THEPLEA OFANAGGRIEVED UTERUS. L. D. WILSON, M. D., WHEELING. {Reprinted from the Transactions of the Medical Society of the State of W. Va., COMMERCIAL PRINTING HOUSE. The Plea of an Aggrieved Uterus. BY L. D. WILSON, M. D., WHEELING. {Reprinted from the Transactions of the Medical Society of the State of W. Va., 1886.) Gentlemen of the .Medical (Profession: In presuming to ask your attention to a communication from one not of your number, I feel that a few words of in- troduction would be proper. I am, or at least I think I am, a much wronged Uterus. For a long time I have felt that the medical profession was not acting with fairness towards me ;-that, on the contrary, I am made the object of unjust suspicion and annoying es- pionage. I am the victim of constant fault-finding and ac- cusation. Contrary to all the rules of law and justice, I am continually called on to prove my innocence-am never allowed the benefit of a plea of " not guilty." Certain members of your profession have gained the ear of my host- ess, and have inculcated a bitter prejudice in her mind against me, so that I am looked on by her on all occasions and under all circumstances as the one peccant organ, con- cerning which nothing good could be credited, nothing evil disbelieved. My innate modesty and shrinking timidity have thus far prevented me from giving voice to my complaints, and I was not without hope that meekness and patience would one day bring their promised reward. But events of late seem to shape themselves more and more adversely. Any anticipation that time would bring relief seems about extin- guished, and I am almost ready to prolapse under my accu- mulated troubles. 2 Oppressed by gloomy forebodings, I yet felt that exist- ence was worth at least a little more of struggle and effort, and while revolving in my mind what I should do, the idea suddenly occurred to me to lay my grievances before, you, in the hope that I might gain a hold on your sympathies, and possibly secure a champion who would enlist his efforts in my cause. To specify, then, more particularly the matters I com- plain of, shall be my first business. You are all acquainted with my hostess. You know she is rather thin in flesh, not very well nourished, with feeble and easily disordered digestion, nervous, whimsi- cal, her social and domestic relations not always pleasant, with a good deal of unoccupied time on her hands, (she does not keep house,) a couple of children, (who are taken care of by their grandmother,) and much afflicted with headaches. You know also, that she very rarely acknowl- edges that she feels well. To give you an idea of how we have been getting along together, it will be necessary to go back a few years. For a considerable period after I began to perform my physiological duties, we got along well enough. But, by and by, late hours and undue indulgence in sweetmeats began to tell on my lady's digestion, and as a consequence, the supply of the particular material necessary to the proper performance of my duties becoming deficient both in quan- tity and quality, I could not perform them well, and we had a little trouble. The old family doctor who was consulted about it, told her mother among other things, that late hours and excitement and dissipation were bad for her, but things went on in the same way nevertheless ; I meanwhile doing the best I could. One day, however, my hostess heard of a certain Great Man, who had been away off some- where, and who could effect almost anything in the line of relieving afflicted females short of a miracle; so she began to complain more and more in the hope that she might in- 3 duce her parents to send her to him : and an unlucky day it was for me when she succeeded, as she did. So away we went; the Great Man was seen ; and with a wise shake of the head, he said : " Miss, it's your womb." Well, I was astonished; I wondered what I had done ; I couldn't think what he meant. I wasn't very long in finding out what he proposed to do in the matter though. A short time after- wards I felt something cold, and then I saw a great round opening to the light, and immediately the Great Man's eye came into view. I was so startled and confused, I didn't observe much that he did, but before he quit he had pushed a hard, smoothe stem up into my cervix, and I had to wear it there ever so long. I believe that after awhile my hostess began to think she was better. She went back home at any rate, and be- gan the same routine of life she had followed before. My work was often interfered with by imprudences on her part similar to those which had caused our first trouble, and we didn't get on at all as we should have done. So after a- while away we went to see the Great Man again. This time he introduced me to a crooked, twisted sort of a thing I heard him say was a pessary, and made me ride on that to correct my malposition as he called it. I didn't like this treatment a bit, and soon let them know it, so they very soon took the thing away, and my hostess went home again rather hastily. I wondered why she didn't stay longer, as she did the other time; and that was soon explained too ; there was to be a wedding. Well, that came off in course of time, and as I never gossip about family affairs, if I am ill-treated, our narrative will be interrupted for a time. Not so very long after this-just as I had expected, too- I found I had another duty to perform. I was glad of it, too, for I hoped by doing my best (as indeed I had al- ways done,) I might regain my hostess' regard. How well I did, you can see for yourselves any fine day, if you will 4 only peep over into his grandmother's yard-as fine a boy as anybody's boy. But I wasn't altogether fortunate in my endeavor, for I had the misfortune at one period of my efforts to lacerate my os a little. This I looked on as a trifling occurrence at the time, as it soon healed up again and seemed all right, but eventually I found out my mistake. My hostess, through nursing and some domestic disap- pointments, did not seem to get along very well, and after some months we went to see the Great Man again. And would you believe it ? "Madam, it's your womb," again. And then he began talking about some other great man, I think he called him Emmet, but I was so set back at the idea of being accused of causing all the trouble my hostess was having, that I didn't attend to much that was said. The result of this conference was that I was vigorously attacked with a lot of sharp tools, scissors, needles, knives and the like. My os was cut where it had been torn, it was stitched up again, and my hostess spent a month in bed. I never could understand what the man did this for, but it all healed up very much as it had done before, and the rest in bed did madam much good. But I had it all to undergo again after the little girl was born. That time my os was again torn, and it hadn't healed up very well, though I be- lieve if they had only kept madam at rest and given us a little more time it would have been all right. Since then we have been getting along very much as be- fore. Sometimes pretty well, sometimes not. We've been to see the Great Man a time or two since, but he doesn't seem to know anything else to do. I've been torn open and I've been sewed up, and that seems to have taken him about to the end of his string; so matters are about as I described in the beginning. The old doctor drops in now and then to see the children, but he doesn't seem to concern him- self much about madam. He tells her mother she will come around all right one of these days. I occasionally hear him tell about the doings of some of the great men of your pro- 5 fession, gynecologists he called them. The Great Man we went to was one of them. I heard him once tell about how one of these, I think he called him Sims, used to slit open our cervices to cure all our hostess' complaints, and then right after him came that other man I mentioned, Emmet, who cured these same complaints over again by sewing up those slits. I could see that the doctor didn't think much of their performances, but I guess they made a great deal of money by them. When I first thought of communicating my grievances to you, I concluded I would examine into this gynecology business a little, and find out if possible what it meant.That a certain number of your profession should call themselves by such a queer name I thought singular, and I concluded that I must be a very complicated organ indeed, to demand so much talent to be especially devoted to my welfare. It would seem that I am born to be astonished, for astonished I certainly was, when I found, on looking a little into my anatomy and physiology, that I am about as simply con- structed as it is possible to be. I have a mucous lining, a muscular wall and a serous covering, so the books say, with a few little mucous follicles and a reasonable supply of blood- vessels and nerves. That is all. As to function, I seem to be of no use at all, so far as the well-being of my hostess is concerned. I perform no vital office-have nothing to do in any of the processes which are necessary in maintaining life-am not connected with any of the organs so engaged -and am even shut out of the apartments where all this work is going on. In fact, I discover that my hostess could get along as well, if not a great deal better, without me, and I believe that latterly she has begun to suspect something of the kind herself. I find that I am only a nest, nothing more ; a place where an egg is hatched. And I find, furthermore, that there is no special peculiarity in my structure which makes my agency necessary for that. I find that an egg can hatch just as well tucked up in a 6 fold of the peritoneum in the abdominal cavity, as it can in mine. I know it is better for the egg and better for the woman that the hatching be done in the nest, but neverthe- less the fact remains, that what can be done in me can be done almost anywhere else. I am merely a convenience in a single respect, and a very decided inconvenience in all others. When I look at the matter in this way, I don't wonder that my hostess seems at times a little nettled at me, partic- ularly when gynecologists induce her to believe me the au- thor of so many of her ills. Being such a simply constructed organ then, and having such a limited field of usefulness, it cannot be otherwise than that I am subject to very simple derangements ; and that the effects of these should not differ in any material respect from similar derangements in similar structures any- where else. An abrasion or laceration in the mucous mem- brane of my hostess' mouth ought to produce pretty much the same effect as when it is located in my os, and it ought to be amenable to pretty much the same treatment. I won't stop here to give my notions in detail about the va- rious disorders, real and imaginary, for which I have been treated ; I do not want to tire you. In my search for knowledge about myself, I accidentally glanced one day into an instrument-maker's catalogue. Here was a " find. " It made me dizzy to look through it. Such a lot of queer, crooked, ugly and savage looking things, no uterus ever imagined. I thought I would look over the list of such instruments as are used in the treat- ment of the less serious disorders attributed to my kind, and this is the result. There were 62 speculums, (one of these is what the Great Man looked at me through,) 31 dila- tors, 7 uterotomes, 8 scarifiers, (scare-ifiers I first read it,) 113 pessaries, and sounds, and depressors, and elevators, and replacers, and uterine forceps, and curettes, and appli- cators, and syringes, and retractors, and oh, I couldn't 7 name them all in an hour. 1 counted 273 of them and then quit. I was impressed with one thought, and that was that these gynecologists must be a wonderfully industrious set of men. Remember, too, that I only counted those instru- ments which are used in minor uterine surgery as it is call- ed; I got tired before I came to those used in the removal of tumors, vesico-vaginal fistula, and the like, there must be one or two hundred more of these. I started out to discover if I could, what gynecology was founded upon, and I found that if I were left out, there would not be much of the specialty left. It was about what I had expected, and yet it made me uneasy. I wish I didn't occupy such a prominent situation. The gynecol- ogist, you know, looks at the world through a speculum, and as I am always at the other end of it, he has some ex- cuse, I suppose, for considering me to be the foundation on which the structure of his fortune and fame must rest. But this thing of having a lot of busy, inventive, ambitious men continually at work contriving new reasons for doing new things to me, and devising new instruments to do them with, opens up a prospect which is far from reassuring. What I most dread is the legitimate and inevitable result of this state of things. Under the stimulation of emulation, honorable and otherwise, ever square inch of my os, cervix and mucous lining is continually interrogated; its va- rious states of anaemia or hyperaemia, congestion-active or passive-redness or paleness, minutely dwelt upon; the tilt of my body wisely scrutinized; the depth of my fundus carefully probed; every segment of my muscular wall sol- emnly investigated ; mucous follicles inspected ; epithelial lining examined; secretions analyzed and differentiated; every constituent part of myself worked over and compared with some ideal standard, which each individual investiga- tor has set up in his own mind as representing the normal condition; all this concentrated attention directed to an organ which is three inches long, two inches broad, and an 8 inch thick, and which weighs from an ounce to an ounce and a half! What must be the result of all this? Each and every in- vestigator (as they prefer to call themselves,) will feel that life has been a dismal failure unless he succeeds in discover- ing some new disease, devising some new operation, or in- venting a new pessary. Whereas, before, I was only map- ped out into states, I am now divided up into counties, and those into districts, and these into precincts ; each and every subdivision becomes a seat of some special pathological condition, with its attendant operation and medicinal treat- ment ; works on gynecology multiply; those elongated yel- low satchels become more and more bulky; and the pessary makers " go forth and grow up as calves of the stall." And in the midst of all this comes the thought which was so ve- hemently expressed by the dying man, when his wife at his bedside was loudly lamenting her forlorn future, and crying out ' What will become of me?" "You !" exclaimed the man, "You're all right." "But what's to become of me?" So what's to become of me by the time this has worked itself out? Will there be any uterus left to speak of? I fear that my usefulness in the field for which my capacities are adapted would be well nigh ended, and that for the remainder of my days I should be fit for little else than to roost on a pessary and weep the pellucid mucous pellicle. Now, gentlemen, speaking for my kind, I think we ought to have a rest. I know this whole business will react in time ; all such things do; but we would like to have the re- action begin now. There are already faint signs of its ap- pearance in certain quarters. It seems to me I haven't heard much lately of the slitting of the cervix operation which a few years ago was so essential, and I think there are fair prospects for witnessing a decline in the equally necessary sewing up process. It puzzles the non-scientific mind to un- derstand why these procedures should be so imperatively demanded at one time and be so useless at a later period. 9 " Alas ! If I so soon am done for, What on earth was I begun for? " Does it advance your profession in its claim to be a sci- ence, or elevate it in the estimation of thoughtful people, to be thus ready to adopt precipitately every fresh hypothesis that is presented, vociferously announcing as each new de- parture is made, that this time, the "elixir of life" has been discovered sure enough, and then almost before the sound of the boasting announcement has died away, to cast the discoveiy aside as of little value, and the quest being again taken up, to noisily discover the much sought boon again ? It seems to me this shows a lack of ballast. You tip over too easily, and the slightest side-wind throws your rudder up out of water and you cannot hold your course. In my natural and excusable anxiety to know more about the prospects of the reaction I spoke of awhile ago, I improved an opportunity which lately presented itself, to glance hastily through some of your periodical literature. I found occasionally something comforting, not as much as I should have liked to find, but still enough to make me feel a little encouraged. One little scrap which I picked up I will quote, it refers to that procedure I so much dislike, sewing up the os. It is a statement by an English physician who had recently returned from a visit to this country. He said, that " even by Emmet himself, the operation was one which was comparatively seldom performed. Those who most frequently performed it were chiefly the men further west" I shall not concern myself about this con- temptuous sneer at you who live in the locality mentioned, insinuating as it does that you occupy a low plane in your profession, and are not the equals of your brethren further east. You can take up the cudgels in your own behalf on this point, and I am free to say that I think the author of this slur is open to a good currying. I will merely say that if you have given justification for this reflection, it could only 10 have been by following too subserviently the lead of some of your brethren further east, which, after all, only goes tp show that you are merely no better than they. If they abandon these fashions sooner, it is only because they begin them sooner, a fact which I would commend to your foreign critic. But I found other things in my search that were by no means so solacing to my anxious feelings. I find that there has been another discovery made, of course by some of the men further east. It is now discovered that rapid dil- atation is the thing for me, and I am afraid by the time they find out that this is about on a par with some of their previous devices, and have abandoned it long enough to enable themselves to entertain a proper degree of contempt for those who continue to practise it, that some of you " further west " may be among its temporary advocates, and as I live " further west " myself, I shall have to keep very quiet or I shall get myself dilated. I don't feel very good over the prospect. What do you suppose they ex- pect to accomplish anyhow, by their rapid dilatation ? Those of us who have fulfilled the purposes of our creation cer- tainly get dilated enough. We ought to be all right after- wards. And as to those of us who are yet in the virgin state, you surely could not think of dilating them-spoiling their pretty shape. Then the danger; you might produce a laceration, which so lately was deemed to be such a dread- ful thing by the men further east. If there be any among you who believe in the doctrine which ascribes such grave and manifold disturbances to the occurrence of this accident, even when it promptly and perfectly heals up again, I am sure such would not subject a cervix to such a risk. In this matter we have to fear those only who are skeptical on the point mentioned. Of course, gentlemen, I do not pro- fess to know as much about these things as you do, and it would be presumption in me to argue such questions with you. I am only making a special plea, as the lawyers say. 11 1 want, if 1 can, to induce you to "letup" on the uterus for awhile, and of course I advance whatever ideas I think may help my side of the case. • Now, gentlemen, I have done little thus far but complain and scold, but I hope that you will not do me the wrong to suppose that I 4m never in a pleasant mood, for you know how natural it is for persons when they once get to airing their grievances, to forget that others possibly are not so much interested as themselves. I should be sorry if any- thing I have written should give you the idea that I have not a very high regard for your profession. I admire this never satisfied spirit of investigation which posesses so many of you medical men very much. It is a grand endowment, and too much cannot be said in praise of its efforts and achievements, only I think I have been receiving a little too much of its attention lately. How would it do to have a little change ? Suppose you try the plan of resting your- selves by changing the field of inquiry. Now, there is my friend at the other end of the avenue, the hymen. Why not take that up as a subject for investigation? Here we have bloodvessels, and nerves, and mucous membrane, and epithelium; surely there must be some pathology where we have so many of these ; then it is constantly exposed to inju- ries of various kinds-lacerations even ; these alone would furnish a fine field for such of you as may be fascinated by such dreadful things. Then there are my neighbors the ovaries-no, I'd rather not; that's a little too near home ; but there are the liver, and kidneys, and a dozen other or- gans; organs too which are complicated in structure and function, and which you cannot get at very readily to do harm to; these will bear any amount of scientific inquiry, and by engaging in it you stand a much better chance of ad- vancing the claims of your profession than you will by poking around me all the time. And there is the nervous system ; this is another fine field, perhaps the most prom- ising, certainly the most mysterious of all, and I am 12 strongly of the opinion that if it is diligently worked, you will find here the origin of the greater part of the mischief which you now attribute to me. About the best friend we uteri ever had was a worker in this department-a Dr. Beard. He is dead now, poor fellow, but if he had lived longer he would have created a diversion which would have brought immense relief to us. In the course of his inquiries he discovered a dreadful state of affairs which he named neurasthenia, which was the pro- lific parent of all sorts of troubles, and it really seemed for a little while that our emancipation had come at last; but about the time all the 'ologists over the country were begin- ning to prick up their ears and turn their heads that way, he died, and the thing apparently miscarried, for the gynecol- ogists returned to their operations on us; the neurolo- gists went back to working their battery racket; all the other 'ologists to their ologies, and there was an end to our hopes for that time. I wish I could get some one to start this up again. To be candid I don't care what you do, or what organ or system bears the brunt of your scientific questioning, just so I escape. I have become the embodiment of undilut- ed selfishness. All other organs may defend themselves as best they can. They never tried to help me any, and I am not sure that some of them haven't done what they could to get me into trouble. There are a number, of other matters to which I intended to refer in this communication, but I find I have become un- pardonably tedious. Especially did I hope to speak of some of the many conditions in which your efforts have been of incalculable benefit to me, and for which I entertain for you the liveliest feelings of gratitude. Perhaps I may make these a subject for another communication in the future. I will promise you one thing. You remember I told you that my hostess was still complaining at intervals. Well, I do not know what will be the next move, if anything. It 13 may be that we will go to see the Great Man again ; but whatever new experiences I may undergo, I promise faith- fully to recount them to you. A Much Injured Uterus.