Diseases of women, including their pathology, causation, symptoms, diagnosis and treatment : a manual for students and practitioners / by Arthur W. Edis.

Edis, Arthur W. (Arthur Wellesley), 1840-1893.

Date:: 1881

Credit: Diseases of women, including their pathology, causation, symptoms, diagnosis and treatment : a manual for students and practitioners / by Arthur W. Edis. Source: Wellcome Collection.

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$the centre of tlie cervix, and take means to prevent it closing again, by tlie occasional passage of bougies, or by the wearing of a glass or vulcanite intra-uterine stem for some time afterwards. Where there is distinct evidence of heematometra existing, the fluid may be drawn off in small quantities at a time by the aspirator or trocar, with antiseptic precautions, as indicated when speaking of the treatment of imperforate hymen, or a crucial incision may be made at.a spot cori'esponding to what should be the normal os uteri, and the retained fluid allowed to escape freely, w^rm waterjjeing subse- quently injected carefully into the uterine cavity, to facilitate expulsion of the treacly fluid, and also to cleanse the cavity of the uterus, so as to prevent decomposition of the fluid remaining adherent to the ■walls. The edges of the incision may be toxiched with the perchloride of ( iron to prevent theii- uniting, to check hsemorihage, and prevent j absorption. It will be necessary to take precautions lest the aperture ! close by cicatrisation. The occasional passage of a bougie or sound | will often be suflicient. The insertion of any intra-uterine stem is I contra-indicated until the uterus has contracted to its normal dimen- I sions, and all the fluid has been expelled. Acquired occlusion of the os uteri, from injury or other cause, will need operative interference, as in cases of congenital occlusion, modified according to the circumstances of each individual case. Closuie of the cervical canal from extiinsic pressure, as in cases of flexion, fibroid tumours, <fec., will have to be remedied by obvi- ating the causal condition. This will be found xmder the various headings. Conical Cervix and Stenosis of Os Externum, is not infrequently found as a congenital condition associated with imperfect development of the uterus or ovaries. The tapering cervix projects further than usual into the vagina, and is often curved forwards, the posterior hps being lengthened ^ and the anterior shortened. There may be / \ stenosis both of the internal as well as the \ I « ] external os, but the latter is generally most i / marked. The cei'vical canal itself is fairly \ / normal in size between these two points. The vagina is often smaller than usual, and there may be an infantile form of pelvis, with absence of sexual feeling. Symptoms. — Dysmenorrhoea is usually present. The pain,' situated chiefly in the sacral and iliac i-egions, radiates to the loins, down the inner side of the thighs, aiiH at Fig. 21.—Conoidal Cervix, times assumes the character of severe.forcing - or expulsive pain, unfitting the patient for the least exertion, and comjjelling her to keep in bed. Pain is not, however, an invariable symptom. Where the menstrual discharge is scanty, and the mucous membrane becomes completely disintegrated, there may be no evidence of obstruction or pain ; but where menoiThagia results, and clots or shreds of decidua attempt to pass, violent spasmodic pain is produced$