WHAT IS THIS HYDATID DISEASE ?
The disease called hydatid is not a peculiar production of the uterus, as it is often found in other parts of the body ; neither is it confined to the human subject alone, some animals, the sheep especially, are frequently affected by it. Hydatids, according to the Linnean system, constitute a tribe of the genus tenia, and belong to the class and order of intestinal
worms. They are characterised by being famished with a vesicle, which is sometimes attached to them posteriorly, or in which some of them are altogether enclosed. They occasionally exist singly in the uterus, but more generally hang together in clusters, each little vesicle being attached to its fellow by a very delicate filamen- tous thread, the whole presenting an appearance very similar to a bunch of grapes ; they are connected with the lining membrane of the womb by a thickish substance, resembling fibrin, having, nevertheless, a bloody appearance when first expelled from the uterus. The size of these vesicular bodies varies, some are very small, whilst others are as large as the egg of a thrush ; when macerated and perfectly freed from blood, they are generally colour less. Dr. Baillie, however, states that he has, in many cases, seen hydatids of the liver of a pale amber colour. Various opinions have been entertained with regard to the forr mation of uterine hydatids. As they so commonly exist in connection with a dead ovum, some have attributed their origin to this circumstance, whilst others believed that the death of the ovum has been the effect of the previous existence of hydatids in the cavity of the womb ; that, in truth, these animalcule were the actual devourers of the foetus. Dr. Blundell, late of Guy's Hospital, has preparations showing this work of destruction in progress. I have never seen a case of uterine hydatids in an unmarried female, and am not aware that it has been observed by others ; still it would be wrong to assert that these bodies cannot possibly form without sexual intercourse ; and, therefore, if called to an unmarried woman, from whose uterus hydatids were growing, I should not feel justified in expressing an opinion which might prove injurious to her reputation. Wherever there exists a reason- able doubt, it is but an act of common justice to give the patient the benefit of such doubt. I have stated to you that married women are very generally the subjects of this disease, and not only married, but in a state of pregnancy ; the symptoms, therefore, at first are those which are attendant upon that condition, but after the death of the ovum the signs of pregnancy disappear. The uterus, instead of diminishing, increases in size, in consequence of the enlargement of the hydatids within its cavity ; and, therefore, it often happens that the medical man, as well as the patient, is deceived, as they imagine pregnancy to be still advancing. There is this marked difference, however, between the two : the enlargement which is the result of concep- tion is slow, whilst that from hydatids is very rapid. Again, there is the absence of the sensation called « quickening," although there may be a kind of indistinct flutter perceived by the patient herself, probably caused by flatus ; or, perhaps, it may depend upon that power of contraction which the hydatids themselves possess. Sir Charles Clarke states, that although hydatids in other parts have this power, yet it has never been"observed in those of the womb ; it however, by no means follows that because they have not been
TREATMENT OF HYDATID :Treatment of Uterine Hydatid — There are no known reme- dies which will prevent either the formation or growth of uterine hydatids, nor do we possess any means whereby we can procure their expulsion in the more early months ; all that can be done is to explain to the female the nature of her disorder, and to attend to any symptoms that may arise, patiently waiting until, from the distended state of the womb, its extraordinary action is excited ; and this, as before stated, will occur, sooner or later, varying greatly in different individuals ; the sooner this contraction takes place, the better will it be for the patient, as the blood-vessels increase in proportion to the enlargement of the uterus, and, consequently, are of smaller size in the earlier months.The os uteri under these circumstances, is usually considerably dilated.so that the finger can, with ease, be introduced into the cavity, and the hydatids distinctly felt. If, however, the hemorrhage be not alarming, no manual interference of this kind is cither necessary or proper : the main object of the practitioner is to control the hemorrhage : to this purpose all his efforts must be directed. The flow of blood, be it remembered, is in some instances so excessive, that the female's life is in immediate peril, the gushes being as profuse as during the puerperal condition ; indeed, they appear much more so in consequence of the large quantity of watery fluid with which they are mixed. In the attempt to restrain these bleedings, we must not forget that the only effectual method consists in exciting a general, perfect, and permanent action of the muscular fibres of the uterus, without which its renewal is certain.Confinement to the recumbent position is imperatively required, and every circumstance carefully avoided, which would be likely to produce either bodily or mental excitement. In some cases (that they are rare must be admitted) this plan of treatment, combined with great attention to diet, is all that is required, especially where the action of the uterus is powerful ; of course no nutriment, of a stimulating kind, should be allowed, and everything should be received into the stomach nearly or quite cold, caloric, as you know, having a great tendency to excite the action of the heart and arteries. Next, in the list of remedial means, I would place the application of cold : a bladder, containing pounded ice, as recommended, in a previous lecture, should be placed upon the lower part of the abdomen ; a piece of ice has by some been recommended to be introduced within the vagina, by which a sudden state of contraction is often procured.After hydatid disease, there is sometimes a tolerably copious secretion of milk, which soon subsides after a laxative has been administered. Lastly, it is often necessary, in consequence of extreme debility resulting from this affection, to employ tonics and cardiacs for a long space of time, a return to perfect health and strength being often very protracted and tedious. Everything likely to increase tone in the general system is here required, avoiding, of course, all local stimuli.