UTERINE OSMOSIS. 
BY 
WALTER S. WELLS, M.D., 
OF NEW^VTFRK 
FROM 
THE MEDICAL NEWS, 
October 22, 1892. [Reprinted from The Medical News, October 22, 1892.] 
UTERINE OSMOSIS. 
By WALTER S. WELLS, M.D., 
OF NEW YORK, 
Among the principal modern discoveries that 
have contributed to the preeminence of gynecology 
we recognize especially those of anesthesia, antisep- 
sis, and the adaptation of atmospheric pressure as 
utilized by the illustrious Sims in the application of 
his duck-bill speculum. 
The object of this paper is to call attention to the 
availability of certain other physical forces—those 
of translatory molecular motion, and known as os- 
mosis and capillarity—as most efficient aids in the 
treatment, and as preventives, by early treatment, of 
some of the diseases peculiar to women, that, once 
developed, are incurable by any device of surgery. 
It has been repeatedly demonstrated in practice 
that these laws may be made as successfully opera- 
tive for curative purposes in all conditions of disease 
of the female pelvic organs characterized by con- 
gestion or engorgement as they can be illustrated by 
osmotic apparatus in the laboratory. 
The human system abounds in capillary materials 
that have, to a limited extent, been utilized by the 
physician, notably in effecting medication by the 
hypodermatic syringe and in vaccination. 
The same principle that governs the absorption 2 
of medicine placed among the lymphatics anywhere 
under the skin may be made operative among the 
same class of vessels under the mucous surfaces, 
through which they communicate by myriads of 
infinitesimal pores. 
The lymphatic system, as is well known, has 
long been regarded as the principal group of vessels 
accomplishing absorption. 
It was vaguely hinted at as having some form of 
existence, undefined and without its present name, 
as long ago as in the time of Hippocrates and Aris- 
totle, and has since engaged the best efforts of the 
ablest anatomists and physiologists in the successive 
centuries and among all enlightened nationalities, 
working out to its present status our knowledge of 
this system as a unity. 
That no valvular arrangement is found in the 
most numerous, smallest, and peripheral lymphatic 
vessels is favorable to making use of them for os- 
motic purposes. 
The lymphatics are remarkable for their exuber- 
ance and anastomoses, especially in the female intra- 
pel vie organs. Profusely, however, as they are dis- 
tributed in and around the uterus, they are even 
more abundant in and around the ovaries. 
These innumerable lymphatic vessels form in- 
finite inosculations and merge into more tangible 
branches. 
Branches from the cervix, together with branches 
from the vagina, coalesce to form trunks that enter 
the internal iliac and sacral glands, and branches 
from the uterus, ovaries, Fallopian tubes, and rec- 
tum also converge and enter the lumbar glands. 3 
These intercommunicating lymphatic channels 
form a circuit through which osmosis of the uterus 
and vagina reaches neighboring organs involved in 
congested conditions requiring treatment. 
Endosmosis of medicated fluids at the uterine and 
vaginal point of these congeries or anastomoses of 
lymphatics will influence the entire circle; and 
simultaneous exosmosis will, in its turn, effect drain- 
age and depletion, not only of those parts to which 
the medicinal application is immediately in con- 
tact, but others adjoining them. 
That portion of the vascular system next in 
importance for the purposes we are considering is 
the capillary system of bloodvessels. 
Some physiologists claim that these networks of 
minute tubes connecting the terminations of the 
arteries with the beginnings of the veins exercise a 
greater power of absorption than the lymphatics. 
It is sufficient that both, being all-pervading and 
intermingling in unnumbered myriads, are equally 
subject to the laws of capillarity and osmosis. 
The endosmometer, as illustrated in works on 
physics, is a very simple contrivance, but it explains 
some of the most important of Nature’s laws. 
Many interesting experiments are illustrated in 
works on physics demonstrating the phenomena of 
osmosis, and others concerning the double current 
of different liquids passing each other in opposite 
directions through the same tube, of even the finest 
possible bore, under the combined influence of 
capillarity and diffusion. 
The general law is that when endosmosis is in 
operation exosmosis is also present; but, exception- 4 
ally, in some cases, movement is only in one direc- 
tion. 
The simple movement of exosmosis is strikingly 
illustrated by the action of glycerin upon the 
mucous surfaces of the os and cervix uteri, inducing 
a profuse outpour of serum. 
For many years advantage has been taken of this 
to deplete the uterus, so as to gain absorption of 
medicines locally applied, upon the principle that 
prompted physicians of the olden time to bleed 
their patients just before giving medicine, to pro- 
mote its absorption. 
The other half of this problem, however the fact 
that the uterus is susceptible of medication by en- 
dosmosis, is a discovery of recent date, especially 
as to the capacity of this organ to be operated upon 
by both osmotic forces simultaneously. 
In the artificial endosmometer we have a mem- 
brane interposed between two liquids of different 
density. A double current sets in, each liquid pas- 
sing the other at the same time, on its way through 
the capillary tubes or pores of the membrane. 
It is well known that in the anatomy of the 
female, the mucous membrane of the vagina, of the 
os, of the cervix, of the cavity of the uterus, and of 
the Fallopian tubes, is one continuous expanse of 
capillary orifices, living, absorbing tubes or pores. 
This membranous expanse of living orifices com- 
prising the mucous surfaces stands, in the human 
endosmometer we purpose to demonstrate, in the 
same relation as to mechanism as the dead mem- 
brane in the artificial endosmometer occupies, and 5 
the living membrane is correspondingly more active 
for osmotic work. 
It is only necessary, in order to institute osmotic 
operations upon the uterus, to complete the relations 
suitable for maintaining medicated fluid in direct 
apposition with the mucous membrane of the organ by 
means of a material composed of soft, porous, clus- 
tered tubes in which capillary action may take place. 
For this purpose nothing has, so far, been found 
superior to the fine Syrian sponge made surgically 
clean, bleached, and kept for use in antiseptic fluid 
until required. 
By bringing such a sponge into contact with the 
os, the cervix, and the vagina, we have multitudes 
of capillary tubes on each side of a living mem- 
brane, itself permeated by myriads of infinitesimal 
pores ; the whole forming a superior endosmometer, 
and, if the sponge in situ is saturated with a suita- 
ble fluid of low density the phenomena of osmosis 
becomes demonstrable. 
Experience has amply demonstrated that, with 
these relations maintained, endosmosis of an aqueous 
medicated fluid in the sponge occurs; this being of 
lower density passes through the pores of the mu- 
cous membrane, to be absorbed by the lymphatic 
and capillary vessels of the organs. At the same 
time, exosmosis of the heavier fluid-deposits incident 
to congestion or inflammation takes place, the ex- 
cretions passing out into the sponge. 
We thus form an endosmometer within the vagina, 
which will simultaneously medicate and drain the 
entire circle of lymphatic and capillary inosculations 
in the pelvis. 6 
The osmotic properties of sponge were, several 
years ago, referred to by Dr. McCourt of New York. 
Since then cases have presented in my practice 
in which it seemed desirable to facilitate relief of 
more deeply-seated engorgements of the pelvic 
organs by extending osmotic influences more directly 
within the recesses of the uterus and Fallopian 
tubes than the sponge alone could reach. 
This I accomplished by introducing through the 
cervix a small spiral-wire tube covered with a woven 
texture, and containing within its caliber capillary 
filaments constituting a wick, each extremity pro- 
jecting beyond the tube about half an inch. 
This tube being passed within the os internum, 
the capillary filaments rest upon the intra-uterine 
mucous surface, while the saturated sponge, being 
placed in siiu, holds the lower extremities of the fila- 
ments; and capillarity and endosmosis convey the 
fluid from the sponge up within, to be diffused upon 
and absorbed by the endometrium. The tube is made 
slightly bulbous at the extremity to be introduced, 
and of a length to just pass through the cervix. 
The bulb aids retention and the spiral form preserves 
the filiform wick from being pressed upon in its 
caliber. 
The extremities of this wick extend beyond the 
spiral tube, so that the upper one lies in direct con- 
tact with the endometrium, while the lower end is 
imbedded in the saturated sponge placed against 
the os and cervix. 
By this arrangement osmosis is brought into play 
upon the endometrium and Fallopian tubes directly, 
while it does not interfere with the same process 7 
going on between the sponge and the vaginal por- 
tion of the uterus. 
As the fluid in the sponge is drawn up the wick 
by capillary attraction it becomes diffused slowly 
upon the mucous lining of the uterine cavity and 
Fallopian tubes, to become absorbed by their ves- 
sels, and we get direct endosmosis and exosmosis 
without any shock, as is so liable to follow injection 
of fluids into the uterine cavity by using a syringe. 
It has been of common occurrence in cases of 
chronic congestion and inflammation of the uterus 
and its adnexa, upon the removal of this apparatus 
-—after about twenty-four hours—to find it saturated 
with puriform, sanious, or mixed excretions ; and 
this, too, when the most careful examination of all 
of its surfaces visible by the Sims method failed to 
find an ulcer or other solution of continuity to 
account for the puriform discharge. 
The purulent or other product found in the 
apparatus represents the exchange effected during 
osmosis, the liquid of lighter density passing inward, 
while the liquid of heavier density passes outward 
from the diseased tissues. 
It might seem that it would be difficult to use the 
intra uterine capillary tube, but the very conditions 
of disease of the uterus especially requiring this 
plan of medication and drainage are accompanied 
by dilatation of the os, cervix, and the uterine 
cavity. 
It is, in addition, an important element of the 
law of capillarity that it works in a vacuum, or 
without reference to the presence of air, quite as 8 
well as in open space, even assuming that the closed 
uterus could maintain a vacuum. 
The filiform fibers constituting the wick in the 
intra uterine spiral wire tube will raise the fluid from 
the saturated sponge in contact with the endo- 
metrium and the orifices of the Fallopian tubes with 
as much ease as the wick in the familiar house-lamp 
serves to raise even a heavy oil to a height of several 
inches; or, as the osmotic action causes the ascent 
of sap in trees. 
In practice, water and alcohol, our best solvents 
for the remedies most available in osmotic medica- 
tion, are, fortunately, the fluids most susceptible to 
osmotic influence. 
Local medication of the uterus in the old routine 
is nearly useless in cases of marked version or flexion 
of the organ causing a degree of bending and com- 
pression sufficient to keep up engorgement. In 
such cases the capillary spiral tube not only main- 
tains the cervical canal patulous, but the sponge 
may be utilized both as a pessary and as a fountain 
for osmosis. 
The sponge to be used as a pessary is first to be 
wrung out of the medicated fluid as nearly dry as 
possible, and, after being placed in situ, a long- 
nozzled syringe is to be used to saturate it with the 
fluid. 
The distention of the sponge by the fluid main- 
tains the uterus upon a soft, elastic support, much 
superior to many other more expensive appliances 
for this purpose. 
It is manifestly impracticable, in the limits of this 
paper, to enter into a detail of all the conditions 9 
treated in works on gynecology and point out spe- 
cifically wherein this system of osmotic treatment 
may be beneficially substituted for the old routine. 
We are justified in stating that the osmotic plan 
of treatment is indicated in all stages of congestion, 
engorgement, or inflammation of the vagina, uterus, 
Fallopian tubes, ovaries, peritoneum, rectum, or 
other tissues whose lymphatic and capillary vessels 
anastomose with those of the vagina and uterus.. 
Osmosis of the two last-named organs will simi- 
larly influence the others. 
If we were to specify conditions in which an im- 
provement in treatment has long been sought, we 
would say that those of ovarian inflammation, puer- 
peral septicemia, and the engorgement incident to 
subinvolution are conspicuous and are influenced 
by osmosis more than by any other plan of medica- 
tion. 
Speaking of the prognosis of chronic ovaritis, 
Prof. Thomas makes the following admission : “I 
know of few curable disorders which I so dread to 
meet as this. The day will probably come when 
our treatment for it will be satisfactory and efficient, 
but it has not yet done so by any means. Many 
cases will entirely baffle treatment, while all will 
prove little amenable to it. That they often re- 
cover is true, but recoveries have, in my experience, 
but little connection with treatment.” 
In the matter of treatment Prof. Thomas expresses 
regret that he has nothing better to offer than the 
old methods, and concludes as follows : “ It is now 
six years since the publication of the last edition of 
this work (Diseases of Women), and during that 10 
time no disease has more especially commanded 
my close scrutiny than this, and yet, in an amended 
edition after that lapse of time, I find myself unable 
to offer any improvement upon what was written 
then.” 
Regarding the prognosis given by Dr. Thomas 
that “ the day will probably come when treatment 
of ovarian inflammations will be satisfactory and 
efficient,” it is our conviction, based upon experi- 
ence, that the day has co?ne and that the “ satisfac- 
tory and efficient ” treatment of ovaritis is that by 
medical osmosis. 
It is our belief further that this osmotic plan of 
medication will prove of great value as a prophy- 
lactic, preventing septicemia, through the prompt 
neutralization of septic conditions such as arise in 
puerperal and syphilitic cases, and, by equally 
prompt relief of conditions of engorgement of the 
pelvic organs will prevent disorganization of tissues, 
which, being allowed to happen, forms the starting- 
point of abnormal growths, and these, if there be 
constitutional predisposition, are liable to degenerate 
from benign into carcinomatous tumors. 
Ninety per cent, of cases of puerperal fever occur 
within three days after confinement. 
In endometritis following puerperal infection the 
after-pains are unusually severe; the lochial dis- 
charges become retarded and fetid ; the temperature, 
following a chill, rises often to 104° or higher; the 
pulse, small and hard, increases from the normal to 
120 or even 160 beats in the minute. 
When, in any case, after confinement, symptoms 
of septic intoxication occur, at once flush the vagina 11 
with antiseptic douches, and, by the use of the wire 
curette and the applicator, remove the debris—such 
as particles of placenta and plugs of bloody mucus 
—from the neck and the body of the womb and 
apply the sponge saturated with an anodyne and 
an antiseptic solution to the os and cervix. 
Osmosis of the uterus will be effected, causing the 
lochial flow to be resumed, its fetor to disappear 
by the antisepsis, and the temperature and pulse to 
become reduced as the medication and drainage of 
the uterine cavity proceed. 
In such cases the sponge should, for the first few 
days, be removed at least night and morning, and 
be cleansed by washing in water (containing spirit of 
ammonia), carbolized, re-medicated with an aqueous 
solution of carbolic acid, morphine, and glycerin, 
or other suitable mixture, as the physician may 
elect, and replaced in direct contact with the os and 
cervix, to maintain osmosis. 
The anodyne-antiseptic mixture should, between 
replacements, be occasionally injected to keep the 
sponge in situ saturated as well as to promote 
vaginal cleanliness. 
Post-mortem examinations by Championnier, Leo- 
pold, and others, show that in puerperal inflamma- 
tions the lymphatics are commonly filled with pus; 
and, according to Courty, chronic inflammation of 
the female pelvic organs confined almost to the 
lymphatics themselves, of this region, is a common 
occurrence. Hence the importance of promptly 
unloading these vessels and relieving the engorge- 
ment of the uterus, so as to arrest local disorganiza- 
tion and neutralize blood-poisoning. 12 
I have no doubt that morbid growths have their 
origin in some one or more of the involved lymph- 
atic or capillary tubes that become obstructed during 
protracted congestion, and, unable to float away the 
clog, disorganization follows. 
It would thus seem easy to account for the fre- 
quency of such morbid growths in the uterus and 
ovaries, considering the great number of women 
who suffer repeatedly from protracted congestions 
of these organs during the years from puberty to 
the menopause. 
If these repetitions of congestions do, in time, 
constitute the focus of an abnormal growth in the 
uterus, the ovaries, or in some contiguous tissues, it 
follows that, if the congestions are promptly relieved 
or prevented by osmotic treatment from becoming 
protracted, there may be fewer women in the future 
applying for the removal of tumors and carcinoma- 
tous growths by surgical measures. 
We cannot too strongly emphasize our belief that 
the intelligent employment of the osmotic plan of 
treatment set forth will, in time, be found to have 
lessened the records of uterine and ovarian cases 
applying for surgical relief. 
There is no restraint in the matter of remedies. 
The physician can choose among the list of anti- 
septics, anodynes, alteratives, etc., that experience 
has found useful in regular routine. He must, how- 
ever, observe the laws of osmosis, which are open to 
all to study, and a reasonable amount of practice 
will soon perfect the average practitioner in the 
management of the uncomplicated apparatus de- 
scribed. 
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