run down more rapidly after their recovery from the uterine disease than before, on account of their softening and discharge. I have not had an opportunity to observe a sufficient number of such cases with that scrutiny so necessary to arrive at a correct conclusion. It might be supposed that, on account of the derivative influence of the uterine disease, the consumption was kept in abeyance by its continued existence. On the other hand, the debilitating effects upon the system at large, which it undoubtedly exerts, might with equal propriety be expected to co-operate in the general prostration. Throat Disease. The frequent complication and the effects exerted by the one upon the other of throat affections,-pharyngitis and laryngitis, and uterine affections, makes it a matter of interest to determine what, if any, is the effect upon the diseases of the throat, of curing ulceration of the cervix uteri. This may be regarded by most of my readers, and probably is, an irrelevant question in this connection, but I think careful attention to it will lead to a different way of thinking about it. I am persuaded that some, at least, of the chronic sore throats of this climate can be much more easily cured after the uterine complication is removed. Women often believe that there is an intimate connection between them, and hope that the cure of inflammation of the uterus will relieve the throat; and I have seen cases in which I was almost ready to believe there was some encouragement for the opinion. Skin Disease.-Psoriasis, lepra, and some other of the chronic forms of scaly eruptions, coexisting with inflammation of the cervix uteri, have been aggravated or ameliorated as the uterus grew better or worse; when the uterus is better the eruption is worse, and the converse. I have noticed several cases in which. this seemed to be unequivocally true; and it is remarkably the case in two patients now under my observation. Without my speaking of it, they have both remarked it. If this observation should prove true on a large scale, it would indicate the extension, in a modified form, of this chronic inflammation to the mucous membranes, and afford us a valuable hint for the appropriate mode of managing a class of very obstinate cases. The above facts have an important and direct bearing upon our prognosis; for, according to my experience, the cases attended with these chronic skin diseases are very obstinate and protracted. Cure remains Permanent.-When cervical uterine inflammations are once cured, are they likely to return? It is a popular belief that these uterine diseases cannot be permanently cured; that they will keep returning. This belief is, no doubt, supported by the fact that many of our patients are constantly laboring under the causes that originally produced the affection; and, therefore, are likely to have them reproduced. Of course, patients thus situated will have a return of the diseases, but where the causes can be avoided and the cure completed, there is no reason why they will not remain cured with as much certainty as any other disease susceptible of perfect removal. I cannot refrain from here expressing the opinion, however, that a large majority of the cases that thus thwart our hopes never are entirely cured, and I believe great discouragement arises from want of the experience necessary to decide when the disease is entirely removed. I have met a number of instances in which the practitioner supposed he had removed the inflammation, but the symptoms remained; where an examination revealed a discharge of muco-pus from the mouth, showing inflammation still remaining inside the neck, and discoverable only by the discharge. CHAPTER XIII. COMPLICATIONS OF INFLAMMATION OF CERVIX. COMPLICATIONS WITH VAGINITIS, URETHRITIS, CYSTITIS, CELLULITIS, Or, as SOME CALL IT, OVARIAITIS-DIAGNOSIS OF CELLULITIS-EXTENT OF CELLULITIS-CAUSE OF IT, ETC. ETC.-RECTITIS-DIAGNOSIS OF RECTITIS— STRICTURE OF RECTUM-FISTULA IN ANO-CAUSES OF THESE RECTAL COMPLICATIONS-PROLAPSE OF THE RECTUM-RECTOCELE-HEMORRHOIDS— HYPERTROPHY OF MUCOUS MEMBRANE OF THE RECTUM-DISPLACEMENT OF THE UTERUS AS COMPLICATIONS-SUBSIDENCE IN ITS NATURAL AXIS, OR LAPSE-ANTEVERSION-RETROVERSION-PROLAPSE-THEORY OF UTERINE DISPLACEMENT. Complications. Various and troublesome intra-pelvic complications are often observed in connection with uterine disease. These complications for the most part arise during the existence, and generally as the effect, of the disease of the uterus; they may, of course, also arise as independent affections. Notwithstanding the frequent secondary origin of these complications, after they have continued for a considerable length of time, some of them become permanent, and after the originating disease has subsided, they go on indefinitely if not cured. Vaginitis. Probably the most common of them is vaginitis, in some form; ordinarily in that of erythematous inflammation of the mucous membrane, which is indicated by an increased mucous discharge, some tenderness and heat. Instead of the inflammation being thus moderate, there may be copious muco-purulent discharge, great irritation, and so much tenderness as to render an instrumental examination very painful, and often unsatisfactory. Such severity of inflammation is apt to be of short duration, and dependent upon some superadded cause of the inflammation. The inflammation is usually more moderate and persistent, continuing more or less for weeks or months together. Another form of complicating vaginitis is eruptive, and, although not usual, it yet sometimes accompanies the simple variety. The eruption in the milder form is vesicular. Small vesicles appear somewhat thickly studding the inner surface of the labia, on the nympha, the membrane of the vestibule, and sometimes the cutaneous surface on the edges of the labia majora and the anterior edge of the perineum. This eruption is attended with great heat, or a burning sensation, and not unfrequently with intolerable itching. The vesicles are not very thickly set upon the surface, but the latter is of a fiery red color. A greater or less amount of serous discharge keeps the parts wet and sticky. Almost always this mild eruptive variety is paroxysmal, and generally appears simultaneously with the commencement of the menstrual discharge, and has seemed to me to be dependent upon the acrid discharge accompanying it, and the congestion present at such times. The eruptive variety of vaginitis is sometimes much more severe in grade, and the vesicles are changed to pustules, and the accompanying inflammation much greater. Fortunately this is not nearly so common as the first two forms. Vaginitis sometimes has its origin, I have no doubt, in an extension of the mucous inflammation from the neck; but frequently, I think, the inflammation is caused by the acrid irritating nature of the perverted secretions from the mucous membrane of the cervix, and by want of proper cleanliness. The vaginal inflammation, although exceedingly annoying to the patient, is otherwise of much less importance than some of the other complications. Urethral and Cystic Inflammation.-Urethral and cystic inflammation also not unfrequently result from or accompany cervical inflammation. It is not necessary to give their symptoms in detail. The main fact to which I desire to give expression is, that when there are symptoms of cystitis or urethritis, we should be watchful for the probable occurrence of inflammation of the bladder and urethra, and be aware of the importance of giving attention to them as complicating diseases. For I think I have seen indubitable instances of cystitis and urethritis which could be traced to this cause, continuing after the uterine disease was cured. When not properly attended to, they may induce nephritis. The inflammation of the neck no doubt directly induces inflammation of the bladder, by reason of its immediate apposition to its walls; and while this inflammation ordinarily is of short duration, yet it sometimes becomes very persistent, and even permanent. The at tacks, when acute in grade, as they sometimes are, become extremely distressing, and absorb the whole attention of the patient, and demand the prompt interference of the medical attendant. More commonly the grade of inflammation is mild, and confined to the mucous membrane of the organ. The scalding micturition, indicative of urethritis, is often distressing to a great degree, and is not unfrequently very persistent. This urethritis and cystitis I think are caused by migrating inflammation from the vagina in some cases, and the inflammation probably goes on through the ureters to the pelvis of the kidneys. When cystic inflammation is persistent and somewhat severe, it often passes for the disease. The symptoms of cervical inflammation of the uterus being overwhelmed and obscured by the more urgent and distressing vesical affections, it is not thought to be the origin of the trouble. Although the vesical symptoms, as before stated, may become urgent, and the inflammation assume an important prominence in the case, usually this complicating affection is slight, and manifested by very mild and transient symptoms. In this form, cystitis and urethritis are very common indeed. Cellulitis. A more formidable, troublesome, and perplexing complication, however, is a chronic or subacute form of cellulitis, as it has been named by Prof. Simpson. It consists of inflammation and suppuration of the cellular tissue contained in the duplication of the peritoneum, at the side of the uterus. I think this is a frequent complication, and more frequent, according to my observation, than we are led to believe by any description I have ever met with. When it is present, it embarrasses our diagnosis, and should very materially modify our prognosis. I have met with instances in which it remained unnoticed, and exercised a very embarrassing effect upon the treatment and the progress of the case for a long time. This complication is important for two main reasons at least, viz., 1st, the great obstinacy with which in the chronic form it resists treatment; and, 2dly, from the fact that the pelvic or uterine symptoms do not subside while it lasts, even when the uterine disease is removed. It is likely to occur in two forms, differing considerably in intensity and duration,-the acute and the chronic. Acute Cellulitis.-In the acute form the symptoms are violent, and run their course somewhat rapidly. The patient, after some |