On the constitutional character and treatment of the diseases of women connected with chronic inflammation of the uterus / by Thomas More Madden.

  • Madden, Thomas More, 1838-1902.
Date:
1873
Catalogue details

Licence: Public Domain Mark

Credit: On the constitutional character and treatment of the diseases of women connected with chronic inflammation of the uterus / by Thomas More Madden. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    IV.—The Physical Signs of Ulceration of the Cervix Uteri. A digital examination will enable the experienced practitioner to diagnose a well-marked case of ulceration of the cervix uteri by tbe peculiar “ soft velvety sensation ” which, together with the patulous state of the os, was first pointed out by Dr. Bennett as characteristic of the disease, and which may readily be recognized by the touch. So con- clusive are the tactile evidences of this condition of the os uteri that I have seen few out of the large number of these cases that presented themselves at the dispensary in which it was not possible to pronounce an opinion from a simple digital examination, even when only a slight degree of ulceration existed, unless it was confined to the cervical canal and had not affected the os or vaginal portion of the cervix. In fact, in the hands of an experienced practitioner, the speculum is chiefly required for therapeutic, and not so much as is generally supposed for diagnostic purposes. The os uteri is usually patulous and much lower down when ulcerated than in its healthy condition, the whole cervix being tumefied and elongated. On making a digital examination we also find the parts to be more tender than natural, and the temperature is almost invariably raised. In short, all the characteristics of inflammatory action are present—“ tumor cum calore et dolore ”—as well as increased vascularity, evinced by the altered colour of the mucous membrane. Having ascertained by a digital investigation that the case is really one of ulceration, the surgeon may now proceed to make an ocular examina- tion by the speculum. The lower part of the uterus will now generally be found congested and vascular looking, the lips of the os thickened, and usually one of them—commonly the anterior lip—longer and more prominent than the other. The vaginal portion of the cervix is coated with a thick glairy mucus issuing from the os and covering the softened hypertrophied mucous membrane, in which, when this discharge is washed away by syringing with tepid water, as it is so tenacious that it cannot be easily otherwise removed, the ulcerated surface may be detected with ease. These ulcers are irregular in form, and vary in extent from a mere speck-like depression in the mucous membrane to a deeply excavated sore. The superior fifth of the vagina at least always necessarily participates in the inflamed condition of the cervix, with which it is so closely identified by structure as well as by situation, and more or less vaginitis attends all cases of inflammation or ulceration of this part. Ulcers of the os uteri are commonly very superficial, and in many cases are but mere abrasions of the mucous membrane. They generally commence just within the os tincse, and extend ultimately to both lips, being, however, more marked on one side than the other. The os is usually very patulous, and we may frequently trace the ulceration through the open cervical canal into the body of the uterus. 1 he viscid glairy mucus, closely resembling the white of egg. which