Part 9

CHRONIC METRITIS.

One day an official in Dresden brought his wife to me, who was 41 years of age. The couple, all of whose children had died soon after birth, longed once more for children. The woman had aborted several times, and both were intelligent enough to see that everything could not be right with the sexual organs, and even begged for a gynaecological examination. The result was in a few words: inflammation of both lips of the uterus, a thickening of the cervical canal with a swelling of the posterior uterine wall as hard as cartilage, and retroversio uteri. Menstruation too early, dysmenorrhoea, blood dark, tarry, passing in clots. Yellowish, fetid leucorrhoea. Stools retained, appetite changeable; pains in the broad ligaments on both sides during rest as well as on exertion. The so-called "facies uterina"--weeps much. Frequent exclamations on the distastefulness of life since the death of all her children, and on account of her present childlessness. Should I register in my journal in the beginning of a scirrhus? I wrote simply: metritis chronica; intumescentia labiorum orificii et colli uteri.

Prognosis, not unfavorable as far as regards the swelling, after my already well-tested experience with Aur. mur. nat. But how about the removal of sterility acquired in her 41st year. I was more cautious about this. The cure took six months, and was not only accompanied by absorption of the affected parts, but the woman became pregnant in good time and gave birth to a boy with comparative comfort. Thus would the wishes of the worthy couple have been fulfilled, if their joy had not been banished once more by the death of the child in four weeks from an attack of eclampsia.

ANTEVERSION WITH PROLAPSUS.

I now come in conclusion to a gratifying case, which I relate partly because we make ourselves guilty of sins of omission in certain instances through neglect of the needful investigation. A woman in her twentieth year, quite healthy, had been delivered with forceps for the first time two years before, nominally on account of deficient labor pains. There was nothing unusual about the confinement. Immediately after the first getting up, she began to have constant pain in the right side of the uterine region, and soon a feeling "as if something would fall out of the parts." The family physician paid no attention to these persistent complaints for a whole year, until finally a constantly increasing leucorrhoea demanded an examination. He now expressed himself as unable to make a diagnosis alone, and the lady was referred to a celebrated gynaecologist in Leipsic. Cauterizations were now undergone at the professor's house at short intervals, and further treatment of a similar character was to be carried out at the patient's own house, which was, however, discontinued when the patient was referred to me. Examination showed: metritis following upon sub-involution of the uterus, anteversion with prolapsus of the whole organ. Both uterine lips were swollen, and on examination with the speculum a greenish-yellow discharge was seen to flow from the uterus. All local treatment was discontinued, the woman received for the first time in April, 1876, Aur. mur. nat., and in June, 1876, again became pregnant; the treatment with gold was continued until the 8th month of pregnancy, in consequence of which the uterus was found in its normal position on examination twelve days after her safe confinement on March 30th. The menses, which up to this time had been very painful, returned for the first time on the 25th of April, and were quite free from suffering.

But now let us ask, whether we have in the salts of gold a simile for the diseases of the female sexual organs under the comprehensive name of chronic metritis. We find in the homoeopathic proving, inflammatory affections of the internal organs; fainting depression and emaciation; great anxiety, sadness, dizziness, whimsical mood, weariness of life, morbid desires, and headache; nausea, vomiting; pressure in the gastric region; cardialgia, contractive, drawing pains in the abdomen. Stitches in the left hypochondrium, pinching and burning in the right, the abdomen sensitive to touch, with distension; dull pains in the abdomen; drawing and stinging in the whole abdomen; eruption of small papules above the pubes; decreased excretion of urine, pressure on urinating, burning on urinating; redness, burning, swelling and moisture of the labia, discharge of yellow mucus, menstruation too soon and lasts too long; amenorrhoea; labor-like pains, as if the menses would appear; symptoms which certainly correspond to the whole picture of chronic metritis and its results.

The mode of administration which I have used for Aur. mur. nat. is in trituration. Generally I have had the patient herself divide into three parts a 10 gr. powder of the 3d trit., and take one of these dry just one hour after each meal. But I have also used the 1st and 2d trituration. The effect cannot be seen before four weeks, hence I seldom make a further examination before that time. Many women notice a remarkable increase of the appetite during the use of gold. After the administration of the 1st trit. I have observed frequent, dark stools. An increase in the urine with a thick, gray sediment is often seen.* * *

UTERINE DISEASES.

Uterine diseases, according to my experience of many years, make more marriages unfruitful than all the other known or fancied hindrances to child-bearing. They can exist many years even with a blooming appearance, without apparently disturbing the general health, and on that account are often overlooked and mistaken by physicians themselves, who are not concerned about gynaecological examinations, or else make only superficial investigations, not having their eyes at the ends of their fingers. I beg, therefore, if this communication should give rise to a more extensive use of Aur. mur. nat., above all things, a thorough gynaecological examination, not leaving this to the so-called surgeons and midwives. If women complain of gastric troubles, dizziness, pain in the loins and back, disturbances of urination or defecation, with a more or less pronounced hysterical appearance, and withal purposely or unwittingly deceive themselves and the physician; if, added to these, leucorrhoea and a sensation as if everything would drop out of the abdominal cavity, one may say of the patient that her uterus is diseased, and may base upon that his proposal for an examination, which will give the correct information of the nature of the malady. As a rule, every deep-seated, morbid alteration in the uterine tissues entails suffering upon the nervous system, which, being in such close relation with the uterus, not seldom apparently suffers the most.

HYSTERIA.

Because the uterus receives its nerves from the sympathetic system, which governs nutrition, circulation, respiration with distribution of animal heat, gestation, etc., these functions being out of sight, it is difficult to get at the root of the matter as regards the uterus in a suffering woman. Her sensations and fancies offer, according to her education, organization, etc., a wide field in which to make her a burden to herself and others. Her mind is generally out of order, she knows not why. In the more advanced stages of disease, the functions of the higher nervous system, the organs of sense, and even the mental activities are disordered. Then appears that chameleon of diseases, which goes by the name of hysteria, suitable in so far as hysteria almost without exception takes root in the "hystera" or uterus. I shall certainly not deny the possibility of primary or purely nervous diseases of the uterus, hysteria sine materia; I am nevertheless convinced that in at least nine cases out of ten, hysteria depends upon objective, sensible, perceptible changes in the uterus. It is these whose existence I ascertain by a thorough examination, and according to these that I regulate my treatment; they give me in every case a more certain starting point than a lengthy account of true and imaginary suffering. If I find, however, no palpable abnormality in the tissue to remove, and prescribe Aur. mur. nat. simply as an excellent nervine, following Niemeyer, it occasionally does good, but generally leaves me in the lurch.

AVENA SATIVA.

NAT. ORD., Graminaceae.

COMMON NAME, Oats.

PREPARATION.--The fresh green plant, gathered in August, is pounded to a pulp and macerated with two parts by weight of alcohol.

(Comparatively little has been written concerning this remedy, the tincture of oats. It acquired a bad reputation somewhere in the "eighties" by being advertised as a proprietary remedy making wonderful cures, but analysis showed the advertised "avena" to contain opium. The following outline of the drug is by Dr. E. H. Russell, in North American Journal of Homoeopathy):

Avena sativa is pre-eminently an anti-neurotic, quieting the nervous system to a remarkable degree. Its special sphere of action seems to be upon the male sexual organs, regulating the functional irregularities of these parts perhaps as much as any drug can. It is a most useful remedy in all cases of nervous exhaustion, general debility, nervous palpitation of the heart, insomnia, inability to keep the mind fixed upon any one subject, etc., more especially when any or all of these troubles is apparently due to nocturnal emissions, masturbation, over sexual intercourse, and the like. For these disorders it is truly specific. It is one of the most valuable means for overcoming the bad effects of the morphine habit. In most cases in which the habitue has not used more than four grains daily the opiate may be abruptly discontinued, and even substituted, without any serious results. If a larger quantity than this amount has been taken for some time, it is better to gradually reduce the daily dose of morphine, in the usual manner, simply prescribing the Avena in addition. The latter should be given in the same dose, as a rule, regardless of the amount of morphine taken. In other words, it is not necessary to increase the Avena as the opiate is withdrawn. When the quantity of morphine has not exceeded four grains daily it should be stopped at once, as stated above, and Avena given in its stead in fifteen-drop doses, four times a day, in a wineglassful of hot water. By this method the disagreeable after-effects will be much less than though the dose of morphine is gradually reduced, and the patient will find life quite bearable, as a rule, at the end of a week.

Avena sativa should always be given in appreciable doses of the tincture. Fifteen drops three or four times a day, well diluted, will usually meet the case. It may be given in doses of from five to sixty drops in rare instances. It should, however, never be given in larger quantities than twenty minims unless the patient is thoroughly accustomed to the remedy, and has found the usual dose insufficient. Otherwise there is danger of getting the physiological effect of the drug, which is pain at the base of the brain. When this symptom makes its appearance the medicine should be discontinued for a day or two, and then given in reduced doses. There seems to be no danger whatever of forming the habit of taking this drug, as it can be suddenly abandoned at any time without evil consequences, even when given in large quantities. In one case it was prescribed by the writer in sixty-drop doses, night and morning, for one year, and then abruptly stopped, nothing being substituted therefore, without bad effects.

Whenever a quick action is desired, and in all cases where Avena is given to overcome the morphine habit, it should be prepared in hot water. It is also a good plan to prescribe it in this fashion wherever indigestion complicates the case.

The writer has employed this drug in his private practice for a number of years with the most gratifying results. He has very rarely found it to fail when indicated, and on account of his high opinion of the remedy he has taken great pleasure in thus bringing it prominently to the attention of the medical profession.

AZADIRACHTA INDICA.

PREPARATION.--The fresh bark is pounded to a pulp and macerated in two parts by weight of alcohol.

(The following synopsis of Azadirachta Ind., is contributed by P. C. Majumdar, M. D., of Calcutta, India):

Azadirachta Indica. Syn.: Sanskrit, Nimba; Bengala and Hindi, Nim. Belongs to the natural order Meliaeae. It is a large tree. Bark is used for making tinctures from which provings were instituted. The leaves, bark, wood, roots and fruits, in short, every part of this tree, is intensely bitter. According to Ayurveda (Hindu System of Medicine) the different parts of this tree possess different medicinal properties. Bhava Misra, Charak, Susratha and several other Sanskrit authors agree that its bark, though very disagreeable in taste, is generally used with success in cases of lassitude, thirst, cough, fever, loss of appetite, helmenthiasis, boils, bilious derangements, catarrh, vomiting, cutaneous diseases, hiccough, gonorrhoea, etc.; its leaves are used in some forms of ophthalmic disease, helmenthiasis and disorders brought on by deranged bile or use of poisonous things. A decoction of fresh leaves is used as a favorite wash to cure old ulcers of long standing. It removes within a short time the sloughs and promotes the healing. The fruit is purgative, demulcent, and is used in some forms of cutaneous affections. A kind of oil is produced from the seed of ripe fruits, and this oil is said to cure lepra, eczema and some other obstinate skin diseases.

Nim is also praised by some of the Allopathic physicians for its tonic, antiseptic, astringent and anti-periodic properties. Its febrifuge action is well-known in our country. Kanirages (native physicians) use Nim as the principal substance in their febrifuge medicines. The vast range of its action is chiefly due to azaderine, margocine and katechin, the three active principles found in this tree. Nim was proved by me and one of my students, U. C. Bagchi. A full report of the proving was published in the Indian Homoeopathic Review, Vol. iii, No. 1. Here I give the most reliable and peculiar symptoms obtained in its proving.

Mind: Depressed and forgetful, mistakes in writing and spelling words, weak and dull, full of anxiety, inactive, could not think or remember names of persons very familiar, or what has been done in the previous day. No desire to go out or walk out. Loss of memory.

Head: Giddiness, as if the head were moving to and fro, especially when rising from a sitting posture; headache, pressure in the head, by moving it; headache, throbbing in the temporal arteries, especially of the right side, with a little vertigo; aching, drawing and throbbing in the whole head; headache, by wet compress, with much pain in the right eyeball; headache, on moving; headache on the right side with much pain. Frontal headache, especially on the right side, in the open air. Throbbing in the vertex, by stooping; scalp is painful and sensitive to touch, even the hair is painful. Vertigo at 10 A.M.; intense headache, pain in the whole head; on walking pain is felt in the back part of the head.

Eyes: Burning in the eyes; burning of the eyes continued throughout even the next day; burning, dull and heavy. Pain in the eye, by slightest pressure; red, congested and burning with slight coryza; sense of pressure in the right eye; eyes red and sunken; pressive pain in the right eyeball.