TRANSACTIONS OF TBfJli 
ARTICLE IXTV. 
The so-called Chronic Metritis and its Rational Treatment. By Horatio Eobix- 
sox Storer. M. I)., of Boston, Professor of Obstetrics and the Diseases of Wo- 
men, in Berkshire Medical College. 
It is with extreme diffidence that, virtually a stranger, I venture 
to address you, in accordance with the kind invitation that has 
been extended to me. It is possible, however, that the five good- 
ly reasons with which I come fortified, may avail at once as my 
excuse, and to ensure for my paper pmyrcnnresk at tent i on. These 
reasons are: 
First, the request made to me for several years in succession by 
your late Secretary, the lamented oarßJ94icl by the good 
Blatchford, of Troy, whom to haye known was an inestimable 
privilege, and by others of y()i>r. numbers, still'diving, in whose 
friendship I delight, that I shou 1 dTakn-oceasieif, when the oppor- 
tunity presented itself, to urge upon my New York brethren some 
one of certain peculiar views that I am known to possess, of 
interest, not to gynaecologists alone, but to the whole profession. 
Second, that from the very intimate relations I so long enjoyed 
with Prof. Sir James Y. Simpson, I am probably no unfair repre- 
sentative of the Scotch school of gynaecology, as contra-distin- 
guished from those of London, Paris and Vienna, to which the 
leading professors in this country more avowedly belong. 
Third, the fact that as a teacher at Pittsfield, so near your 
confines, I consider myself, for a portion of the year, at least, as 
fairly within the New York atmosphere. 
Fourth, that as a guest, enjoying your hospitality, it is my duty 
.to contribute something, however slight it may be, towards the 
great ends for which you have come together,—the dissemination 
of knowledge, the check of disease, the saving of life. 
And finally, and most important, the intrinsic value of the sub- 
ject I shall now bring before you. 
I have been interested in no ordinary degree by a discussion 
that has lately taken place, during Nov. and Dec., 1866, at the 
New York Academy of Medicine, and been reported in the medical 
journals*, the participants in which were my friends, those great 
* Phil. Med. and Surg. Reporter, Dec. 15, 22 and 29, 1866; N. Y. Med. Record, Dee. 
15, 1866, and March 15, 1867. NEW YORK STATE MEDICAL SOCIETY. 
213 
authorities in all matters pertaining to the diseases of women, 
Profs. Budd, Fordyce Barker and Peaslee; the subject of their 
deliberations having been chronic metritis, its pathology, etiology 
and therapeutics, I should consider it presumptuous indeed for 
me to sit in judgment upon the opinions of these learned men, to 
call any views into question that either of them may have express- 
ed, or to make any suggestions in addition to those by them 
presented, were I not sure that with me they each of them recognize 
the facts that the best of us are yet but apprentices in the great 
work-shop of nature, and that as such we must labor humbly, faith- 
fully, reverently to assist each other in the elucidation of her pro- 
blems. • 
Half New Yorker as I now consider myself, when at Pittsfield, 
there was a time when weary of continental travel, and settled for 
a quiet year of work in Edinburgh, being entered in the directory 
of that city as a regularly licensed practitioner, chosen into its 
several medical societies, and becoming the father of a Scotch 
lassie, I felt myself almost a Scotchman. My professional friends 
and neighbors were a canny set of people, prone to inquire into 
the why and wherefore of things, and yet afraid, for the most part, 
of metaphysics, whether in philosophy, science or religion, and 
excessively practical in their dealings with disease. I was taught 
not so much to discuss the ultimate pathological distinctions or 
peculiarities that might be presented, whether for instance in the 
most common forms of the so-called chronic metritis, there existed 
peri-uterine, endo-uterine or parenchymatous inflammation, or none 
whatsoever at all, as to seek whether or no the disease, whatever it 
is, may be cured, and if so, in what manner. You will pardon me, 
therefore, if I do not give to the purely pathological features of 
my friends’ arguments, the attention that the neatness and force 
with which they were presented deserve, and that, now that I 
have become thoroughly re-Americanized, I should be glad to 
devote to them. 
No disease, whatever its site or character, it has been well 
insisted by Prof. Brown-Sequard, can be well treated except 
upon strictly logical deductions from physiology. No disease, 
whatever its site or character, can be well treated save upon 
general principles. This remark is especially applicable to the 
diseases of women, where if a mere routinist or the victim of a 
single idea, the best general practitioner becomes the veriest 
empiric, and where, on the other hand, the specialist, if true to 214 
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his science, and mindful of the great dangers to which I have 
now alluded, must of necessity bring to bear all the resources of 
general practice. When I stated this fact in the report upon 
Specialism, that I was called upon to render to the American 
Medical Association, at its late meeting in Boston, my assertion 
was derided by some and considered presumptuous by others. 
At the ensuing meeting at Baltimore, however, the same statement, 
expressed in almost the same identical language, by the eminent 
physiologist I have above referred to, was applauded to the echo. 
Thus the world moves. 
To certain eminent men, some of them nevertheless but hobby- 
ists, we are indebted alike for our advance towards, and our retro- 
gression from, the successful treatment of uterine disease. Henry 
Bennet, of London or Mentone, for it is difficult now to decide 
where it is in reality that he belongs, would have us to find the 
key to nearly all these troubles in inflammation of the os and 
cervix; while West, upon the contrary, scouts the idea of a mere 
superficial abrasion effecting a tithe of the results that have been 
attributed to it, and Hughes Bennett, of Edinburgh, fairly anathe- 
matizes those who apply the term inflammation to anything short 
of that perverted alteration of the vascular tissues which produces 
an exudation of the liquor sanguinis. “It is this exudation only,” 
he asserts, “which can be held to unequivocally characterize an 
inflammation.” Tilt again would make us believe that there is 
scarce else ever to be found than an irritable ovary; while others, 
among whom our own Hodge, and I say this with all respect, for 
I believe strongly in his levers where they are indicated, would 
fain confine us almost entirely to displacements, as alike the cause 
and effect of metritic engorgement, if not indeed, the disease 
itself. Of these conflicting views, all are to a certain extent true, 
and all to a certain extent false. The publications of Henry Ben- 
net have done far more than any others could have effected towards 
arousing our countrymen to the importance of pelvic lesions, and 
upon them, to whatever extent modified, have been based the 
teachings of Meigs, Byford and most of our other authorities, old 
and young, of the present day. But the publications of the same 
author have also accomplished a great deal of evil, by practically 
inculcating, however unintentionally, the creed that all that is 
needed for the cure of the manifold disorders the female presents, 
is the possession of a speculum, and what is still too often its 
sole accompaniment, some nitrate of silver. I cannot agree with 215 
NEW YORK STATE MEDICAL SOCIETY. 
one half of Robert Lee’s arguments against the speculum, disap- 
pointed and unforgiving partizan that he was, but there can be no 
doubt that too great reliance upon this instrument often spoils a 
diagnosis, and that the undue or unskillful use of even so simple a 
caustic as that mentioned, often spoils a vagina. Scanzoni, a mere 
pathologist, and knowing comparatively little of practical thera- 
peusis, I make this statement upon good authority, despite the 
warm encomiums of Dr. Gardner, is often unreliable; while to 
Tilt we are indebted for that useful suggestion unconsciously given, 
to be more observant than he has been, in our physical explora- 
tions. The more constantly we use the uterine sound, the less we 
find of the existence of real, and the more of pseudo ovaritis. 
Is then chronic metritis never the effect of cervical disease ? 
Can this not extend from the os by direct transmission of inflam- 
mation towards and to the uterine cavity ? If merely considered 
paroxysmal in its character, occuring at or near the catamenial 
periods, or merely during the interval, are we never to employ 
for it local measures ? Or if called a permanent lesion, regularly 
aggravated by the periodical crisis, are we not to recognize the 
importance of those that are simply constitutional ? All of these 
questions, and many others of a similar character, I readily assent 
to, but yet assert that the treatment thus far employed has been 
for the most part empirical, and that in many of the com- 
paratively few cases where relief has been obtained, the improve- 
ment has been coincident with, or in spite of, the measures resorted 
to, rather than their direct result. 
The treatment of chronic metritis is as yet based, in great mea- 
sure at least, upon erroneous physiological theories, at variance 
with those general principles of our art that control the treatment 
of all other regions of the body. It is in reality in its infancy, 
just as was the therapeusis of most of the affections of the uterine 
cavity, before resort was first had to sponge tents by Simpson, 
some twenty-three years ago. Now we consider it almost mal- 
practice—it would be malpractice in one pretending to be an 
expert, to neglect in an otherwise inexplicable case of menorrhagia 
this crucial test. It is possible that within the same short space 
of time before us, a similar remark may become true of those 
who ignore the means of treating chronic metritis that I am now 
O 
about to bring to your notice, and refuse or neglect their employ- 
ment. This is bold language, I am well aware. Let us see if 
there is not for it some good foundation. 216 
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It is well, however, that I proceed to my point deliberately, and 
by logical sequence, as befits it. 
The frequency of the disease, or class of diseases we are con- 
sidering, to which the specific or generic and frequently inappro- 
priate name of chronic metritis has been applied, is now admitted 
by all who know anything soever of uterine pathology. I am 
aware indeed that there are many, unduly influenced by that 
spirit of conservatism which is in other respects the salvation of 
the profession, who deny its frequency and even its very existence, 
as is sometimes done of every other form of uterine disease. The 
time, however, of these gentlemen has passed. Scepticism in this 
direction has culminated, and those under its sway are beginning 
to be viewed with mingled feelings of wonder and pity, tempered 
perhaps with pride at the earlier achievements of these very per- 
sons, and with regret that the evil days of being left behind in the 
march are so rapidly drawing near for ourselves. 
Granting, then, the frequency of chronic metritis, or of its two 
chief classes so well pointed out by Dr. Kammerer, the regularly 
or irregularly relative hypertrophy of the several uterine tissues, 
I proceed to the fact of their obstinacy under all the methods of 
treatment usually employed. Upon this point I might adduce a 
large mass of evidence. That of the three metropolitan professors 
shall, however, suffice, and it is of the more weight from the fact 
that at least two of these gentlemen are fresh from beyond the 
seas, and, therefore, thoroughly posted as to the latest foreign 
advances in treatment. Prof. Barker avowedly considers, with 
Profs. Budd and Peaslee, that it “ is one of the most intractable, 
rebellious and unsatisfactory diseases we are called upon to treat,”* 
a very opprobrium medicorum ; and yet upon this problem we 
have all of us, Scotch, French, Germans and Americans, been com 
stautly at work for many years, constantly drawing nearer the 
goal it is true, but in a stumbling, uncertain kind of a way, here a 
hit and there a miss, frequently going astray widely from the 
mark, never as yet fairly striking it, simply because our physiology 
being wrong or doubtful, and our principles of practice generally 
the very reverse of true, we had no rational basis of treatment. 
Such, however, may I hope, you will find that I am about submit- 
ting to you. 
A glance at what has been hitherto done, must precede the 
*lffed. and Surg. Reporter, 22 Dec., 1866, p. 517. NEW YORK STATE MEDICAL SOCIETY. 
217 
advance. It is found that the past treatment of chronic metritis 
resolves itself into three great groups of measures, consisting of 
those that are purely constitutional, the result of a stubborn con- 
servatism, those that are purely local, but yet mainly applied in 
the wrong place, the result of a too hasty radicalism, and those 
that are of both classes, so far wisely combined together. Rest 
and confinement to a recumbent posture on the one hand, exercise, 
even to horseback riding, on the other, have each had their advo- 
cates ; as have total abstinence from coitus, and, perhaps upon 
the principle of similia similibus curautur, occasional or excessive 
indulgence therein, an abstemious diet and free license to the plea- 
sures of the table, stimulants and depressants, tonics, alteratives 
and general depletives. The trouble has been that these measures 
have too indiscriminately been resorted to ; indicated in some 
cases, they have been counter-indicated in others, and yet the dif- 
ference has not been perceived. In many they have been required 
in combination with more strictly local measures, in too many 
they have been employed alone. 
As regards local measures, also, in the great variety that have 
been resorted to, a similar natural grouping into classes is seen to 
obtain, according to the especial theory accepted by the practi- 
tioner. Those who have sworn by Henry Benuet and his school, 
forgetful of the first great maxim for us all to learn, nullius jurare 
in verba magistri, have seen in chronic metritis but the result of 
inflammation of the os and cervix, making this, as has wmllbeen said, 
the base of their pathological pyramid, and have accordingly 
stimulated the cervix on the one hand and depleted it on the other; 
irritating and counter-irritating, for both ends seem to have been 
had in view, though their measures were purely local; that is, 
applied to one and the same place, the cervix, putting aside for 
the moment the consideration of measures more justly counter- 
irritant, as applications to the abdomen, etc.; pleting and deple- 
ting, even at once, by endeavoring to cause more active cervical circu- 
lation, and perhaps at the same time endeavoring to allay it by 
scarifying and the like; the puzzled physician being fortunate if 
he took such precautions as ensured him from fright at the 
occasional escape of a leech into the uterine cavity. Cauterization 
of every kind, from Meigs’ gentle antiphlogistic touch of the nitrate 
crayon to the more heroic but far more effectual potassa fusa and 
hot iron; douches of every variety, simple and medicated, varying 
from hot to cold, and applied from a single moment to an hour or 218 
TRANSACTIONS OF THE 
more, and from a drachm to gallons; ointments of every make and 
hue, blistering and emollient, opiate and alterative, applied by 
vaginal suppository or by the finger of the attendant; and worst 
of all, if too often repeated under the plea of ascertaining the 
patient’s progress, the simple touch or an attempt by its mere 
pressure to produce an alterative effect. This is no fancy sketch. 
All these measures I have seen relied upon as sheet anchors by 
masters in our art, through every phase of them I have myself 
plodded. 
Is it different with the school who have considered the uterine 
lesion the result of ovarian disease? Witness the abdomens 
bescarred, worse than ever by nature at the close of a pregnancy 
with quadruplets, by leechings and cuppings, blisterings and acu- 
puncturings innumerable. 
Am I doing injustice to those gentlemen who have ignored the 
reflex and sympathetic influence of the ganglionic and excito-motory 
systems, and who in their theory of direct spinal irritation have left 
the apostles of “hysteria,” “general debility” and “anaemia” 
far behind? The city of Albany alone, certainly that of Boston, 
could afford enough poor backs, innocent of all truly spinal 
disease, that have yet been tortured by croton oil and by anti- 
monial plasters, by the actual cautery and moxa, aye and by bedsores 
that would seem to have been intentionally inflicted, enough did I 
say, far more than enough to fill this hall. 
Do the believers in the all essentiality of displacements as the 
cause of chronic metritis, and in pessaries in one or another of 
their innumerable forms as the only treatment of displacements, 
fear lest lam slighting them? Let them understand then that 
while I defend the frequency of displacements against all who 
would deny it, I yet acknowledge that ten pessaries are used 
improperly where one is used properly, that by that abomination 
of abominations, the abdominal supporter, speaking generally, 
without here considering its specific varieties and indications, and 
only excepting an elastic, well-fitting and lifting bandage, dis- 
placements are very frequently made worse or even initiated, and 
that in the daily or frequent use of the uterine sound, or worse 
still, the finger of the operator, as the only means employed to 
elevate the uterus or to produce a cure, I recognize often but 
the grossest abuse of a license granted only to supposed scientific 
acquirements, and to a decent and honest man. These so-called 
manipulators or movement workers, of whom I have now known 219 
NEW YORK STATE MEDICAL SOCIETY. 
very many instances, are exposed to the chance they too often find 
a certainty, of awakening in their patient a slumbering passion, or 
of but pandering to the vilest of lusts. 
Am I giving too much importance to the cervix and those who 
bow down and worship it as their professional idol, upon which 
they stake their faith, and whence they receive their yearly 
income? I have described but a portion of what has comprised 
till of late, and even of late, the usual treatment of chronic 
metritis. 
There are other and wiser men who have recognized tnat to 
take the citadel, its outposts must be passed, and who have 
directed their attention to the parts within. Leaving the outer 
hall into which the cervix projects, they have penetrated the 
middle and inner chambers, and though stigmatised as too heroic 
in their practice, they have found and have tried to combat, how- 
ever unsuccessfully, the real disease. 
In -what way? By the same measures as have been applied to 
the os, omitting only the most important of all. They have intro- 
duced emollients and stimulants, opiates and astringents, caustics 
and alteratives, into the cavity of the cervix and into that of the 
uterus, and, though sometimes effecting a cure, it has been in the 
blindest way. These various agents have been thrown up in 
solution or applied by a brush or pledget of lint, passed in as an oint- 
ment by a porte-cerate, introduced in a solid state as suppositories, 
and there left, or as a bead fused upon a metallic rod, wdaich allows 
it to melt off and is then withdrawn. Interstitial absorption or 
resolution has been attempted by pressure from tents of sponge 
or sea-tangle, or from intra-uterine bougies, either as a series of 
graduated dilators, the occasional passage of the sound, or the 
wearing, through days, weeks or months, of stem pessaries, 
■whether of a single metal as copper, silver or electro-plate, or of 
hard rubber, ivory or bone. For the same end, and respective 
or irrespective, as the case might be, of the character of the 
catamenia, either as regards their quantity, quality or regularity 
of appearance, galvanic bougies of copper and zinc, placed end to 
end or side by side, have been resorted to. Each and every one 
of the measures referred to, I have myself tried, not merely for 
their more usual indications, but for this specific end; in some 
cases with success, in others with failure, and in still others where 
there had been apparent failure, such a tendency to the reparative 
process had been established, that the removal of the patient to 220 
TRANSACTIONS OF THE 
other surroundings, as by advice or by her own impatience to a 
water cure, has at once effected recovery, the credit of which was 
not so much due to the apparent and generally only acknowledged 
last cause, as to the preparatory measures which had preceded it. 
I have said that many of our brethren in this country have dared 
to penetrate to the very head-quarters of the disease. It will not 
be improper if I mention in addition to the distinguished gentle- 
man whose debate I am now commenting upon, the names more 
particularly of my friends Gaillard Thomas, of New York, Mack, 
of St. Catharines, C. W., Greene, of Pittsfield, Mass., Tewksbury, 
of Portland, Me., and the veteran Henry Miller, of Louisville. 
There was one step further, however, to be taken, and that it is 
my purpose now to indicate. It is not a measure that is always of 
itself sufficient to enable us to reach the goal; it is one, however, 
that is generally, I might indeed say always, of very essential 
importance for this, namely, the scarification of the fundus uteri. 
This method of treatment is constantly resorted to in the instance 
of inflammation, congestion or engorgement of the os and external 
cervix, but beyond this point, few have thought or dared to go 
with their lancet in hand; or if the cavity of the cervix has been 
thus invaded, it has been for a wholly different purpose than the 
special one that is indicated. Thus Huguier, who undoubtedly 
performed this operation of scarifying the cervical canal, resorted 
to it only prior to the use of caustics, and simply that he might 
“expose the glandular structure of the cervix more directly to the 
action of the caustic succeeding-.”* 
O 
The idea of artificially abstracting blood from the uterine cavity 
is not, per se, a new one. It is indeed, but following out the indi- 
cations of nature, as shown to us at the menstrual periods, and in 
the hemorrhage following parturition; that is to say, given a con- 
gestion, normal in these instances and periodical, it is allayed by 
a critical discharge. It is not necessary for me here to discuss at 
any length collateral questions connected with either the lochia or 
catamenia, as to the function performed by the uterus as an acces- 
sory respiratory organ, or as to the effect of lactation calling the 
tendency of the circulation away from the uterus, in reflexly stimu- 
lating that organ to a free discharge of muscular debris, rendered 
useless by the close of gestation, and to the normal degree of 
involution by which it is restored to its former condition of com- 
• Graily Hewitt: Diseases of Women, 1863, p. 524. NEW YORK STATE MEDICAL SOCIETY. 
221 
parative atrophy. I simply refer to these points as affording indi- 
cations of treatment for the disease or diseases we are now study- 
ing. 
I have said that the abstraction of blood from the uterine cavity 
is no new idea. It has, however, been confined, so far as lam 
aware, by those who have published upon the subject, to the relief 
of partial amenorrhcea, or to the re-establishment of the menses 
in the event of their complete suppression. lam not now speaking 
of the modes of effecting these ends, of a reflex or purely medici- 
nal character, as by galvanism, or by drugs stimulant, alterative or 
haemapoietic, nor of the intra-uterine applications so frequently 
employed and so frequently useless in chronic metritis, and so often 
successful in amenorrhcea, but to the direct abstraction of blood 
from the uterine cavity, which Simpson attempted and accom- 
plished by the use of his intra-uterine air pump, a method of treat- 
ment which I have no doubt gentlemen now present have also used 
with satisfaction. In a former paper of my own upon the surgi- 
cal treatment of amenorrhcea,* I pointed out the advantages and 
disadvantages of this instrument. By it I have repeatedly induced 
and kept up the normal menstrual discharge, even where it had 
never before appeared. 
Thus far, however, the principle of direct depletion had only 
been applied for the increase or re-establishment of the catamenia. 
Some seven years ago or more, it struck me that it might with 
advantage be resorted to during the menstrual interval, for the 
treatment of uterine inflammations, congestions, and engorgements, 
whether acute or chronic. I based my reasonings upon the follow- 
ing facts, which must be familiar to all. We have a case of hyper- 
trophied uterus, perhaps with the os open, perhaps with it closed, 
and with or without an increased menstrual flow, or an alkaline 
leucorrhoea. Imagining that there may be an intra-uterine polypus, 
we search therefor and find nothing. Upon the supposition that 
there exists the so-called polypoid condition of the mucous mem- 
brane lining the cavity, and either assuming that there is present, 
or detecting, a turgid and perhaps unusually plicated condition of 
this membrane ly the touch, we scrape out the cavity by liccamier’s 
curette, produce more or less profuse hemorrhage, and often find 
our patient wonderfully improved. This has frequently been my 
own experience. 
* Amer. Jour, of the Med. Sciences, Jan. 1864. 222 
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Again; In a similar case we have resorted to sponge tents, and 
finding nothing requiring direct operative interference, we yet. 
shortly discover at times that the enlargement of the uterus is soou 
measurably lessened. How is this effected? Not by the mere 
pressure of the tent alone, which undoubtedly does do some good, 
as Marion Sims has shown, especially where true neoplasms have 
existed, but by the hemorrhage that is not unfrequently produced 
by the fibrilke of the sponge having almost as closely penetrated 
into the interstices of the uterine mucous membrane, as do the 
chorionic villi of the placenta, and their forcible separation from 
each other may be attended by haemorrhage, less in quantity it is 
true, but effected much in the same way as occurs during the other 
disseverments to which I have referred. 
Moreover, we have, all of us, when operating for dysmenorrhoea 
depending upon organic contraction of the cervical canal, by means 
of the hysterotome, an operation that is, of course, performed 
during the menstrual interval rather than at its period, for fear of 
greater haemorrhage, if not of peritonitis, we have at that time ob- 
served that after the operation not only is the dysmenorrhoea les- 
sened, but also frequently the size of the uterus, provided this has 
been hypertrophied. 
Still again: More than once when removing sessile tumors from 
the fundus uteri by the knife, or gouging out portions of them on 
the plan of Baker Brown, or incising them with the hope of pro- 
ducing their enucleation, after Atlee, each of these measures being 
attended by haemorrhage, more or less profuse, I have noticed a 
general lessening in size of the uterine parietes, which could not 
be accounted for merely by the operation that had been perform- 
ed and the loss of substance, from whatever means, that had thence 
ensued. 
And finally, we sometimes see during the intermenstrual period 
in non-pregnant women far from the final climacteric, who may 
have complained or not of uterine disturbance, but this non-malig- 
nant in its character, sudden and sometimes profuse gushes of 
haemorrhage, followed by unusual feelings of comfort or relief; 
such being truly critical discharges, at once suggestive and curative 
of a local plethora. 
Arguing from these premises, I decided that direct depletion 
might be resorted to for the relief of the body of the uterus, as 
well as its os and cervix. NEW YORK STATE MEDICAL SOCIETY. 
223 
How could this best be effected? At first I tried the intra-uterine 
air pump to which I have alluded, but found that it produced un- 
necessarily great lacerations of the uterine mucous membrane, this 
entering the fenestra) of the instrument under forcible suction, 
and clinging closely to them while it was being withdrawn. 
Having little dread of the uterine cavity, I then proceeded to fur- 
ther measures. I had already been publicly berated for having 
been the first, so far as I yet know, to suggest the application of 
potassa fusa within the body of the uterus, a method to which 
many other gentlemen are now in the habit of frequently resort- 
ing, and as I had said, I had made little, scruple of applying the 
knife or scissors to internal outgrowths. With the hysterotome and 
a variety of bistouries cach£es, especially that of Blandiu modified 
by Guerin for the radical cure of hernia, I endeavored to get control 
of the uterine cavity so far as concerns blood-letting therefrom. 
These instruments, to a certain extent, effecting my purpose, were 
yet somewhat dangerous to the patient, and occasioned a certain 
measure of anxiety to myself. 
During the course of these investigations, and rather more than 
three years ago, it came to my knowledge, purely by inference, 
that a neighboring practitioner was scarifying the interior of the 
uterus. Patients frequently came to me who had been previously 
under the charge of this gentleman, and they all told me the same 
story, viz: that the uterine sound had been passed, and had been 
immediately followed by hemorrhage, leaving only a single belief 
possible, such result not generally following the alleged cause, 
that the sound used had been hollow, and had contained a con- 
cealed blade. This discovery made me renew my efforts to obtain 
what I had for some time seen was indicated. 1 even discussed 
the matter with the maker, as it proved, of the instrument that 
had been used in the case of the patients above referred to, him- 
self a retired physician still in good standing, and I was told that 
such an instrument as I wanted, was impracticable; this statement 
being now explained, on the ground that a pledge of secresy had 
been exacted by his previous client. Thus matters went on until 
May of the past year, when through a third party, also a physi- 
cian, and in a perfectly honorable manner, the instrument itself 
fell into my hands. During the next five days, I tested it upon 
nineteen of my private patients, and satisfied myself, that at last 
what I sought I had found. It was simply, as I had supposed, a 224 
TRANSACTIONS OF THE 
hollow sound, and in reality but a slight modification of Eicord’s 
urethral scarificator, the knife emerging upon the concave instead 
of the convex margin. Feeling that credit was due to Dr. Miller 
of Dorchester, for his application of this instrument to the uterine 
cavity, I desired that he should himself take opportunity to bring 
it before the profession, after the three years or more, during 
which he had constantly employed it in practice, and I sent him a 
message to this effect. After the time named by me had expired, 
without such publication upon his part, he asserting as I under- 
stand, that he had already shown the instrument to several of his 
neighbors, the secret being apparently kept by them, I had no 
hesitation in using the scarificator openly, giving all the credit to 
its original employer, that could be done consistently with the 
spirit of chapter 2, article 1, section 4 of the code of ethics of 
the American Medical Association. The publication of the instru- 
ment by Dr. Miller, was finally made to the Norfolk District Medi- 
cal Society of Massachusetts, on November 14, 1866, some seven 
months after he knew that it was in my hands. To this form of 
scarificator, though an improvement upon my own previous instru- 
ments, there were certain objections, as I found in practice. 
First—It was kept clean with great difficulty. 
Second—lt was too flexible, allowing the knife to become 
caught under the edge of the sheath, when this was at all twisted 
as frequently occurred when a displacement existed. 
Third.!— The instrument in this event, required to be wholly 
withdrawn before it could be used, and 
Fourth—It was, like the earlier styles of sound and intra-uterine 
porte caustique, furnished with a knob at the 2-| inch point, which 
is sometimes an obstacle to the introduction of any instrument to a 
further depth, if this is necessary. 
I have, therefore, had manufactured by Mr. Tiemanu, a modifi- 
cation of the scarificator, which overcomes all these difficulties. 
It is more easily introduced than the other, more readily cleansed, 
and is in other respects superior to it. It besides does not so cer- 
tainly convey to the patient, as I have reason to believe has occurred 
with the other instrument, the deceptive idea that the sound only 
is being employed. Honesty in medical matters, is not only the 
best policy so far as the surgeon himself is concerned; 1 believe, 
that oftener than wTe imagine, a resort to it upon his part is also 
for the patient’s good. NEW YORK STATE MEDICAL SOCIETY. 
225 
Dr. Storer’s Intra-uterine Scarificator. 
It will be seen by the above wood cut, that my intra-uterine 
scarificator forms a very simple and compact instrument. A hol- 
low stem, six inches long, receives at its lower extremity a hinged 
sheath, entering the first and there fastening by a screw thread. 
This sheath is three inches in length. Through the continuous 
canal thus formed there passes the knife, which is attached to a 
slender stafi*, and may be advanced or withdrawn by a button near 
the handle of the instrument. The latter is attached to the tube 
by a screw and may be readily removed, both for the purpose of 
cleansing the blade and shortening the instrument when to be 
packed in its case. The hinged sheath of which I have spoken is 
provided with a slit on its anterior portion, for the emergence of 
the knife, as will be perceived by the cut below: 
Blood-letting by the simple process of scarification is then pos- 
sible for the uterine cavity, and we are now able to treat its 
diseases upon an antiphlogistic or merely a slightly depletive basis, 
as circumstances may require—that is to say, upon the same gene- 
ral principle that we apply to the rest of the body. The cases for 
which this method is available are very common, and I can truly 
say that thus I have repeatedly produced a greater amount of relief 
in a week or two than I had previously been able to effect during 
many months. I used at first to immediately precede its employ- 
ment by the uterine sound, that I might be sure of the length of 
the uterine cavity, and that I might restore the organ, if displaced, 
to its normal position, before introducing the scarificator. With 
my own stiffer instrument, these precautions are often unnecessary, 
and the dilatation of the cervix effected by its entrance allows any 
[Assem. No. 230.] 226 
TRANSACTIONS OF THE 
effusion of blood, however profuse, to escape ; generally, however, 
except in extreme congestion, the amount of htemorrhage effected 
is but small. I ordinarily make several linear incisions through- 
out the whole length of the uterine cavity before finally withdraw- 
ing the instrument, turning it about to the four points of the com- 
pass, and sheathing or unsheathing the blade as occasion may 
require. It will be perceived that the depth of the blade renders 
it impossible to do more than simply scarify the mucous mem- 
brane, unless employed too soon after the catamenial period, when 
exfoliation of the mucous membrane having taken place, a deeper 
tissue might be reached 
It will be perceived that the measure now described at once 
harmonizes the conflicting views as to treatment, of our friends who 
conducted the discussion upon chronic metritis at the Academy of 
Medicine. Prof. Budd points out the benefit often produced in 
these cases by ordinary menstruation, and argues, therefore, that 
a certain measure of depletion is indicated, a view with which I 
certainly agree. Prof. Peaslee recognizes the phenomenon to 
which allusion has just been made, and would hence make of 
chronic metritis a recurrent and clonic rather than a persistent and 
tonic affection. He has seen serious results produced by free 
depletion at a comparatively distant point, as at the os uteri. He 
does not understand how depletion at the os can effectual!}* re- 
lieve any serious trouble within, and in case of any depletion 
whatever, he would restrict it to a very small extent at any given 
time. These are each of them positions that cannot too cordially 
be acceded to. Prof, Barker again, while apparently differing in 
toto from his antagonists, in that he has not of late years relied 
upon depletion in these cases at all, yet bases his objections to it 
upon the facts that by leeches the loss of blood is often carried to 
a degree dangerous to patients who are already anaemic, and that 
the depletion to be effectual should take place at the very seat of 
any congestion, inflammation or engorgement, to combat which it 
is employed. “Whether the amount of liquor sanguinis of the 
body of the uterus becomes decreased by depletion of the cervix 
seems/7 he says, “very doubtful.77 
Do I pretend then to say that the so-called chronic metritis can 
be rendered more curable ? I do. Do I assert that reliance should 
always be placed upon the intra-uterine scarificator alone ? I do 
not. But Ido believe that thus accompanied, the other measures 
that may be advantageously employed in given cases, may be NEW YORK STATE MEDICAL SOCIETY. 
227 
resorted to more scientifically, and with less empiricism than has 
hitherto been the case. I have already enumerated a host of 
measures that are commonly employed, some of them at times 
useful, others of them seldom or never. There are several, how- 
ever, well grounded in their application, that I have not known 
employed for this especial purpose by others than myself* 
What these rational adjuvants of the treatment should be, I 
have already indicated. To them I have been brought by a close 
study of the physical lesions following, as a direct or indirect conse- 
quence, abortion as contra-distinguished from pregnancy at the full 
time, to some of which I have briefly alluded in the Prize Essay 
issued for general circulation among women, by order of the 
American Medical Association.* In these cases we are very apt 
to have sub-involution, a deficiency of the process by which the 
uterus is restored to its normal size, owing in great measure to the 
fact that the ordinary fatty degeneration of certain portions or 
the greater part of the uterine muscular tissue, by which nature 
provides for its detachment safely from the placenta and mem- 
branes, has not occurred. In many of these instances there is a 
peculiar proneness to the re-establishment of pregnancy, perhaps 
because there is a greater extent reproduced than is normal, of 
uterine mucous membrane, in which an ovum may become entangled 
and retained for impregnation. However this may be, there is no 
doubt that a subsequent abortion is rendered more imminent, 
especially at the times corresponding to the first miscarriage and 
to the regular menstrual periods.! If, however, these perils can 
be passed and gestation be completed, a cure frequently becomes 
possible, more particularly if lactation is encouraged or enforced; 
the irritation of the breasts, as I have already said, producing a 
peculiarly kindly reaction upon the muscular structure of the 
womb, and inducing absorption, or rather discharge of any surplus 
and therefore abnormal connective tissue. 
Again. There is no doubt that the application of heat and cold, 
the one or the other, or both alternately, by Chapman’s plan, to 
the sacrum, is often of immense advantage to us in treating this 
class of diseases, just as it is in controlling the disorders of men- 
* The fact has been allowed by several observers, latest among whom perhaps are Kirsten 
and Beck, as quoted in the New York Medical Record of last week (Feb. 18, 1867), from 
Braun’s Jahr Biich, though no explanation like that now given, seems ever to have been 
suggested. 
t Why Not? A Book for Every Woman. Lee & Shepard, Boston, 1836. 228 
TRANSACTIONS OF THE 
struation. If heat to the sacrum will frequently check a menor- 
rhagia, or prevent a threatened or commencing abortion, as it does, 
or if ice in similar manner will re-establish or increase the men- 
strual flow, or produce a premature labor, as is also true, we may 
reasonably look to the same measures when we wish, by reflex 
action, to control the uterine circulation, and consequently the 
inflammatory, engorged or congested states of that organ. We 
may thus indeed often subdue them at our will. 
Still again. By irritation, not of the mammary gland, but of 
the nipple and adjacent superficial nerves, as by a sinapism, we 
often produce a great increase of the catamenial discharge, and, 
therefore, a determination of blood toward the organ from whence 
it proceeds. So by avoiding all pressure upon those parts by the 
clothing, and quieting any undue excitability by local applica- 
tions, as of atropia, or the Arnott-Simpson-Richardson induction 
of local anaesthesia to a not unreasonable degree, we may lessen 
any existing tendency to uterine plethora. 
In producing a direct influence upon these cases by simple 
medication, I have little faith. By bromide of potassium we 
may occasionally quiet the uterus it is true, and perhaps set up or 
increase fatty degeneration of its fibres, but rather by first affect- 
ing the base of the brain, and thence reflecting uterine peace. By 
hypodermic injections applied even into the very uterine parietes 
by the proper instrument, we may soothe its hypenesthesia. By 
intra-uterine applications of caustics and the like, whether of 
chromic or pyroligneous or carbolic acid, et coetera usque ad finem 
as so frequently resorted to, we may destroy or otherwise quiet any 
existing point of irritation, and by the seton-like influence of 
potassa fusa or of the actual cautery, we may produce an inter- 
stitial change. 
But there is still yet further to be done. If the woman is left 
to the unbridled caresses of even a considerate husband, or is 
allowed to indulge in any of the conjugal indecencies of the 
present day, preventing impregnation by the use of a sponge, or 
by cold injections, or by the employment of condums or the so- 
called womb-guard, or that worst measure of all, incomplete 
intercourse, the practitioner’s hands are tied. He cannot expect 
to effect a cure. 
I must not be thought to condemn as useless all the various 
methods of treatment upon which most physicians are accustomed 
to rely. These, however, can be considered at best as but adju- NEW YORK STATE MEDICAL SOCIETY. 
229 
vants of the true ratio meclencli. If resorted to, it must be for 
some special indication of the case, and not at hap-hazard or ran- 
dom. Thus, while pessaries are at times not only advisable, but 
absolutely necessary for the progress of a cure, a wise discrimina- 
tion as to the theory of the instrument, its indications as to mate- 
rial and size and shape and position, and the length of time 
during which it is to be worn, must be employed. To resort to a 
ring, therefore, for an antero-posterior displacement, or a lever 
for simple descent, as is still too frequently done, will almost 
necessarily cause disappointment, if not an unjust condemnation 
of the instrument improperly used. To employ any such mea- 
sure whatever when inflammation is present, or excessive irri- 
tability of the part, without preliminarily subduing these, is 
certainly no evidence of wisdom on the part of the attendant. 
There are some forms of pessary, however, as my own hard rub- 
ber loop, or rather artificial finger, first communicated to the 
Suffolk District Medical Society of Boston, some months since, 
and to be procured of Tiemann & Co., of New York, which, for 
the purposes for which they are indicated, are well nigh perfect. 
You will pardon me for trespassing so much upon your patience, 
but in view of the despairing expressions of Profs. Budd, Peas- 
lee and Barker, I think it possible yon may have been interested 
in the paper now read. More particularly would I rest my 
argument upon the remarks made at the close of the New York 
discussion. Regarding hypertrophy of the body of the womb, 
frankly confessed Dr. Kammerer, that he did not know what to 
do. How the body of the uterus in this condition was amenable 
to surgical measures, he did not understand.* “If,” said Dr. 
Peaslee, “we cannot affect the body of the womb, as has been 
asserted, by any application to the cervix, of course all local 
treatment must be abandoned as useless.” “As to removing the 
induration of the uterus,” he continues, “ I regret that I cannot shed 
much light upon that point. We must trust mainly to medicinal 
measures, and especially to time.”f 
Hoping that I may have now indicated the direction in which 
therapeutists must tend, I thank you for the courtesy with which 
you have listened to my communication. 
♦Phil. Med. & Surg. Reporter, 29 Dec., 1860, p. 535. 
t N. Y. Med. Record, 15 Jan., 1867, p. 530.