A practical treatise on the diseases peculiar to women, illustrated by cases. Derived from hospital and private practice / by Samuel Ashwell.

  • Ashwell, Samuel, 1798-1857
Date:
1844
    A PRACTICAL TREATISE ON THE DISEASES PECULIAR TO WOMEN. PATHOLOGY OF FUNCTIONAL DISEASES OF THE UTERINE SYSTEM. I PROPOSE to comprise the diseases peculiar to women in two divisions. In the first, I shall place the functional ; and in the second, the organic sexual diseases. A few preliminary observations on the pathology of each of these classes may explain and illustrate what is subsequently to be advanced. The functional are more complicated and less easy of accurate diagnosis than the structural diseases. It is often difficult to assign a precise locality to the former, as few of them are exclusively confined to the uterus, but exert, through the medium of the ganglionic system of nerves, an extensive constitutional influence. The difficulty is not so great in de- termining the seat and degree of an organic lesion. A functional disease is one which is dependent on deviation from the natural or healthy action of any part of the organization, indicated by symptoms during life, which, after death, are found to be uncon- nected with discernible changes of structure. Contrast such a disease with cancer or scrofula, essentially organic maladies, and the difference is striking. In the latter, any part which is attacked will suffer conspicuous changes of its texture and con- B
    y THE PATHOLOGY OF formation. Functional uterine affections are mainly dependent on the derangement of menstruation; such, for instance, as chlorosis, amenorrhcea, and dysmenorrhea, profuse menstrua- tion, menorrhagia, and in some measure leucorrhea. In all, there is a deviation from the standard of uterine health. In chlorosis, amenorrhcea, and dysmenorrhcea, there is scantiness of the catamenial secretion and pain; while in menorrhagia and its varieties, there is profusion and excess; results indica- tive, probably, of marked difference in the nature of the primary affection, both of the organic nervous system and of the circu- lation. In health, the catamenial secretion is generally of the colour of the venous blood, perhaps slightly more florid, but less viscid and without the power of coagulation, never separat- ing, as blood does, into its component parts, however long it may be kept. Ordinarily, it occurs once in every lunar month, and without pain, the process continuing for three, four, or five days, and the excretion amounting, in quantity, to three, four, or five ounces; the fluid having a faint and sickly, and occa- sionally an offensive odour, quite different from blood, and but little disposed to putrefaction. There is considerable variety in these particulars. In some women, menstruation is performed more, in others, less fre- quently. In one individual, the amount of the secretion exceeds, while in another, it falls short of the usual quantity, differing also in its quality or character. So far, however, as my obser- vation extends, at least within certain limits, regularity in the periods of menstruation appears of greater importance than either the absolute quantity or quality of the fluid. Nor must it be forgotten, in estimating the influence of menstruation on the health, that the catamenial secretion is peculiar to the fe- male of the human race. There is no analogous secretion in other animals. Their uteri are neither so thick, so capable of development during pregnancy, nor so vascular; nor in any of them, not even in those species of apes which walk nearly in the erect position, have we any proof that the mucus discharged during the cestrum, is furnished by the uterus; it is thought to be almost entirely a vaginal fluid. Menstruation may with truth be said to be a function of the highest importance to women; so intimately connected with
    # the whole of their economy, that its partial or entire suppres- sion, may and does often induce serious and sometimes fatal disease. It might have been supposed: that there. would be. struc- tural or physical changes. in: the uterus, concomitant with these affections. But, it is, not.so;) for, if the undeveloped organization of the uterus and ovaria, in chlorosis, be excepted, there is little discovered by post-mortem examination, to account for these derangements. ‘ Even in protracted. and incurable menorrhagia, which oc- casionally destroys life, by giving rise to dropsies and other secondary diseases, if there have been no morbid growths co- existing, the, uterus will not, yield evidence of much structural disease. An increased softness and paleness of its parenchyma and lining membrane, will generally comprise’ the whole’ of the visible organic change. ._The same may be said of amen- orrhcea and dysmenorrhea... Beyond hypertrophy and. conges- tion in the latter affection the organization generally continues unaltered. | | | The local symptoms accompanying these affections, excepting dysmenorrhea, are usually slight and obscure. The consti- tutional derangements, on the contrary, although functional and Sympathetic, are severe and extensive. Thus, it is common in chlorosis, amenorrheea and dysmenorrhcea, as well as in me- norrhagia, but particularly in the former, to. have marked dis- turbance of the nervous, vascular, respiratory, and. digestive systems ; pointing to the fact, that the womb and its appendages derive their nervous energy from, the, organic nervous system, while the external genitals derive their supply, almost. entirely from the spinal marrow. Thus are the internal and external organs of re-production, in great measure, functionally indepen- dent of each other. Even paralysis of the lower extremities and external organs may exist, without a similar want of power in the conceptive faculty of the ovaries and, uterus. The proximate cause of these functional maladies has excited a good deal of controversy. Chlorosis ought to be attributed to an impoverished circulation and undeveloped ovaries. Dr. Hamilton, seeing that costiveness frequently precedes and accompanies chlorosis, erroneously, I think, regards this Bie
    on the general health, and says “that castrated and spayed animals suffer certain changes of constitution, but they retain the enjoyment of perfect health. Reasoning from this analogy,” he says, “I do not understand how the influence of the female occasion retention of the menses, or should induce chlorosis.” and spayed animals, puberty was either already present, or on the contrary, puberty is absent when it ought to exist, and the subsequent evils are not so much the result of the absence or abstraction of the genital organs (for in Mr. Pott’s celebrated case the woman lived and did well after the removal of the ova- the costiveness, equally with the chlorosis, is one of the results. This author overlooks, in the conservative effects of life, when important organs have been taken away, the injurious and sometimes fatal consequences of such a congenital deficiency of vital power, as shall permit the reproductive apparatus to re- main partially or entirely undeveloped, and who can measure the amount of the injurious effect? The examples, therefore, torpid and inactive state of the generative organs, excepting in those cases where, from a variety of causes, marked derange- ment of the uterine circulation exists. Dysmenorrhea, as a functional disease, appears to be most frequently induced by irritation more or less acute, by a low inflammatory state of the uterine mucous membrane, or by an active, or even slow con- gestion of the uterus. Menorrhagia and profuse menstruation may arise from different conditions of the capillaries, which are sometimes over-distended from repletion; and at others, having lost their tone, permit the passive exudation of their contents.
    BARE ch FUNCTIONAL DISEASES OF THE UTERINE SYSTEM. CHAPTER I. OF CHLOROSIS. Derinition.—A peculiar affection of the general health; in which debility, languor, and deranged stomachic functions are prominent symptoms ; most frequently occurring when puberty is or ought to be established, although it may exist at any subsequent period, always characterised by anemia of the system, and a yellowish, dirty green pallor of the surface; when a disease of early youth, almost invariably connected, either with entire absence of menstruation, or with a scanty, painful, and irregular performance of the function, and if a disease of later life, in addition to these causes, it may have been preceded and produced by menorrhagia, or leucorrhea. History and Sympioms.—In furnishing these, precision is important, as chlorosis presents itself in three forms: as a mild and incipient, an inveterate and confirmed, and a complicated disease. The incipient and mild form commences almost unobserved : the patient has been, perhaps from infancy, or at least for some years previously, delicate and feeble, so that anxiety has existed about her; but now, at the age of twelve, thirteen, or fourteen years—without any obvious exciting or morbid cause, other than a negative one, the non-establishment of puberty— a series of distressing and perplexing symptoms are ushered in,