CHAPTER XVII. GENERAL TREATMENT. GENERAL TREATMENT-SPONTANEOUS CURE-FROM CHANGE OF CIRCUMSTANCES -CHANGE OF GENERAL CONDITION ONLY PALLIATIVE-SUPERVENTION OF ACUTE INFLAMMATION-AFTER PARTURITION-AFTER ABORTION CURATIVE-LOCAL TREATMENT, PRINCIPLES OF-POSTURE, EXERCISE AND REPOSE-DIET-ABSTINENCE FROM SEXUAL INTERCOURSE-MAIN OBJECTS OF GENERAL TREATMENT-SYMPTOMS REQUIRING SPECIAL TREATMENTTREATMENT OF NERVOUS PROSTRATION-TREATMENT OF NERVOUS EXCITE MENT AND EXCITABILITY-TREATMENT OF ANEMIA-OF PLETHORA OF LOCAL CONGESTIONS-OF CONSTIPATION. General Treatment.-I am sensible of the great difficulty of properly estimating the value of any given remedy or plan of treatment for the cure of disease. Nature does very much sometimes to aid imperfect means, and even to effect a cure under improper treatment, while at other times the circumstances inseparable from a case thoroughly thwart the best directed efforts; and very often we record cures and attribute great efficacy to our plan of management, when the favorable termination is due alone, and perhaps in spite of us, to the natural conservative energy of the system or the parts concerned. It is a mistake, therefore, to be too sanguine in our expectations even with the use of our favorite course of treatment, or to depreciate everything which has not fulfilled our hopes. We should patiently, honestly, thoroughly, and judiciously try every means within our knowledge for the benefit of our patient, let him labor under whatever disease he may. The reader is doubtless perfectly aware of the very great differences of opinion in the profession as to the treatment most beneficial in inflammation of the cervix uteri and its accompanying ailments. In alluding to these many and diverse opinions, I must record my conviction of the honesty with which they are maintained by the principal disputants of the present day, and must exhort the junior members of the profession to cautious and thorough research on the subject. There must be a right and a wrong side to every disputed question; and, as a general thing, extremists are wrong; remembering this general truth,—we cannot always be kept in doubt by the facts in the case, if, without prejudice or party bias of any kind, we earnestly set to work to learn. Spontaneous Cures.-Are there any spontaneous cures in these cases? I think there are, and I propose inquiring into the method adopted by nature, and take it as a guide to some extent, at least, for the plan of artificial treatment. Change of circumstances frequently makes robust persons of invalids. This change is generally from irregular habits of living to regular and appropriate; from the highest state of luxury and ease to one of need, or at least economy and industry, in which the patient must exercise her mind and muscles to a proper degree. The healthy tone of the stomach, muscles, and brain thus brought about decreases the susceptibility to slight suffering, enables the patient apparently entirely to recover from disease, and bear small ills without complaint. I need not specify the various circumstances and conditions of life which improve the tone and elevate the functional activity of the whole organism; they are numerous, and will suggest themselves to the reader. How many journeys are taken, how much time spent at watering-places and places of amusement for this purpose! And often they answer the purpose, and the patient is restored to health. Change of General Circumstances only temporary in their Effect. -This improvement, in cases of disease of the uterus, is brought about rather by diminishing the nervous susceptibility to the wearing influence and pain of the local disease, and by fortifying the system against its advance by establishing excellent general health, than by actual cure of the ulceration and inflammation. As a consequence we find a return to the former mode of living, habits, and circumstances reproduces more or less rapidly the same train of general symptoms, and makes it necessary to resort to a repetition. of the journey, or whatever other means were previously successful for their removal. This is only an apparent, not a real cure, and I hope I will be excused for saying that such is the kind of cures which always result from an exclusive general treatment. Tonics, laxatives, and alteratives put the general condition of the patient on a better footing, and the patient suffers less from her local dis ease, and even considers herself well; but suspend the general roborant appliances and the patient again sinks into her former state of valetudinarianism. I have often witnessed these changes as the effect of accidental mutation in the condition of the patient, intentional changes of place and circumstances, or well-advised general treatment. Supervention of Acute Inflammation.-There is, however, another method resorted to by nature, and which sometimes results in permanent and complete cure. Chronic inflammation has very little tendency to spontaneous subsidence; its duration is at least indefinite. Situated in the neck of the uterus this is particularly the case. Acute inflammation, however, on the contrary, has a strong tendency to terminate in resolution, to subside and leave the parts in a healthy condition. And, in cases of chronic inflammation in any of the organs, the supervention of the acute form proves sometimes salutary. It absorbs the whole chronic action and takes its place in the tissues; and as it subsides, the diseased organ is left in a healthy condition. We have an opportunity of seeing this process of usurpation, displacement, or whatever else it may be termed, in diseases of the eye, and witnessing the salutary sequence. Acute Inflammation after Parturition or Abortion sometimes works a Cure.-Some of the functions of the uterus when naturally performed are followed by acute inflammation in the neck of the uterus. I allude particularly to parturition; and while these inflammations sometimes linger and become themselves chronic, they generally, under favorable circumstances, subside kindly, and where the cervix had previously been affected by chronic inflammation, sometimes favorably modify, if not entirely cure it. I think that very few cases of parturition occur that do not cause sufficient violence to the cervix and os uteri, to be followed by a greater or less degree of acute inflammation. A great many are certainly thus followed by inflammation. The acute inflammation resulting from abortions occasionally has the same effect. I hope there is no danger of being misunderstood. Instances have occurred in the hands of most experienced practitioners where the uterine health of a primipara has been benefited by pregnancy and the processes of parturition. Principles of Local Treatment.-The local treatment of these inflammations is founded on the same principle of these natural cures. In the case of obstinate inflammation of the eye, we often resort to strong stimulants to modify a chronic inflammation, i. e., turn it into a moderately acute one, which, usurping the place of the chronic, causes it to subside, and leave the organ sound. And we know how successful it often is. ment of inflammation of the cervix uteri. inflammation in the tissues occupied by the chronic; and, as the former subsides, the disease is favorably modified, if not entirely cured. This is a radical cure, where a sufficiently strong impression is produced either by the natural or artificial process. So with the local treat- Physicians array themselves in two divisions in the treatment of uterine diseases. One division comprises those who consider the local disease as unimportant effects of the bad condition of the general health, who pay particular attention to the general condition of the patient, and who give but little, if any, local treatment. While the other division relies upon local treatment for the cure, and the general merely as accessory. Those who look upon the local as the essential treatment, are also somewhat divided as to the kind of treatment. One of these subdivisions thinks that if the uterus can be placed and sustained in its proper relative position to the other organs that the inflammation will spontaneously subside; while the other party believes in the use of strong stimulants and caustics applied directly to the diseased parts. I shall not at present pay much attention to the plan of mechanical support, leaving it for a future chapter, but will proceed to give the general and local treatment which can be relied upon with most confidence for the relief of patients affected with inflammation of the cervix uteri, and I shall first give the general treat ment. Posture, Exercise, and Repose.-The young practitioner will soon learn that posture and exercise are important considerations in the general treatment, and he will be taught by most writers that the reclining posture and strict quietude must almost universally be observed. Walking generally causes an increase of pain, and, it is natural to suppose, an increase of inflammation; so that exercise on foot or in the erect position is regarded as injurious. On the other hand, confinement to the recumbent posture and the observance of strict quietude is very hard upon the general health; the patient becomes more nervous, and all her functions are performed in an irregular and imperfect manner. As a consequence, in very many instances, the symptoms are much aggravated. In the great majority of these cases, therefore, I think the patients are injured by confinement and recumbency. It would neither be scientific, sensible, nor successful, however, to lay down any absolute rule in respect to exercise and quietude. I think we may arrive at pretty accurate conclusions as to the sort of cases and the conditions under which each should be observed. More than ordinary acuteness of the symptoms, indicating a high degree of inflammation, occurring in the beginning and continuing throughout, or arising during the progress of a case as the effect of temporary causes, will make rest indispensable to the removal of them. Hemorrhage at the time of menstruation, or between the menstrual periods, is also a reason for strict quiet. Where neither of these conditions are presented, I think the patient will in most cases be much benefited by judiciously directed exercise. I feel like insisting upon the enforcement of outdoor exercise as the rule in these eases; for I have often had an opportunity of contrasting, in the same cases, the influence of quiet and exercise upon the recovery of patients of delicate nervous constitutions. One patient who had been unable to sit up for even a short part of the day for several months, on account of the pain in the hips, dragging in the loins, and great nervous prostration, was sent to a water-cure, and in three months she returned home capable of walking several miles a day, and enjoyed comparatively robust health. In a few weeks after returning to a home in which she enjoyed the luxuries and ease so desired by all who prize good living, she became "miserable," and was obliged to abandon her exercise entirely. It is encouraging to state, that in less than six months of proper local treatment, she was permanently cured. This is but a type of many similar cases that have been benefited by the enforcement of exercise and other items of proper living, but, I must also add, not cured. It has been my constant aim for many years to induce patients of this kind to take as much exercise as they can bear. Under the mistaken notion that any local pain indicates an aggravation of their disease, and that to exercise when it gives them pain, even to a moderate amount, is a great evil, they confine themselves to their room, and even their bed, to the forfeiture of |