Page:Clinical Lectures on the Diseases of Women.djvu/143

Rh tions; and I shall tell you another remarkable phenomenon which illustrates the same thing. The sticky cervical mucus, as you are all aware, in 999 cases out of 1000 hangs out of the uterus into the vagina; but I have seen it, instead of hanging out of the uterus into the vagina, ascending, and filling the cavity of the body of the uterus. This forms a good text, of great importance in pathology, which I hope to lecture upon some other day. This function of the uterus when it acts in the way I have mentioned, drawing the cervical mucus into the cavity of its body, instead of expelling it, certainly tends to produce morbid conditions of the uterus itself. The same condition is illustrated in pregnancy. The ascent of the pregnant uterus itself is a phenomenon in this category; but, during pregnancy, as I have seen in several dissections, the cervical mucus, instead of running into the vagina, ascends and runs into the uterus, and hangs into the uterus instead of into the vagina; and this circumstance has led to considerable mistakes recently in the investigation of the condition of the cervix uteri during pregnancy.

The best evidence we have of uterine contractions during menstruation is from the observation of cases of dysmenorrhœa spasmodica, and this observation reveals that the contractions may be either clonic or tonic. The clonic contractions are probably the most frequent. By "clonic" you know I mean come-and-go contractions like uterine pains. You will find women suffering from dysmenorrhœa tell you the pains come in pangs; and in the most violent pangs, in the most severe cases, the contractions, not only affect the uterus, but may also affect the bladder and rectum, producing strangury and tenesmus, and also violent abdominal bearing down by reflected influence. Tonic contractions of the uterus, however, are not uncommon, and then you have the pain incessant, probably because the contraction is almost unceasing.