Edward John Tilt.

On diseases of menstruation and ovarian inflammation : in connexion with sterility, pelvic tumours, and affections of the womb online

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Pbefacb 4 . . . xi

Pr:^iminary Questions: —

I. Why should Medicine be uncertain ? . . . . xv

II. What are Diseases of Menstruation ? . . . . xix

III. What is Menstruation 1 xxiii

IV. What are^ the Organs of Menstruation ? . . . xxix
V. What is Inflammation ? xxxii

VI. By what influence docs Inflammation in the
ovarian tissues produce Diseases of Menstru-
ation 1 ' xxxiv


'Extraordinary confusion relative to the history of ovarian

inflammation 87

Its frequency proved by that of inflammatory morbid

lesions in the ovaries 41

Reasons for the past neglect of ovarian pathology ... 43

Ignorance of ovarian physiology, and the pre-eminence
traditionally assigned to the uterus amongst the or-
gans of reproduction 44

Difficulty of exploring organs so small, and so deeply
seated 46

Similitude of many of the symptoms of sub-acute ova-
ritis to those of inflammation of the womb — The
popular conviction that menstruation is a natural




function, and that there is no remedy for ^vhatever
evils may attend it-The repugnance of patients to sub-
mit to the necessary modes of investigation— The re-
pugnance of the Physician to press for an examination
which is not imperatively demanded _ •

Sketch of ovarian bibliography from the time of .^tius
to the present day -Authors, ancient as well as
modern, have described the puerperal form; some
few moderns the acute idiopathic; but none have fully
investigated the sub-acute form of ovarian inflamma-
tion, although many have given hints, suggestions, &c.,1 ^^
of the existence of this disease • • • _

On the dififerent modes of ovarian exploration

, 56

Abdominal exploration ^^

Vaginal exploration

Bectal exploration

Exploration by the double-touch


Synonomy and Definition— Morbid Anatomy . . . • • 75
Anatomical conditions of the ovaries during menstruation ^^

in the healthy woman '

Lesions of the ovarian peritonaeum; of the stroma; of
the Graafifian vesicles ; of the ovaries in the puerpe-
ral sub-acute form ; of the Fallopian tubes .... 78



predisposing causes : —

Structure and functions of the ovaries-Lymphatic tem-
perament—Over stimulation of the ovaries ; or their

total deprivation of a natural stimulus 85

Exciting Causes:—

Some are of a permanent kind; others produce arrest
of menstruation, as damp, cold, or sudden moral



impressions — Transmission of inflammation from
the uterus to the ovaries — Uterine injections, inju-
dicious cauterization of the uterine neck, pessaries,
stem-pessaries — Dangerous tendencies of the i^rcs-
ent mechanical school — Meddlesome surgery inter-
fering with the uterine organs 94

Specific Causes : —

The puerperal state — Blennorrhagic infection and Rheu-
matic diathesis 107


Common ovarian symptoms

Pain and its differential characteristics generally unat-
tended to ; and the disease attributed to the uterus
by some, and by others called "inflammation of the

bowels" Ill

Frequent desire and impossibility to pass water or fseces 114
Effects caused by the descent of the swollen ovary into

the recto-7aginal cul de sac. . . , 115

Confused notions entertained by authors concerning ovarian
pathology, proved by their considering nymphomania

as a symptom of ovaritis 116

Peculiar insidiousness of puerperal sub-acut» ovaritis has

caused it, until very lately, to be overlooked 117

Special symptoms characterizing each typo :

Amenorrhoeal type — Necessity of combining local
depletion with tonics and steelr-Chlorosis caused
by the diminished power of the generative sys-
tem 120

Dysmenorrhaal type — Governing power of the ova-
ries over the womb, as shoAvn by their causing
the painful secretion of false membranes from its
inner surface, and by determining inflammation

of the cervix-uteri 123

Menorrhagic type — Obstinacy of such cases as are
accompanied by ovarian swelling 125


Hysterical type — Strange connection between nerrous
phenomena of variable intensity with the fulfilment
of each act of the great drama of reproduction — Hys-
teiia peculiar to the reproductive period of the life of
both sexes — A disease almost peculiar to woman —
Concurrence of modern with ancient experience in
proof of hysteria being produced by some deranged
ovarian action 127



Sterility — Most frequently caused by inflammatory action
in the different tissues of the ovaries — Dr. Old-
ham's case — Sub-acute ovaritis causes sterility, (1)
by accelerating the shedding of imperfectly develop-
ed ova 5 (2) by the retention of blighted ova in the
ovary; (3) by placing mechanical impediments to
their transmission from the ovaries to the utenis 137

Uterine inflammation — Sub-acute ovaritis frequently pro-
duces uterine engorgement and erectile swelling
of the cervix — Concord of opinions of modern ob-
servers in support of these views — Cases in illustra-
tion 146

New light thrown on uterine pathology by this explana-
tion of the persistence of the patient's suff"erings
after the cure of uterine inflammation 154

Blood-letting — Purgatives — Injections — Blisters — Innunc-

tions — Habituation to use of drawers 161

Treatment of

Amcnorrhceal type 174

Dysmcnorrhoeal type 175

Menorrhagic type 175

Hysteric type 17ft



Should marriage be sanctioned ? and when ? ..... 177

Treatment of sterility I79

Fallopian catheterism ISO

Opinions of Sir B. Brodie and Dr. Oldham— Opinions of

the Author 180


Synonomy and Definition— Morbid anatomy of idiopathic

and puerperal forms 184

Causes, vide Chapter II.— Symptoms— Pain— Mechanical
disturbance caused by the neighbouring organs-
Pelvic tumours— Termination by sub-acute ovaritis,
or gradual wasting of the vital powers— Tubal
acute inflammation— Blenorrhagic ovaritis— Rheu-
matic ovaritis— Diagnosis— from metritis, from C£eco-
iliac abscess — Peculent collections 189


Resolution — Elimination — Cutaneous opening — Vaginal
opening— Intestinal opening — Vesical opening — Peri-
toneal opening— Partial ovarian peritonitis — Pcrito-
nseal eflusion— General peritonitis- Effusion of pus
in the peritoneum— Effusion of menstrual blood in
the peritoneum— Cases in proof— Dr. Pagct's report

on post-mortem appearances of Mrs. M —Result

of obliterations of the Fallopian tubes— Mechanism
of retention of menstrual blood— Bursting of the
Fallopian tubes— Great advantages of Dr. Simpson's
plan of dilating the os uteri 207




Bleedin-, leeches, calomel-Case of cure by rcsolution-
^ ElUnation of pus-Great advantage of the early
opening of pelvic tumours-Case showing fatal con-
sequences of procrastinating this opening- Fa^rinai
opening always to be preferred-Anatomical conside-
rations-Professor Recamier's moac of operatmg-
Illustrative cases-Rectal opening-Cutaneous open.
ina-Incision as proposed by Dr. Graves and Dr.
Begin— Plan of Professor Recamier— Application of
Vienna paste— Cases


Is the Author's answer to the sixth introductory question
satisfactory ?— Important practical deductions— Addi-
tional confirmation of the Author's views-A descrip-
tion and delineation of an extraordinary machine
found in the vagina of an English lady in the year




It is not without some degree of diffidence that I have ven-
tured to add even a small volume to the number of those which
oviferload medical shelves, for I feel that the flattering reception
of an ephemeral production* offers no guarantee of similar
success for a work addressed to the profession on the treatment
of important diseases. Urged, however, by a conviction that
books are not only useful to diffuse the knowledge of great
discoveries, but also to connect those facts which, although
sterile so long as they are left disjointed, assume importance
when connectedly put together, I have here more methodically
arranged, and more fully developed, views first expounded in a
series of papers on the sub-acute forms of ovarian disease,
which appeared in The Lancet in 1849,

I am further induced to do so, because those contributions
were favourably noticed in various organs of the medical
press,f and also on account of the gratifying concurrence in
my views which has been spontaneously offered to me by many
of my brethren engaged in practice.

Perhaps it would not be unbecoming for me to state, that

* The Serpentine AS IT is, and as it Oitght to be ; and
the Board of Health as it is, and as it ought to be. 1848.

t Edinburgh Monthly Journal, 1849; Dr. Banking's Retrospect,
January and June, 1849 ; Braithwaite's Retrospect, January and
June, 1849 ; American Journal of Medical Science, vols. 43 and 44;
London Journal of Medicine, December, 1849.


whether as pupil or house-physician to the Paris hospitals, I
have (from the beginning of my career) enjoyed the full ad-
vantages of the widest field for uterine investigations which
can ever be afforded by a medical school ; and that whilst
practising in Paris and in various other capitals of Europe, I
not only had abundant opportunities of testing the value of my
views relative to diseases of menstruation, but also of strength-
ening them by the practice of those who so well represent our
noble profession in each country.

I might even add, that since my return to England I have
found abundant opportunities of confirming my pecuUar views
on the diseases of menstruation, while attending the numerous
patients at the Farringdon General Dispensary and Lying-in
Charity, and also those of the Paddington Free Dispensary for
Diseases of Women and Children, to which institutions I am
attached in the capacity of Physician.

My aim has been to perform, for the ovaries, the principal
organs of menstruation, vi'hat has been successfully done for
other organs by many eminent men, and I feel assured, that
although some of my deductions may be contested, my prac-
tice will be admitted by all to be indubitably safe, and necessa-
rily destined to diminish the number and intensity of female

I can lay claim, unfortunately^ to no discoveries ; but from
an acquaintance with the literature of that branch of the pro-
fession to which I have devoted my chief attention, I feel justi-
fied in affirming, that in no other work will the reader find so
complete an account of the various ways in which sterility is
produced by the action of inflammation on the ovarian tissues,
of the great importance of ovarian peritonitis as a cause of dis-
ordered menstruation, or of the influence of ovarian inflam-
mation in the production of uterine disease — facts forcibly ex-
emplified and proved to be, not mere conventional possibilities,
but events of frequent occurrence.

I must also observe, in reference to the numerous cases with


which I have enriched my work, that I have given them more
with a view of illustrating, than of establishing, each particu-
lar point of ovarian pathology. 1 have therefore taken from
my own case-book only those select cases which bear forcibly
on the subject, borrowing from authors and contemporary ob-
servers, facts, rendered much more valuable by their not having
been collected under the influence of the views which they will
be found so admirably to exemplify. If I have derived my
cases more from foreign than from British practitioners, it is
simply because Continental obstetricians, having been the first
to investigate scrupulously the diseased oigans of generation
by the combined assistance of the touch and of the eye, have
been able in many instances to detect the hidden causes of those
diseases which, until late years, were only guessed at, and
could only be treated symptomalically.

As a fitting introduction to this work, I intended to prefix an
essay on the natural history of woman, but finding the matter
to grow rapidly under my hands, and the vast importance of
the undertaking becoming every day more perceptible, I have,
for a time, desisted from the accomplishment of what must be
considered the only rational introduction to any treatise on the
diseases of women.

In noticing the many deficiencies of this work, the reader
will also remember that it is the first systematic attempt to do,
for the principal organs of generation in women, what has now
been done for every other important organ of the body, and
that, considering the rapid progress which has lately been made
in ovarian physiology, it cannot be wrong if some one should
seek to give to the pathology of the ovaries a development
which would be greater and more satisfactory if the labourer
were better able to accomplish his self-imposed task.

I am fully aware that by the very title of the work I lay

myself open to criticism. It will doubtless be said that it

should have been " Diseases of the Organs of Menstruation,"

as we say diseases of the " organs of respiration ;" but rath-



er than prejudge a question, I prefer being censured for an im-
perfect, although received and pretty well understood, phrase-

I cannot record the progress of ovarian physiology without
testifying my admiration for the illustrious Regnerus de GraafT,
■who, nearly two centuries since, originated a movement which
has only been followed up within the last few years. Can I
better conclude this address than by borrowing the words in
which he ends the preface to his immortal worki*

*' Vale itaque amices Lector, at que conatus meos non sine
labore et sumptu adornatos, tibigue gratis ohlatos, candido et
benevolo {quo illos conscnpsimus) animo, castoque pervolve.^^

Edward John Tilt.

8, York Street, Portman Square.
March 25th, 1850.

^ Regncri do GraafF De MuUenim Organis Generationi Inservi-
entibus Tiactatus Nov us : Demonstrans Tarn Homines et Animalia
ccBtera omnia^quoe Vivipara dicuntur, hand minus quam Ovipara ah
Ova oriyinem ducere. Ad Cosmum iii Magnum Eirurioe Ducem. —
liUgduni Batav. Ex Olficina Hackiana, 1672.


" An introduction, like unto a ladder, should lead us step by
by step to the main object of our research."

QuARLEs' Enchiridion.

Question I.— Why is medicine so uncertain ?
Notwithstanding the immense progress which has
been made within the last fifty years in every
branch of medicine, we must still admit, to a marked
extent, the fact of its uncertainty ; and it seems to
us that the want of precision in medical language
is one of the principal causes of this uncertainty.
Why should there be such obscurity in our nomen-
clature, since it is in our power to give a definite
value to every term we employ ? Perhaps we
attach too little importance to words, considering
them as the mere garment of our ideas, to be
assumed or cast off, as we like, and when we like.
But are not (names we speak of those w^hich
embody doctrines) the offspring of the mind, par-
ticipating in its power, inheriting its genius ? Like
our children, when they are conceived, incubated,


and once fairly brought forth, must they not be con-
sidered as living things, impregnated -with a vital
principle, endowed with human power ?

They were meant to be the mere symbols of man's
conception of things, but soon they assume the
place, and usurp the potency, of tangible existence ;
it is by their means that man acquires a kind of
terrestrial immortality, for by them he extends his
sway over future generations. During the pro-
longed lifetime of such words, they strenuously op-
pose all new discoveries, because they are at a
loss to express them ; and even when the doctrines
they once effectually supported are defunct — ghosts
of what they were formerly, they still are able, either
to give rise to interminable discussions, or else to
weigh with undue force on the thoughts and actions
of our race. It is in the indolence of human nature
to be led by any phantom-power that will but
take the trouble of walking first. In religion, in
politics, in science, are we not led by names ? they
show the way, and on we follow, with blind im-
petuosity, as the soldier does his flag — it may lead
to truth, or to error ; to glory, or to destruction ?

It appears from the history of medicine, that
■words and names have always governed practice,
and they will no doubt always augment, or diminish,
our bills of mortality. At one time, vitalism was
the ruling ^uord, and the patient was often left to
struggle on as he could against disease, while the


physician was philosophizing on the autocracy
of Nature. At another period, the profession
hoisted a yellow (not the quarantine) flag, and hile
was the prevailing word. The art of medicine
dwindled into the art of exhibiting emetics, and
illustrious doctors talked of the human body as if
it only consisted of one gigantic liver.

What have we not seen lately in a neighbouring
country, under the influence of the word inflam*
^nation? Almost every disease was considered in-
flammatory. Patients were bled to the verge of
exsanguinification. Drs. Sangrado rejoiced in the
deadly paleness of their patients' features, and when
the relatives complained of their interminable con-
valescence, they were quietly told that it was in the
nature of the Divine infliction, and not the result
of a most pernicious treatment. Such, in medicine,
has been the power of mere words, and when such
words have become tenantless of their former
spirit, they still meet us at the patient's bedside,
where an old crone often thinks she knows as much
about the hot and cold things as Galen himself, and
can theorize as well about peccant humours as the
ultra-humorists of the middle ages, or exhibit an
aptitude of deducing every disease from inflam-
mation, which would have even fascinated Brous-
sais. At the bedside, then, we have not only
to guard against the exaggerated influence of
the word^ under which we ourselves have beea


educated, but also against the influence of those
symbols of old doctrines tumbled from tlicir high
estate, into the brains of a nurse. The analytic spirit
of this age, however, does not so willingly bow to
words, and we now ask them for the title-deeds of
the power they assume. In medicine, the general
terms under which superficial knowledge hopes to
find a comfortable shield, are taken to pieces, and
•we love to grapple with those assemblages of symp-
toms -which have long been called by common
names, and to submit them to a cautious analysis,
in order to discover, if possible, to what organ of
the human body they may be specially referred,
and through which their treatment may be the
most successfully directed.

The diseases of most important organs of the body
have been specially studied, and severely analysed ;
and when we merely assert that a patient is suffering
from disease of the head or of the chest, or from
morbus cordi, we no longer think to impose on a
fellow practitioner a very clear idea of the case, or
of the extent of our own information. It seems to
us necessary, that w^hat has been effectually done
for other diseases should likewise be done for the
diseases of menstruation, distinguishing the different
meanings of the terms by which they are described,
in the hope that a greater precision in definition
may lead, not only to better practice, but also to
the prevention of a great proportion of those ^com-
plaints to which women are liable.


Question II. — What, then, are the principal dis-
eases of menstruation ?

Amenorrhcea, or suppressed menstruation ;
Dysmenorrhcea, or painful menstruation ;
Menorrhagia, or profuse menstruation ;
Leucorrhcea, or various discharges ; and
"We shall briefly examine into the meaning of these
What does Amenorrhcea imply ?

Absence of organs of ovulation, their destruc-
^ tion, their chlorotic arrest of development.
Sub-acute or acute ovaritis ;
Or it may represent the inflammation, or the

obliteration, of the Fallopian tubes ;
Undersized womb ;
Inflammation of the womb ;
Morbid stricture, or obliteration of the neck of

the womb ;
Ulceration of the neck of the womb (Dr. H,

Bennef) ;
Its induration (J. P. Frank') ;
Retroversion of the womb (JDr. Righj) ;
Or the organs of reproduction may be perfect,
but, under the influences of various acute
and chronic diseases, the menstrual flow
may be impeded or suppressed.
This word Amenorrhcea, which answers to so many
conditions, can, then, be no longer admitted as a sub-
stantive term. It means so much that it means


But what does Dysmenoiirh(EA indicate ?
Sub-acute ovaritis ;
Ovarian peritonitis ;
Effusion of the ovum and menstrual blood

into the peritonaeum;
A neuralgic ovarian affection ;
Tubal inflammation and partial obstruction, with

flow of blood into the peritonseum ;
An undersized womb ;
Deviations of the womb ;

Inflammation of its body, or of the inner sur-
face, producing false membranes ;
Stricture of the neck of the womb ;
Its induration ;

Ulceration of the neck of the womb ;
Cancerous affections of the neck of the womb ;
Coarctation of the vagina ;
And constitutional diseases, such as a rheumatic
or gouty habit (^Righy^,
Djsmenorrhoea, as the name of a disease, ought
therefore to be expunged from every medical work,
for it has no definite meaning, and must lead to
hazardous practice.

What does Menorrhagia represent ?
Sub-acute ovaritis ;
A neuralgic affection of the ovaries ;
Uterine catarrh ;
Cancerous affection of the womb ;


Ulceration of the neck of the womb ; .

Retroversion of the womb ;

Irritable uterus.
Menorrhagia, likewise, should be discarded as
one of those words which mightily entangle and
pervert a true judgment.

But let us now take Leucoriih(EA, which stands
for — Hypersecretion of the mucous follicles ;

Chronic catarrh of the Fallopian tubes —
(Roldtanslcy^ ;
NJterine catarrh ;
Ulceration of the neck of the womb ;
Various inflammations of the vagina or external
Again too many different significations to be ade-
quately represented by one word.

The words Amenorrhcea, Dysmenorrhcea,
Menorrhagia, and Leucorrhcea, then, cannot be
received as things substantive, because vague and
injudicious treatment must spring from vague and
general terms in medicine. Such words can only
be applied in an adjective sense, to point out the
different morbid conditions of the organs of genera-
tion, which produce in so many different ways the
diseases of menstruation.

We presume to protest against names imposed
by high authorities, because under their pernicious
influence we have too often seen women doomed


to long years of continued suffering ; sometimes
receiving no sort of treatment, at other times
treated in a way which would disgrace those who
dispense nostrums to barbarous tribes. The con-
tinued study of menstruation, and everything con-
nected with that function, has convinced us that
there is no reason why the flower of woman's
lifetime should remain blighted by intolerable
misery, if those organs which stamp the physical
character of woman were studied as minutely as
the other organs of the body, and if the diseases of
each particular portion of the organs of reproduction
were investigated with adequate perseverance.

Such maladies have been the engrossing study of
our life. Wherever we have resided, whether in the
Paris hospitals, or in those of Germany or Italy,

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Online LibraryEdward John TiltOn diseases of menstruation and ovarian inflammation : in connexion with sterility, pelvic tumours, and affections of the womb → online text (page 1 of 17)