Neuralgia and 
Uterine Affections. 
Charles Greene Cumston, M.D. 
BOSTON, MASS. 
Reprinted from Annals of Gyncecolog-y 
and Pcediatry. 
BOSTON, 1895. NEURALGIA AND UTERINE AFFECTIONS. 
A CLINICAL LECTURE DELIVERED AT THE SUFFOLK DISPENSARY 
CHARLES GREENE CUMSTON, B. M. S., M. D. 
Instructor in Clinical Gyncecology, Tufts College, Member of the Societe Fran raise <T Elec- 
trotherapies etc. 
Gentlemen: —To be a good sur- 
gical or gynaecological diagnostrician 
is entailed the necessity of being most 
familiar with general medicine, and 
the nervous system with its patho- 
logy is certainly closely related to 
existing pathological conditions of the 
genital organs in many cases. 
Today I would invite your atten- 
tion to the subject of neuralgia de- 
pending on lesions of the uterus, a 
subject which has not received the 
attention that it deserves, and with- 
out going into details I would recall 
to your minds the fact that early in 
the history of medical science phy- 
sicians have recognized and recorded 
the near relations uniting genital 
disorders with the most varied mor- 
bid phenomena. 
Of late gynaecologists have called 
attention to certain gastric symp- 
toms and neuropathic disorders in 
patients affected by some lesion of 
the uterus or adnexa. It may be 
said, taking into consideration the 
former and present records, that 
there is not one system, one organ, 
that may not offer some pathological 
condition of greater or less duration, 
but which is always capable of ame- 
lioration in direct relation to the 
progress of improvement of the 
uterine affection. 
Among these various disorders 
those of the nervous system are fore- 
most. They are first marked by a 
change of character, while sensitive 
or motor symptoms of every descrip- 
tion may also be present, and here, 
as in the case of intoxication, the re- 
action of the nervous system is all 
the more pronounced the greater 
the hereditary or acquired stigmates 
of the subject. 
Besides the major nervous troubles, CHARLES GREENE CUMSTON. 
which are clearly hysterical or neu- 
rasthenic, you will frequently meet 
patients who complain of severe pe- 
riodical pains seated in the nerves 
and having all the classical characters 
of neuralgia. The neuralgias are of 
two orders; one type depends on a 
propagated lesion, as for example 
sciatica produced by compression or 
invasion of the nerve by a uterine or 
ovarian tumor, and here the path- 
ogeny is clear. But the other type 
is neuralgia of nerves situated at 
some distance from the genital 
organs. In this type the relation 
which unites them to the patholog- 
ical condition of the genital organs 
is not hardly evident and may even 
go by unnoticed. 
It is these distant neuralgias 
that I wish to particularly treat in 
this lecture. I, however, include in 
this class certain pelvic neuralgias, 
which in spite of their proximity to 
the diseased genital organs do not 
show upon examination that the 
pathological condition has any direct 
action on the painful nerve. 
These neuralgias are so frequently 
met with in gynaecological practice 
that it is almost impossible to think 
that they may be passed over un- 
noticed. The recent text books 
have little to say on the question, 
but there are some publications which 
have treated it, and Debove, in his 
recent and very excellent Manuel de 
Medicine, volume three, particularly 
calls attention to the genital origin 
of many neuralgias. 
In the great majority of cases 
your patients will consult you for 
the pains, never suspecting any 
uterine trouble, but if you proceed 
with care in your questioning and 
examination you will not be long in 
drawing your conclusions as to the 
probable factor of their production 
The following types of neuralgia 
are probably the most frequently met 
with when produced by a lesion of 
the uterus. (1) Facial neuralgia; 
(2) Intercostal neuralgia; (8) Sciat- 
ica; (4) Abdomino-lumbar neuralgia. 
As to the genital lesions that have 
produced them I will mention en- 
dometritis, polypus of the cervix, 
ulcerations of the cervix, fibroids, re- 
troflexions and carcinoma. I think 
that the facial and intercostal types 
are perhaps the most frequent. 
Facial neuralgia is in dh-ect rela- 
tion to the anatomical distribution of 
the trijeminus, the pain being seated 
in one or all of its numerous 
branches, or in a part of a branch. 
It could be bilateral; although I am 
not acquainted with any record of 
such a case. 
Generally speaking, the situation of 
a neuralgia depends on its cause. In 
the greater number of cases neural- 
gia of the inferior and supei’ior 
branches of the maxilliary is produced 
and kept up by alveolo-dental lesions ; 
when the ophthalmic branch is af- 
fected the cause will generally be 
found in the eye or nose. In the 
first-mentioned type the teeth may 
be found in a perfectly normal con- 
dition, but Prof. Duplay has pointed 
out that a lesion in a tooth may not 
exist, the pain being due to lesions of 
the alveola that have been aggravated 
by some dental operation. 
But there is a type of facial neu- 
ralgia whose factor should be looked 
for, not in a local lesion, but by some NEURALGIA AND UTERINE AFFECTIONS. 
3 
distant influence; such is the super- 
orbital neui'algia that you will fre- 
quently meet with in syphilis, gout, 
chlorosis, dyspepsia or constipation. 
It is also frequent as a symptom of 
malaria and still more so of acute gas- 
tritis, but especially is this true of a 
poor general condition. Now, when 
you have eliminated the above etiolog- 
ical factors of your neuralgia, turn 
your attention to the genital organs of 
your patient, and very likely you will 
discover the cause of the trouble 
there. 
Intercostal neuralgia appears to be 
one of the most frequent forms de- 
pending on lesions of the reproduc- 
tive organs. According to Bassereau 
utero-ovarian affections are the most 
ordinary cause of the intercostal form, 
and Valleix, in his statistics, found 
this neuralgia more frequently in the 
female. But as is pointed out by 
Desnos, it would appear that in many 
cases there are intermediate affec- 
tions existing between the genital 
trouble and the intercostal neuralgia, 
which is most often a gastrointes- 
tinal lesion, and if you consider this 
fact for a moment you will recollect 
that these gastrointestinal affections 
are often directly dependent on some 
genital lesion. Of fourteen gynae- 
cological cases suffering from neural- 
gia, reported by Villian, seven, or 
fifty per cent., were affected in the 
intercostal nerves. 
Sciatica, according to many writers, 
is extremely frequent in diseases of 
the genitalia, although Villian only 
found two out of his fourteen cases 
suffering from this very painful affec- 
tion, and he states that from other 
observation besides his own cases he 
is of the opinion that it is not very 
frequent in gynaecological affections. 
It is to be remembered that I do 
not allude to large pus tubes or 
abdominal tumors pressing upon the 
sciatic nerve or invading it by metas- 
tasis, for as a matter of course these 
lesions produce alterations in the 
nerve that would provoke severe 
pain. 
Villian reports one case of abdom- 
ino-lumbar neuralgia produced by a 
salpingitis, which had been present 
for a considerable period, and which 
after removal of the diseased adnexa 
was completely cured. When you 
think of the frequency of renal pains 
complained of by patients suffering 
from gynaecological affections you 
must remember that this is not a 
neuralgia of the lumbar nerves. 
These pains are nothing like a neu- 
ralgia of the lumbar plexus, which is 
a very rare complication of uterine 
disease. 
I have now put before you the 
principal painful phenomena which 
are met with in uterine affections, and 
it now remains for me to endeavor to 
explain their nature and outline the 
means of their cure. 
I shall not insist on the differen- 
tial diagnosis of these pains, as 1 think 
you will easily arrive at a correct 
conclusion in a given case, now that I 
have shown you that the fact exists. 
But you may ask, are these pains 
really a neuralgia ? In reply I would 
recall to your minds that a neuralgia 
should present the following funda- 
mental symptoms, as has been pointed 
out many years ago by Valliex, viz.; 
The seat of pain must follow the track 
of a nerve, it must be paroxystical, 4 
CHARLES GREENE OUMSTON. 
and lastly, it is greatly increased by 
pressure over the point correspond- 
ing to the exit of the nerve trunk. 
These latter are known as Valliexs 
points. 
In the fourteen cases reported by 
Villain, these three symptoms were 
well-marked, and the pains sustained 
by his patients were not the vague 
type, seated in the muscles or in the 
viscera, such for example as lumbar 
pains, dull, continuous and not in- 
creased by pressure, which are so fre- 
quent in the case of uterine disease ; 
it was along the track of the nerve 
that these patients felt the pain. 
This character is common to both 
true and pseudo-neuralgia, which has 
been so well described by the regretted 
Charcot, and which depend on an 
intra-rachidian irritation of the nerve 
roots. As you know, in these cases 
pressure on the nerves produces no 
pain, and still more a painful anaes- 
thesia is observed; and lastly the 
pains are usually bilateral. 
All these symptoms are wanting 
in cases of neuralgia due to diseases 
of the female genital organs. 
You may also ask if these pains 
are not due to a neuritis rather than 
to a neuralgia ? The frequency of 
these pathological changes in the 
various infections, intoxications or 
cachexise, might lead one to suppose 
that it is a neuritis, but the term 
neuritis, that is to say a material 
lesion of the nerve, implies that it is 
a durable affection which must follow 
the cause which has produced it, as 
is seen in lead or alcoholic intoxica- 
tion, severe infectious diseases, or 
following prolonged compression of 
the nerve trunk itself. 
Then on the other hand, indepen- 
dently of the pain which is usually 
not very severe, a neuritis produces 
a series of trophic troubles, either of 
the skin or muscles. 
Now in the cases reported of neu- 
ralgia due to gynaecological affections, 
no trophic troubles have been noted, 
and what is to be particularly borne 
in mind is, that the nervous symptoms 
have quickly disappeared when the 
genital disease has been cured. Con- 
sequently, gentlemen, I believe it safe 
to profess that neuralgia, using the 
term in its full understanding, is a 
complication that is met with in 
women having lesions in the uterus 
or adnexa. 
Now what is the origin of these 
neuralgias and in what manner are 
they connected with the pathological 
conditions of the uterus ? 
In the first place, every neuralgia 
is dependent on some local or general 
cause. The local causes need not be 
considered here, as in the beginning 
of this lecture I said that I should 
not take up those cases in which the 
nerves were directly influenced by 
the morbid condition of their neigh- 
borhood. The general causes may be 
considered under four groups, viz.: 
(1) the intoxications; (2) the dia- 
theses ; (3) the infections; (4) the 
various neuropathic conditions. 
Of the first group I have nothing 
to say, as it is a subject rather foreign 
to this lecture. 
Various dyscrasic conditions pro- 
duced by anaemia, pregnancy, labor, 
etc., are in no manner infrequent in 
genital diseases of the female. The 
many forms of nervous diseases are 
often factors in the pathological con- NEURALGIA AND UTERINE AFFECTIONS. 
5 
ditions of the female, as many re- 
ported cases demonstrate. 
Let me first speak of the neuro- 
pathies. These may be divided into 
two classes, viz.: hysterical and 
neurasthenical. As yon know, hys- 
teria is a frequent cause of neuralgia; 
this is true of neurasthenia, but there 
is a distinction to be made between 
the two forms. 
You will often have patients whose 
neuropathic heredity is marked, but 
who appear to have a perfectly 
normal nervous system, or nearly so. 
Other than a few peculiarities of 
character, and perhaps an occasional 
syncope, they can be considered as 
well. But when an infectious disease, 
a physical or moral strain attacks 
them, the equilibrium of their ner- 
vous system is broken, and the nervous 
subject becomes a true and complete 
neuropath. 
This is a phenomena similar to the 
toxic or traumatic hysteria, and what 
is true of hysteria is true of neu- 
rasthenia, only the former appears to 
more often accompany the more seri- 
ous lesions, while the latter is a com- 
plication of slighter ailments. In 
genital pathology more or less severe 
nervous troubles are the general 
rule. 
The nervous system of woman, 
being more delicate and impression- 
able, re-acts with greater intensity, 
and let me state that all gynaecologists 
have remarked that especially slight 
affections, such as metritis, are more 
prone to produce hypochondria and 
digestive troubles, which are so often 
connected with neurasthenia. 
But a disease of the uterus or 
adnexa may occur in an hysterical or 
neurasthenic subject, in which case 
the genital lesion will exaggerate the 
pre-existing neuropathic condition, 
and this latter state will itself re-act 
on the genital affection, rendering it 
and its treatment more complicated. 
At any rate the question is not 
simple. From the fact that a patient 
with some uterine trouble is a hys- 
teric or a neurasthenic and suffers 
from a neuralgia, a frequent symptom 
of both these neuroses, it does not 
necessarily follow that this neuralgia 
is of an hysterical or neurasthenical 
type. When you witness the simul- 
taneous development of a uterine 
affection and a neuralgia in a nervous 
subject, who never before has suffered 
from the pains, and when you per- 
ceive that this neuralgia improves in 
direct relation to the amelioration of 
the genital lesion, I think that you 
will be forced to admit that the 
lesion of the latter organs certainly 
plays a part in the genesis of the 
neuralgia. 
The important question for you is, 
if the neurosis is the real cause, It 
must be treated, but remember that 
the treatment directed against it may 
be bad for the uterine disease; or 
you may be persuaded that the 
neuralgia depends on a genital affec- 
tion, and by a proper treatment the 
pains will disappear. 
Under the term ansemia, I only 
understand that condition which has 
been produced by loss of blood. Prof. 
G. S6e has studied the question in 
detail, and only considers ansemia as 
present when due to a loss of blood. 
You all know how frequent neuralgia 
is in ansemic subjects, and as Romberg 
has truly said, “ neuralgia is the cry 6 
CHARLES GREENE CUMSTON. 
of distress of the nerves, asking for a 
richer blood.” The exact manner by 
which anaemia produces painful phe- 
nomena in the nerves is as yet not 
completely demonstrated, although 
it may be surmised, given the results 
of experiments. An animal which 
has been freely bled will have con- 
vulsions, which is nothing more than 
a symptom of an irritation of the 
motor nervous system. But the 
animal gives no clue as to the sensa- 
tions that it experiences; but it is 
most probable that the sensitive 
nervous system is also irritated, al- 
though in a lesser degree. 
Considering now those patients 
who do not present any former neuro- 
pathic taint, and who have not had 
metrorrhagia sufficient to produce 
anaemia, it is evident that then- 
neuralgia should be considered as 
sympathetic, providing that this term 
is employed scientifically, in other 
words a reflex phenomenon. 
It is by this supposition that may 
be explained the sciatica of women 
suffering from uterine affections. 
The irritation is first produced in the 
collateral branches of the sacral 
plexus, and from there extends down- 
wards into the sciatic nerve. 
But it is not possible to give such 
an explanation for painful symptoms 
occurring in nerves far from the 
genital organs, such as the trijeminus 
for example, or the intercostal nerves. 
In neuralgia of the latter, gastric dis- 
turbances may serve as an inter- 
mediary, as in a case reported by Vil- 
lian, of a woman who had suffered for 
some time with dyspepsia, and whose 
intercostal neuralgia disappeared 
when the uterine affection (a fibroid 
tumor) was relieved, although the 
condition of the stomach remained as 
before. 
The only explanation that I am 
able to give you is, that these distant 
neuralgias are of a reflex nature, the 
nerve attacked by reason of the 
habits or antecedents of the patient, 
having become a locus minoris resis- 
tentioc. That they do depend upon a 
lesion of the genital organs is beyond 
a doubt, as many cases show. 
As to the prognosis I have little 
to say, other than that a proper treat- 
ment directed to the true factor of 
their production will surely put an 
end to them. This will be accom- 
plished when you have eliminated all 
the ordinary etiological factors of 
neuralgia in general, and an examina- 
tion of the reproductive system will 
show you that it is the seat of some 
pathological condition.