UTERINE 
PATHOLOGY 
AND 
TREATMENT. 
By R. E. BEACH, M. D. 
REPRINT FROM ILLINOIS MEDICAL RECORDER 
VANDALIA, ILLS. : 
Charles G. Smith & Son, Printers. [ With Compliments of the Author.] 
UTERINE 
Pathology & Treatment. 
R. E. BEACH, M. D. 
The almost universal prevalence of uterine derangement has in- 
duced me to offer a few remarks for your consideration on the 
above subject. While I may introduce nothing absolutely new, 
I hope to be able to call your attention to some points of interest. 
It is generally supposed that the present state of knowledge of 
gynaecology has been wholly developed within the nineteenth cen- 
tury. The works of the ancients, however, disprove this as is 
evidenced by the writings of Galen, Hippocrates, Araeteus, Celsus 
Paulus, and others, who were not only familiar with the use of the 
speculum, but accurately describe many of the diseases wdth which 
\Ve are now familiar. In the exhumations of Pompeii tri and bi- 
valve specula were found of excellent workmanship, and as the de- 
struction of Pompeii occurred in the year 79, of the Christian era, 
the speculum must have been in use considerably prior to the time 
of Galen, who makes the earliest allusion to the speculum of an}7 
of the ancient writers. 
The science of medicine became very much contaminated with 
astrology, especially in the hands of the Egyptians. The interest 
in the study of this branch abated, and not until the earlier part of 
this century did it receive a new impulse from the hands of Reca- 
mier. It has since that date received the attention it fully merit- 
ed, and to day American gynaecologists rival the world in the suc- 
cessful treatment of uterine diseases. But in this as other special- 4 
ties, “men are prone to become partisans of some special theory or 
dogma, which is warmly attacked by others who hold some oppo- 
site view, equally narrow and exclusive.” 
In order to combat diseases successfully, it is essential to have a 
clear and correct conception of the existing pathological condition 
present. This can only be accomplished by the most careful ana- 
lyzation and deduction from each particular class of diseases con- 
sidered. I desire to call your attention more particularly tb those 
conditions of uterine derangement resulting generally from pro- 
longed congestion, and which Thomas designates areolar hyper- 
plasia;—Bennett & Telt internal metritis;—Klob chronic paren- 
chymatous metritis. The opinions of authors are divided in regard 
to the pathology—some claiming that the enlargement is due to in- 
flammation which has assumed the chronic form, while others con- 
tend that it is due to congestion. 
The distinctive feature of Bennett’s writings are that be locates 
the disease exclusively in the os and cervex, and that the body of the 
uterus rarely becomes involved. He’ also maintains that atomic 
disease is a local inflammation of the os-externum and curves, and 
extends as the disease assumes greater intensity to the substance of 
tip neck, and results in the effusion of lymph, And eventually in 
the supervention of an ulcer, induration and hypertrophy—that the 
ulceration is inflammatory in its nature, constantly renevVs, and in- 
definitely perpetuates the morbid action' going on in the substance 
of the neck. Rcanzoni states that uterine disease consists of an in- 
flammation of sometimes the parenchyma, but mote frequently the 
lining membrane of the uterus. 'Tyler Shiitli considers that a 
highly vascular condition of the cervichl mucous til fern bra life occa- 
sions hypersecretion from the cervical glands. The oS externum 
being constantly bathed in this secretion becomes eroded. Hyper- 
trophy of the cervex may arise from two eAiises—a serous effusion 
into its substance, of a varicose state of the blood vessels.. Thom- 
as, in his work on diseases of women, asserts that hyperplasia of 
the uterus may result from three entirely different pathological 
states: “1st, Retrograde metamdrphd'siS 6f the puerpural uterus 
from any cause; 2d, By congestions long kept up from mechanical 
causes, e—g., displacement's; 3d, A form of formative or hyper 
nutrition excited by endometritis.” Pehslee,fh his lectures 
on congestions and inflammations of the nongrbvid uterus, em- 
phatically denies the existence of chronic inflamation. He asserts 5 
that “inflammation is essentially an.acute process, i. e. itis perfect- 
ly developed land brought to an end in a few days at longest. 'Con- 
gestion, on the other hand, may continue through protracted peri- 
ods—many months and even many years.” He denounces the term 
“chronic inflammation” as a chimera, and says the so called chronic 
inflammations of the uterus are in reality chronic congestions. Chap- 
man, in his work on diseases and displacements of the uterus, en- 
tertains views similar to those expressed by Peaslee. The follow- 
ing is a synopsis of his ideas on the subject : “Menstruation, sex- 
ual congress and utero-gestation. occasion a physiological conges- 
tion of the uterus. That disease whenever arising consists simply 
in a perversion of natural laws. That the genital organs are es- 
pecially, prone from morbid causes to have this physiological action 
converted into a pathological action. That an increased blood 
force develops the embryonic germ cells of the uterus, whence hy- 
pertrophy simulating that of pregnancy ensues.” He excludes the 
idea, of chronic inflammation of the uterus on the following grounds : 
The entire absence of the products of inflammation. “By stasis of 
the blood, as that due to suppression of the menses, subinvolution 
after abortion, or labor, or to obstruction due to displacement be- 
ing usually the cause of uterine disease. By true ulceration pro- 
duced by sponge tents, pessaries, or other extraneous causes, cica- 
trizing spontaneously, a singular result were the substance of the 
cervex inflamed and ulcerated. By the so called inflammatory ulcer 
lacking all the characteristics of an ordinary ulcer, and resisting 
direct applications, but yielding to depletion of the uterine vessels. 
By the cervical glands always secreting albumen and never pus.” 
That there is congestion and not inflammation is proven “by the 
puffy and elastic feel of the neck, by its slight increase in temper- 
ature, by the trivial pain caused by examination, by the augment- 
ed bulk of the uterus, by the congested appearance of the os tinea* 
as seen per speculum, by the persistence of uterine disease for years 
with little or no variation, by the Restoration of the uterus to its 
normal state, by local depletion, and by the absence in all cases ex- 
amined after death, of structural changes and inflammatory pro- 
ducts.” He also says that a confirmed case of womb disease was 
never radically cured by general remedies, and more than this, that 
symptoms even were never permanently relieved. Hence he con- 
cludes that uterine disease is primary and not secondary—is not 
the effect but the cause of constitutional disorders. 6 
l have refrained from commenting upon the views entertained b}7 
l he authorities whose opinions I have briefly rehearsed My own 
convictions, resulting from a careful study of uterine pathology, 
and observation of a limited number of cases which I have treated, 
force me to accept the views expressed by Chapman and Peaslee. 
Any cause which tends to produce prolonged congestion of the 
uterus or its appendages will inevitably be followed by functional 
or organic disease. Among the many causes which tend to pro- 
duce prolonged congestion may be mentioned the following : 1st, 
Subinvolution; 2d, An altered condition of the nerves governing 
the circulation of the uterus and ovaries; 3d, Excessive indulgence 
of the sexual desire; 4th, Mal-positions; 5th, Laceration of the cer- 
vex uteri from parturition. Subinvolution, whether it results from 
abortion, miscarriage, or a normal parturition, is a prime factor in 
causing uterine disease. The uterus being heavier than normal, its 
natural supports are weakened and it assumes a faulty position. 
The normal circulation and enervation is disturbed. Congestion, 
stasis, and effusion into the parenchyma of the organ follow in 
their natural order, and a gradual hypergenesis of tissue takes place. 
A uterus which has previously been healthy, suddenly becomes ret- 
roverted. Here we have a condition the results of which, if unre- 
lieved by timely interference, are analagous to those above de- 
scribed. Modern physiologists are agreed that a special set of nerves 
govern the sexual desire. These are dormant except when stimulated 
by erotic desires or fancies, and when thus excited, invite an afflux 
of blood to the genitalia, and a physiological congestion ensues 
which is relieved by the act of copulation. Excessive indulgence 
leads to an exalted sensibility of these nerves. The physiological 
congestion is now converted into a pathalogical congestion, and if 
the morbid action is not arrested hyperasthesia, hypernutrition 
and enlargement of the cervex or body of the uterus is the result. 
Let us stop to enquire the nature of this condition which is denom- 
inated by Thomas “Areolor Hyperplasia ” Those familiar with 
the histological elements composing the healthy uterine parenchy- 
ma. will remember that it consists of five elements, viz : “1st, 
Fusiform fibre cells; 2d, Round and oval nuclei, supposed to be eh 
omentarv fusiform fibre cells; 3d, Connective tissue which perme- 
ates the parenchyma and binds together the fibre cells and nuclei; 
-1th, Fihrillated connective or white fibrous tissue; 5th, Elastic fi- 
brous tissue. These elements, together with nerves, blood vessels 7 
and lymphatics, make up the tissue of the uterus.” Under tin* 
stimulus of undue excitement these embryonic germ cells are devel- 
oped, and a condition simulating that of pregnancy is brought 
about. The increased weight of the organ, especially if there be 
corporeal hyperplasia, may superinduce mal-positions which as 
complication will render the disease far more intractable. On re- 
flection it may be readily conceived how the neuralgic and conges- 
tive forms of dysmenorrhoea, by inducing a pathological conges- 
tion of the uterus, may cause disease. I have previously noticed 
the influence which mal-positions exert as one of the predisposing 
causes and shall not again refer to them except in treatment. 
To Dr. T. Addis Emmet, of New York, is ascribed the honor of 
being the first to call the attention of the profession to the fact that 
laceration of the cervex uteri from parturition is a frequent and un- 
recognized cause of uterine disease. He remarks that the fissure 
is frequently mistaken for an ulcer and treated as such. He has 
written an interesting article “on the proper treatment of lacera- 
tion of the cervex uteri,” which appeared in the “ New York■ Med- 
ical llecord," vol. II., pp. 823. As I am already exceeding the 
limits originally intended for this paper, 1 shall not be able to no- 
tice the particular treatment recommended in this class of diseases. 
This as a cause is well worthy of investigation, and to those in- 
terested in the subject 1 would recommend the careful perusal of 
the article above referred to. 
Contrary to the teachings of some writers we find that uterine 
disease is not confined to multipara, though occurring much 
more frequently with them than nullipara. The uterus once de- 
veloped by pregnancy never returns to its original size. Its 
walls being thicker, veins larger, neck fuller and rounder than that 
of the virgin uterus. The walls of the uterus in nullipara are dense 
and unyielding, and resist any considerable accumulation of blood 
in the veins—a condition necessary for increased nutrition, hence 
the greater liability of multipara to uterine disease than nullipara. 
When the virgin uterus does become the seat of disease it usually 
proves far more intractable than in the multipara. The reason as- 
signed for this is, that the greater capacity of the multiparous ute- 
rus for enlargement allows a simple form of congestion to take place 
that is, when judiciously treated, removed with but little difficulty. 
On the other hand the dense resisting tissue of the nulliparous ute- 
rus, when subjected to an extraordinary amount of blood, it is re- 8 
fleeted back on the ovaries and a super sensitive or hypertesthetie 
state of the uterine nerves ensue, that by instituting and keeping- 
alive an active type of disease greatly adds to the severity olbthe 
symptoms. 
Treatment.—This may be comprised in the following; Sublat.a 
causa toilUnr effect us. Ascertain nearly as possible the cause; 
direct your treatment to'the removal of this cause,'and the effect 
will cease. Assuming a pathological congestion to he the prime 
cause of uterine derangement, a treatment should be adopted which 
will fend to relieve that condition. Perfect rest should be enjoined, 
especially during mehstrual periods; skirt supporters should be 
worn to remove the superincumbent weight of the clothing.’ Mal- 
positions of the uterus should be corrected by well adjusted me- 
chanical supports. For ordinary cases of retroversion and ante- 
versions I have found the pessaries devised By Dr. E. Outter to ful- 
fil every requirement. Local depletion may be effected by scari- 
fication or the use of the pledget of cotton,1 saturated with glycer- 
ine, placed against the os and allowed to remain ten or twelve 
hours. The free use of warm vaginal injections exerts-ft beneficial 
influence by washing awily morbid secretions, and aids materially 
in reducing congestion. In a granular condition of the os,- Rich- 
ardson’s styptic colloid painted ov'er the os seems to produce good 
results. “It appears to act as a direct alterative, and by forming 
a protective crust over the surface, constitutes for it fa shield against 
friction and uterine discharges', and by its constringing effects di- 
minishes local congestion. Direct local-applications exert atr al- 
terative effect upon the nbrves governing the nutrition and -circula- 
tion. For this purpose nothing excels the stick of nitrate of silver. 
Pure carbolic acid and tincture iodine, equal parts, form an excel- 
lent combination. These remedies when applied locally produce 
an alterative effect upon the glands and mucous membrane > of-the 
cervical canal,modifying and diminishing secretion.’ The benefit 
derived from tlie sponge tent, plain or cavbolized, I attribute to 
its mechanical action, and while it is almost indispensable in the 
treatment of certain forms of uterine disease, it is capabkvof pro- 
ducing serious mischief; They are inadlnissable where the uterus 
has become hound down by adhesions, the result of pelvic celluli- 
tis. As a rule, no local application should be made just before or 
immediately after the menstrual flow. Should the symptoms point 
to a granular condition of the cervical canal, a sponge tent should 7 
be introduced, and after the canal is well dilated, the curette used 
thoroughly and effectually. When there exists much thickening of 
the endometrium with hypersecretion the benefit derived from the 
occasional introduction of a sponge tent cannot be denied. After 
its removal we are better enabled to bring local remedies directly 
and more thoroughly in contact with the diseased surface. When 
there is considerable enlargement or elongation of the os externum, 
which cannot be reduced by the more ordinary methods, we are jus- 
tified in attempting its removal either by the curved scissors (with 
edges serrated) ecraseuror the galvano cautery. The only instru 
ment with which I have had any practical experience and which is 
amply sufficient for this purpose is Byrne’s Ualvauo ( buttery. It is 
small, compact, and can be relied upon. I shall here take occasion 
to describe two typical cases of uterine disease occurring in my own 
practice, which will I think serve more fully to illustrate the pre- 
ceding remarks. Mr. M brought his daughter to me for ad- 
vice in October, 1875. The following history is taken from notes 
of the case. 
Mary M., aet *27; single; of medium bight; moderately developed; 
nervous temperment, suffers almost constantly with neuralgic dis- 
orders, pseudo angina pectoris, pleurodynia ami cephalgia; appetite 
poor; bowels constipated; menstruation regular hut painful. Com- 
plains of great uneasiness in the praecordial region. Pulse 100, and 
regular. Physical examination failed to discover any organic af- 
fection of the heart, lungs, liver, or kidn. ys. Pressure over the hy- 
pogastric region produced some pain. I suspected some uterine dis 
ease, and asked for permission to make an examination, which was 
not granted. The case fell into the hands of an irregular, who 
treated her for dyspepsia until he learned by accident that 1 had sn - 
‘pected uterine disease, when he asked and gained permission to make 
a vaginal examination. He diagnosed prolapsus uteri and applied 
a McIntosh uterine supporter. As he utterly failed to relieve her 
( though by the way he managed to secure about forty dollars for 
the supporter and advice ?) the ease again returned to me for tie t- 
rnent. Examination per speculum revealed the os congested and 
slightly enlarged, A gelatinous plug of mucus hanging from the 
os tincse gave evidence of the hypersecretion of the Nabothian 
glands. The introduction of the sound showed the uterus slightly 
retroflexed—depth normal. The vagina was intensely congested at 
its superior portion. file introduction of the speculum, which was 8 
a small valvular one, produced considerable pain. I removed the 
secretions and applied to the cervical canal the following : 
R Acidi Cabolici, 95 <{0ct. - - - - 3 ss 
Tr. lodinii, • - - - 3 i 
Mix. 
I then placed a pledget of cotton saturated with glycerine against 
the os externum, and directed its removal on the following morn- 
ing by the means of a thread which was attached to the cotton and 
allowed to project beyond the labiae—the removal to he followed by 
copious injections of warm water. I introduced occasionally a 
small sponge tent with a view of endeavoring to correct the retro- 
flexion. The local treatment was continued about eight weeks at 
intervals of from three to five days between applications. She 
then declared herself so much relieved that treatment was discon- 
tinued. (At the date of writing this article Miss M. continues 
in pretty fair health, the dysmenorrhoea—which was a prominent 
symptom, and which was I presume due to the retroflexed position 
of the uterus having nearly disap neared.) 
Mrs. E. visited me in August, 1876, for advice. Her fam- 
ily physician had diagnosed valvular disease of the heart, and told 
her that death might occur at any moment. The following is a 
history of the case and treatment as nearly as I can recollect—a 
part of the notes referring to the case having been lost. Mrs. E , 
aet 28, full habit, has been married about fifteen months, she was 
confined at full term, about twelve months after date of marriage, 
and gave birth to a still-born child. Health previous to confine- 
ment good. One week subsequent to confinement became subject 
to what was, I presume, a hysterical affection, dependent upon 
uterine irritation, which recurred at irregular intervals and showed 
no tendency to periodicity. Yet her medical advisers pronounced 
them of malarial origin, and prescribed quinine in both antiperiod- 
ic and tonic doses, with stimulants at! lib, nil infinitum. She ob- 
tained no relief, and up to the time she visited me (about three 
months subsequent to the first attack ) they had been gradually 
increasing in frequency and severity. Present condition, full habit; 
appetite poor; bowels constipated; tongue coated; pulse about 85 
and regular. Is subject at irregular intervals ( sometimes occur- 
ring as often as twice daily ) to what she terms “spells.” During 
the attack the pulse is rapid, feeble and irregular. The extremi- 
ties become cold and cyanotic as far as elbows and knees; com- 9 
plains of great distress in the pnecordial region, and a sense of 
weight in the epigastrium; breathing labored and apparently diffi- 
cult. A careful examination failed to develop any organic disease 
of the thoracic viscera. Examination per speculum revealed the 
os congested and oedematous, with os tincte patulous; profuse se- 
cretion from both uterus and vagina. The sound entered the ute- 
rus to the depth of three and a half inches. Uterus slightly retro- 
verted. Diagnosis, subinvolution. The mal-position, congestion 
of the os and cervex, being dependent upon this condition, pre- 
scribed the following : 
ft Potass Bromid - - - - - - 3 ss 
Potass Iodidi - - - - - - 3 i ss 
Syr Zingiber - - - - - - fl 3 ii 
Aquae Dest qsad - - - - - fl 3 ii 
M Sig—A teaspoonful three times daily in a little water. Also 
a saline aperient to keep the bowels freely soluble. 
As a local application used the carbolic acid and iodine be- 
fore referred to. Occasionally used the solid stick of silver. This 
with scarifications of the os and the use of the tampon saturated 
with glycerine, its removal to be followed with injections of warm 
water, constituted the local treatment, with the exception of the oc- 
casional introduction of the sponge tent. At the expiration of 
eight or ten weeks I had the satisfaction to find her restored to al- 
most perfect health, nor has she had any return of the symptoms 
to this date. 
Now, while I deprecate the practice of referring all mental, gas- 
tric, hepatic, or urinary disorders occurring in the female to uterine 
derangement, these two cases may serve to direct your attention to 
a train of anomalous symptoms, which if rightly interpreted will 
rarely mislead you. I regret that a lengthened consideration of 
the pathology of uterine disease has forced me to abbreviate an im- 
portant part of my subject, viz : treatment. 
In conclusion I will say that in the preparation of this article 1 
have fully appreciated the difficult and complex nature of the sub- 
ject under consideration. That it is written in a desultory man- 
ner I will admit, which is in part due to its hurried preparation. 
W ant of time for deliberation and reflection has perhaps caused me 
to omit many important features. Under these circumstances 1 
trust you will kindly overlook all discrepancies.