks often recur periodically in the course of epilepsy, associated with more or less maniacal excitement. During these periods of moral alienation there has often occurred in patients under my charge an irresistible desire to indulge, in alcoholic stimulants to excess, so that for the time the patient, if not restrained, would pursue a course of inebriety, his reason seeming powerless to conliol the temporary dipsomania. There is still another class of cases in which the moral insanity takes the place of the epilepsy or epileptic mania, as the case maybe; and these cases are also very prone, according to my experience, to be addicted to inebriety, if the opportunity of gratifying their morbid impulse occurs. In my observations, and in my study of insanity. I am continually called upon to witness its connection with disease, and more particularly with the hereditary diseases; and 1 have come to believe, as I have endeavored to show, that inebriety and epilepsy are mutually convertible diseases. They both dc|K.'ud upon II"' morbific force before alluded to, which may remain latent in the nervous system for a long time lictwewi the intervals of its manifestation; and although there is a certain dissimilarity of the symptoms between the two diseases, it does not at nil follow that they art owing to different causes. The fact of the-hemlitary disease appealing in different forms in menibew of the same family, and passing from one form 10 another, leads us to positively infer a correlation of morbific force which leads to this mutual convirtibility, which includes not only inebriety und cjrflcpfT, but also, I think, phthisis, skin disease, insanity, anil scrofula, and perhaps rheumatism and gout In my asylum practice 1 have had ample proof of this, in th' existence of the different phases of hereditary dtse«»

[ocr errors]

and their alternations, both in the same individual and in various members of different generations of the same family. With regard to the treatment of hereditary diseases, which I do not propose to take up in this paper, the chief indications, I think, point to hygiene and to wise marriages. As we have seen that the symptoms of constitutional disease are manifested soon afterbirth in convulsions or some affection of the nervous system, we must turn our attention to the nourishment and education of the child, and endeavor to exclude everything prejudicial to its future mental and bodily health. By such attention to hygienic rules are we, as physicians, to endeavor to secure an exemption in the rising generation from these hereditary diseases, so far as we may; and it is certainly our duty to aim at the eradication and stamping out of hereditary disease, which, if it is accomplished in the future, as we hope it may be, will complete the entire round of the possibilities of preventive medicine.

Epilepsy occurring in offspring as the. result of inebriety in the progenitors is complicated with defects or disorders of the mind in various ways, and the manifestations may with propriety, I think, be classified as follows: 1st, epileptic idiots whose intellectual faculties have never been developed; 2d, epileptics who are imbecile or demented; 3d, epileptic maniacs, who, without obvious disorder of the mind, when epileptic fits are coming on. are irritable, morose, malicious, and dangerous, and sometimes perpetrate fearful crimes. In some instances the mental disorder takes the form of a paroxysm of acute mania, coming on suddenly. 4th. Epileptics whose intellects are not impaired.

Pathology.—The pathology of the production of. epilepsy in the offspring of intemperate parents is very obscure. The condition of the mother during gestation, if abnormal, as in inebriety, cannot fail to interfere with the proper nutrition of the cerebral tissue of the foetus; and it is in this way, I think, that during embryo life the brain of the infant often undergoes pathological changes, which induce both deficient moral power and epilepsy. It is certain that any pathological state whicli destroys the equilibrium of the functions of the organs of the mind, producing depression of some functions and excitement of others, cannot fail to produce in the children of such parents an ill-balanced and defective state of the nervous system, disposed to take on diseased action. It is probable that there exists in such children a state of the cerebral vessels which interferes with the uniform and healthy interchange of nutritive plasma, passing from the vessels to the brain cells, and of the fluid cell contents in a state of degenerative metamorphosis, passing from the brain cells to the vessels. This state of the cerebral capillaries induces a morbid activity of the cerebral cells, which is in all probability the determining cause of the epileptiform convulsions from which such children suffer. That the functional disturbance resulting in epileptiform convulsions in such children may be due to diverse causes—that is, to uniemia as well as hyperremia—I have proved to be a fact, as I have found in two or three instances the brain and membranes completely bloodless in children who died in hospital in the midst of convulsions, ulthougliT think that the general rule in such cases is more often to find an excessive quantity of blood present.

After numerous dissections of the brains of epileptics, both in cases resulting from intemperance and in cases occurring under ordinary conditions, Foville and Audral agree in their testimony that there is no special

lesion attending this malady. Andral insists upon tin; necessity of distinguishing between those cases in which death occurs in the interval and those in which the patient dies in a fit, as in the latter class of cas< s there will be congestion of the cerebral vessels, which is the effect and not the cause of the fit, as some might suppose. I have found that among the cases coming under my charge in which inebriety in the ancestors could be clearly traced as a predisposing cause, very few, if any, of the patients had been healthy persons previous to the accession of the disease. That in a great many instances, especially in women, hysteria and other nervous affections had existed previously, and that functional derangements of the nervous system had been of frequent occurrence since infancy. The pathological appearances which have been found by Schrocder van der Kolk in the medulla oblongata would seem to show that epileptic convulsions depend generally upon an increased afflux of blood to the medulla oblongata; although, as I have previously stated, it is a fact which has been proved by Kiissmaul's and Tenner's experiments, by cutting off the arterial blood from the brain, that arterial anaemia is also a cause of epilepsy. Schroeder van der Kolk found that in the medulla there generally existed a dilatation of the arterioles and capillary vessels, with thickening of their coats. In the cases where arterial ancemia of the medulla is the cause of the epileptic convulsion, it is probably the effect—when it occurs in the inebriate—which the alcohol exerts in producing a transitory spasm of the muscular fibres of the arteries, with consequent arterial ana?min.

Prognosis.—In epilepsy occurring in the inebriate himself, as the result of the morbid irritability produced in the central nervous system by his excessivo drunkenness, we may reasonably expect an ultimate cure if there is no structural change in the brain which has resulted from the course of inebriety. I have had three such cases of recovery in patients under my charge. On the other hand, when the disease occurs in the offspring of intemperate ancestors as the result of the hereditary tendency, it depends more certainly upon structural disease of the brain; and, as a general rule, the more frequent the recurrence of the epileptic convulsions in such patients, and the deeper the impression which they leave behind them, the less hope do I entertain of ultimate recovery.

OBSERVATIONS ON THE PHYSIOLOGY OF MENSTRUATION; WITH NOTES OF A CASE IN POINT.

Br JOSEPH WORSTEK, M.D.,

NEW YORK.

TnE contributions of Dr. Kraus, of Vienna (Austria), to the physiology of the prostate gland, afford sucli decided evidence of the importance of normal function of that organ to sexual competence, and establish such an undoubted homology between the sexual processes of the male and female, as indicated by the observations I shall presently describe, that I am emboldened to give a summary of his conclusions before entering upon subject matter of my own. The points established by Dr. Kraus arc:

1. As long as the seminal fluid remains within the testes, vesicles, and other seminal passages, it is colorless, scentless, and has an appearance very similar to that of fresh honey while deposited in the comb. In this state its reactions are neutral.

2. It is only after it has quitted the passages and

arrived in the urethra that it acquires its white color and its peculiar faint smell.

3. During its passage through the prostatic portion of the urethra the prostate gland pours out its fluid, which colors the semen white, and confers upon it the property of coagulating on exposure to the atmosphere. As would be inferred from the last statement its reaction is now alkaline. On the other hand, semen taken from the vesicles is not subject to coagulation on exposure to the air, but continues transparent, colorless, and odorless.

4. In the absence of the prostatic fluid, the spermatozoa of the mammalia cannot live in the mucous membrane of the mammalian womb ; but, with its assistance, they may retain their vitality for from thirty-six to forty hours in utero.

Dr. Kraus professes to have conducted his experiments very carefully, and to have repeated them with sufficient frequency to insure a high degree of certainty to his induction. I cannot profess to have observed with frequency as concerns the homologous functions in the female; for only one case in all my practice has ever off.;-ed the necessary opportunities for exact observation, and, on looking over the literature of the subject, I find no data to assist in forming a conclusion. For the present, then, so far as I know, our views of the relative functions of the ovaries and the womb in menstruation must rest on the testimony of a single series of studies.

The case was one of uterine inversion and consequent protrusion from the vagina; that is to say, the womb was completely turned, the body of the organ having descended through the cervix in such a manner that its internal surface was presented externally between the labia. I made repeated attempts to reinvert the organ, but the work was one of slow degrees, and had to be continued at intervals during four successive menstruations, as after each operation a lapse of some days was required to repair the damage from laceration, by pressure and other means employed to correct the displacement. Having prepared to operate one morning, with the hope of finally disposing of the problem, I observed, on exposure to the light, a deep red blush suffusing the whole surface presented to inspection, which consisted of course of the lining membrane of the organ. On making the necessary inquiries, and consulting my notes of the case, I found that the patient was within four days of the menstrual period; for during the treatment her catamenia had been regular, and the calculation could be readily and accurately made. I consequently desisted from operating, and observed the progress of the infra-uterine blush from day to day. It continued to thicken until it was about four lines deep, and had the appearance of a flattened mass of currant jelly retained in place by the decidua. Closer scrutiny revealed the fact that the mass "was, in the main, an undoubted product of the utricular glands, and hence a true uterine secretion.

On the fourth day after the appearance of the uterine blush the jelly commenced to break up, and a thin, scanty, pink fluid began to escape from the orifices of both fallopian tubes. The proper menstrual discharge now commenced, consisting of course of the disintegrated uterine blush, commingled with the pink fluid oozing from the fallopian canals. The latter did not constitute more than a hundredth part of the whole discharge. I had, during the progress of the c.use, four opportunities for observing the process, and in neither instance was there any material variation from the details I have described, either as respects tlie precession by four days of the uterine blush, or aB respects the relative quantities of fluid generated in

utero and discharged from the ovarian aqueducts. Actual volumetry was impracticable under the circumstances, and I only express a judgment from ocular data when I state the ovarian to the uterine product as 1 to 100. What special part the infra-uterine secretion plays in, or in what manner it promotes, the phenomenon of fertilization, must remain as yet an undecided question; but when it is considered that the prostate gland in the male is the proper homologue of the womb in the female, the inference is, I think, a fair one that the uterine secretion acts as a menstruum, protecting the ovum, and that its al>sence would be followed by infertility. In the egg-laying animals, without exception, so far as I know, the oviduct supplies the menstruum, which is secreted by special series of glands near the junction of the tubes. In the rodentia, as I am informed by a gentleman who has made a careful study of their development, the womb is cleft longitudinally by a well-marked fissure during the youth of the animal, and commences as an enlargement of the tubes at their junction and a little above; while in the higher vertebrates, even at maturity, there is considerable variation as concerns the distinctness with which its bilateral structure is marked. The most important aspect of these observations, particularly to the practitioner, is, however, that they may serve as the basis of an intelligible theory of the various pathological states with which the gynaecologist has to deal. As a matter of fact, ray observation has been that most forms of uterine displacement have their startingpoint in catarrh. How catarrh has its origin, and its importance as a derangement of function, arc things readily appreciated with a correct conception in mind of the fundamental importance of the glandular structure concerned in normal menstruation. Hyperemia ensues, the uterine tissues become loaded and engorged with blood, the organ is distended and enlarged, and some form of displacement follows as a natural consequence. Anteversion is, I apprehend, rather the most common aspect of the lesion. Now, one of the necessary accompaniments of hyperemia is distention of the arterial feeders of the hypereraic organ, with more or less contraction or obstruction of the venous system, by pressure partly, and partly, I am inclined to think, by an original act of nature resulting from the tonic influence of irritated nerves on the coats of the venous vessels. The anteversion, by doubling the venous tubes upon themselves, still more materially obstructs the circulation, and so perpetuates the inflamed state. Ulceration, as one form of resolving inflammation, usually follows, if the patient is a healthy one. If not, the exudation, in place of being resolved in this manner, may take the form of a tumor, runcerous, or less malignant, depending on constitutional bias. It cannot be too firmly held in mind by practitioners that obstruction of the venous circulation, however slight, is, if long continued, always fraught with peculiar danger to the tissue in which it occurs: since the various products of decomposition that are ordinarily disposed of by oxidation become accumulated as local materia morfn, and must necessarily give a more or less malignant type to the product of the exudation.

It follows, then, as a matter of course, that the restoration of the venous circulation to its normal function is a condition precedent to the healthy resolution of the hyperemia, or of any pathological product in which the consequent exudation may have resulted, cither hy suppuration or by absorption. In anteversion, incision peculiarly favors this essential condition, by straightening the flexed vessels, nnd by temporarily relieving the arterial pressure. The rationale of the operation

« PreviousContinue »