126 DISEASES OF THE UTERUS. 



bedded in the uterine mucous membrane. In the former case the ovule 

 does not become attached near the opening of the ovary, but at a deeper 

 point ; in the other case it is not even arrested at the os uteri, but falls 

 through and is lost. The symptoms of uterine catarrh are not much 

 altered by the development of the ovules of Naboih^ and catarrhal and 

 follicular ulcers at the os uteri. Granulating ulcers, on the contrary, 

 cause pain, and bleed readily during coitus, and are most apt to induce 

 the nervous symptoms of which we shall hereafter speak. 



The influence of chronic uterine catarrh on the general health varies 

 greatly. Some women bear even high grades of the complaint well ; 

 their nutritive condition, strength, and blooming appearance is all that 

 could be wished for. But some soon emaciate, become dull, relaxed, 

 and pale or dirty-colored, with blue rings around the eyes. 



From the anaemia and hydraemia, but particularly from irritation of 

 the nerves of the uterus having a reflex action on other nerve-trunks, 

 we find anomalies of innervation in many patients with chronic uterine 

 catarrh. Most frequently there is general hyperaesthesia ; but neuralgic 

 and spasmodic affections, and decided hysteria, not unfrequently accom- 

 pany chronic uterine catarrh. Proving the frequent association between 

 these so-called " hysterical " symptoms and catarrh and other diseases 

 of the uterus, and carefully studying them up, were certainly steps 

 in advance ; but recently there is great tendency to fall into the error 

 of referring all hysteria to uterine disease without due examination, 

 thus neglecting the other causes of hysteria. Since in this disease the 

 whole attention has been paid to the portio vaginalis, and both laity 

 and physicians have almost exclusively given over the treatment to 

 gynecologists, it cannot be denied that many cases are cured which 

 would formerly have remained uncured ; but many also remain uncured 

 now, which would formerly have received aid. Hence it is important 

 that every physician should have a certain acquaintance with " the 

 diseases of women," and particularly that he should understand the 

 use of the speculum. If he do not wish to enter on the local treat- 

 ment, he may turn the case over to a gynecologist ; but he should be 

 able to determine whether local treatment is advisable or not. The 

 fact, that the objection women have to the use of the speculum is 

 almost overcome, is due to the specialists. In the upper classes the 

 women and their husbands consider it as a matter of course that, when 

 there is fluor albus, the speculum must be introduced ; but among the 

 middle classes also, a physician who has the confidence of his patients 

 will find but little difficulty if he says that it is necessary to make a 

 careful examination with the speculum. It is only by introducing this 

 instrument that we can attain any certainty as to the source of the 

 discharge, and concerning most of the changes of the os uteri above 



