VOL. V.

THE CRITIQUE.

Formerly THE Denver JourNAL OF HOMEOPATHY.

DENVER, COLO., JULY 15, 1898.

No. 7.

THE COMMON ORIGIN AND SIMILARITY OF SOME

PELVIC DISEASES.

By Luther J. Ingersoll, M. D., Denver.

"What is the difference between prolapsus uteri and hernia?"-Dr. G. H. Patchen, N. Y.

There is and must always exist in the healthy abdominal and pelvic viscera a natural movement, a peaceful pulsation; synchronous with the motions of the lungs, heart and general circulation. This movement extends throughout every part of the body, the throb and thrill of inherent life. It is called "organic or respiratory rhythm;" without which there cannot be normal circulation, nutrition or temperature. Rhythm is the evidence and result of vitality.

The health of the abdominal and pelvic viscera, is proportionate to this rhythmic motion. When rhythm ceases or is greatly impaired it is because of lost or perverted vitality. The waste tissues remain to prevent nutrition, and the organs fail in their functions from sheer exhaustion. Within the pelvis as elsewhere, hyperemia, inflammation and congestion, whatever these terms may mean, are not causes but results; effects, the outer manifestations of an already diseased, enfeebled condition. They are practically the same in cause, nature and effects, wherever they exist, and mean an imperfect capillary and venous circulation. Inflammation in all its stages is characterized by fullness, swelling and pain. If this condition obtains in the rectum for some time and involves a considerable portion of its surface, especially if attended by constipation or

a dainful activity of the colon, the engorgement and weakness of the surrounding parts will be great.

The power of resistence may be so overcome that some part of the rectum will give way and prolapse. Whether this prolapse will be partial or complete, will depend upon the conditions, especially upon the general health and vitality of the patient.

When the inflammation is more acute and is confined to the smaller blood vessels and capillaries, they enlarge at certain points, and weighted by engorgement, swell and gravitate downward, or press outward toward the surface, and we have varicosis, proper, or hemorrhoids. From the rupture of these, and from other causes, ulcers of various kinds and forms may arise, or abscesses may form in the the deep tissues and slowly work their way downward and open externally in the form of fistulae. Or again, this engorgement from inflammation may for a time be somewhat relieved by a copious discharge called a catarrh of the rectum, or bowels.

When long continued inflammation exists in the uterus, we may justly expect similar or even the same results. If the engorgement from blood stasis is great, and if the ovaries, ligaments, and the upper part of the vagina are involved, their weight and consequent weakness are greatly increased, and in a like ratio their power of resistence and of sustentation are di minished. Here is a lowered general vitality; the pelvic-functions are imperfectly performed, normal rhythm is destroyed, the overloaded uterus, unsustained by vitality, can but yield, and gravitating downward end in "prolapsus uteri." So in the rectum, so in the uterus, and from the same cause, the prolap sus is partial or complete, according to the extent of the causative conditions.

If the inflammation is less general, more confined to the cervix and os, the veins and capillaries are very turgescent, and stand out full and hard. They look like small drops of blood upon the surface. These, as in other localities, under like conditions, may rupture, and the engorgement be temporarily relieved. But the conditions being the same, we have here, as in the rectum, true varicosis or hemorrhoids. We give different names according to the location.

The flat ulcer of the rectum finds its like in nature, form, and slough, in ulcerations of the os, and cervix of the uterus. Leucorrhoea is a catarrh of the mucous surfaces of the uterus or vagina. Like catarrh of the rectum, or of any other mucous surface, it arises from and is the result of inflammation.

Even fistulae of the rectum, in their general causes, modes of procedure, discharges, and difficultness of cure, correspond to those of the vaginal tract.

Inflammation of the consequent engorgement of the capillaries of the anus, and just above or below, often so disease the surrounding integuments that we have a very troublesome "pruritus ani." The same conditions produce the same results elsewhere, and we have just as troublesome a "pruritus vulvae."

All the contents of the abdomen and pelvis exist under the same general conditions; therefore, similar results must follow similar causes. Remembering this, let me call your attention to another similarity which I have noticed. Prolapsus of the uterus is similar to hernia. In form and nature both are caused by the same general condition; a depleted vitality: as shown in diminished power of sustentation and rhythm of the parts involved.

Hernia is the protrusion of the contents of one cavity into another cavity. It may, therefore, occur anywhere, according to circumstances. What is "prolopsus uteri" but a real hernia under another name. The uterus passes out of its normal location into some other cavity or location, as anterior upon the bladder, or posterior against the rectum; or downward along the vagina. In hernia the advancing mass leaves its normal location, and, making a tube through the abdominal muscles, appears, finally, externally, in an elevation more or less distinct and painful. Here is a true prolapse of some portion of the intestine or omentum or of both. which we call a hernia.

The anterior lower border of the trunk is known as the "hernial region," because from its anatomical structure hernia more frequently occurs here. But the causes of hernia, like those of uterine prolapse, exist long before hernia is established externally. There is always a lack of toughness and vitality of the parts immediately involved in hernia as in uterine prolapse, The abdominal muscles become thin and weak. Their fibres

are feebly united, and can offer less resistance, to the boring, impinging force from within.

But there is another and a far more serious predisposing cause of hernia. We found the same cause to exist in uterine prolapse. It exists whenever there is imperfect nutrition, there is a loss of vital energy; and of abdominal and pelvic rhythm, as produced by the diaphragm, under the inspiration of a vigerous respiration. The pelvic viscera, have but feeble sustentation. So in the production of hernia, under restricted rhythmic movements, the intestine enfeebled by a lowered vitality, a sluggish circulation and diminished sustentation, tends downward. In this condition some part of the intestine forms a "loop" or knot, or the omentum a "fold," or both acting conjointly, by a continious pressure, from peristalsis separate the weak, soft, flacid fibers of the abdominal muscles and after weeks or months, there is a protrusion or hernia. Hernia is a true prolapse and like uterine prolapse, results from a lowered vitality, and the consequent loss of abdominal and pelvic rhythm.

Because of their very great importance I call special attention to the following statements: In no case where there is full uninterrupted rhythm, of the pelvic organs and viscera, can there be either a prolonged hyperemia or an anemic state, neither a prolonged prolapsus of the uterus, nor of the rectum. So here, hernia cannot occur, nor long continue while there is an uninterupted rhythm, of all the abdominal viscera, produced by a vigorous diaphragm lifting and sustaining them in their rightful positions, giving to them a normal circulation and nutrition. That this view is correct seems clear since all forms of prolapse are cured only by a restoration of rhythm, and rhythm is produced and maintained by general vitality.

It is usual for patients to ascribe their hernia as they do their uterine or rectal prolapse, to severe exercise. They are ignorant of the predisposing cause which always exists. It is vastly more probable that in hernia, the intestine or omentum, was slowly working its way through the muscles, and that their uterine or rectal prolapse had long existed incipiently; slowly progressing to a culmination, in obedience to a general condition of abdominal and pelvic weakness. The exercise was only