28 OBSTETRICS. 



particularly the preparations of iron. A solution of nitrate of silver, 

 applied by means of a speculum to the interior of the cervix uteri, 

 has succeeded when other means have failed. Should there be any 

 suspicion of a syphilitic taint, the remedies proper in such cases 

 should be used. 



HYSTERALGIA, OR IRRITABLE UTERUS, 



May be defined, a permanent and painful sensibility of the uterus, 

 especially of its neck ; often accompanied by increased frequency of 

 pulse, a dry hot skin, and generally, in protracted cases, with gastric 

 and renal derangement. The disease commonly occurs in the mid- 

 dle period of life, though it is someiimes met with in early youth. 



The local sympto^ns are pain in the small of the back and sacrum, 

 extending down the thigh to the knee, and around the brim of the 

 pelvis to the lowest part of the abdomen. There are also sometimes 

 erratic pains in the thorax and loins. The character of the pain is 

 that of soreness, slight pressure relieves it, but it is aggravated by 

 rough handling. Sometimes it is spasmodic, like those of abortion. 

 Dewees describes the pain as often pulsating. 



The pain is aggravated by excitement of any kind, by exercise, 

 and sometimes by standing. Straining, either in defecation or urina- 

 tion, constipation, flatulence, and diarrhoea all aggravate it. 



A per vaginam examination may prove the uterus to be either dis- 

 placed or engorged, but not altered in form, size, or density; 

 extremely painful to the touch, in the body as well as in the neck, 

 the pain is " as if a knife had been plunged into it." 



Causes. — Among the predisposing causes may be placed, educa- 

 tion, fashionable life, prolonged lactation, and temperament. Among 

 the exciting causes, bodily exertion during menstruation, astringent 

 injections, abortions, prolapsus and sudden arrest of the menses from 

 any cause. 



Diagnosis. — From neuralgic dysmenorrhoea, by the constancy of 

 the pain. From acute inflammation of the cervix, by the absence of 

 heat, swelling and throbbing ; by the absence of discharges, and 

 by the slight change of the cervix compared with the amount of 

 suflering. 



Pathology. — Gooch considers it a permanently painful condition 

 of the uterus, neither accompanied by, nor tending to produce change 

 in its structure. Ashwell considers it a modified inflammation, or 

 at least, closely allied to inflammation or congestion. 



Treatment. — Two indications present themselves, viz. ; 1 . To 

 mitigate local suffering ; 2. To sustain and improve the general 

 health. The first indication will be fulfilled by the use of anodynes, 

 -either by the mouth, rectum, or applied directly to the uterus itself; 

 by the application of nitrate of silver, by dilating the cervix by 



