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Title: Femina, A Work for Every Woman
Author: Miller, John Alexander
Language: English
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[Illustration: JOHN A. MILLER, M. D.]
FEMINA,
A WORK FOR EVERY WOMAN
ILLUSTRATED.
A perfect woman, nobly plann’d,
To warn, to comfort and command;
And yet a spirit still, and bright,
With something of an angel light.
—_Wordsworth._
BY
JOHN A. MILLER, M. D.
GRADUATE MEDICAL DEPARTMENT UNIVERSITY OF CALIFORNIA, ALSO HOLDING
CREDENTIALS FROM THE UNIVERSITIES OF BERLIN AND
HEIDELBERG, GERMANY.
SAN FRANCISCO,
THE FEMINA COMPANY,
1893.
ENTERED ACCORDING TO ACT OF CONGRESS, IN THE YEAR 1893
BY JOHN A. MILLER,
IN THE OFFICE OF THE LIBRARIAN OF CONGRESS,
AT WASHINGTON, D. C.
TO
THE LATE
DR. CARL SCHROEDER,
PROFESSOR OF DISEASES OF WOMEN
IN THE FREDERICK WILLIAM UNIVERSITY, BERLIN
MY TEACHER AND FRIEND.
[Illustration]
PREFATORY NOTE.
The publication of this volume was suggested by the astonishing
ignorance displayed and the antiquated ideas entertained upon questions
of health and disease by most persons with whom I came in professional
contact, even by those who were accomplished in other subjects of a
scholastic and scientific nature. The practical importance of the
subject naturally led me to the consideration of diseases that are
essentially inflammatory, for over seventy-five per cent of all
diseases of women are of an inflammatory nature. In this respect the
book differs from other works on similar subjects.
In discussing this class of diseases I have aimed to present a treatise
simple in style, and easily understood by the casual reader. While I
have endeavored to impart strictly scientific information, I have tried
to impart it in familiar language, avoiding the use of technical terms
as far as possible, and carefully defining them when their use became
indispensable.
JOHN A. MILLER, M.D.
No. 1137 Geary Street, San Francisco, Cal.
[Illustration]
BY THE SAME AUTHOR.
MEDICAL EDUCATION IN THE UNITED STATES AND AN OUTLINE OF THE GERMAN
SYSTEM. Essay read before the Alumni Association of the Medical
Department of the University of California, March, 1886.
EROSIONS OF THE VAGINAL PORTION OF THE CERVIX, OR ULCERATION OF THE
SAME PART. _Pacific Medical and Surgical Journal_, January, 1887.
RETROVERSIO-FLEXIO AND A NEW INSTRUMENT FOR THE REPOSITION OF THE
UTERUS. _American Journal of Obstetrics and Diseases of Women and
Children_, February, 1887.
UTERINE HEMORRHAGE AND LIGATION OF THE UTERINE VESSELS AS A
THERAPEUTIC EXPEDIENT. _The New York Medical Record_, September, 1889.
PHLEGMASIA ALBA DOLENS, OR MILK LEG; ITS PATHOLOGY AND TREATMENT
BY MEANS OF COLD WATER COMPRESSES AND ICE BAGS. _Pacific Medical
Journal_, June, 1891.
CONTENTS.
CHAPTER I.
THE REASON WHY 15
CHAPTER II.
DELUSIONS AS TO THE CURATIVE VALUE OF DRUGS 36
CHAPTER III.
WHAT IS MIND CURE? 46
CHAPTER IV.
GENERAL CAUSES OF UTERINE AND PELVIC DISEASES OF WOMEN 61
CHAPTER V.
UNCLEANLINESS AS A CAUSE OF DISEASES IN WOMEN 76
CHAPTER VI.
MARITAL EXCESSES AND PREVENTION OF CONCEPTION 87
CHAPTER VII.
CRIMINAL ABORTION OR FETICIDE 101
CHAPTER VIII.
ANATOMY OF THE FEMALE ORGANS 119
CHAPTER IX.
MENSTRUATION AND MENSTRUAL DISORDERS 126
CHAPTER X.
HISTOLOGY OF INFLAMMATION 145
CHAPTER XI.
URETHRITIS AND NEURALGIA OF THE URETHRA 150
CHAPTER XII.
INFLAMMATION, CATARRH, AND OTHER DISORDERS OF THE BLADDER 157
CHAPTER XIII.
ACUTE AND CHRONIC INFLAMMATION OF THE VAGINA 172
CHAPTER XIV.
HYGIENIC MEASURES FOR CATARRHAL DISEASES OF THE FEMALE ORGANS 182
CHAPTER XV.
METRITIS OR INFLAMMATION OF THE WOMB 196
CHAPTER XVI.
CHRONIC METRITIS OR CHRONIC INFLAMMATION OF THE WOMB 203
CHAPTER XVII.
ENDOMETRITIS OR CATARRHAL INFLAMMATION OF THE WOMB 209
CHAPTER XVIII.
THE NATURAL POSITION OF THE UTERUS AND HOW IT IS SUPPORTED 226
CHAPTER XIX.
PROLAPSUS OR FALLING OF THE WOMB 231
CHAPTER XX.
VERSIONS AND FLEXIONS OF THE WOMB 240
CHAPTER XXI.
DISEASES OF THE FALLOPIAN TUBES 258
CHAPTER XXII.
DISEASES OF THE OVARIES 263
CHAPTER XXIII.
PERIMETRITIS AND PELVIC PERITONITIS 275
CHAPTER XXIV.
PELVIC CELLULITIS OR PARAMETRITIS 285
CHAPTER XXV.
ELECTRICITY AS A REMEDY 294
CHAPTER XXVI.
SIGNS AND SYMPTOMS OF PREGNANCY 305
CHAPTER XXVII.
PRECAUTIONS AND SUGGESTIONS TO PREGNANT WOMEN 315
CHAPTER XXVIII.
WHILE IN CHILD BED 328
CHAPTER XXIX.
DISEASES PECULIAR TO CHILDREN 341
CHAPTER XXX.
DISEASES PECULIAR TO CHILDREN—CONTINUED 356
CHAPTER XXXI.
EMERGENCY TREATMENT IN SUDDEN ACCIDENTS 377
CHAPTER XXXII.
SOMETHING ABOUT DIET 392
CHAPTER I.
THE REASON WHY.
I see a large field of usefulness which has not been covered by
competent authorities. I propose, therefore, to offer a plain, simple
statement of the most common causes of physical suffering in women,
and a simple and reliable method of home or domestic treatment, to be
carried out by the patients themselves, which, in the great majority of
cases, is easily applied.
The first nine years of my professional life was an untiring and
incessant devotion to the arduous demands of a large family practice,
after which I decided to go to Europe, and there prosecute such studies
in two German universities as my experience as a practitioner had fully
convinced me to be of the greatest practical and scientific importance;
hence, I offer no excuse or apology for aught I may say on a subject
with which I have taken especial pains to familiarize myself. Having in
a measure established my identity, I am more fully prepared to proceed
in a more congenial way.
In the realm of thought there is no monopoly, and it is, after all, at
the bar of public opinion that a final judgment must decide the merits
of my course.
The question is not what to teach, but whom to teach. This may seem, at
first sight, an easy matter to determine, but a more careful inquiry
will show the complexity.
The platform of a medical college is considered by some the only
legitimate place from which a medical man may impart his knowledge,
but here the opportunity is limited, notwithstanding the abnormally
great number of these institutions. This, however, is not the only
reason. Medical colleges are becoming so numerous, that they should
be discouraged by all honest and high-minded medical men, because in
this country they are private institutions, with very few exceptions,
and subserve sinister purposes, in furthering the interests of their
promoters either as advertising schemes or money-making institutions,
or both.
Of course they are incorporated under State laws, which make them
_quasi_-public institutions, but the State exercises no authority over
them, and their self-constituted professors conduct them to suit their
own private ends. They are not limited by law, nor is a _required
course_ for their students imperative, so that the public have no
guarantee of the fitness or competency of their graduates. There is,
also, an unhealthy rivalry among our colleges for students, improper
material is taken in, and correspondingly poor material is turned out;
this in turn causes a rivalry among their graduates in making spoil of
the sick.
Every self-respecting and competent medical man has an utter contempt
for these doctor mills. This will never be different in this country
until we follow the plan of European governments, and make medical
colleges State institutions, and their professors officers of the
State, with liberal salaries.
The medical press has a comparatively limited opportunity for imparting
information to the public, unless the editor of the secular press
happens to make a quotation.
The exclusiveness that has characterized the learned professions
generally, and the medical profession particularly, is rapidly passing
away. Only half a century ago, the medical lectures in Germany were
mostly delivered in the Latin language, and, while we now often suffer,
in listening to medical lectures in _bad_ English, the latter may
still be the lesser evil. In fact, so great is the deference to public
opinion in favor of diffusing knowledge that medical faculties court
popular favor by delivering a course of lectures on medical subjects,
and consider these the best-drawing card of the institution.
Information that is not sensational nor untruthful cannot fail to do
incalculable good to the class for whom it is intended, namely, our
wives, mothers, daughters, and sisters, so that they may avoid errors,
that entail suffering and disease; information that will teach them how
to cure themselves of the commoner and simpler ailments, and thus avoid
running to the doctor, who cannot always afford to tell them the truth.
Some would not if they could.
The Darwinian theory is of wider application than to mere animal or
plant life; it extends itself to the overcrowded professions, and the
increasing “struggle for existence” in the ranks of the profession
makes men dishonest and greedy for any opportunity to raise a fee, so
that patients are being treated for diseases which are created for them
by the cunning and dishonesty of their doctors.
A little common sense and a knowledge of the elementary principles of
disease would be the best protection against these deceptions; but,
as a rule, sick persons are inclined to throw aside all good sense,
and give themselves up entirely to their feelings or to their doctor.
This is a very wrong thing to do, and opens the door for all manner of
impositions.
The general practitioner of thoughtful and studious habits finds that,
in the course of years, a diversified reading on the different diseases
which in the routine of his work he is called upon to treat makes him a
generally well-informed man, but not a thoroughly exact man, either in
theory or in the details of his treatment.
Fifty to sixty years ago the entire field of medicine was comparatively
so small that it was easier for a brilliant mind then, to comprehend
all that was believed to be known, than it is for the same quality of
mind to understand any of the subdivisions of medicine to-day.
Those were the days of doctrines and rules. Little that was absolutely
correct or true was then known about disease, otherwise such absurd
theories as the “_dynamization_ or _spirit-like_” influence, causing
disease on the one hand, or that the “great source” of chronic
diseases was _psora_, or itch, on the other, as Hahnemann would have
them believe, could never have gotten a foothold.
These are the days of scientific deductions from microscopical
and physiological research, in laboratories connected with great
universities, and the result is, that any of the specialties or
subdivisions of medicine is as large and interesting a field as the
entire area was some time ago. It thus happens, that some thoughtful
persons, after years of general practice, drift almost involuntarily
into some one department of medical art and science. To this they
become gradually wedded, and in it they grow in knowledge and
experience far beyond their previous anticipations. What they read on
the subject is better understood, and new ideas are constantly formed,
which enlarge the scope of their knowledge. In this manner the writer
drifted into the domain of diseases peculiar to women, which was as
unhappy on the one hand, as it is interesting on the other, for the
phrase “_diseases of women_” has fallen into disrepute because every
superficial practitioner professes to know all about them, and it often
is but another name for criminal abortion.
But for all that, there is a legitimate and scientific specialty of
women’s diseases. The time-serving specialist must be exposed in every
department of medical science. Whether the pretender is labeled, a
professor in a college, or labels himself through glaring newspaper
advertisements, one is just as much a catch-penny as the other.
The object of educating the laity cannot be reasonably confined to
a few medical truths, but the perversion of the truth must also be
understood, so that the false can be detected. It is necessary to
point out the dangers and frauds which are the unhealthy outgrowths or
excrescences of established truths, and there must be no veneering of
the wicked and sinful with ambiguous phrases to shield the guilty; the
truthful and innocent require no apologist.
The honest observer can pursue no middle way in a work to which he
has devoted the best years of a studious life, and hence he may seem
radical in his opinions. While policy often dictates a conservative
course, that which conscience and reason dictate to be true is prompted
by loftier motives, namely, to subserve the highest purpose of moral
integrity.
It has often been said that this is a mechanical age. How true is this
even in the furtherance of science! How true is this of the science
of astronomy, which was revolutionized by the construction of good
telescopes! Mechanical genius has perfected a lens for Mount Hamilton
thirty-six inches in diameter, and one is now in course of construction
for Mount Wilson, in Southern California, which is to measure forty
inches. Through these means scientists hope to decipher the complexion
of remote planets.
Microscopic lenses have been equally perfected, and, by means of
achromatic condensers and immersion lenses, great magnifying power can
be obtained with perfect distinctness. That this mechanical spirit
of the age should also have obtained a foothold in medical art and
science, is but natural. Surgical and other mechanical methods have
entered so boldly into the field of diseases of women that the writer
feels constrained to sound a note of alarm. Great strides have been
made in a more perfected technique in abdominal operations, and, by
favorable recoveries from grave and severe operations, the field
of surgical usefulness became enlarged, but this has degenerated
into a license for notoriety and personal aggrandizement of not
over-scrupulous and selfish surgeons who are over-anxious to operate so
as to be able to boast of the great number of their capital operations,
or laparotomies.
I was enthusiastic in abdominal and pelvic surgery, but not until I
entered the field as a specialist in this department of medicine did
I see and hear of daily abuses and misuses of this branch of surgery.
In many instances it degenerated into criminal malpractice. It will be
instructive information to cite a few cases which occurred under my
observation, and present the actual facts to the reader.
It was in the month of February, in the year 1888, that a business trip
to the southern part of the State forced an absence of several weeks
upon me. Some two months before this time I had been called to see a
young woman, who had then been sick for several months. She informed me
that she had been married nine years, and, not having had any children,
she concluded to see a noted specialist of female diseases. By this
physician she was told that her sterility was owing to a closure or
contraction of the mouth of the womb. This was obviously a wrong
diagnosis, and for these reasons: she had always menstruated regularly
and without pain, which excludes a constriction; and, secondly, no
physician can honestly call a woman sterile until he has examined her
husband, who, in the majority of instances, is the cause of his wife’s
sterility, because it is he who is sterile. This woman and the doctor
agreed, however, on a course of treatment, which was to forcibly open
or stretch the mouth and cervical canal of the womb. This by itself is
neither a dangerous nor a severe operation, if carefully performed, but
care in this case was evidently not exercised, because the young woman
was taken with severe inflammation, which caused a pelvic abscess.
I found her after two months of suffering. The discharge had become
extremely offensive, her body emaciated, and her strength exhausted.
I enlarged the opening of the abscess, placed a large drainage tube in
the cavity, through which it was washed out, by means of an antiseptic
solution of bichloride of mercury, 1 part to 2,000 parts of water, and,
by further giving her simple, nutritious food, she improved rapidly,
so that the day before I left the city she was at my office, and told
me that she felt as well as ever, although not thoroughly recovered. I
was absent two weeks, and a few days after my return I incidentally met
her husband, who told me that a week after I had left, his wife felt
unwell and called in one of her former doctors, who, by the way, rides
a hobbyhorse on surgery. This man found a few pimples on her body,
which can be found on almost any healthy person, these, he said, were
signs of blood poisoning from her abscess, and that an operation to
extirpate the abscess, with one or both of her ovaries, was of urgent
necessity to save her life from blood poisoning. The deceived woman was
of course frightened into giving her consent to the operation, which
was undertaken immediately, and, as luck would have it, she recovered;
but she might have easily died, which she undoubtedly would have done
had this _knife-man_ got her sooner, or before I had restored to her a
splendid physical condition, which withstood the unnecessary butchery
to which she was induced to submit.
Some doctors seem to have a perfect mania for cutting operations, just
as though the entire science and art of medicine were exhausted in
surgery alone. To assume this for an instant is manifestly ridiculous.
More lives are annually saved by a scientific application of other
methods of cure than the most elaborate and brilliant statistics of
surgery can approach. There is science and skill in selecting proper
medicines, in the employment of hygiene or the rules of health, in the
practice of obstetrics, and in a variety of other ways to demonstrate
the triumphs of the art of healing.
The rash and unnecessary resort to the knife has brought surgery into
general distrust, so that some patients would rather die, or wait until
they are almost dead, before they allow an operation to be performed on
them, in cases where surgery is, indeed, the only possible method of
cure.
A lady recently called at my office for a consultation. I found her
uterus and other pelvic organs in a perfectly healthy condition,
although she suffered pain there. This was due to neuralgia from a
generally exhausted and debilitated condition. I was not a little
surprised to learn, from her own lips, that she had been treated for
womb disease, and was about to undergo an operation for a tear in the
mouth of her womb. This was manifestly absurd, because no laceration
existed at all, and if there had it might not have been necessary,
because it is quite natural for women who have borne children to have
the scars of old lacerations on the mouths of their wombs, and they are
not any the worse for them.
It is important for mothers to know something about themselves and of
the common diseases to which they are liable, for then they will not
be so easily persuaded to permit the use of caustics, or the cutting,
stitching, or scraping of their wombs, which is quite likely to excite
complicated inflammations, more serious in their results than the
diseases for which these operations were performed. I know of what I
write, and there is no one who can successfully deny it.
Dr. William Goodell, who stands as high in the department of diseases
of women as any American, had an article in one of the medical journals
on “The Abuses of Uterine Treatment.” He says: “From a large experience
I humbly offer to the reader the following watchwords as broad helps to
diagnosis: 1. Always bear in mind what another has pithily said, that
‘woman has some organs outside of the pelvis.’ 2. Each neurotic case
will usually have a tale of fret or grief, of cark and care, of wear
and tear. 3. Scant or delayed or suppressed menstruation is far more
frequently the result of nerve exhaustion than of uterine disease. 4.
Anteflexion of the womb, _per se_, is not a pathological condition. It
is so when associated with sterility or painful menstruation, and only
then does it need treatment. 5. An irritable bladder is more a nerve
symptom than a uterine one. 6. In a large number of cases of supposed
or actual uterine disease, which display marked gastric disturbance, if
the tongue be clean the essential disease will be found to be neurotic,
and it must be treated so. 7. Almost every supposed uterine case,
characterized by excess of sensibility and by lack of will-power,
is essentially a neurosis. 8. In the vast majority of cases in which
the woman takes to her bed, and stays there indefinitely, from some
supposed uterine lesion, she is bedridden from her brain and not from
her womb. I will go further, and assert that this will be the rule even
when the womb is displaced, or it is disordered by a lesion or disease,
that is not in itself exacting or dangerous to life. Finally, uterine
or womb symptoms are not _always_ present in cases of uterine disease,
nor, when present and even urgent, do they necessarily come from
uterine disease, for they may be merely nerve counterfeits of uterine
disease.”
There is not a physician of any extended experience in the land who,
if he be true to his better judgment, will not indorse every word of
Professor Goodell’s propositions. But the chances are they will never
accomplish the good for which they were intended if the mothers, wives,
and daughters are not permitted “a little peep” behind the curtain,
and learn for themselves. For those who are wealthy and have plenty
of money, doctoring may be a luxury or an amusement, but there the
line must be drawn for the benefit of the deserving poor, with whom
any treatment is a hardship. Stupidity of the masses is one of the
causes of the abuse of surgical treatments, for they always look upon
a surgical or bloody operation as one of the greatest achievements of
modern medical art. Then there is the cupidity of the professional
classes, who trade upon this popular error and delusion, and charge
correspondingly large fees, which, as a rule, are exorbitant,
particularly when the working classes are the sufferers.
A little cutting or stitching is much more quickly done, and the
patient may be dismissed as cured, or left under the impression “that
everything was done that could have been done,” than a conservative
medical or hygienic treatment, which involves more thought, labor, and
patience, qualities which are not as eagerly cultivated as the art to
wring out a good fee by a little surgery, with less labor and skill.
There is not only too much mischievous doctoring, but there is too much
of every kind, whether good, bad, or indifferent. The trouble is there
are too many in the ranks of the medical profession; and this is not
only true of this country, but is raising a cry of warning in Europe.
The struggle for existence is a natural law, and nature is immutable. I
do not mean to say, that it is a humane law, or that competition is a
virtue; in fact, I believe quite the reverse. But much that is natural
from a physical standpoint might not be so from a moral or spiritual
plane; thus the two natures are distinct.
It is reasonable to suppose that, if the natural crop of diseases falls
short of supplying the demands of those who hunger for an opportunity
to treat disease, and it lies within their power to create disease,
they will certainly do so. The deficiency must be supplied, or one of
two things must be done by the doctor: he must either starve, or go to
work at something else. This may be cruel logic, but I know that these
are the actual facts.
Now let me ask how many persons who have some sort of a diploma will be
self-sacrificing enough or sufficiently unselfish to prefer to starve
or honestly work for a living, if they can avoid either, by defrauding
someone out of a fee, for pretending to cure some manufactured
disease? It seems almost a waste of time to argue such a self-evident
proposition. I have known physicians of high standing who treated women
for womb diseases which never had a real existence, and surgeons of
large incomes to remove the female breast for a “supposed cancer;”
and, that being the case, what would you expect from a less fortunate
brother practitioner who is eking out a miserable existence?
How many a case of simple sore throat or tonsilitis is being paraded
as a case of diphtheria. Why, I know of doctors who built up their
reputations in that way. It is quite an easy matter, to call an
ordinary, simple case of bronchitis, pneumonia. Harmless swellings, no
matter of what sort, are treated and palmed off every day as cancers.
The quack cancer doctor is almost ubiquitous. Some would much rather
part with the village parson, or their regular old town doctor, than
to part with the cancer doctor. Diseases that are conjured up in the
minds of susceptible or hypochondriac persons have for them a real
existence, because if a person believes he has a certain disease, it
becomes a reality, as far as his own state of mind is concerned, and
as far as the treatment is concerned to him who created the delusion,
it is much more desirable than if the disease were real, because you
can cure an imaginary disease, which may be impossible when a real one
comes under treatment. This is another method of making a reputation
for extraordinary cures that really never occurred.
When I contemplated writing a book, which I hoped to make a _vade
mecum_ for those who felt interested in the subject, I felt that it
would be a duty which I should reluctantly perform, for it would be a
criticism on the status of the medical profession of this country. I
was convinced that whatever I said that would lower the tone of the
profession in the estimation of my countrymen would naturally reflect
on me as unfavorably as upon any other member, for I never claimed to
be anything else but an American physician, and, as such, I have an
ambition to elevate the rank and file to honor and respectability.
There is also a motive that underlies a work of this nature which
should appear justifiable to the author. It is absolutely necessary
that side-lights should be thrown into dark corners and recesses
that are usually screened from public notice. If there is a growing
deterioration in methods of proficiency and morals, the public should
know it, for who is the greater villain, he who trifles with human
life through officious ignorance and venturous operations, or the
midnight assassin, who, under cover of darkness, waylays his unwary
victim? The title “doctor,” from the Latin _doceo_, “I teach,” has a
halo of learning that it derives from the original significance that
was attached to it when it was first sanctioned at Bologna University,
about the middle of the twelfth century, where it first passed into the
faculty of divinity. It was afterwards introduced into the universities
of Northern Europe, and remained ever since a degree of distinction in
theology, law, philosophy, and medicine. In the German universities
_doctor_ implies also a license to teach within the university, as a
_privat-docent_.
When we now consider that no person can matriculate in a German
university who has not graduated from the gymnasium or high school,
it is clear that, under the above conditions, the title “doctor”
guarantees that the possessor is an educated person, not only of the
high school, but added thereto is the accomplishment in the specialty
of which he holds the doctor degree.
What may a “doctor degree” mean in this country? The title of an
illiterate and utterly incompetent person, who was by natural
environment and occupation a teamster, saloon keeper, barber, tailor,
or patent-medicine vender, etc.
If a woman, she may be retraced to an ignorant nurse, midwife, or
quacksalver, the conceited wife of a man who indulges her in the freak
of “learning to be a doctor,” for she had demonstrated her genius
for the profession by successfully treating a case of measles, which
started the doctor’s bee a-buzzing in her bonnet, until she passed
through a medical college; last, but not least, are the winsome
daughters of the millionaire or successful business man, who imagine
themselves too smart to make useful housewives and good mothers.
There is not a medical college in this State, and there are few, if
any, in the United States, that would not eagerly take in all of this
material, and guarantee to them beforehand, that they can graduate as
_medicinæ doctor_ in twelve months to three years, a five months’
course being considered a year.
The above comparison is a disgraceful commentary on the degree of
_doctor_ in this country, and the public should learn to know the
difference.
“The United States and Its Doctors” is the title of an editorial in
the July number of the New York _Medical Record_, and it says: “There
is certainly no more curious social phenomenon than that of the
extraordinary popularity of the medical profession in this country as a
means of securing a livelihood.
“This subject is one that is often dwelt upon, but we doubt if many
even yet realize the grotesque misproportion which medicine in the
United States holds to other bread-winning occupations. Here are some
of the naked facts in the matter:—
“France has 38,000,000 of population, 11,995 doctors, while it
graduates 624 medical students in one year. Germany has 45,000,000 of
population, about 30,000 doctors, and graduates 935 students in one
year. The United States has about 60,000,000 of population, 100,000
doctors, 13,091 medical students, and graduates 3,740 students in one
year.
“Germany, which has relatively less than half as many doctors as
America, is already groaning over its surplus. When one compares
France with this country, the excess of medical men here seems most
astonishing.
“A comparison of the United States with European countries, in whatever
way it is made, leads one to think that there is something almost
alarming in our medical productiveness.”
In connection with the above comparison, in which it is shown that
Germany has proportionately less than half as many doctors as the
United States, it will be interesting to learn the views of the German
profession. The Berlin correspondent of the Medical Press writes that
the “Deutcher Ærztebund,” Society of German physicians, felt it to
be their duty to warn the guardians of young men studying in the
gymnasiums or high schools, against entering the medical profession,
the state of overcrowding being so great as to _insure disastrous_
consequences. In glancing over the above figures, there is one very
important point which is greatly in favor of the German profession and
militates against the Americans. It is the enormous patent-medicine
trade and quacking that is done through it in the United States; on the
whole, this has been calculated to amount to at least fifty per cent
of all the doctoring that is done; that means, that where one hundred
doctors now practice for a living, fifty more could make a similar
living, were it not for the patent and quack medicine trade, which, in
some of the German States, is almost prohibited, and in others I know
it is entirely inhibited.
When the Society of German physicians warns the German people that an
overcrowding “insures disastrous consequences,” what does it mean?
This is a question which, we presume, was answered in Germany, and
it is certainly worth our while that we should answer it here, and
in this we have decidedly the advantage, because in that country the
answer was entirely based upon what was anticipated, while in this
we can answer from what we have already realized, namely, disastrous
consequences to honor and to integrity on the one side, and to health
and security against imposition on the other. To this I have already
referred. Everyone competent of judging, and who has lived in that
country, knows from study and observation that the arrangements and
conveniences there for treating the sick are in a much higher state of
perfection than with us. Hospitals and physicians are as accessible to
all classes as the most humane and philanthropic heart can desire, and
now we learn that if this wholesome state of affairs shall continue
with less than half the proportion of doctors that we have here,
there must be no further increase of physicians, or it would insure
_disaster_. This statement and warning a close and careful observer
clearly appreciates. The writer was personally acquainted with a large
number of German practitioners while in that country, and knows as
an actual fact that while their fees were and are much smaller than
anything ever paid in this country, they had not overmuch to do, and
were only leisurely employed. This applies to some of the greatest
and world-renowned medical professors, as well as to the ordinary
general practitioners. But there is a reason for all this, too.
These men as a rule are honest, they are no money grabbers, they are
thoroughly competent and scientific and manufacture no diseases to suit
emergencies nor conjure up complaints that have no real existence. If
their number were doubled, if the normal proportion were disturbed,
the _disaster_ would surely follow, professional demoralization would
ensue. So the German profession sounds a timely note of warning ere the
canker of selfishness has destroyed the noble altruistic principles of
physicians, without which the doctor is as likely to be a messenger
from hell as a ministering servant from heaven.
Medical legislation in this country has been nothing less than a
farce, partly because the general public is not aware how abased the
profession is, and partly that Americans are extremely jealous of what
they term personal liberty. It is being attempted to remedy some of
the abuses of the medical profession by regulating the practice of
medicine by State Examining Boards. Experience has demonstrated that
these boards are but the excrescences of the various medical colleges,
who are themselves the root of the very evils that are sought to be
remedied. The duties of these boards are simply to make themselves
officious, and to inquire into the source of the credentials or
diplomas of the applicants for a license to practice medicine, and
not into the qualifications or competency of the applicants. All that
is necessary under such laws is simply to present a diploma of some
sort; whether it was stolen, or the diploma of a dead man, or gotten
from any of the numerous worthless colleges, is not made the subject
of inquiry; and as by far the greatest number of quack-salvers in this
country have diplomas, the law falls short of remedying quackery.
There are, usually, enough boards of examiners, representing the
different schools, so that the different interests of the diploma
manufacturers are well represented. A medical examining authority whose
functions and powers do not go higher or beyond the mere granting of
licenses, or which does not examine into the qualifications of the
persons who possess diplomas, is utterly absurd, because it is no
protection against ignorance and imposition. A law that presumes that
all persons holding diplomas are qualified and competent to practice
medicine, is essentially wrong, or inadequate to fulfill the purpose
for which it was designed. I have known graduates from what were
considered good colleges who could neither write a safe prescription
nor diagnose a case.
There is only one way towards an approach to an efficient and
intelligent board of medical examiners, and that is, one single State
board in which the different schools may be represented as to their
pet theories of prescribing medicines, but in all other departments
of medical science and art there must be a uniformity of talent and
qualification.
There must be a _standard of excellence_ established by the State,
which is higher than and above the recognized standard of any medical
college, for no medical college is trustworthy in this respect.
The State in its sovereignty must prescribe what shall constitute
a medical education, and the requirements should be embodied in
the statutes. A license or degree from that source, after a final
examination, should be the only legitimate license to practice medicine.
Such a method would establish a system that would clearly define the
status of every medical practitioner. The board must have the power,
and it must be their duty, to examine each and every applicant for a
license, as all candidates for the army medical service are examined.
All this noise and talk about a preliminary examination and an extended
course of medical study are simply the vaporings of superficial minds.
It is neither the preliminary course, nor the length of time that a
person consumes in trying to become a doctor, in which the public
is interested, but what kind of doctor a person is when he hangs
out his shingle and begins to practice, whether he is competent to
do that which is expected from him in the hour of sickness or great
peril, irrespective of any diploma or any medical college. Foreign
graduates should be amenable to the same examination, for behind
these, too, belongs the interrogation point. The gushing mediocrity of
some of these diploma holders gives rise to the suspicion that their
credentials are not genuine.
As an American to the manor born, I would not for a moment deny the
humblest citizen an opportunity to elevate himself to the highest
professional honors; but why can he not be required to thoroughly equip
himself and prove, by oral and written examinations on subjects of
preliminary education, that his mind has become disciplined for broader
or special studies, irrespective of any course in a college? After
the State has satisfied itself of the proficiency of the applicant in
scholastic acquirements, it should go further, and examine into the
qualifications for a degree of medicine, just as they do in the _U. S.
Army_, only with this exception, that no diploma of any medical college
should be required from the candidate, and if he has one it should not
be recognized.
This would simply incorporate in the State laws the distinctive feature
of the University of London, which examines and confers graduation on
persons who have received instruction in such institutions at home and
in the colonies as have satisfied a Secretary of State with regard to
their studies.
This university also has and exercises a power of examining for degrees
persons who have not been at any institution. Nothing could be more
democratic than for the State to make such a provision for State
medical examinations. The German Government does precisely the same
thing, with the exception that it makes graduation from the medical
department an essential prerequisite. It has a State board of examiners
to examine all graduates in medicine of their own universities, to
further prove if they are really qualified. A diploma in Germany is of
no value; it is the so-called _ærzliche Approbationspruefung_, _State’s
examination_, that gives the license to practice legally.
When this is found necessary, notwithstanding the high standard of
German medical schools, how much more is this safeguard against
incompetency needed with us? I have endeavored to prove from the
methods of Germany and the course of the _United States_ medical
department that diplomas cannot be accepted as _bona-fide_ evidence
of a medical education. With us a half dozen doctors can get together
any time, incorporate a medical college, call themselves professors,
and start out advertising themselves and their college for the purpose
of manufacturing diplomas and doctors. Why, a diploma under these
conditions should not be worth the parchment it is written on, as
evidence of a medical education, unless attested by a higher and
perfectly independent authority!
If the public once understood that too many doctors are dangerous to
the morals and health of society, they would be quite as anxious as the
most enthusiastic medical educator to remedy the evil.
The question of too many doctors is one of economical and social
science, not of medical science, and, therefore, it can only be
intelligently considered from these philosophical standpoints. It is
a well-understood and accepted law of political economy that in the
industrial pursuits, whether in the manufacturing departments or in
agricultural production, the surplus or glut in the market of any of
the products of industry, reduces the price and stimulates consumption,
which, in the course of time, is regulated by a suspended or reduced
production, thus restoring a healthy equilibrium. It would be an
absurdity to apply the same rule to a surplus of doctors, because
human ills or diseases do not increase in proportion to the surplus of
doctors, nor will fees be any less. But the surplus, in order to live,
must live on the earnings of the community, and here the disastrous
consequences appear.
The credulous, and those who often may imagine that they require
medical advice, become the unconscious victims of the unhealthy
disproportion, for the doctor seizes the opportunity to make a case,
while the normal proportion of cases do not reach around. Thus, it
is calculated that at least fifty per cent. of all the diseases for
which patients are treated are fictitious as far as actual disease
is concerned, and the remaining fifty per cent. are, in the majority
of instances, overdosed and overdoctored. For this reason medical
legislation would not make a privileged class of physicians, nor
throw unusual safeguards around medical practitioners, but medical
legislation is to protect the people themselves from imposition and
quackery.
The reason for the overcrowded state of the profession is not alone
the laxity of medical laws, or the low standard of medical education
in most of our colleges, but the general tendency of the country
population to drift into the cities. Honest labor has not the dignity
which its importance demands, and a radically faulty method of
common-school education is another reason. Utilitarian manual methods,
in which the hands are educated for useful employment and the minds to
habits of industry, are to be wished for. Young men who have acquired a
technical education in mechanics and arts will learn to respect labor
in every department, and their ambition in life will be greater than to
swing a cane or wear a silk tile.
In proportion as the productive employments are made respectable, this
questionable ambition to become M. D.’s will fall off.
History tells us that the opulence of Rome was speedily accompanied by
a decline of its agriculture, after which came the fall of the Roman
Empire, because the country population became too indolent and restless
and flocked to the cities for an easier and luxurious living. History
in this respect seems to be repeating itself. We are always talking
of encouraging the beauty and growth of our cities, but not one word
of encouraging agriculture; no one talks of encouraging farm life
and making it profitable and attractive, so that men and women would
prefer the more independent subsistence in the country to a shabby
gentility in the city. Some reader may ask, What has all this to do
with doctoring? I say that the answer must already have been apparent;
it becomes the duty of everyone to interest himself, that the division
of labor shall be apportioned so as to do the greatest good to society.
We have a national characteristic which shows itself in an abnormal
conceit for everything American in a degree that is not essential
for true patriotism and love of country. But when by comparisons we
learn that there are abuses and errors which are destructive to a
healthy intellectual and material growth, we must have the honesty and
independence to acknowledge them, and busy ourselves to find a remedy
for existing evils.
The physician who can assist in the amelioration of society by
administering to human ills which are the result of unwise laws, is
accomplishing as much good as if he writes prescriptions or _bleeds_
patients. The sooner everybody recognizes the fact that the time has
come to deflect the current of ambition from the practice of medicine
as a means of making a living, the sooner will untold suffering be
lessened, and there is no honest-minded physician who does not heartily
agree with me. Mercenary persons, and ignorant or unscrupulous doctors
who run diploma mills, may criticise severely the honest sentiments
here expressed, but the truth is so apparent, that he who runs may see
the inevitable consequence of this unhealthy competition. Professors
of colleges have a direct interest in the ignorance and incompetency
of their graduates, because they are the means of calling them into
consultation on every possible occasion in trifling ailments, and if
the disease belongs to some specialty, they have the cases entirely
turned over to them, because, in the mind of the incompetent and
newly-made doctor, the professor who was the means of getting him a
diploma, poses as the _beau ideal_ of medical wisdom. In this way
it becomes exceedingly profitable to be a professor. If there are
not enough medical colleges in a community to afford places for the
ambitious, it is considered to be one of the best-paying financial
investments for a company of physicians to start one, and in most of
these concerns it is easier to get a diploma as a doctor than to learn
to be a good dressmaker or shoemaker.
Hence there is only one remedy to control the educational aspect of
this evil, and that is to take medical colleges entirely out of the
hands of private individuals and make the State the only source of the
necessary credentials to practice medicine.
An American system of medical education fostered by the State would
be productive of grand results, because, under the shadow of our
free institutions, the mind transcends the circumscribed sphere
of despotism. This has already been proven in numerous instances,
notwithstanding unfavorable surroundings.
Forming the galaxy of great names that illumine the milky way of
science, there are none brighter than a Gross, a Flint, a Sims, and
some others. These were great American authors and physicians, who
never pretended anything else; they never dreamt of the Don Quixotic
escapade of pretending to be American professors while they appended
to their names initials or abbreviations of questionable credit from
foreign institutions. The brilliancy of true genius was their only
passport to fame.
CHAPTER II.
DELUSIONS AS TO THE CURATIVE VALUE OF DRUGS.
MEDICINES that are sure cures for all the diseases to which humanity
is heir, are not the spurious discoveries of the quacksalver and
patent-medicine vender alone, but some very intelligent persons believe
that if there is not a panacea, there is at least a remedy, for every
disease. In cases where the patient does not recover, they believe that
either the disease was not thoroughly understood or the medicines which
were given were not properly selected.
This is a great error, because there is no such thing as a specific
or infallible remedy for any disease, and, on the other hand, it is
quite possible that most patients, with proper nursing and diet, would
naturally recover without any drugs or medicines whatever. Outside
of those drugs, like ether, chloroform, opium, or morphine, that are
employed for the purpose of deadening the sensibility of the nerves, so
as to render them insensible to pain, there is not another drug that
is absolutely sure and true in its medical effects. Some few are very
useful at times, but the great bulk of medicines do much more harm than
good.
Medicine in its broad sense means a knowledge of the cause, course,
treatment and ultimate results of disease. The study of medicine cannot
be circumscribed by dogma or theory, nor can it be mastered in a few
short years of study at the very best medical schools. It requires a
mind adapted by nature for a plodding investigation of her laws, and
incessant application, long after the college curriculum is ended. In
fact, the student must unlearn much of the stereotyped lessons of the
text-books, and this is particularly true of the supposed medicinal
effects of drugs, which are always exaggerated. When physicians
really have a threatening case, under their observation and care, the
attributed therapeutic action of drugs is nearly always disappointing,
and very often injurious, and they are forced to let the drugging
entirely alone, and bring their skill to bear on measures which support
the strength and vitality of the system, so that nature can effect a
cure in her own way. This may seem to some simple doctoring, but I can
assure the reader that it requires the highest degree of medical skill,
notwithstanding the droll sarcasm of Voltaire, that “medical science
is the art of amusing the patient while nature performs the cure.”
There is neither skill nor much learning required to give an ordinary
prescription; that the average apothecary could do with the greatest
exactness. But science and medical skill can be exhausted in managing
and husbanding the resources of nature, in order to effect a cure.
Medicine no longer stands alone as a simple art, based on theoretical
deductions, as it was less than a hundred years ago, but it has become
a department of natural science, a part of the natural history of the
human race.
Disease is as much a vital process as health, only in one case the
vital function is perverted, or destructive, while in health it is
constructive. The germ theory of disease and cellular pathology are
clearly within the domain of biological research, while chemistry has
solved many physiological processes. Mental philosophy has been no less
serviceable in the department of medicine, by teaching the wonderful
influence of thought and emotions on the physiological functions of the
organs.
A one-sided education is inadequate to appreciate the subject of
healing or teaching. A comprehensive knowledge of all that bears on
the subject of health and disease has several important objects in
view, namely, it thoroughly acquaints the doctor with all of nature’s
resources for the amelioration or cure of disease; and it gives him
judgment in all cases to avoid irreparably wrong treatment, which
places obstacles in the road of nature’s efforts to heal spontaneously.
The quack or professional imbecile will, in the ordinary course of
diseases, be accredited with remarkable cures; in fact, the cures
wrought by a quack or an ignorant person are just as welcome and
valuable to the patient interested as if they were accomplished under
the advice of the most erudite and skillful physician, but the invalid
ran the chances of malpractice or bad treatment at the hands of the
quack, which might have cost him his life, because the incompetent
healer does not know when his method of treatment does mischief. Every
method of cure may possess merits of its own, which are beneficial when
the disease or conditions for its employment are present, whether this
is mind cure, water cure, or anything else that you may name. All that
any system of treatment can do is simply to stimulate the curative
force of nature, which is the only _first cause_ of any cure.
The reparative energy of nature has never been duly recognized, because
the selfishness and pride of the doctors will not concede this as often
as they ought. The doctor should be the most useful as a monitor to the
sick, in guiding and controlling thought and conduct, in harmony with
the curative energy of nature. From this point of view the pretensions
of anyone effecting this or that cure are only a delusion, because the
doctor effects nothing, he only assists, guides, and directs towards
effecting a cure. What this curative force is has by no means been
understood. Some believe it identical with life or vital action, which
manifests itself only in organized substances, but even if we admit
this identity, we are balked again, because we do not really know what
life is, any more than we know what electricity is. Descartes resolved
life into matter and motion; this, however, is rather the phenomena of
life and gives us no idea of the real essence of the force that we
call life. There is another theory, that all life whenever or wherever
found is a spiritual force, ethereal and universal. For our purpose,
the discussion of this question has no particular value, were it not
for the fact that life, or vital activity, wherever we find it in
organized substances, whether in the lowest living thing or in the
highest type of physical development, is accompanied by or is endowed
with the natural tendency to repair defects or injuries in that in
which it is active.
Regeneration, or the curative process of nature, is always the handmaid
of vital activity. It is present at the earliest formation and division
of a cell, which constitutes the unit of all organisms. Just as one
brick is laid on the other with mortar or cement between them, so as to
make a whole wall of a building, so are our bodies built up of minute
cells, one added to the other, with cement between them, until the
entire structure is completed. There is no tissue of the living body
which was not at one time during its existence a cell. This curative
force is beautifully illustrated in the lower animals, where parts of
organs are replaced to a far greater extent than among warm-blooded
animals.
Professor L. Landois, in his work on “Human Physiology,” says that
“when a _hydra_ is divided into two parts, each part forms a new
individual—nay, if the body of the animal be divided into several
parts in a particular way, each part gives rise to a new individual.
The _planarians_ also show a great capacity for producing lost parts.
Spiders and crabs can reproduce lost feelers, limbs, and claws; snails,
part of the head, feelers, and eyes, provided the central nervous
system is not injured. Many fishes reproduce fins, even the tail
fin. Salamanders and lizards can produce an entire tail, including
bones, muscles, and even the posterior part of the spinal cord, while
the triton reproduces an amputated limb, the lower jaw, and an eye.
This reproduction requires that a small stump be left, while total
extirpation of the parts prevents reproduction. In amphibians and
reptiles the regeneration of organs and tissues, as a whole, takes
place after the type of embryonic development, which is by cell
division, and the same is true as regards the histological processes
which occur in the regenerated tail and other parts of the body of the
earth worm.” Comparative pathological anatomy clearly demonstrates the
inherent curative power of nature, and this is also apparent in the
vegetable kingdom, and together they deliver a lecture on the “art of
healing” from the stage of creation, in silent and modest language, but
eloquently instructive to the thoughtful observer.
The question now naturally arises How far this curative energy of
nature operates in warm-blooded animals, and especially in man? The
answer must be that, while it falls short of reproducing parts of
organs or even tissues in the same degree of perfection as in the lower
orders, the innate tendency towards regeneration and recovery from
injury and disease is, on certain lines, practically the same. There is
not the slightest doubt that ninety per cent. of all cures, whether the
invalid took this, that, or the other medicine, or whether the method
of treatment was homeopathic, allopathic, or mind cure, are entirely
due to this inherent curative energy; and the other ten per cent.
may have required some active remedy, but this, too, alone, without
nature’s healing force, would have been ineffectual.
What is ordinarily termed mind cure is not mind cure in the sense
that the term implies, but it is simply the mind toying or playing
with the idea of a cure, for while the mind is thus engaged, nature’s
energy is accomplishing the result or cure. This is the only rational
explanation, and corresponds with the cures that nature is continually
making in the lower orders of animals. If the recovery of the sick
depended entirely upon the caprice and wisdom of the doctor, and not
on the reparative forces of nature, the race would soon die out. I
fully recognize the fact that the curative force can be stimulated;
this may be done through the influence of nourishing food, alcoholic
stimulants, a drug or medicine, or through purely mental influences. No
physician can estimate how much merit he can accredit to the methods
or substances he employs in any particular case that recovers, and how
much to the lady physician, Dame Nature. This old lady doctor is ever
active, and the most inert drugs, employed or administered with her
assistance, have achieved wonderful cures; this the history of medicine
confirms. The tar water cure of Bishop Berkeley is an illustration
how an inert substance is capable of making for itself an enviable
reputation for curing ailments, like pleurisy, pneumonia, erysipelas,
asthma, indigestion, hypochondria, and other diseases. This remedy
had the vehement indorsement of one of the greatest metaphysicians of
the English-speaking world, and that the cures reported by him were
genuine no one will doubt for a moment; but the bishop, like many of
our day, was determined to have a remedy to cure disease, where none
was required, but the mind had to be humored, while nature was actively
repairing the disorder. To-day almost everyone is satisfied, that the
virtues ascribed to tar water by Berkeley were a delusion, which was
shared by all those who believed as he did.
The Weapon Ointment affords another instance where the credulity of the
public was supported by abundant facts to prove the efficacy of the
remedy, yet it was based on the wildest superstition. This ointment
was employed for the healing of wounds, but instead of being applied
to them, the weapon with which the wound was inflicted was carefully
anointed and hung up in a corner, and the wound was washed and bandaged
without the salve being allowed to touch it. This ointment created such
a furor that eminent medical men indorsed its virtues as a healing
agent. Another example of superstition and charlatanry was the equally
famous Sympathetic Powder, which, when applied to the blood-stained
garments of wounded persons, cured their injuries even when miles
away. That dukes and knights vied with each other to obtain the secret
of its preparation and ingredients is a matter of history. Instances of
delusions on medical subjects could be multiplied a thousand fold, but
they prove nothing but ignorance and superstition on the one side, and
the inherent all-powerful curative force of nature on the other. While
I wish to avoid wounding the fastidious and sensitive in the matter of
their faith in their cherished system of cure, I cannot refrain from
classing homeopathy as a similar delusion.
I am glad to admit at the outset that I have read Hahnemann’s “Organon
of the Art of Healing” with a great deal of interest and some profit.
I am convinced that his theory of infinitesimal dilutions is as absurd
and ridiculous as either the Weapon Ointment or the Sympathetic Powder
treatment already referred to.
If we consider the harsh, or, preferably-termed, _heroic_ treatments,
then in vogue, we need not be surprised that the pendulum of medication
should have swung in the opposite extreme. Blood was drawn from the
already enfeebled body, emaciated by disease; emetics were administered
to sensitive and inflamed stomachs, and only aggravated into greater
disorder; blisters, or the burning moxa, scorched into greater agony
the suffering mortal, while large doses of drastic cathartics depleted
the waning forces of nature. There was a tendency of the medical
profession about that time to entirely ignore the _curative forces_ of
nature, and to attack disease as you would a midnight marauder, with
the most powerful and dangerous weapons at command; and there is no
doubt that with these powerful expedients, disease was destroyed, but
life also. Under these conditions Hahnemann appeared on the scene, and
I am frank to admit that he rendered suffering humanity invaluable
service by espousing a system of cure which had the merit of being
harmless. If we take into account that physiological studies were then
in their infancy, and that the word “Biologie,” from the Greek words
which signify a discourse upon life and living things, was made use of
for the first time by Lamarck, in a work published in 1801, it will
not seem altogether strange that even learned men were mystified into
beliefs which, in the light of our present knowledge of the subject,
appear preposterous. This was a most opportune time to fasten on the
healing art any doctrine or dogma, however absurd, and on this tide of
ignorance and superstition, the doctrine of infinitesimal dilutions
floated into popularity. Homeopathy affords us one of the most striking
illustrations of the uselessness of drugs in ordinary ailments, and
conclusively proves that nature possesses inherent curative powers.
Cases treated under this system make splendid recoveries, and often
much better than when the powers of nature are opposed or weakened with
nauseating drugs and poisonous doses, prescribed by incompetent persons.
Hahnemann truthfully observed that existing diseases are liable to
become aggravated, complicated or replaced by _drug diseases_.
There is no doubt of the truth of this statement where drugs are
heedlessly administered. When I was a student I was told that _calomel_
was par excellence a babies’ medicine without any qualification. I was
credulous enough to believe it and prescribed it for my own children
for its purgative effect whenever it was deemed necessary. In later
childhood, when the second dentition set in, the germs of the permanent
teeth were so injured, evidently from the calomel that had been
absorbed into the system, that the teeth were ragged and defective.
The glands of the neck were also inclined to swell and suppurate, and
there is no doubt in my mind that a great deal of what is generally
supposed to be scrofula in young children, is nothing more nor less
than a “drug disease.” I believe that Hahnemann was cognizant of the
potency of nature under ordinary circumstances to cure disease. I
believe that he absorbed this view of the philosophy of healing from
the writings of Paracelsus, which he had studied, and from which he
drew his inspiration, but he also appreciated the practical necessity
that success depended on satisfying the superstitious belief of the
times, and that consisted in offering some tangible remedy. Hahnemann
proved himself equal to the emergency by formulating his doctrine
of potentizing drugs or medicinal substances by reducing them to a
wonderful degree of minuteness.
The preparation of these dilutions was directed to be carried out in a
ceremonial sort of way. Chalk from an oyster shell, sulphur, charcoal,
or any other substance, was potentized by taking one grain of the
drug and mixing it with one hundred grains of sugar of milk. Of this
mixture one grain was taken and mixed in the same manner with another
hundred grains sugar of milk. This gave the ten-thousandth of a grain
of the drug. Take one grain of this with another hundred grains of
sugar of milk and the powder will contain the millionth of a grain of
the substance, or the first potency, which forms the bases of other
dilutions. This is reducing the doses of any drug to an absurdity,
and Hahnemann was too brilliant a mind not to know this. It might be
mentioned in connection with these dilutions, that if one grain of
the most powerful drug, strychnine, aconitin, arsenic, or any other
chemical that is known, is mixed with six hundred grains of sugar of
milk, one grain of this powder, or the one six-hundredth of a grain of
this substance, cannot be detected by any test or chemical reagent; or,
in other words, the quantity of the drug or chemical contained is so
small that the most delicate chemical test fails to show it; yet, in
homeopathy, the dilutions are carried to the decillionth of a grain,
from which important medical effects are expected.
Drugs are physical agents, and if they are diluted so as to destroy
their chemical or physical properties, it is sheer nonsense to expect
any physical result from them on the system. Chemical and physical
facts conclusively prove the utter inertness of certain drugs either
in themselves or in the manner in which they are employed, and the
indisputable evidence of biological science demonstrates the natural
curative tendency of nature observable in the lowest living thing to
the highest, so that we should stultify our reason were we to arrive at
any other conclusion than that the doctrine of this therapeutic creed
is one of the most irrational delusions that ever befogged the mental
horizon of a thinking being.
The supposed cures effected through the employment of the Weapon
Ointment, the Sympathetic Powders, the endless dilutions of the
Hahnemann system, and, indeed, most other remedial agents from any
school or source, whether offensive powders, mixtures, or patent
medicines, or the more agreeable and tasteless pellets, have but _one
role to play_, that is, to assuage the apprehensions of the mind while
nature is performing the cure; that is, to engage the mind with the
thought or idea that something tangible is being done to bring about a
certain result.
If the patient has pinned his faith to the curative value of mind
alone, the mind is for the time being engaged with idea that _mind_ is
performing the cure. This is a delusion quite similar to the previous
one, in which medicines are taken, with only this difference, that
while you pin your faith on drugs in the one case, you pin it to mind
cure in the other.
CHAPTER III.
WHAT IS MIND CURE?
THIS subject has given rise to an endless variety of contradictory
discussions, and while it has won for itself fanatical devotees on
one side, it has been ridiculed on the other. This is not at all
surprising, when an inquiry is made into the competency of the parties
to the controversy. To be informed in metaphysical philosophy, or
fully equipped in scriptural lore, but without a practical study in
the art and theory of medical science, precludes the possibility of
presenting the theme in a logical manner, or establishing a relevancy
between medical science and mind cure. A medical education that is
based on strictly physical characteristics of disease, as they are
studied at the bedside, or in a microscopical laboratory, is equally
inadequate; for the question of mind cure goes beyond the physical into
the metaphysical, and not until the operations of the mind have been
closely followed to the bodily or organic functions, can the intimacy
of their relations be thoroughly appreciated. Medical men betray their
incapacity for observation if they contemptuously dismiss the subject
of mind cure by some superficial, disparaging illustration, for there
is much more in the subject than is dreamt of, even in the mind of the
average college professor.
“The mind,” says Dr. W. F. Evans, “can be made the plastic or formative
principle of the body, and that thought can retard, pervert, or
stimulate and correct the different functions of the human organism.”
The relation of spirit and matter is very intimate, and some very
clever thinkers resolve all matter into spirit, in its ultimate
analysis.
Bishop Berkeley affirms this in his “Principles of Human Knowledge.” In
section seven he says “there is not any other substance than spirit.”
If we view nature from a materialistic standpoint, we see only one-half
of what we think we do, and even that must be very imperfectly judged
by our senses. Friedrich Wilhelm Joseph Schelling states the relation
of matter and spirit, in very simple and plain words, so that a child
can understand what he says: “Nature is spirit visible, and spirit, is
invisible nature.” This may be illustrated in physical science from
what chemistry teaches of the physical properties of the _diamond_,
whose atoms or molecules are so perfectly continuous and closely
aggregated that it forms one of the hardest substances known to
physicists. These atoms of pure carbon may be made to repel each other,
so that the diamond assumes a gaseous state, which is imperceptible to
our senses.
I am aware that the definition of a gas is not that which
metaphysicians would accept as applicable to spirit, and yet it
illustrates the idea from a physical standpoint. It is much better to
illustrate a question with something with which people are generally
familiar. The body and every organ and tissue forming a constituent
part of it, is simply the plain ordinary matter in motion, vitalized
by what we call life, and this life principle is a mystery, and what
is true of the diamond is true of the human body in its entirety. If
placed in a crematory, it is reduced to a few ounces of bone ash, and,
with the addition of a little acid, this too would soon disappear into
invisible gases, so that the doctrine of philosophers, that matter is
spirit, is, after all, not so far removed from physical evidence.
Physiological science gives abundant proof that the mind has a powerful
influence over the body. By mind is meant all that class of mental
phenomena called reason, and the emotions and passions. Doctor Evans
says “the body is included in the being of the mind,” or, in other
words, that matter is included in the being of spirit.
The thinking quality of the mind is undoubtedly the mainspring of its
action, of which the formation of ideas is the highest kind of mental
activity. These originate either within the mind or are brought within
its sphere by transformed impressions from without, but through the
power of the Will these are more or less modified, and may, indeed, be
entirely suspended, so that the mind may become entirely passive and
not think of anything. It is the exercise of this Will power which may
make the operations of thought conducive to health or disease.
_Cogito ergo sum_, “I think, therefore I am,” is a maxim of Descartes.
What we think and give shape to in thought has for us a real existence,
and we have it in our power to create thoughts that will have either
a painful or pleasurable sensation. Painful sensations have occurred
to persons by the conviction of the existence of a cause which would,
when present, have produced certain results. Of this several examples
are given in W. B. Carpenter’s physiology: “A clergyman told me that
some time ago suspicions were entertained in his parish of a woman who
was supposed to have poisoned her newly-born infant. The coffin was
exhumed, and the coroner, who attended with the medical men to examine
the body, declared that he already perceived the oder of decomposition,
which made him feel faint, and in consequence he withdrew. But on
opening the coffin it was found to be empty, and it was afterwards
ascertained that no child had been born, and consequently no murder
committed.” The second case is yet more remarkable: “A butcher was
brought into the drug store of Mr. Macfarlan, from the market-place
opposite, laboring under a terrible accident. The man, on trying to
hook up a heavy piece of meat above his head, slipped, and the sharp
hook penetrated his arm, so that he himself was suspended. On being
examined he was pale, almost pulseless, and expressed himself as
suffering acute agony. The arm could not be moved without causing
excessive pain, and in cutting off the sleeve he frequently cried
out. Yet when the arm was exposed, it was found to be quite uninjured,
the hook having only traversed the sleeve of his coat.” In this, and
similar cases, the sensation was perfectly real to the individual
who experienced it, but it originated in the mind by an impression
through the nerves of _internal sensation_ which created the idea or
image in the brain, and the _external senses_ to which it was referred
had nothing to do in causing the feeling. Diseases are thus created
every day, either by ourselves or by those to whom we go for advice.
I call to mind a lady who had gone to a distinguished practitioner
for a supposed womb disease for some six months. She experienced no
change for the better, but kept on growing continually worse, so that
she no longer had a refreshing sleep, and her appetite for food was
entirely gone. On examination I found her womb entirely healthy, in
fact, exceptionally so, thanks to her attending physician, because,
after a certain amount of useless doctoring, the rule is quite the
other way. I told this lady of her error or delusion respecting her
womb, and prescribed a quieting mixture for the night and a tonic for
the day. She began at once to improve, and when I saw her again, six
weeks afterwards, she had so fleshed up that I failed to recognize in
her traces of her former delusion. The disease of which this woman was
suffering was imaginary, and had no real existence for anyone outside
of herself. She was the victim of the harrowing symptoms which her
mind conjured into shape, and an attempt to brush aside the disease,
with the flippant remark that “there was nothing the matter with her,”
would have been cruel, unscientific, and absurd. The ailment which she
thought she had, had as much an existence as though the most malignant
disease was destroying her life; for her imaginary disease was doing
the same thing, only in a different way.
Imagination is the most powerful function of the human brain.
Associated with thought, it constitutes the empire of the soul, which
recognizes neither time nor space. With it we are brought into
communion with everything that is grand and beautiful in nature.
Imagination is the architect of our souls; it continually creates and
projects into the beyond; it enlarges the sphere of our thought in
building up artificial structures for our pleasure and entertainment.
When it becomes perverted and abnormal from false impressions, either
through the nerves of internal sensation or through the nerves of
external sense, or, what quite often occurs, from morbid thoughts or
ideas received from others, it becomes equally potent in causing misery
and disease.
Expectation or attention influences, in a remarkable degree, the
bodily functions. There are a great many persons who keep themselves
in misery and disease by always thinking of their imaginary or real
sickness. I had a profitable experience some years ago in my own case,
which conclusively proved to my mind the aggravating tendency which
constant attention has on disease. I had contracted an ordinary catarrh
of the pharynx, or what is generally called a sore throat. At first I
did not mind it, but in the course of time, from continued exposure
in all kinds of inclement weather, at all hours of the day or night,
it fastened itself upon me so that it was at times very annoying by
its dryness and pain. I do not know of anything that I did not use,
but, after a trial of several years, I was convinced that the more I
looked at it and the more I treated it with sprays, gargles, etc., the
worse it became, so that one day I resolved to let it alone, and not
think about it. I took a teasponful of glycerine once in a while when
it became too dry. For years I have not looked at it, and for all I
know, it is perfectly well. I stopped bundling up my neck, used light
bedcovering, so as not to sweat, and by this simple method accomplished
what the very best selected drugs utterly failed to do.
The great English authority, Daniel Hack Tuke, in his work, “The
Influence of the Mind on the Body in Health and Disease,” quotes from
Unzer’s work, published in Germany in the year 1771: “Expectation of
the action of a remedy often causes us to experience its operation
beforehand.” And John Hunter said as early as 1786: “I am confident
that I can fix my attention to any part until I have a sensation
in that part.” A great number of cases are recorded where complete
insensibility to bodily pain has been induced without the use of drugs.
The intention of administering a certain drug was made known in this
manner. Bread pills have acted as decided cathartics, and an empty
chloroform or ether bottle put the sensitive into a profound stupor or
insensibility.
Dr. Woodhouse Braine, of the Charing Cross Hospital, writes: “During
the year 1862 I was called upon to give chloroform to a very nervous
and highly hysterical girl, who was about to have two fatty tumors
of the scalp removed. On going into the operating room, it was found
that the bottle containing the chloroform had been removed to the
dispensary, and on testing the Snow’s inhaler, which at that time I
was in the habit of using, I found it to be quite devoid of even any
smell of chloroform. Then, having sent for the bottle, in order to
accustom the girl to the face-piece, I applied it to her face, and she
at once began to breathe rapidly through it. When she had done this for
about half a minute, she said, ‘Oh, I feel it, I feel I am going off,’
and as the chloroform bottle had not arrived, she was told to go on
breathing quietly. At this time her hand, which had been resting across
her chest, slipped down by her side, and as she did not replace it, I
thought I would pinch her arm gently to see the amount of discomfort
her hysterical state would induce her to bear. She did not notice a
gentle pinch, and so I pinched her harder, and then as hard as I could,
and to my surprise I found that she did not feel at all. Finding this
was the case, I asked the operator to begin, and he incised one of
the tumors, and then, as the cyst was only slightly adherent, peeled
it away. At this time I had removed the face-piece, and, wishing to
see the effect of her imagination, I said to the operator, who was
going to remove the second tumor, ‘Wait a minute; she seems to be
coming round.’ Instantly her respiration, which had been quite quiet,
altered in character, becoming rapid as when I first applied the
inhaler, and she commenced moving her arms about. I then replaced the
face-piece, and her breathing again became quiet, and she submitted to
the second operation without moving a muscle. When the water dressing
and bandages were applied, in answer to the question as to whether she
had felt anything, she said, ‘No; I was quite unconscious of all that
was done.’” The mental phenomenon that we observe in this case clearly
shows how completely the sensation of the patient was suspended by the
imaginary chloroform, which existed only in her mind, yet the real drug
could not have been more potent in its effects.
Phenomena of the same mental process, like the different colors of the
solar spectrum coming from one source, constitute the different stages
or degrees of what is generally called mesmerism or somnambulism,
until the sensitive arrives at that condition of complete double
consciousness now commonly called hypnotism, in which state the will
power of the person becomes entirely suspended, so that he acts
only from suggestions of another person, regardless of propriety or
consequences. When a subject who has been completely hypnotized is
restored to his normal condition, he remembers nothing of what has
transpired during the somnambulistic state. We all have acquaintances
of whom we speak as being easily led; by that we mean that they have no
will or mind of their own. These persons are truly unfortunate, because
they are at the complete mercy of every designing person or cunning
rogue. They constitute the large army of dupes who support the great
number of idle women and lazy men, who claim to be clairvoyants, life
readers and fortune tellers. In sickness they are equally as credulous,
and when they are a little out of sorts, they would a great deal rather
be told that some dangerous or severe illness has hold of them than
to hear the truth that, outside of not eating properly, or clothing
themselves improperly, or being out late at nights when they should be
in their beds, there is nothing the matter with them.
These are the dupes who fill up the chairs in the doctor’s waiting
rooms, on regular days, for local or special treatment for diseases
which could be much better treated by themselves at home, if they
only were fortunate enough to fall into a physician’s hands who had
the honesty to tell them so. This can be further illustrated by an
experience of which every one of us has been a victim at least once
in our lives. When we were trying on a pair of new shoes, we felt
that they pinched, or were too short and generally uncomfortable; but
the salesman insisted that they were a “perfect fit” and that after a
little wearing they would surely suit. The shoes were bought, and we
were convinced, after a few days, that our impression of the smallness
of the shoes was correct, because they continued to pinch us; but we
were for the time mesmerized or psychologized by the clerk into buying
what we were satisfied in our own minds to be not what we wanted. This
should be constantly guarded against, and our conscious will power
should always be exercised on all occasions.
Parents should take particular pains to cultivate the will power of
their children, in the right direction, of course. To stifle the will
of children, when the exercise of it entails no bad consequences, is
wrong, because it weakens their character, and makes them the prey
of the wicked and selfish when they are grown to adult age. This
influence which one person may exercise over another is not due to any
particular force or magnetism, as was supposed by Mesmer, and which
is yet claimed by ignorant frauds and pretenders, but it is simply a
suspension of your own _will_, or a sacrifice of force of character.
Dr. J. M. Charcot, of France, has lately taken up this subject, and
has given it a great deal of attention. His researches have confirmed
the experiments and conclusions of Braid, an English surgeon of
Manchester, who, in 1841, showed that, in order to produce artificial
somnambulism, there was no need of any extraneous influence, and that
any person of moderate sensibility can easily produce in himself the
“magnetic sleep” without any aid or act of another.
Braid discovered that to simply fix the eyes for a few minutes on
some shining object, placed a little higher than the ordinary plane
of vision, and five or six inches from the eyes, caused that total
abstraction which Doctor Braid called “hypnotism,” and which now, in
honor of the experimenter, is often called “Braidism.” This Doctor
Charcot calls “impersonal” sleep, artificially produced by mechanical
means. He remarks: “The psychic characteristic of the state of
somnambulism is an absolute trust, a boundless credulity on the part
of the subject toward the one who has hypnotized him. Take one example
from among a thousand: I present to a woman patient in the hypnotic
state a blank leaf of paper, and say to her: ‘Here is my portrait; what
do you think of it? Is it a good likeness?’ After a moment’s hesitation
she answers, ‘Yes, indeed; your photograph! Will you give it to me?’
The image being now fixed in her mind, I take the leaf of paper, with
a private mark, and mix it with a score of other leaves precisely like
it. I then hand the whole pack to the patient, bidding her to go over
them and let me know whether she finds among them anything she has seen
before. She begins to look at the leaves one after another, and as soon
as her eyes fall upon the one first shown, she exclaims, ‘Look! your
portrait!’” This is the latest phenomenon, and proves how the mind may
print an image on a substance, as the sun prints on a negative.
For persons of casual thought or reading, hypnotism may at first appear
complicated and mysterious, but if you will only bear in mind that the
different mental processes operating between two persons always resolve
themselves into a _weaker_ will power _yielding_ and a _stronger_
will power _controlling_, you have a key which unlocks the different
manifestations of minds in their relations one with the other. This
does not relate to action alone, but to the creation and meaning of our
thoughts.
The cures effected by the royal touch, which prevailed in England
from the time of Edward, the confessor, to Queen Anne, were but a
disguised hypnotism, or a sort of mind cure. Soothsayers, or magnetic
healers, who claim a healing magnetism, are either knaves or fools,
and often both. They undoubtedly can report cures, but these are due
to the natural tendency of some diseases to get well, and to the
hopeful thoughts which these persons inspire by their promises of a
cure; sometimes these hopes are heightened by the different movements
or passes which the healer makes. The greatest healer of whom we
have any reliable record never claimed any abnormal power or force.
Christ healed by the Word, that means by the thought or mind. Faith
in anything creates a curative or healing thought in the mind of the
patient, which stimulates the reparative or healing force of nature,
and in this manner wonderful cures are effected.
The faith, or confidence, which you have in a physician stimulates you
at once into a better or stronger feeling. This has been the experience
of every sick person, but this is not due to any power or force that
this person possesses, which departs from him and goes over to you,
but is entirely due to the confidence, which stimulates your own nerve
centers, and especially the brain. The soothing and quieting influence
which the “Weapon Ointment” had on the injured person was not due to
any virtue of this ointment, because it was never applied to the wound,
but to the weapon or implement which caused the wound. Its operations
were entirely mental or psychical. It pacified the excited and anxious
mind into the faith or belief that the best possible thing to do was
being done, and nature went on triumphantly and effected the cure, for
which, of course, she never got any credit. When a doctor or healer
enters the chamber of the sick, putting on a wise air, or indulges in
affectation, and when he succeeds in making a good impression, that
alone assuages the pain. But if, on the other hand, he impresses his
patients unfavorably, the sooner he gets out of their sight, the better
they feel, because his presence has inspired neither confidence nor
hope.
Hysteria constitutes a peculiar group of diseases which belong to
that class of nervous ailments that are included among functional
affections; they are oftener amenable to faith or mind cures than
to drugs. A great number of diseases of women belong to this class
and these poor deluded creatures never had anything real or serious
the matter with them, until they went to some doctor who began to
apply irritating drugs to their delicate organs, which made them ever
afterwards habitues of doctors’ offices.
Functional diseases have a wide range. As their name implies, they
are characterized by a disturbance of the function of an organ or
system, without any visible alteration of its tissue or texture; there
are no pathological or histological changes, which the most careful
microscopic examination can detect. They constitute a scapegoat for our
ignorance; it appears to be in the majority of instances a disturbance
between the psychic or spiritual forces as they operate on the tissues.
The normal and harmonious relations between the mind and the body
or any particular organ are disarranged. Such are the hysterical
convulsions or spasms which we see in women who have suffered
great mental strain, especially grief, and often it is due to pure
“cussedness,” or unbridled passion. In men there is also a hysteria;
it was formerly believed that this peculiar nervous derangement was
confined to women only, hence the name, but this was an error. I was
once called to attend a physician of more than average ability, who
located in this city for the purpose of enlarging his field of labor
and usefulness; from where he came he had been very successful. His
reputation as a surgeon was enviable and deservedly so, but here, in
this city, among strangers and strange customs, he was a failure. This
preyed on his mind so that he became despondent and gloomy. He failed
in flesh and strength. I found him in his room convulsively sobbing,
which shortly turned into a paroxysm of laughter. I prevailed upon
him to return to his former residence among his friends and admirers,
which he did, and he told me afterwards that from the moment he struck
his “old stamping-ground” he felt stronger and better, and shortly
recovered his former mirth and healthfulness.
Girls show this abnormal nervous function in different ways. I have
known a case where a sensitive girl accidentally saw another girl in an
epileptic fit; the contortions became so real and fixed in her mind,
or imagination, that they were transmuted into motions or epileptic
fits. I tried remedies but without any beneficial results. The parents
afterwards went the rounds of the “fits doctors,” but with the same
negative results. A Christian scientist or faith healer cured her, by
cultivating or strengthening her will power.
There is a class of these faith healers, composed of silly, loquacious
women and men, who know nothing at all of the principle governing their
cures, and they glibly tell their patients, “You must say or think
there is no disease, or I have no pain, or there is no body; all is
well; all is good,” and a great deal of similar nonsense. All is not
good, and all is not well by any means. I would say, Indeed there is
pain, disease, and a body, but by striving to live a healthful moral
life, and thinking healthful thoughts, of the good, the pure, and the
beautiful, the curative energy of nature will become stimulated to
repair the defects, to harmonize the functions and dissipate disease.
A person who is troubled with dyspepsia cannot get well if he thinks of
nothing but an acid or sour stomach, or feels the food disagreeing with
him before he has it in his mouth. He must have thoughts quite remote
from these, and the chances are nine out of ten he will not feel what
he eats. There is the same state of mind about “catching cold.” Some
persons are forever on the alert to catch a cold, and why should they
not, when they are always watching out for it? If you dress so that
you do not sweat, and do not use too thick bedcovering, and are not
constantly on the catch or lookout, I assure you you will not catch
cold, nor will it catch you.
Terror or fright causes or cures diseases. Dr. Toad reports the case
of a boy, in Tuke’s work, nine years of age, who was frightened into
chorea, or St. Vitus’ dance, by his sister, who had covered herself
with a white sheet and appeared before him unexpectedly, while he was
in bed. I know, also, a case of functional bladder weakness of a child
who wet his bed at night during sleep. There appeared no signs of any
local disease, nor was any remedy which I employed of the slightest
advantage. The father of the child, becoming exasperated, gave the
child a severe thrashing one morning. The mother remonstrated at what
she considered cruel and useless chastisement. But, strange yet true,
that child never wet the bed after that; it was entirely cured by
fright.
Sympathy will often make persons sick; of this I had in my own
experience an opportunity for a very interesting observation. It was
the husband of a woman who had been retching and vomiting incident to
the early months of her pregnancy. So great was the sympathy of her
husband that he retched and vomited exactly like his wife, not only
when in her presence, but when separated from her, the impressions
or thought exciting the _excito-motor_ nerves of the stomach. This
sympathetic sickness lasted as long as that of his wife.
Dr. H. C. Sawyer, author of “Nerve Waste,” has kindly shown the writer
another form of functional or hysterical disorder, which was, or
is even yet, considered by many general practitioners a scrofulous
enlargement of the joints; but the doctor discovered the peculiarity
of _metastasis_, which means a sudden or complete removal of a disease
from one part to another. This gave the disease what he termed a
hysterical or functional character. It would be the swelling of the
elbow of one arm and the knee of the opposite side at one time; and
in the course of a few weeks or months these would feel and appear
entirely well, while the disease had located itself in other joints.
This case the doctor considered could be only reached through the
mind, or some faith cure. He further believed that many of these
enlarged and swollen joints among the wealthier classes were due to a
nervous trouble. Indeed, it would be an easy matter to cite case after
case, from my own experience, or quote cases from the highest medical
authorities, illustrating in every conceivable manner how the mind, the
imagination, the emotions, or the different passions, are continually
causing disease and suffering.
It must naturally follow that what is potent to induce diseases will,
under different conditions, be a means of curing them.
A serious question now arises with reference to the selection of
cases suitable to _mind-cure_ treatment. Bigoted fanaticism is quite
incompetent, so are the great majority of spiritual healers, owing to
their absolute ignorance of the scientific aspects of disease. The
first prerequisite for intelligent and proper treatment is to establish
the precise nature of the disease under consideration. It must be
distinctly grouped or classed, whether it be a functional or hysterical
disease, or a zymotic or contagious affection.
In diphtheria or typhoid fever mind cure subserves no purpose; the
treatment must be avowedly antiseptic and stimulating.
If it be a physical injury, say a fractured bone, it must be treated on
mechanical principles.
A woman suffering in the pangs of labor, which is being delayed from
some abnormal position or some other physical obstruction, can only
be delivered through mechanical methods; and here the enthusiastic
mind healer may commit serious errors, sacrificing limb and life by
unnecessary delay. So I would lay down this broad maxim, that the mind
healer must either be a competent, educated physician, or a physician
should be a competent metaphysician.
NOTE.—In the year 1887 Mrs. A. C. Hurrell was a healthy, middle-aged
woman and the mother of two children. When the youngest was ten months
old she contracted a severe cold. The coughing spells “took her
breath,” and from these exaggerated expiratory paroxysms she drifted
into _spasmodic asthma_, at least that was the diagnosis of prominent
medical men of Sacramento and of this city. Change of climate was
advised and tried, so were also the different drugs which experience
had taught to be useful, even operations were performed on her nasal
passages by enterprising specialists, but all to no purpose. Morphine
was prescribed by the first medical attendant, and when her suffering
became unbearable she had to fall back on this drug for relief. In
May, 1890, I was consulted, but a most careful examination revealed
nothing which I could assign as a cause and upon which to base a
hopeful treatment.
In October, 1891, she was persuaded to take treatment from a lady
who claimed to cure through Christian Science (a mind healer). The
treatment commenced on a Thursday afternoon. The lady impressed on
her that the morphine, of which she now consumed, hypodermically,
the enormous quantity of ninety grains a week, was injurious, and
that if she made up her mind that there was no disease the asthma
would leave her. Friday night the patient was in great agony, both
from the withdrawal of the drug and the asthmatic attack, and this
double pressure weakened the faith of both patient and healer, but
the husband stood firm and insisted that she have no morphine. The
struggle for breath and the narcotic continued until four o’clock
Sunday morning, when she began to get easier; the improvement
continued, and in ten days she had “outgrown” both. I saw her two
months later, entirely recovered, and the most brilliant specimen of
the efficiency of mind cure that one could wish to see.
CHAPTER IV.
GENERAL CAUSES OF UTERINE AND PELVIC DISEASES OF WOMEN.
WHY are womb diseases so prevalent? is a question which we are not
infrequently called upon to answer. At first sight this would strike
one as a casual or commonplace remark, but a moment’s reflection makes
it one of vital interest, for a truthful and intelligent reply lays
bare the causes which undermine the health, strength and character of
the mothers of our citizens, and when a disease of this sort becomes
common, it threatens the morality, health and life of our nation.
The causes which operate in producing these diseases of the female
differ widely in their origin; some are due to ordinary imprudence,
while others are deeply rooted in moral depravity and marital abuses
and for this reason I consider it convenient to arrange them into three
distinct classes or groups.
The first class is characterized by comprising those causes which are
for the most part accidental. They are peculiar to confinement and
motherhood, and may be in a great degree controlled or averted by the
skillful and competent accoucheur. They have principally a scientific
interest, and do not fall within the scope of the non-professional
reader.
The second class is entirely beyond anyone’s control. The causes
belonging to this category are innate to the human organism; they
induce those numerous afflictions which here and there sprout up in
previously healthy persons, and are, in all probability, due to some
specific hereditary taint. They are to be attributed to the natural
imperfections of humanity, and are a constant reminder that the body is
simply the transient abode of the soul, or spiritual man, and as such
only perfect in its imperfections. Like the causes of the first class,
these, too, have principally a scientific interest.
The third class of causes of uterine diseases constitutes a very large
group, and has a popular or general interest. For this reason it should
be freely discussed, because the causes of this class are _avoidable_.
They are entirely within the control of the average sensible person,
and for that reason should be known and understood by everyone. These
causes superinduce inflammatory diseases, which are not confined to the
womb alone but take in the entire pelvic _appendages_, the Fallopian
tubes and ovaries. They are the greatest source of revenue to the
doctors, and vary in symptoms in different persons, from a slight
casual reminder of something wrong to harassing pains and physical
suffering; and that these all are brought about through ignorance,
wanton carelessness, or sinful disrespect of nature’s or God’s law, is
the characteristic feature of the causes under investigation.
Exercise in the open air is so essential in strengthening the nervous
and muscular systems that where this is neglected it predisposes
to womb disease. I consider the differently-devised indoor or room
calisthenics or exercises as totally inadequate and no substitute
whatever for healthful outdoor movement, and for the following reason:
that while it irritates the muscular and nerve fibers, it lacks the
stimulating and tonic influence of pure oxygen-laden air, so that the
blood becomes still more deteriorated and overloaded by excessive waste
material, which is not thrown off. If a person exercise at all with a
view of deriving physical benefits, let it always be in the open air.
Like walking, riding, rowing, to which bicycling should be added as one
of the very best of outdoor exercises, the mind can then be engaged at
the same time, though it must not be overstrained. The great obstacle
nowadays arises from a fashionable and morbid desire to cultivate
an appearance of delicacy; if, instead, recreations which required
muscular exertions were more fashionable, the results in developing
strong and hardy women would be astonishing.
No exercise can be profitable which is not interesting to the person
who practices it.
It is not the bodily exertion alone which can profit a person, but
the happy associations, the abandonment of self thought, the mental
relaxation, and the pleasure which accompanies it. With one or two
companions we can have a jolly time, while taking a swimming bath or
floundering in the surf, but alone it soon becomes tiresome. If we
take a stroll with an agreeable companion, we can walk a distance
which, when undertaken alone, would fatigue and tire us completely out,
while, when with an associate or friend, we cover the same distance
refreshed and invigorated, because the mind is entertained while the
body is exercised. This must have been the experience of everyone, and
if it teaches anything worth remembering, it teaches that monotonous
exercises should be avoided and entertaining ones sought and practiced.
Walks over hills in small, friendly groups is one of the best modes
of exercise I know of. And then there remain the many outdoor games.
The pernicious systems of training which are observed in some female
seminaries often plant the seeds for future disease. All the school
hours are employed in reading, drawing, music, and other brain work,
while the evenings are devoted to preparing lessons for the following
day. This is very injurious, and should never be permitted.
After school hours the mind should have complete respite from study, so
that the forces can recuperate themselves for the next day.
Nervousness or neurasthenia is often a result of this excessive mental
application. Where the mind is constantly engaged in intellectual
pursuits, the result often is a too rapid development of the brain and
nervous system.
When the thoughts and memory of girls of tender age are too long and
too laboriously engaged, there will be an abnormal development of the
nervous centers; they will grow or develop beyond the muscular or
physical strength, and a morbid impressibility, great feebleness of the
muscular system, and a marked tendency to disease of the pelvic organs,
is established. Parents may refer with pride to the precocious talents,
the refined and cultivated tastes, of their daughters, as qualities to
be admired and appreciated, but without a physical substratum it is
a dreamy delusion. It would be much better for the children if their
parents took more pride in rotund figures and robust constitutions,
for these would ever be a source of joy, while the cultivated talents,
especially at the expense of their health, will not only be of little
practical value to them in after years, but often incapacitate them
for wives and mothers, by making them restless, discontented, and
physically unfit for maternal functions.
There is entirely too much scholastic education imparted to our girls,
and not enough domestic education. I believe that the most favored
should not have too much of one and not enough of the other, because if
parents do not prepare girls for household duties in early life, they
run desperate chances of laying the foundation for a failure in the
remote future.
Children must be constantly reminded that they are in this world to
serve a useful purpose, and that co-equal with every accomplishment is
a utilitarian training.
We take a pride if our boys trade pocketknives, especially when our
own gets the better one of the two, because we appreciate the natural
business trait. He will be no less a good candidate for some of the
learned professions, and, indeed, it has come to this, that material
success in the professions depends as much on shrewd business tact as
it does upon proficiency in professional attainments.
The knowledge or even wisdom of a person is of no earthly use to
himself or the world if he or she do not possess the faculty of letting
the people know of this superior wisdom; and that is why some persons
often become more celebrated and even renowned than others, who are
intellectually their superiors, because the former possess the faculty
and cunning to make people believe in their superiority. By this I
simply desire to impress upon parents not to be over-anxious about
their daughters standing _first_ in their class room, but, rather, to
be very anxious that they attain a healthy and vigorous growth, and
that sufficient practical knowledge of domestic affairs be imparted to
them so that they can creditably fill their mother’s places some day.
This I consider the best legacy.
The time to commence to train mothers is from the moment they are born.
The minds of parents should be disabused of the false delicacy about
this aspect of a girl, and while no one expects daily lectures to be
given to children or young girls upon the responsibilities which await
them, such information should not be studiously avoided. I insist that
this important fact should not be lost sight of, motherhood is the
ultimatum of feminine existence.
Mistaken conceptions of woman’s education, in pinning girls to a life
of close mental application, is often productive of uterine disease, by
lowering the tone of the nervous system; while others who are ambitious
to acquire a professional education in later life, fall by the wayside
as hopeless invalids.
I do not disparage her capacity to study with equal proficiency the
arts and sciences, often with more ardor and closer application, than
her male colleagues, but she is simply striving to accomplish that
which the men can and do willingly accomplish for her, while at the
same time she is neglecting the education of those qualities which are
the sole inheritance of her sex, and which man could not usurp if he
would.
This class of uterine diseases develops in a few years into melancholy,
which closes the windows of the soul to the sunlight of hope, and
gradually drags the sufferer into a decline, that nothing but an entire
change in the habits and thoughts of the patient will ameliorate or
cure.
I would have our girls as independent of our boys as the latter are of
our girls. I would have it understood that each, in their specialty for
which God and nature has ordained them, is as honorable and important
in the social and industrial conditions of mankind as the other. I
would give woman the right, and deem it her privilege, to frankly and
unrestrainedly profess her fondness or desire to marry the man who she
believes would make her a desirable husband, because woman’s intuition
transcends man’s reason.
A reform in this direction would, indeed, elevate the woman to man’s
estate, where she belongs. A little less sentiment and more sense is a
wholesome panacea for some of the abuses of the marital contract.
I fully subscribe to the view that a woman shall at all times receive
the same wages for her mental and physical labor that men receive for
the same work, but I am entirely opposed to that modern tendency and
false social philosophy which is constantly striving to make a man
out of a woman. There is something so grossly absurd and unnatural in
this artificial readjustment of the natural duties of the sexes, in
their industrial and social relations, that it has degenerated in many
instances into fanaticism.
Women are organizing everywhere for the purpose of increasing the
facilities of their sisters in the studies of science and philosophy.
Large sums are offered to the faculties of universities to gain
admission to female students on an equal footing with the male
students, for the purpose of studying some of the already overcrowded
professions. In the main, all this abnormal rivalry does not contribute
a single advantage to either sex.
There was a time in the history of civilized nations, and that
time is not more than twenty or twenty-five years ago, when an
academical education gave an immense advantage to its possessor over
his less-informed contemporary, but this is not true in our time,
because there is now an overproduction of college-bred men. The man
who can decline a Greek noun or conjugate a Latin verb is no longer a
rarity, because the sons of European tradesmen and American farmers
have deserted the pursuits of their progenitors—which, in the case
of the American farmers, is to be deplored—and obtained a collegiate
education, that is no longer the inheritance of the privileged few,
so that in our time and day an academical education has run to seed
among the men. And now the attempt is being made, under the guise of
social progress, to burden our girls with the same wisdom that has
incapacitated many of our boys from making an honest and independent
living. It would be much better for the State if two-thirds of our
universities or high schools were changed into manual training schools
or polytechnical colleges, where the foundations for the industrial
pursuits may be laid, so that labor will be made not only respectable
but intelligent.
We would then hear of educated mechanics or artisans, and scientific
farmers, which, to my mind, requires the same order of intelligence to
excel, that it does in the professions generally qualified as “learned.”
Why crowd our girls, then, into the professions for which they are not
only unsuited by nature, but which are already demoralized by the keen
competition within their ranks? It is, certainly, an open secret, in
the profession to which I have now devoted the best years of my life,
that the methods in vogue to get business have descended to the level
of the “confidence trickster,” and that, no matter what ability or
merit a person may possess, without the natural instincts and elements
of the quack and charlatan he can gain neither a livelihood nor fame.
This theatrical demeanor of the profession, this aping the gaudy
display of European aristocrats by riding in closed coaches, driven by
liveried coachmen, is but the outward symptom of the internal disease
of contention for notoriety and success.
If, instead of all this false and demoralizing philosophy, termed
“woman’s rights”—which is more appropriately designated “woman’s
wrongs”—we turn the thoughts and ambitions of women towards domestic
economy and domestic virtue, which alone should be and ever will be the
_ideal_ of noble womanhood, there will be, then, much less disease,
more happiness, and less discontent. There is enough on God’s earth
for all of his children to eat, wear, and work, if the labor and the
subsistence are fairly and wisely apportioned.
The growing sentiment, which is as vicious as it is absurd, is that a
girl, to be educated or accomplished, must be either a teacher, lawyer,
or doctor, or anything else except an accomplished housekeeper, just
as though it required less talent or ability to raise a child, cook a
wholesome or digestible meal, and cut or sew a garment.
Why, there is much more thought and judgment required in making an
angel mother than in administering or prescribing a dose of medicine
and filing a legal brief, and there is not a lawyer or doctor who has
given sufficient thought to the duties and requirements of maternity
who disputes it for a moment. If our strong-minded women would preach
this doctrine, which would tend to make household duties respectable,
they would be benefactors instead of mischief makers, and then our
comely girls would prefer to cultivate habits of domesticity, which
should and would become as honorable an occupation as that of a
doctoress or lawyeress.
Improprieties of dress are to be found in excessive or deficient
clothing, in an improper adjustment, and in an inherent defect of the
undergarments. I will reserve some of my views on these questions, for
the chapter that is devoted to hygienic measures. In the main, the
custom or manner of dressing women in Christian countries does not
deserve that sweeping denunciation that some radical dress reformers
make. I would not, if I could, change the very becoming and graceful
modern female dress, for it possesses the merit of displaying the
beauties of the figure in a modestly delicate manner, and it hides its
defects from the vulgar gaze.
As a rule, there is too much pressure on the abdomen, from the weight
of heavy skirts that are suspended from the hips, and not sufficient
room for the chest to expand, so as to accommodate the respirating
movements of the lungs. In the absence of shoulder bands, to which
the skirts should all be fastened, the much-decried corset has its
redeeming qualities, for it serves the purpose of a yoke or support
for the different undergarments, and when not tightly laced is rather
a benefit than an injury, and if the corset had a shoulder strap
fastened to it over both shoulders so as to keep the garments from
dragging on the hips, there could then be no objection to it whatever.
The corset must always be so loosely worn as to permit the wearer’s
hands to be easily passed between it and the waist. It then becomes a
useful brace to a weakly woman and entirely harmless to a strong or
healthy one. We can imagine how a tightly-fitting corset will cause
mischief by compressing the ribs and abdominal walls, and that this
absurd fettering will prevent the lateral expansion of the chest, and
also injuriously press upon the internal organs, but this is not due
to an inherent property of the corset itself, but to an abuse of it.
One might as well advocate a return to the Roman sandal, on the ground
that some persons are foolish and vain enough to wear shoes altogether
too small for their feet, thereby causing deformities and corns. For
my part, I admire a nice, well-shaped, healthy foot, incased in a
low, broad-heeled, comfortable shoe, even if its size were one or two
numbers larger than a pinched-up, deformed one. But no one would be
enthusiastic enough on the question of healthy feet to have us all wear
sandals again.
Warmth of the lower extremities is a very important point in a female’s
apparel, and of more importance than all the other questions raised
on this subject. The exposures endured by women, from ignorance or
indifference to this fact, is, in my experience, a fruitful source
of disease. The chilling blast which sweeps under the skirts must
be mitigated and the moist vapor arising from a damp and cold earth
neutralized. If the limbs are only protected by thin cotton fabrics,
they are insufficiently clad to avoid the evils above mentioned. It is
of the greatest importance that the limbs of women should be incased in
flannel drawers, and these can be worn underneath the white muslin or
linen ones, and the hose, especially in cold or damp weather, should be
made of woolen material; the soles of the shoes should be sufficiently
heavy so as not to be permeable by the moisture from the ground, and
in wet or rainy weather rubber overshoes are always a necessity. When
the feet and lower limbs are kept warm, the whole body is more or less
protected against cold.
Superfluous or too warm garments are the cause of an endless variety
of diseases. The rule is this, that any garment which by its weight
or thickness excites perspiration when the wearer sits quietly or
exercises moderately, is either superfluous or too thick or heavy, and,
as perspiration relaxes and softens the skin, it makes one susceptible
to take cold. It is reported on good authority that sealskin wraps
cause more deaths among those who wear them than typhoid fever and
for the reason above mentioned. Loosely-woven woolen goods make the
best wraps and the best underwear. If we were called upon to state a
single proposition which we considered of the greatest importance in
preventing disease, we would frankly say that, next to an irregular and
unwholesome diet, excessive clothing is the most mischievous factor in
causing or predisposing to disease.
The same rule applies to bedcovering; if it be so heavy as to make
the sleeper sweat during the night, he is almost sure to take cold
from the sudden change, from a warm, moist bed to the cool room or
comparatively chilled clothing.
Imprudence during menstruation. A heedless disregard, ignorance, or
carelessness of the precautions above referred to is, during the
catamenial days, quite sure to lay the foundation for disease. Every
practitioner has met with a great number of cases where the disease
originated during menstruation from some indiscretion, and it ran
on for years, until a condition of affairs was developed which was
well-nigh incurable.
The female organism is particularly sensitive about this time and much
easier affected than at any other.
During this period the ovaries and uterus are intensely congested, and
the Fallopian tubes which connect the former with the latter share this
condition, and if a cold should suddenly check or interfere with the
natural functions of these organs, it might result in inflammation of
the ovaries or in a catarrh of the tubes and womb. Any one of these
conditions is painful and often troublesome to cure, but when all these
organs are complicated in the diseased process, which we frequently
find to be the case, it may entail serious consequences.
Dysmenorrhea, or painful menstruation, will be a prominent symptom,
if any of the above organs have suffered from imprudence, during this
period, and I have known of cases which gave me no end of trouble
before they were restored to health.
Measurements of the healthy uterus. In a grown person the average
length is three inches, two inches in breadth and an inch in thickness.
It weighs from an ounce to an ounce and a half. The size of the uterus
is an important guide to the physician in establishing the presence or
absence of certain diseases.
In the child-bearing period measurements and weight change, because
the organ grows correspondingly large to accommodate the growth of the
child.
Growth of the uterus from the moment of conception is one of the most
interesting physiological studies. All its tissues, muscles, nerves,
vessels, and lymphatics are increased in bulk and multiplied in number.
The human ovum is an extremely minute microscopic cell, from one
two-hundred-and-fortieth to one one-hundred-and-twentieth of an inch in
diameter. This grows so rapidly that at the end of nine months we often
have the average nine-pound baby. The growth of the muscular fibers of
the womb is truly remarkable. They grow eleven times longer and twice
to four times thicker, so that the growth of the womb keeps pace with
that of the child.
Changes immediately after confinement. Women as a rule, and their
husbands also, are wofully ignorant of the condition of the womb just
after confinement, and at this point it will be opportune to impart the
necessary information illustrating that it is one of the most critical
periods of the entire process, because the pelvic organs are again very
sensitive, somewhat akin to the menstrual condition, namely, one of
engorgement, or congestion.
After the child is in the world, the uterus usually contracts to about
the size of a cocoanut; its measurements and weight as compared with
what it was before pregnancy have materially increased.
The diameter is now about four inches, and its weight a little over two
pounds. If we now stop to reflect that its weight was formerly an ounce
to an ounce and a half, to which size and weight it must again return,
we can readily appreciate the important changes that must take place
to accomplish this object. The scientific world has only learned how
this is effected within the last thirty years. It was a very important
discovery. The superfluous or excessive tissues are converted into
fat—the process is called _fatty degeneration_—and as fat the tissues
are absorbed into the blood and disposed of, and thus gradually is the
superabundant substance removed, until its measurements are as they
were formerly and its weight as it was before.
Involution is the name given to this process by medical writers.
It signifies a rolling back of the size and substance of the womb
to where it was before pregnancy. It is the physiological activity
in the tissues of the organ to restore it to its former size and
healthfulness. The time usually required for nature to accomplish this
remodeling varies in different individuals from six weeks to three
months.
Subinvolution is a term employed to designate a partial or complete
cessation of this restorative action. The prefix _sub_ means always
_under_; in this case the same thing is meant, _under-involution_ or
_incomplete_ involution.
When, in six weeks to three months after confinement, the womb has not
returned to its previous healthy size, weight and state, or if the
enlargement of the womb incident to pregnancy lasts longer than already
specified, we have the disease termed subinvolution. It generally
becomes complicated with inflammation of either the cavity of the womb
or of its entire substance, and often the inflammation extends to all
the other organs and tissues in the pelvis.
Indiscretion in getting up too soon may cause this state of affairs.
Taking cold and excessive exertion should be guarded against.
A mother who has just been delivered must gradually feel her way as to
how much and what she may or can do without jeopardizing her recovery.
Pains in the pelvis, back, and thighs, or a heavy, dragging sensation
after getting up, indicate a subinvolution. These symptoms should
be attended to, because the longer they last the more obstinate the
disease becomes.
Lying on the back after confinement for ten or twelve days is not only
injurious but an unnecessary hardship for every mother. It is one of
the most fruitful causes of an abnormal position or falling back of the
womb, and very often this excites diseases which greatly complicate the
improper location of the organ.
Retroversion and retroflexion of the womb will be considered more
minutely later on. It is generally caused by this common error of
nurses and physicians, who allow the delivered woman to lie and
often insist on her lying on the back. Thus the womb gradually sinks
backwards, instead of falling forwards, where it belongs: see Plate IV.
Women will not generally feel that anything is wrong until some time
after they are up and around. The first few weeks or months after
confinement, persons are inclined to attribute their weakness, pains in
the back or thighs, and other disagreeable sensations, to the natural
consequences of what they have gone through. But after weeks roll
into months, and their former strength and health do not return, then
they seek the advice of a doctor, who will disclose to them the cause
of their suffering. This can be avoided every time by changing the
positions of lying, from one side to the other, and from the back to
the stomach for a change; then naturally the womb will gradually resume
its normal position, which is inclined forward and rests with its body
over and on the bladder. All of these displacements should receive
early and prompt attention.
Antiseptic precautions. Only a few years ago this phrase was entirely
unknown. It originated with the modern antiseptic treatment of wounds,
and from the domain of surgery it has been transplanted into the
department of obstetrics, in which the application of antiseptic
principles has achieved the most brilliant triumphs. From this
conception has sprung the germ theory of disease, which is now, beyond
doubt, an established fact.
I never can forget my first case of _childbed fever_. It is only
fourteen years ago, and then there was as yet no one who could give a
scientifically truthful interpretation of the disease. My patient was
a young mother, who was being rapidly consumed by a fever, but beyond
that science had not unlocked the causes lurking in the organism,
which had doomed the young woman, on the threshold of motherhood, to a
premature grave.
Thousands of lives were yearly destroyed by _puerperal fever_. Volumes
of literature had been written on the subject, but as yet no one had
deciphered its origin.
Now the whole scene has shifted; we know that the fever is essentially
a blood poison, a septic infection of the patient, precisely similar
to a wound infection anywhere else on the body. The act of parturition
causes wounds or abrasions; these, then, place the woman in imminent
danger of infection of every sort, and it is this infection which it
is now possible to avoid. There is the greatest precaution necessary
on her part and on the part of her attendants, that she be not
contaminated by suspicious-looking finger nails, or dirty hands, or
soiled linen, or unhealthy and unclean surroundings.
The German Government has a compulsory law for a system of antiseptic
precautions, which is incumbent upon all who attend lying-in women.
The importance of a rule to guide midwives and others in carrying out
strictly antiseptic measures was recognized in that country some ten
years ago, and the statistics show a remarkable diminution of diseases
peculiar to the childbed period. The sources of these infectious
micro-organisms are very different. They may be derived from the body
of another person, sick or having died from an infectious disease, from
suppurating wounds and even from the secretions of healthy lying-in
patients. The patient or person herself may have improperly bathed or
neglected cleanliness and ablutions, but the greatest danger arises
from the neglected and unclean hands and sleeves of the midwives and
physicians, and from the instruments usually employed under these
circumstances, like forceps, catheters, or the nozzle of a syringe. The
law above referred to requires all these instruments to be thoroughly
scalded, washed, and brushed every time they have been used, and by
such a complete system of disinfection, the chances of infection are
reduced to the minimum. I hope some day our legislators will be wise
enough to give us similar laws.
CHAPTER V.
UNCLEANLINESS AS A CAUSE OF DISEASES IN WOMEN.
THE custom of washing and bathing has existed from the earliest times.
Among the Egyptians it was a part of their religious worship. Among
the Jews it formed part of the ceremony of purification prescribed by
Moses. The Greeks considered it a sanitary expedient, and among the
Romans it was instituted for similar purposes. All virtues when carried
to extremes degenerate into folly or vice, so bathing in the days of
the Roman Empire, became immoderate and degenerated into enervating
luxury and unbridled debauchery, in which indiscriminate bathing of
both sexes was one of the demoralizing features.
The bath was usually taken after exercise and before the principal
meal, which rule holds good to-day, as the very best and proper time.
The gorgeous splendor of the _Thermæ_, which was a palatial edifice
constructed by Agrippa, was adorned with beautiful statues and fine
paintings, while luxuriant green foliage of great variety formed
enchanting bowers of fairy splendor. This was thronged by the Roman
citizens for the pleasures of gymnastic exercises and bathing.
In those countries which have adopted the religion of the Arabian
prophet, Mohammed, people bathe as a part of their devotions, and a
religion which has for a part of its ritual the washing of the body,
goes a great way towards cleansing the spirit.
Among the Northern nations the introduction of the bath dates back to
the period of the Crusaders, although _Tacitus_ speaks of the river
bathing of the Germans, which was one of the strengthening methods
employed by the early Saxons. That filth and dirt generate crime and
moral depravity seems to be apparent, where squalid misery has dulled
the sensitiveness to unwholesome surroundings.
Sanitary science has also demonstrated that filth is the most fruitful
source of diseases that are called infectious, because their origin is
due to germs of the lowest forms of vegetable life. The brightest page
in the medical history of the nineteenth century is that which records
the discovery of these micro-organisms as the cause of such diseases
as septicæmia or blood poisoning, pyæmia, diphtheria, tuberculosis or
consumption and others. All forms of fermentation and putrefaction
are due to the presence of some germs, and upon this fact antiseptic
surgery bases its scientific premises.
The germ theory of disease, like every new discovery, which supplants
the accustomed and deeply-rooted theories of the speculative
philosophers, met with opposition, criticism, ridicule and
misconstruction, but the brilliant achievements of Lister and Koch have
established its founders upon a pinnacle of fame, which promises to be
an immortal monument to their genius, and not only in surgery has its
beneficial influence been exerted, but the entire field of medicine has
been enriched by the germ theory, which plays so formidable a part in
the causation of many diseases.
The great boon that medical science will confer upon humanity, in the
future, will not be so much in improved methods of treatment, as in
the means and methods which medical science will devise for preventing
disease. One ounce of prevention will always be worth a pound of cure.
When we look back fifteen or twenty years, we must even now acknowledge
that preventive medicine has accomplished greater results than curative
measures, because the former can be made in the very nature of things
_absolute_, while curative agents are only relative. Puerperal, or
childbed fever, which is an _infectious disease_, was at times a
pestilence, which destroyed women by the score, in maternity hospitals,
or in certain neighborhoods, by the infection being carried by midwives
or accoucheurs from house to house, yet no one had the least suspicion
that it was possible to carry the germs of this disease under the
fingernails of the attendant, or on the clothing or a syringe, or on
some other little instrument, from one patient to another, and, indeed,
there are a great many to-day who are practicing midwifery who are
still ignorant of the importance of refined cleanliness.
But for this ignorance, there is no longer an excuse, because the
infectiousness of this and other diseases is so positively established,
and even the physical characteristics of the micro-organisms have
become familiar to the microscopists. This knowledge of the causation
of puerperal fever has been applied to the employment of preventive
measures, so that this dreadful malady is becoming a rarity,
particularly in countries where scrupulous care and cleanliness are
enforced by governmental rules and regulations. I refer to this
particular _fever_, because it is, to my mind, one of the most
brilliant illustrations of the efficacy of preventive or antiseptic
medicine.
There is a gynecological hygiene with which women should become
familiar; it is based on the principle of antiseptic precautions
applied to the daily lives of their sex. The object of this is to keep
the body and reproductive organs that are exposed to contamination
or infection from the outer world in the most refined and scrupulous
cleanliness. The vaginal douche or syringe is as important an auxiliary
to a refined woman’s toilet case as her tooth brush, because the
cleanliness of the genitals is as essential to the preservation of
health and comfort, as the possession of a sweet breath and the
preservation of the teeth. I am therefore convinced of the hygienic
value of familiarizing little children with washing or sponging their
external genitals; in a few years this will have become second nature,
and they are thus protected for all future time from contracting
diseases which have their origin in personal uncleanness. It behooves
mothers to avoid all delicacy on this subject, so that their little
ones may grow up with the sentiment that to the pure in heart all
things are pure. It is false modesty and ignorance which degenerate
into vice and excesses; the scientific truth is always pure and
holy, because it is based on reason, while abnormal delicacy is only
emotional, and is quite likely to shoot into the other extreme, namely,
licentiousness.
As the world grows wiser, the physiology of the reproductive organs
should form a part of its wisdom, and in proportion to this knowledge,
will their functions become questions of sense, instead of sentiment
and nonsense.
The vagina is a membranous canal. It is situated in the cavity of
the pelvis, below and behind the bladder, and in front and above the
rectum. Its direction is curved from before backwards and a little
upwards; its walls are flattened and ordinarily in contact with each
other. Its length is about four inches along its anterior wall, and an
inch or two longer along its posterior wall. In introducing a nozzle
of a syringe it must always be remembered, that the tube is to be
introduced directly backward on a horizontal plane with the body in the
erect posture; by attempting to introduce it directly upwards, you meet
with resistance from the anterior wall of the vagina.
In this cavity the secretion is susceptible of decomposition, owing to
the accessibility of air laden with germs, which excite fermentation.
A day or two after the cessation of the menstrual flow, there still
lingers a little blood in the cavity of the vagina; this becoming
infected with the germs in the vagina, a decomposition is the result,
which is recognized by an offensive smell. The naturally soothing and
harmless secretion is now changed into an acrid, irritating fluid,
which not only may cause an inflammation of the membrane of the
vagina, but also excoriate the skin at the orifice of the canal.
Leucorrhœa, or what is commonly called _whites_, is the most
distressing symptom of this condition. In the course of months or in
some instances a few years, the inflammation spreads from the vagina
to the mouth and lining membrane of the uterus. Inflammation of the
endometrium or lining of the womb will excite another complication,
the so-called ulceration, but more correctly termed _erosion_. Who
will deny the usefulness of any advice that will teach girls or women
to avoid all these diseases? It is all contained in the simple phrase,
_Keep clean_. Young girls must be taught by their mothers or guardians,
not only the necessity of keeping the external genitals clean by daily
ablutions, but a few days after menstruation, upon the slightest
indication of offensiveness, she must resort to the employment of the
vaginal douche or syringe, so as to wash out the seeds of disease,
that are rapidly multiplying themselves, and if allowed to remain will
entail the consequences to which I have already referred.
As an antiseptic wash, there is nothing so simple, efficacious and
healing, as a solution of borax in previously boiled water, that has
been allowed to cool to the proper temperature, which is between 103
and 106 degrees Fahr., one teaspoonful of the powdered article to the
half gallon of water, to be used as a rinsing for each time.
Directions for administering vaginal douches will be given elsewhere.
The proper time of the day for the employment of the wash is always at
bedtime; and once or twice a week is quite often enough in the majority
of instances.
Married women are more exposed to infectious contamination than single
ones, because they are constantly liable to have infectious microbes
introduced into the vagina during the ordinary course of marital
relations. Men, as a rule, are neither cleanly nor careful in their
habits, and approach their wives without any thought of serious
consequences in their sexual relations. I had a married woman under
treatment for an offensive discharge from her vagina which I traced
to her husband, thence to a suppurating wound on his horse, which the
husband had under his treatment. This can happen, of course, only
through carelessness. By getting some of the matter or pus on the
fingers, which incidentally contaminates his person, or not washing
and brushing the finger nails, the husband may directly convey
the infection to his wife, and thus inaugurate, unconsciously, an
inflammation of the vagina, which becomes complicated, as the primary
disease is neglected, leading to inflammation of the womb and ovaries,
and often to abscesses, that compromise not only the health but the
life of the sufferer.
To preclude the possibility of _innocent_ infection, between husband
and wife, there is only one means of prevention, and that is a careful
_toilet_, which thoroughly cleanses the bodies in general and the
genitals in particular.
Another fruitful source of disease of women, in this country and to
an alarming extent in Europe, to which the elder Martin of Berlin
called the attention of the profession over thirty years ago, is the
specific or gonorrhœal infection of wives by their unfaithful husbands.
The number of poor women whose health has been irretrievably ruined,
by their husbands having had illicit relations with lewd, diseased
women, is only known to those who have made this class of diseases a
special object of inquiry. I have nothing to do with the moral aspect
of this question, but only with the physical suffering that such men
inflict upon their innocent wives and the mothers of their children,
for the brief indulgence of libidinous pleasure. To think that any
man would take the chances of making his wife a suffering and perhaps
incurable invalid, just for the purpose of gratifying temporary animal
passions, is to place him beneath the brute creation, which has not the
intelligence to reason on the fearful consequences. No man who has
been guilty of illicit relations should return to his wife until seven
days have elapsed, and even not then until he has repeatedly washed
himself by means of a syringe with some cleansing or disinfecting
fluid, like borax water, or, what is preferable, a weak solution of the
bichloride of mercury.
The wife and mother who entertains the slightest suspicion, must insist
upon these precautions, and then not neglect to thoroughly wash and
cleanse herself in the manner previously referred to. It is the height
of hypocrisy to be mealy mouthed on this subject; the wives and mothers
who are fortunate to have husbands beyond suspicion, should learn
that some of their sisters have dangers to encounter and heartaches
to suffer, with which their own lives are not marred, but perhaps the
lives of their daughters may be; for the unhappy woman who becomes the
wife of the blear-eyed sensualist, there is only one relief, and that
is education in these subjects.
I know of no disease in which a correct and early diagnosis or
recognition is of greater importance to avoid the frightful consequence
and serious complications, than this one. It begins with a mild vaginal
catarrh, which, when it is as yet locally confined to the vagina, can
be easily cured. In course of time it spreads itself along the vaginal
tract to the cavity of the womb. When it gets there, the treatment
becomes more complicated, and for this reason; in order to reach the
disease now, the cavity of the womb must be dilated, and this is an
operation which the average physician can only accomplish in a bungling
and imperfect manner. But even in this stage of the disease, in the
hands of a skillful physician, the course of the disease can be checked
and the patient readily cured. When the disease gets beyond the womb,
when it invades the Fallopian tubes and the ovaries, the picture has
entirely changed.
The organs affected are then inaccessible to local treatment, so that
the disease invariably continues until the organs are more or less
destroyed by inflammation, which results in the tissues breaking down
into an abscess. In this stage of the disease it has become quite
the fashion to operate in this class of cases, offering as an excuse
a sure and speedy cure. Here I would interpose a word of warning to
sufferers belonging to this class, not to be too willing to comply
with surgical methods, because I know from careful observations, that
promises of this nature end often in disappointment and death, while an
intelligent conservative treatment can only disappoint but never kill,
and with patience and perseverance in the application of electricity
and hygienic rules of health, a cure is almost certain. The sick in
body and mind are often beguiled into operations of a very serious
nature, which are entirely unnecessary, because better results can be
accomplished by other methods of cure, in which the possibility of a
fatal termination is excluded.
Some women feel tired and languid from morning until night; they
feel as tired in the morning when they get up as they were in the
evening when they retired. If we tell them that it is entirely due
to negligence of their own persons in not using vaginal washings
regularly, they will undoubtedly feel surprised. In the great majority
of these cases, this is owing to putrefactive changes going on in the
cavity of the vagina. In the process of fermentative decomposition,
the so-called _ptomaines_ are developed; these are chemical poisons,
which are absorbed into the blood, and by their depressing influences
on the nervous system are the cause of the weakness and tired feeling.
There are no remedies which, when taken into the stomach, will do the
slightest good for this condition, and it is a waste of both time and
money to expect relief from drugs.
This can easily be remedied by cleanliness, so that the secretions are
not long enough retained in the vagina, to decompose and develop these
ptomaine poisons.
During and after confinement is another important time for the
employment of vaginal washes. The _lochial discharge_, which is one
of the ordinary accompaniments of the newly-delivered woman, is a
discharge from the uterus, which continues for several days, growing
less and less, for a few weeks, when, in a normally healthy state
of affairs, it should cease entirely. The lochia is the oozing from
the mouths of the blood-vessels of the womb where the placenta or
afterbirth was attached, together with the passing off of the old
lining membrane of the womb, while the organ is returning to its
original condition. At first the discharge is bloody, and it may
retain this character for two or more days after delivery; then the
color is changed, partaking more or less of a watery nature and
presenting a yellowish hue; it then becomes whitish and ultimately
ceases altogether. After the first four or five days the lochial
discharge often becomes very offensive; this is a sign of putrescence
or decomposition, and the only remedy in this, as in all other similar
instances, is to wash the vagina thoroughly with borax water, or with a
preparation for which a prescription will be given further on.
In every case of delivery, the mouth of the womb is more or less torn
or lacerated; this is unavoidable, and it is generally harmless. One
of the surgical humbugs is to sew or stitch, or attempt to stitch,
these little harmless tears together, not of course for the good it
will do the patient, because she is more likely to be injured by this
meddlesome surgery, but to make a business and a fee. The common
practice of these and kindred surgical expedients is one of the crying
evils of an overcrowded profession which is trying to keep itself
employed at all hazards.
The vagina also receives more or less injury during an ordinary
confinement; if the midwife or the doctor is too meddlesome or in too
big a hurry to get through, he will use the forceps, which simply
means, to pull the child out and through the vagina, before nature has
had time to dilate or stretch the parts sufficiently, to allow the
child to pass through the maternal organs without injuring them. As a
result of this brutal haste, frightful lacerations are incurred, which
require immediate attention, but small lacerations heal without any
further treatment than to keep clean.
After every confinement there is considerable sore or raw surface,
with which the offensive discharge comes in contact, to become readily
absorbed or taken up into the system, giving rise to fevers or
inflammations of the womb and other pelvic organs. If one has a wound
on any part of the body, the first thought would, or rather should, be
to keep it clean; exactly the same treatment is required for wounds of
the womb and vagina.
When the discharge becomes offensive, it also becomes dangerous and
poisonous, and the only and proper thing to do is to thoroughly
wash out the entire vaginal cavity until all offensive smell
has disappeared. The only sure sign that anyone can have of the
completeness and thoroughness of the vaginal washings, is that there is
no longer any fetid or offensive smell perceptible.
It requires no particularly trained nurse or expert to administer a
cleansing vaginal injection, yet it is more likely to be done in a
bungling, inefficient manner than in a proper workmanlike manner;
for this reason, it would be well to remember a few of the necessary
details of carrying out the douching. In the first place, the room in
which the vaginal douche is administered must be comfortably warm, so
as to preclude the possibility of chilling the patient; the windows or
any other opening liable to cause draft must be closed. The nozzle of
the syringe, whether it be a fountain or a family syringe, must have
been thoroughly brushed and cleansed with soap water, before and after
each use; if the instrument is old, or has been used for questionable
purposes, or, perchance, made the rounds of the neighborhood, it had
better be thrown into the ash barrel, and an entirely new syringe,
the “Alpha,” be employed, which, by its sure and continuous stream, I
consider the most suitable female syringe. The bulb of a syringe must
be compressed in the palm of the hand slowly and deliberately.
The position of the patient is of considerable importance; a vessel is
placed under her, which is carefully adjusted, so as not to tip too
far backwards, otherwise it will overflow and drench the bed or the
patient’s clothing. Beneath the small of her back a few extra pillows
are placed, and thus she comfortably reclines on her back, while the
attendant manages the disinfecting wash and syringe, placed in a basin
between her thighs. Half a gallon of the fluid is usually sufficient.
The temperature of the wash is very important and may range between 103
and 106 degrees Fahrenheit.
The recumbent position is only intended for women who are confined to
their beds; others, who are around and about on their feet, can sit
comfortably over a chamber, on the edge of a low chair, having the
vessel underneath them, and the wash of course in a separate basin.
In the course of my experience I have been called to mothers, five to
eight days after delivery, who were in a raging fever, presumably from
the ptomaines which had developed in the vagina and poisoned the blood.
After a few vaginal injections, sometimes after the first, the fever
subsided entirely. These remarkable results we owe to the _antiseptic_
treatment of disease, and when it once becomes generally known that
this is only another word for cleanliness, infectious diseases will
grow correspondingly less, and the cure for those that exist will be
less experimental and more reliable.
CHAPTER VI.
MARITAL EXCESSES AND PREVENTION OF CONCEPTION.
IN a previous chapter, the physiology of conception was explained, and
it was shown to be an organic function, independent of and remote from
the sexual act, and over which the parties to the act have no control.
From this scientific statement of the actual fact, it becomes at once
apparent that conception or pregnancy may result without natural
sexual congress, by simply injecting the sperm of the male, by means
of a uterine syringe, into the womb of the female, while she is in a
state of unconsciousness. It is also quite probable that a criminal
conspiracy of this nature could be carried out, without any violation
to the delicate anatomy that is involved in the natural process; a
detailed account of all the probabilities which the ingenuity of a
scientifically-trained mind could devise, belongs more properly to the
department of medical jurisprudence. It is, however, of sufficient
general importance that the reader should have at least an idea of the
door that has been unlocked through physiological researches.
What we are at present endeavoring to make clear is, the great
distinction and difference between _coition_ and fecundation or
conception; while one is but the result of the natural instinct aroused
by the senses, the other reaches out into the realm of the Creator.
When man undertakes to destroy the product of conception, he has
interfered with the prerogative of God and is guilty of murder.
The question may now naturally arise in the minds of pure and
morally-disposed persons, whether there is any time, without doing
violence to God’s law, that the children of men have the moral right to
control, or regulate, the procreation of the human race? If I answer
the question in the affirmative, I will then proceed to inquire into
the ways and means to that end, and also into the pernicious methods
that are employed, to accomplish this result.
It is true, that the Divine command was to be fruitful and multiply,
but before this command was given, man was a free agent and a reasoning
being, which implies that he is after all to be the judge as to the
degree in which this command is to be carried out. That is, that there
are mitigating and qualifying circumstances, which man has not only a
right to consider, but which he is expected to take into account in
propagating the species, by virtue of his reasoning faculties.
If this command were absolute and universal, chaste celibacy would be
a cardinal sin, yet it has always been held by the canons of spiritual
growth and morality, to be a Divine virtue, and even the loving Jesus
knew not woman, because the forces that are thus expended will exert
their power in other directions and towards developing powers of a
higher order.
I believe that a moral code, which is too exacting to be observed
by the average person, fails to accomplish the restraint or reform
that is desired, so that, after all, it becomes essential to lay down
such rules as the average men or women can follow as guides for their
actions. A reformer, who starts out with the broad declaration that
it is immoral to take human life, and a murderous act to destroy a
half-formed human being in its mother’s womb, and that it is equally
murderous to prevent the recent products of the sexual act from
becoming a viable being, fails to make the impression he desires.
The first half of the proposition neutralizes the second of its
sacred essence, in placing on the same level the organic function of
conception and the animal function of the sexual act.
This view is so manifestly absurd to the person of even ordinary
perception, that I feel assured, that it would neither lessen feticide
nor sexual excess.
Spermatozoa on the one hand, and the ova of the female on the other,
are, even in the natural and uninterrupted course of nature, destined
for destruction, for whenever the female menstruates, these ova are
discharged, and whenever the male copulates, hundreds of spermatozoa
are found swimming in the spermatic fluid, which in case there be no
ripened ovum are nothing more than so much waste secretion. Both are a
means to an end, and that end is the reproduction of the species. It
appears to me a flight of fancy, from the sublime to the ridiculous, to
assign to the sexual act the same importance as to the passive function
of conception, and I believe that doctrines of this nature lack not
only the least scientific support, but weaken any argument in favor
of the moral or spiritual aspect, which alone raises the question of
feticide from a social evil to a mortal sin.
Man is prompted by a powerful instinctive desire for the use of the
sexual organs, that draws him involuntarily to the opposite sex, not
for the continuance of the race, because the passion arises much
oftener without the remotest thoughts of any fruitful results. I have
the greatest regard for the life of the unborn child, yet I am far from
agreeing with those who would stamp as libidinous every thought of the
sexual instinct, that has not as its stimulus the procreation of the
species. While the average man is in the flesh, he is an animal man,
and there is no use of trying to make a spiritual saint out of flesh
and blood, and when we do find that, we have a very exceptional and
remarkable person. But what, as reasonable beings, we should do, is
to bridle the animal passions with moral reins, so that we can stand
up, in full-statured manhood, with the respectful approval of our
own conscience, able to rise above the mere animal appetites, to the
dignity of reasonable beings. This instinct, like other propensities,
is excited by sensations, and these may originate either in the sexual
organs themselves, or may be excited through the organs of special
sense. In man the passion is most powerfully aroused by impressions
conveyed through the sight or the touch. It often happens that
localized sensations will excite the sexual desire of either sex, so
that many cases of excessive sexual desire can be traced to some local
disease of the genital apparatus: chief among the numerous causes that
may be cited, is pruritus or local itch, erythema and active congestion
of the womb and ovaries.
“This tendency cannot be regarded,” says Dr. Carpenter, “as a simple
passion or emotion, since it is the result of the combined operations
of the reason, the imagination, and the moral feelings: it is in
this engraftment of the physical or spiritual attachment upon the
more corporeal instinct, that a difference exists between the sexual
relations of man and those of the lower animals. In proportion as
the human being makes the temporary gratification of the mere sexual
appetites his chief object, and overlooks the happiness arising from
spiritual communion, which is not only purer but more permanent, and of
which a renewal may be anticipated in another world,—does he degrade
himself to a level with the brutes that perish. Yet how lamentably
frequent is this degradation.” This quotation gives the entire physical
and spiritual aspect of the question, by one of the most eminent
physiologists of our time, so that in the natural course of our
investigation we are led to inquire into the currents of thought, which
would tend towards developing _moral restraint_.
Moral restraint means the restraint of the animal man by his spiritual
or higher self; the _will_ must possess its due predominance to
exercise its determining power in curbing the passions of the one, and
directing the course of the thought in the other.
The cold, calculating materialist, whose ideal is circumscribed by the
laws that have been deduced from the phenomena of the material world,
can scarcely appreciate the higher sentiments that are involved in
this investigation, unless he becomes changed in thought and feeling
to the things that are about him. To accomplish this result is hardly
within the scope of this work. With the average man as we find him, my
observation has taught me that it makes, after all, little difference,
whether he believes in a spiritual nature or is avowedly materialistic.
The great majority of men and women live, so to say, in the turbulent
waters of their own passions, wafted hither and thither by the impulses
of emotional excitement and instinctive desires. There is little or no
hope for reform, if they have not sufficient force of character to cry
halt, and stop to think a little upon questions which are to them of
the greatest importance.
Marital excesses are the mainspring of so much disease, that ordinarily
is attributed to quite different causes, that this chapter would be
very deficient were I to omit to call the attention of my readers to
this fact. The men on the whole are oftener the victims of the ill
effects of unbridled lust than the women, which shows itself by violent
and uncontrollable temper, in the one case, and stupid docility in the
other: by a lean, hungry, nervous appearance, or a brutish, sanguineous
obesity; extremes of the different temperaments and habits are but the
natural outgrowth of the constitution inherent in each individual case.
Women, as a rule, are more passive, less amorous and more chaste in
thought and feeling than men, and if we define emotion as an _idea_
associated with pleasurable or painful feelings, women are, as far as
appertains to their sexual nature, contrary to the generally-accepted
opinion, much less _emotional_ than men. Continence, among the
unmarried women, is the rule, while among the men it is the rare
exception; this is because her _will_ is by nature stronger, while her
_reason_ is weaker, she intuitively arrives at conclusions that are her
guide and saviour.
It is a prevalent idea among men that the marriage ceremony removes
all restraint from the exercise of the sexual function; this not only
neutralizes and destroys all sentiment of true love, which seeks for
the happiness of the object it loves, but breeds hatred and contempt.
To be permanently happy and mutually respectful, there must be love
beyond the pleasure of gratifying the mere sexual instinct, there must
be love in the realm of thought and a spiritual communion above the
instincts of the flesh.
“Any warning against sexual dangers,” says Dr. Acton, “would be very
incomplete if it did not extend to the excesses so often committed
by married persons in ignorance of their ill effects. Too frequent
emissions of the seminal fluid, and too frequent excitement of the
nervous system, are in themselves most destructive. The result is the
same within the marriage bond as without it. The married man and woman
who think that because they are married, they can commit no excesses,
however often the act of sexual congress is repeated, will suffer as
certainly and as seriously as the unmarried debauchee, who acts on
the same principle in his indulgences—perhaps more certainly, from
their very ignorance, and from their not taking those precautions
and following those rules which a career of vice is apt to teach the
sensualist. Many a man has, until his marriage, lived a most continent
life; so has his wife. As soon as they are wedded, intercourse is
indulged in night after night, neither party having an idea that these
repeated sexual acts are excesses which the system of neither can bear,
and which to the man, at least, is absolute ruin and to the woman a
source of disease. The practice is continued till health is impaired,
sometimes permanently, and when a patient is at last obliged to seek
medical advice, he is thunderstruck at learning that his sufferings
arise from excesses unwittingly committed. Married people appear to
think that connection may be repeated as regularly and almost as often
as their meals. Till they are told of their danger, the idea never
enters their heads that they are guilty of great and almost criminal
excess; nor is this to be wondered at, since the possibility of such a
cause of disease is seldom hinted at by the medical man they consult.
Some go so far as to believe that indulgence may increase these powers,
just as gymnastic exercises augment the force of the muscles. This
is a popular error, and requires correction. Such patients should be
told that the shock to the system, each time connection is indulged
in, is very powerful, and that the expenditure of seminal fluid must
be particularly injurious to organs previously debilitated. It is by
this and similar excesses that premature old age and complaints of the
generative organs are brought on.”
Wives of men of great vital force are not long before they become
delicate, sickly and nervous, and, entirely ignorant of the real cause
Of their feebleness, seek relief by taking “a good iron tonic,” which
does them about as much good as if they had left it alone, the tonic
effect of iron being entirely overestimated, but the delusion is
created by associating the word iron with the idea strength. After the
different _tonics_ have been tried, the patient consults a physician,
who, on general principles and after a hasty examination, informs her
that she has “womb disease.” These two words for the time being settle
the question; she now begins “to doctor,” and from the general or
family doctor she finds her way to the _female_ specialists, who, as a
rule, belong to the recognized magnifiers and humbugs of the day. Here
she becomes one of the regular habitues of the specialist’s waiting
room, disappointed and not a little discouraged. She makes the rounds
of the most prominent of them, until she has been doctored out of her
dear patience and her still dearer money. Hope is often a forlorn
consolation, and if by chance she now takes a trip to the country or
undertakes a long visit at some distance, to her folks, which gives the
poor woman respite from the “marital rights” of her Lord and Master,
she recovers her former health, strength and buoyancy. Of course
everybody congratulates her upon the wonderful effect of the climate,
when the climate had no more to do with her recovery than the moon. The
remarkable change was owing to having been let alone by husband and
doctor.
That the attempt to call attention to these flagrant abuses of the
dishonesty and ignorance of the one and the blind animal instinct
of the other will be decried and stigmatized as “cranky,” I know
beforehand, but I know also, that those who criticise these sentiments
are fully convinced of the truth of the statement. The diseases
that belong to this class are, like most uterine diseases, of an
inflammatory nature, and for that reason _rest_ is one of the most
essential features in the treatment. But as this class belongs to the
avoidable causes, prevention is much better than cure. I therefore
advise, as of first importance, to abandon the American custom of man
and wife occupying the same bed, which is only customary among the
poorer classes of Europe, who cannot afford to have separate beds or
chambers. The advantage of the European custom in segregating one’s
self on retirement, to avoid the sexual instincts being unduly excited,
can be borne out by remembering the physiology of the instinct, which
we were told is excited by sight and feeling. Besides these, there
is the possible undue familiarity, which the joint occupancy of the
chamber or bed of man and wife may engender, and that, too, is likely
to lead to excessive relations.
All efforts to exercise voluntary control, by prolonging the sexual act
or extending the venereal orgasm, are fraught with the most pernicious
results to the nerves, terminating in a partial or complete paralysis
of the different organs of the body, or a low grade of inflammation is
excited, which offers a fruitful soil for the development of various
diseases.
A man who has become the husband of a woman should never cease to
be a gentleman on that account, nor should he become lost to a
consideration of those delicacies of refinement, which smooth the
common relations in the exercise of daily duties.
Continence is the complete restraint from sexual indulgence, which in
its fullest sense does not apply to the married state, but it comes
within the scope of every married life to cultivate and practice it
as one of its virtues. Every married couple should be continent for
days and weeks at a time, and when one or the other is not feeling
well, abstinence should be practiced, as the rule, not only to avoid a
nervous shock, which may have serious results, but because conception
in an abnormal physical condition, will perpetuate itself in the child,
which is quite likely to inherit a nervous or sickly constitution.
When pregnancy supervenes, undue sexual excitement of the mother often
has the most serious consequences to the fetus, and may result in its
death, or induce abortion.
Diet is to be regulated, to assist a firm determination to lead a
chaste and purer life. Stimulating and highly-seasoned food, and
alcoholic beverages, are not to be used, because they increase the
circulation of the blood and stimulate the nerves to inflammatory
activity. Meat should be eaten only once a day, and the supper should
be bland and light.
Nature has set a time during which continence should be practiced for
the purpose of preserving the health and controlling the reproductive
function, that is, the menstrual period. Menstruation in women
corresponds to the ripening and discharge of the human ovule. The
aptitude for impregnation is a day or two before and six to eight days
after the courses cease. This is a rule which applies to the great
majority of women, and if the sexual relations are suspended from a few
days before the onset of the menses until six or eight days after the
flow has ceased, the chances for pregnancy are reduced to the minimum.
This physiological relation of the organic function of conception to
the sexual act is to be recommended as the most wholesome check to
reproduction in early married life, although I believe that there is no
time better calculated to raise a family than while you are young and
hopeful.
Children are common objects of love and hope for both parents. Life and
health are ever changing the relations of our surroundings, and when
newly-married people put off to the dim future the hopes of rearing a
family, they are often doomed to everlasting disappointment. Nature is
capricious and jealous of her prerogatives, and those who trifle with
her functions must expect to be frustrated in the end, and have no one
but themselves to blame if she fails to respond to their capricious
wishes. Children make trouble of course, so were we as troublesome in
our time, but there is also a great deal of pleasure in watching them
grow from day to day in bodily strength and mental perception, which no
amount of selfish enjoyment can compensate.
The diseases that are brought upon women by the different practices and
mechanical devices to prevent conception are too numerous to mention in
a work of this character. Some of the methods are absolutely loathesome
to all sense of decency and reduce sexual intercourse much below the
instinctive indulgence of the brute; these debauches of the conjugal
bed not only sap the vitality of the participants, but must lower or
destroy all mutual respect, and ultimate in dissension and strife,
which the divorce court will finally assuage.
Referring to the practice of conjugal onanism or interrupted or
incomplete coitus, Dr. Franklin Devay says: “However, it is not
difficult to conceive the degree of perturbation that a like practice
should exert upon the genital system of woman by provoking desires
which are not gratified; a profound stimulation is felt through the
entire apparatus; the uterus, Fallopian tubes and ovaries enter into a
state of orgasm, a storm which is not appeased by the natural crisis;
a nervous super-excitation persists. There occurs, then, what would
take place if, presenting food to a famished man, one should snatch it
from his mouth after having thus violently excited his appetite. The
sensibilities of the womb and the entire reproductive system are teased
for no purpose. It is to this cause, too often repeated, that we should
attribute the multiple _neuroses_, those strange affections which
originate in the genital system of women. Our conviction respecting
them is based upon a great number of observations. Furthermore,
the normal relations existing between the married couple undergo
unfortunate changes; this affection, formed upon reciprocal esteem, is
little by little effaced by the repetition of an act which pollutes
the marriage bed; from thence proceed certain hard feelings, certain
deep impressions, which, gradually growing, eventuate in the scandalous
ruptures of which the community rarely know the real motive.” This is
in every respect as hurtful as the vicious practice of solitary vice,
although that is comparatively less common among young virgins than
among those of the opposite sex. Nevertheless, this is a frequent cause
of hysterical symptoms and uterine disease. Stop it at once; there is
no burden that a large family of children can impose upon you, be it
even poverty and want, as great as the inevitable results of these
unnatural habits.
The use of caps or tissue coverings, made of thin rubber or
gold-beater’s skin, are not only suggestive of the licentiousness of
the brothel but their employment causes physical lesions from their
irritating friction to the walls of the vagina. I have had under my
treatment obstinate ulcerations of the vagina which were due to their
use, and in one instance it degenerated into cancer. The use of the
“womb veil,” which originated in France, has been denounced as a
fruitful source of ulceration of the womb, by modern French writers,
who are more familiar with their indiscriminate employment than
Americans. There has been also a plug or stem pessary employed for the
purpose “of sealing up the womb,” which is partly introduced into the
mouth and cervical canal of the organ; this obviously adds insult
to injury, by also irritating the cavity of the womb and exciting
inflammation of its lining membrane. There are other devices for a
similar purpose, that have the same tendency of irritating and wounding
the genitals of the female.
There is nothing that could be said, to intimidate some women, by
forewarning them of the danger of their preventive measures; they will
continue to make business for the specialists, and drain the purses of
their husbands, but there is a great majority of good, noble, matronly
women who are pure in heart and mind, that appreciate the value of
the information that I impart. What I desire to further suggest, is
a preventive measure that is entirely harmless and consistent with
chastity and cleanliness, for I believe that within certain bounds, a
woman has a moral right to limit or control the conception of her womb.
But right here the option ceases. If she pushes her measures beyond the
portals of the womb, if she employs medicines or mechanical devices to
bring around her courses, when she suspects pregnancy or conception,
she becomes a murderess in the eyes of the Creator. The bowl of tanzy
tea, or any of the many quack nostrums, advertised in the public
prints, are as much an instrument of murder as the _probe_ of the
abortionist. It would be the height of sophistry to make a distinction
between the embryo of an hour or a day old, and that of any future
period. The potentiality of a human being is established at the moment
of conception, and the destruction of this, at any period, is homicide.
No one can deny less importance to the cause, which is conception, than
to the effect, which is the human embryo, for without the one, the
other is impossible.
Hence, not to bear a child implies not to conceive a child, for if once
conceived, it must be born.
The reasons that may exist for limiting the progeny of each particular
pair cannot be formulated into a code, for these are questions of
conscience, between the individuals and their Creator, on the
one hand, and on the other, they should be influenced by economic
conditions and physical or constitutional taints of the progenitors.
I do not believe in the truth of the law of Malthus, that there
is a tendency for population to increase faster than the means of
subsistence, but I am inclined to the view held by John Stuart Mill,
that “no one has a right to bring children into life to be supported
by other people.” But when the same eminent authority designates the
procreative act as brute instinct, I think he is in great error, for
that is not so. Conjugal affection and the sentiment of love spring
from the reproductive systems, through the reflex action of the brain,
and these have their moral significance, and should not be branded as
brutal, for upon their normal functions depends the perpetuation of the
race, and as it was so ordained by the Creator, it cannot be an unholy
passion.
To be physically strong and well are the prerequisites for happiness,
and if we cannot transmit to our offspring this essential quality,
it would be much better for society if we were not instrumental in
bringing defective children into the world. The competitive struggle
for existence is hard enough for the vigorous and robust; how much
greater must it be for the constitutionally infirm? When these
conditions of infirmity exist, they should influence our course as
progenitors; this appears to me self-evident, and I trust in the wisdom
that is innate to the human soul, that only the best ends will be
subserved.
An expedient that is to accomplish the object in view, must be in
the nature of a wholesome sanitary measure, that violates no law of
nature. The inordinate use of any preventive, coupled with excessive
indulgence, cannot be without ill effects. Excesses must be studiously
avoided, so as not to incur the diseases of which mention has
already been made. The employment of a vaginal douche of the proper
temperature, medicated with a little pure alcohol, is not injurious and
is the most reliable of all preventives, provided it is intelligently
used and without delay. The quantity of fluid to be used is a _quart_
of warm water, of 103 to 105 degrees Fahr., to which two tablespoonfuls
of alcohol is added; of this, three-fourths or all is to be douched
through the vagina.
The vaginal irrigation is to be undertaken immediately after the act;
if sufficient time is allowed to pass, the spermatozoa will have
entered the mouth of the womb; then they are clearly beyond the reach
of the wash. The warm water and the necessary paraphernalia are to
be held in readiness so as to lose no time in making the toilet, nor
should there be unnecessary exposure to the danger of catching cold.
The nozzle of the syringe should always be of hard rubber, because
that is not likely to rust or corrode. The syringe is to be kept
scrupulously clean by means of occasional brushings in soapy water.
Vaginal injections should never be taken in the morning, if the person
is required to exercise on her feet, and for the same reason, should
any husband have marital relations with his wife before rising in the
morning, the wife is likely to suffer all day, either by soreness or
pain or by a dragging sensation of the womb and vagina.
The same rule is to be followed in vaginal irrigation as for other
purposes, the main point being to throw the fluid well up into the
vagina, and that can only be done if the nozzle is carried directly
backward and not upwards. No violence or force is to be used, under any
circumstance.
CHAPTER VII.
CRIMINAL ABORTION OR FETICIDE.
I HAVE so far endeavored to give a cursory description of _avoidable_
causes, which were inadvertantly or thoughtlessly encouraged, and it is
to be hoped that my friendly reproof and counsel will incite my readers
to modify their pernicious habits and direct the currents of their
thoughts into channels more or less in harmony with the hygiene that I
have been at liberty to suggest.
There are few persons, if any, who would voluntarily act and think in a
manner that would be prejudicial to their physical or moral welfare, if
they were educated to a standard of knowledge that gave them an insight
into the evil consequences. The law of _self-preservation_ is innate in
our natures, so that we are ready to cultivate the good and useful and
shun that which may do harm.
Among the avoidable causes there is none so prolific of disease as that
which is traced to the premature expulsion of the ovum or fetus from
the mother’s womb.
This appears self-evident, when we stop to consider that the function
of reproduction is at once by far the most complicated of the
physiological processes of the female economy, so that its sudden
interruption will naturally induce any one or all of the physical or
pelvic ailments which we are called upon to discuss.
For our purpose it will not be sufficient to consider the subject from
a medical standpoint alone, because the thoughts drift involuntarily,
as it were, from the physical into the metaphysical, from the material
into the spiritual part of our nature.
It is not within the scope of this work to enter upon an inquiry
into the scientific evidence of the existence of the soul or advance
any argument whatever in support of that doctrine, but I assume the
existence of an immortal soul to be a fact.
What I will endeavor to explain is when and where this mystic union
of the soul with the body takes place? Here the speculations of the
medical philosophers have been contradictory, on account of attributing
to the fetus different kinds of life, that is, an organic or vegetating
existence attached to the mother’s womb, and as such not possessed of
sentient principle, until the real or spiritual life imbues the fetus,
when it becomes a living soul.
Hippocrates, the most famous physician of antiquity, who, even in the
light of the nineteenth century, looms up as one of the most brilliant
intellects that the world ever had, lent the weight of his judgment to
this very unreasonable doctrine.
He supposed that animation occurred from thirty to forty-two days after
conception.
The Stoics went still further and maintained that there was no vitality
until after birth and the establishment of respiration.
The Academicians were of the opinion, that life was imparted to the
fetus during the period in which the mother carried it in the womb, but
they could not agree on the time when it began. Even the Roman Church,
which, in the main, is right on this question, speaks of _animate_ and
_inanimate_ fetuses. When it is remembered that there was no scientific
physiology upon which the ancients based their opinions, it is not at
all surprising that, in the light of modern research, they are shown to
be all wrong.
There is no time during the child’s sojourn in the mother’s womb that
life is less active than at another, and any opinion to the contrary is
manifestly absurd and unscientific.
I appreciate the distinction between _physical life_, or vital
activity, and spiritual life, but the one must necessarily be in the
other.
A central fountain of physical force is consistent with scientific
deductions, and physicists are inclined to admit such a source. Many of
the phenomena of the material world are explained upon this hypothesis.
The sun is supposed to be that central fountain of physical force which
inspires activity in matter on this planet. Matter in itself is inert
and motionless; the globe we inhabit has no energy in itself which
could keep it in motion, but the forces playing on and around it impart
to it its motive power.
The life of any complex organism, such as that of man, is in fact the
aggregate of the vital activity of all its component parts, and each
elementary part of the fabric has its own independent power of growth
and development. If we contemplate the history of the life of a plant,
we perceive that it grows from a germ or seed to a fabric, sometimes of
gigantic size,—it multiplies its species, by the production of germs
similar to that from which it originated. This it performs without
feeling or thinking or any effort of its own. All the functions of
which its life is composed are grouped together under the general
designation of organic functions, or vegetative life.
In the building up of the animal structure we have precisely the same
operations taking place, one minute cell added to the other, like the
stone mason running up a brick wall, each brick representing a cell,
until the structure is completed.
The question that we are particularly interested in is whether this
“animal life” which stimulates the growth of the fetus from its first
inception, can be any the less sacred at one time than at another?
There is a general impression among a large portion of the community
that the fetus first becomes endowed with life at the period of
quickening, which is between the fourth and fifth month of pregnancy.
The time when the mother first feels the motion is considered the
period when the child becomes animated, that is, when it receives its
spiritual nature into union with its human nature.
The English law recognized the truth of this infamous doctrine, in
varying the punishment of an attempt to procure abortion according
to whether the woman be “quick with child or not,” and in delaying
execution when a woman can be proved to be so, though the execution is
made to proceed, if she be not “quick,” even if she be unquestionably
pregnant. This was a most barbarous penal provision and hardly
excusable in a savage nation, much less among a Christian people,
because it is contrary to all fact, to all analogy, to reason, and at
variance with biological science.
If the embryo or fetus is simply an animal growing in the mother’s
womb, until the period of quickening or birth, it would not be a crime
to procure an abortion, at any time, before these events take place.
No sacrifice of a human life would be involved, so that the act would
be simply a “misdemeanor” regulated by the degree of injury which the
mother sustained as a result of the operation. This was the prevailing
opinion for many centuries, until, in the year 692, the Roman Empire so
amended its law that the procuring of an abortion at any time during
the period of gestation was _homicide_, murder, to be punished with
death.
France patterned after the Roman law for a time and made criminal
abortion punishable by inflicting the death penalty; during the French
revolution this law was amended by imprisonment for life; and later,
under Napoleon, in 1810, the law was again changed, and the punishment
lessened.
In England there has been a gradually growing moral sentiment to
protect the defenseless child in its mother’s womb, so that to-day
England has so amended her law that the fetus has the same protection
in the uterus before as after quickening, so that a conviction for the
procurement of criminal abortion at any time during gestation from
conception until birth is _felony_ and punished by imprisonment or
transportation.
In Germany the law makes abortion a State prison offense, and public
opinion is in such a healthy state there that anyone justly accused of
this crime is quite sure to meet with a punishment.
In America legislation on this subject differs widely in the different
States. In Massachusetts the barbarous distinction, “before quickening
and after,” was still recognized a few years ago, so that the crime of
abortion before quickening was not an indictable offense. In some of
the States the laws are stringent and conform with the physiological
facts of fetal life, but, like most of our “good laws,” they are.
observed only in the breach.
The essential peculiarity in the process of reproduction is the
absorption of a small cell of the male, the spermatozoon, by another
small cell of the female, the ovum. This coalescence of the two, _male_
and _female_ cells, is the fertilization of the ovum, and constitutes
_conception_.
The spermatic fluid of the male holds in suspension a large number
of very small bodies, or cells, which, from their usually remaining
in active motion for some time after they have quitted the human
body, have been erroneously considered animalcules. A more thorough
familiarity with these bodies, and careful microscopic examinations,
can distinguish nothing in the nature of structure within them. They
are simply little oval, flattened, transparent cells between the
one-six-hundredth and one-eight-hundredth of an inch in length, having
a little thread-like “tail,” gradually tapering to a fine point.
These measurements make the spermatozoa considerably larger than the
average red blood-corpuscle, which is one-thirty-two-hundredths of an
inch in diameter.
The spermatic fluid of a single emission of a healthy male contains
thousands of these little ciliated cells, the cilia or tails of which
are seen in an active vibratile undulatory motion, in the field
of the microscope, wriggling hither and thither, like a school of
frightened fishes. This lashing motion is continued for hours, and
under favorable circumstances for days. In the cases of microscopical
examinations of vaginal secretions of married women, for causes of
sterility, I was able to establish their activity thirty-six hours
after marital relations.
Through this peculiar lashing motion the ciliated cells are propelled
onward and upward, through the mouth and cervix of the womb, thence
along its body to the openings of the Fallopian tubes, along which they
migrate to the ovaries of the female. In a healthy condition of the
female generative organs, hundreds of spermatozoa arrive at the ovaries
about the same time, a few hours or days after copulation, but as the
ova ripen and are discharged only at regular intervals, the hundreds of
ciliated bodies that travel thither are doomed to disappointment, and
gradually lose their vitality, and perhaps are removed by absorption.
Of all these hundreds of germs it requires only a single one to combine
with an ovum, or a similar little cell of the female, to constitute
conception. When this combination has been accomplished, a new being
is inaugurated, another human soul is started out, by the magic wand
of nature, to go through the different spheres of evolution, of whose
ultimatum we can have no clear conception, but this is perfectly clear,
that after this coalescence of the two germs, the die is cast and the
female becomes then only the vehicle in which the creative forces are
effecting their elaboration.
Coition and conception are widely different processes, and require to
be separately analyzed to be understood.
Coition is always a physical act, a gratification of the senses,
and, like many other human passions, is often abused by excessive
indulgence, degenerating into lust.
Conception, on the other hand, is purely passive, an organic function,
without consciousness on the part of the female.
Thus far there is a similarity in the organic processes of conception
in all mammalia, so that their embryos cannot be classified and
assigned to their respective species in the early stages of their
development. Physiologists are unable to say whether the one belongs
to and will ultimately develop into a brute animal or a human being,
yet one has the attributes of mental force, the elements of a soul,
while the other is to follow a blind instinct, without the possibility
of spiritual perception. Conception, in the one case, is simply a
vegetative or organic function, while in the other there is, in
addition, a spiritual effort to individualize a human soul.
The creative energy of nature is separate and independent of the sexual
act, for it does not take place during copulation of the sexes, nor
immediately after it, but hours or days after the act is accomplished.
I am often called upon to say when and where the human soul becomes
associated with the human body?
There is a divine life, or spiritual energy, that animates the soul
from the spiritual realm. It is the correspondency of the physical
force that animates the physical body.
The term or phrase which I employ to designate this force is of less
importance than the definition which is given to it, and upon this,
of course, we must agree. I recognize in such an energy or power, the
primal cause or force, behind and beyond the phenomena of nature. This
force must be universal and omnipresent, hence _spiritual_; it must
be the central source of supply for all spiritual things, so that the
doctrine of Paul is scientifically in harmony with a rationalistic view
of the subject, when he says “in Him we live and move and have our
being.”
The science of the _conservation of forces_ teaches, that forces are
never lost, that they are indestructible and eternal. We derive our
spiritual existence from this central spiritual sun and inherit the
quality of eternity with it. Mind is spirit and the soul is mind; this
is the view of Spinoza, who, in the second part of his work “Ethics,”
employs the terms synonymously throughout the chapter “Of the Nature
and Origin of the Mind or Soul.” Mind differentiates man from the
inferior animal creations, and can make him what he will.
Professor Carpenter in his “Principles of Human Physiology,” tells us,
that when we first discern the primordial cell, which is to evolve
itself into the human organism, we can trace nothing that essentially
distinguishes it from that which might give origin to any other form of
organic structure. The earliest stages of its development consist in
simple multiplication of cells by “duplicative subdivision,” so that
a mass of cells comes to be produced, amidst the several components,
of which no difference can be traced; and this also finds its parallel
among the simpler organisms of both kingdoms. There is nothing at
this period to distinguish the germs of man from that of any other
vertebrated animal, yet in the course of nine short months a human
being is developed possessing all the faculties of its progenitor, and
how could all this come to pass, if not instituted at the moment of
conception?
It is at this time and moment, that an _atom_ of the universal spirit
becomes separated and individualized, and the germ of a human soul
is implanted, deep in the dark recesses of nature’s laboratory. The
ovum of the female and the germ of the male coalesce, imbued by the
incarnation of the immortal spirit, and no time can be more opportune
for that union than at the very inception of our being, because the
soul and the body must interact, one on the other.
In the reproduction of man, there is a higher purpose than simply to
multiply the species. The Creator can only manifest Himself, if he has
intelligent souls or spirits as his creatures, and the reproduction of
the human species is the natural means of bringing this about.
The mystic union is accomplished at the time and moment of conception,
when a _unit_ of the universal spirit becomes _individualized_ into a
human soul. In the dark recesses of the mother’s womb the ovum of the
female and the germ of the male, imbued by the immortal spirit, begin
their growth and development together, this constitutes the _triune_ of
nature, from which the evolutions of body and soul take their beginning.
Sexual instinct is not an unholy and depraved action of the human
mind, but the necessary means to an end, a finite instrumentality
of the Divine mind to procreate the body, as an abode for the human
soul. One of the attributes of the Creator is, in the very nature of
things, _to create_, and he has thus endowed us, His creatures, for
the manifestation of His creative power. He perpetually and eternally
creates, and this has no reference to time, place or space: just as
in the beginning, God created all things, so we recognize the supreme
hand, now, to-day, and forever, ever active in His natural element.
The operation of nature’s law may be contravened by the selfish,
sordid, criminal acts of the human heart, but it cannot be frustrated.
No one can console himself, that the invincible law of evolution is
at the capricious behest of finite man, and can be neutralized and
obstructed at will; that would place a limitation on the Creator;
it would contradict the omnipotence of the Divine mind; it would
place every life or soul at the mercy of the sordid conscienceless
abortionist, and it would reduce the Divine origin of man and the
soul’s immortality to an absurdity.
After the fetus is murdered, its soul continues to grow in the
spiritual realm, an undying witness of the criminal infamy which
deprived it of that earthly experience which nature intended for the
children of men. It is the greatest crime against nature to kill off a
human fetus, and prematurely hurl into eternity a human soul, which has
the same right to human experience as those already born, and, in the
eyes of God, it is no less a crime than the murder of an adult.
“Dust thou art, to dust returnest,
Was not spoken of the soul.”
The meaning of the term abortion is etymologically not to be born or
not to be carried out, or, in other words, the premature expulsion
of the fetus from its mother’s womb, which is any time before it is
capable of independent existence. This is according to the construction
of the law of France, which means any time previous to the termination
of the sixth month of pregnancy. Abortion may be accidental, that is,
it may be due to a casualty which was entirely beyond the control of
the person suffering or going through an abortion, or it may be due to
disease affecting either the embryo or the mother.
The word “miscarriage” is generally preferred to that of “abortion”
under the misconception that only the latter implies criminal
culpability; this, of course, is an error, because each word means
exactly the same thing, with this difference, that one is of Latin
origin, while the other is a plain Anglo-Saxon term. An abortion that
is brought about, from other than natural causes, for the deliberate
and avowed purpose of escaping from the inconvenience, privation, and
cares of maternity, is always qualified by the adjective _criminal_.
In the early months of pregnancy, it very seldom, though it
occasionally does happen, that complications arise which place the life
of the mother in imminent danger; that the embryo shares this danger in
a corresponding degree is self-evident, because the fetus is unable to
live independently of the mother any time before the expiration of the
sixth month of gestation, so that the death of the mother means death
to the fetus also.
Through a fall, heavy lifting, or a sudden jar, a partial detachment
is liable to occur between the placenta of the fetus and the wall of
the mother’s womb, that being the place where the blood of the one
is exchanged into the blood of the other; from this, a hemorrhage
may result, which will not yield to rest nor to other means which
experience has taught to be useful. This loss of blood may be so great
that, if it continues, the life of both will be sacrificed.
In some women pregnancy may become complicated with convulsions; these
may be so violent, and recur so often, as to threaten life, and they
are obstinate to all medicinal resources.
Contingencies of the above nature evoked the scientific inquiry,
whether abortions are ever justifiable. The answer must invariably be,
that when it is clearly seen that the mother will surely die, and her
fetus with her, an induced abortion becomes a justifiable obstetric
resource, and under these circumstances it is not a crime nor even a
sacrifice of the embryo, which would have perished with the mother.
This rule of practice has been endorsed by the very highest authority
in obstetric science, and the competent conscientious physician will
readily draw the line between cases where so radical a measure becomes
necessary, and where milder conservative measures will save the life of
both mother and child.
This cannot be a license for crime, except that the sordidly depraved
time server may often try to stretch the threatening danger, but when
this is done it is no less a crime of murder in the eyes of God, than
if he had premeditatedly and willfully slain a fellow-being.
Such persons would not shrink from the perpetration of any crime, be it
ever so heinous and black. These wretches are too cowardly to thrust a
poniard into their victims on the highway, but ever ready to operate
in secrecy in the abortion chamber, which is hidden from the eyes of
man. I have known abortions being sought and abortions being committed,
upon the flimsy pretext of being too weak, or too sick at the stomach.
These are shallow subterfuges, that should not be countenanced by any
conscientious practitioner.
Many reasons are either imaginary or pretended, and I have often proved
the fallacy of pretensions of an inability to carry a child, after
women had gone through the abortion mills, by persuading them to become
reconciled, for the time being, and that I would see them through to
a happy end, and in no case were their fears justified by subsequent
developments. There is a great deal in controlling the minds of these
women, and directing them into wholesome channels of thought, and after
that they become much happier and contented than ever before in their
married lives.
If the proposition is generally accepted, that abortions are
justifiable as a therapeutical expedient, you open the door to the
criminally inclined. Wily women will impose upon inexperienced
practitioners by feigning physical suffering as a result of pregnancy,
for the purpose of getting rid of their fetuses. There is a certain
amount of hardship and discomfort associated with the average pregnancy
for a part of the period at least, but this should be suffered with a
mother’s fortitude.
The testimony of the early canons of the Catholic Church is very
decisive on the crime of abortion, namely, “that the destruction of the
fetus in the womb of its parent, at any period from the first moment of
conception, is a crime equal in turpitude to murder.”
In Protestant countries abortions are on the increase, and in America
it is one of the crying crimes of society, which has so thoroughly
tainted and defiled the moral sense of American communities, that it
has become next to impossible to get a jury of twelve men who will
agree on a verdict to punish this dastardly foul crime of murder, and
the abortionist is thus encouraged in his iniquitous vocation.
Professor J. Taber Johnson, of Maryland, stated in his annual oration
before the State Medical Society: “The difficulty of conviction for
producing abortion is shown in the statement of the Attorney-General of
Massachusetts, that of thirty-two arrests and trials of abortionists
in that State, in a period of eight years, not a single conviction
resulted; and this fact is equally true of other States.” This is
indeed a sad commentary on the jury system, which often degenerates
into a farce or travesty on justice.
The practice of abortion is on the increase. This is not due to a
single cause, but to a number, operating separately or co-operating
jointly to the same end. Boarding-house or hotel life exercises a
pernicious influence on the habits and morals of women. They sit all
day in their apartments with indifferent occupations, or walk the
streets between meal hours, without the inspiring thoughts which a
cozy home alone can inspire. The maternal instinct languishes or
dies completely out, and if women become pregnant while transiently
domiciled, they scruple not against committing this great crime,
because their surroundings and accommodations may not be suitable for
the changed relations which motherhood brings about. If these people
had their own little homes, were they ever so humble, their minds
would run in different grooves, their lives would be much happier and
offspring longingly desired, to fill the nooks in the little household.
Want of domestic training in childhood lays the foundation for this
crime. The American girl is trained with a view to display so-called
refined accomplishments. This is done by totally ignoring domestic
duties; these are to be shunned as menial and degrading; and when girls
grow into womanhood and are married, they naturally look upon the
ordinary household duties as drudgery, and quite unbecoming a woman
of their attainments. There is nothing in their bosoms to arouse a
pride in their homes; quite the reverse; that principle has never been
inculcated in their youth, so that it is quite natural, that they hie
to a boarding-house; here they patronize the abortionist, or acquire
proficiency in that art themselves, from lack of nobler occupation.
Changed relations of the sexes destroy the maternal instinct. A man
in a man’s place, and a woman in the sphere for which God and nature
intended her, is for the best interests of society. There is useful
and profitable work for everyone, but each should labor in his or her
respective field of natural adaptability, in which there is plenty to
do. There is, in the very nature of things, never anything gained by a
woman doing a man’s work, because there are always plenty of men around
to do that, but while a woman is doing a man’s work, she is necessarily
neglecting a woman’s, which it is physically impossible for any man to
do for her. There is, consequently, an irretrievable loss to society
from misapplied labor. When the great Napoleon was asked by Madam de
Stael whom he considered the greatest woman in France, his curt reply
was, “She who bore the largest number of children.” This is a tribute
to motherhood, which no one can ridicule, for whom should we honor
and respect more than the faithful, loving mother, who makes her life
subservient to that of her children? There is no comparison between
the self-denial of parental devotion and the devotee to amusements and
fashion, or the slothful wife, who imposes sterility upon herself for
the sake of pandering to depraved appetites and frivolous pleasures.
Depraved associates pave the way to feticide. Some married women
are so brazen and callous, that they have no delicacy in narrating
their exploits of child murder with a triumphant air, whenever their
acquaintances are patient and foolish enough to listen to them. These
gadding persons often contaminate the minds of newly-married women,
who had never for a moment entertained the thought of such an awful
crime, and who would have made happy and contented mothers, were it not
for the seeds of discontent and crime which were sown in their early
matrimonial career. I have known mothers who had lost the delicate
maternal instincts, without which a mother becomes a monster, advise
their daughters and encourage them in the perpetration of this crime.
Women of this type should be avoided like the dreaded mancanilla
tree, for they poison the body and soul of pure, virtuous women, with
whom they come in close contact; they should be shunned by the young
housewife like a pestilence, because their hands are scarlet with the
blood of their own children.
Unprincipled physicians are too often instrumental in abetting criminal
abortions, and this for two reasons, namely, for the immediate lucre
which is to them in hand paid, and also for ingratiating themselves
into the confidence of their patrons, so that they may become their
physician in other ailments. These are the pariahs of the profession,
but, viewed from a business standpoint, they are very successful. It
is through the looseness with which medical colleges are conducted
in this country, many of them not deserving the name of college, but
more properly denominated a rendezvous of self-constituted professors
and ingenious advertising sharps, that the ranks of the profession
are overcrowded, because there is no scrutiny of moral character or
professional attainments. These once labeled M. D.’s are determined
to make a professional living, and nothing deters them from becoming
_particeps criminis_, but owing to the corrupt and depraved jury
system such a thing as punishing a physician for feticide is hardly
ever heard of. I would advise my readers to shun each and every one of
these criminal monsters as they would a pestilence. In general, “female
specialist” is but another name for abortionist, for the great majority
of these self-constituted specialists do not know the rudiments of the
science of gynecology; and women should exercise great precaution in
whose hands they place themselves, or, rather, their lives. I know of
no calling that is capable of rendering more good to humanity than the
profession which I have made my own.
The honorable physician occupies a position where he can do a great
deal to improve the tone and morality of the community. He can do more
than the pulpit in preventing feticide, because he can depict the
physical dangers and the moral turpitude, for it is to him that the
deluded woman first goes for advice. It is with him to become an oracle
of heaven; in the great majority of instances he can be instrumental
in saving human life and prevent the mother from murdering her own
child.
Maternity is the function of Divinity in human nature. Who can look
upon a newly-born babe without seeing something truly Divine, a
manifestation of the Divine mind to create in his image, through the
instrumentality of man, an innocent human flower, planted upon this
earth to enjoy the fullness thereof, and what miscreant shall deny it
its inheritance?
That husbands are often the instigators of this crime is a fact well
known to every physician of experience. I have known of a number of
cases where wives came to my office with a woeful tale of discontent
on the part of their husbands, who did not want an “_increase_.” Such
men are not worthy the name of father or husband. They should have been
emasculated before they ever approached the marriage altar, for they
are below the brute creation and have no claim on human affections.
The luxuries of life should not be considered as weighing against
the birth of children, nor the expense of maintaining a large family
considered as an excuse for feticide; expenses had better be reduced
and economized in other directions, so as to meet the little extra
increase, which the little stranger may cause. It is a fact, that among
thrifty people, large families are no barrier to material success, for
the blessedness of heaven rests upon them.
I invariably solicit an interview with the recalcitrant spouse, and
take the opportunity to tell him of the responsibilities which married
life imposes upon married couples; that the simple gratification of
the carnal senses is lust, which can and should be controlled by every
person, and more in particular by married men. Matrimonial relations
based only on libidinous pleasure are transient and evanescent;
incompatabilities arise, which cause conflict and dissension,
ultimating in estrangement and divorces, but when soul is wedded to
soul, then they are in harmony with the music of the spheres, and
children constitute the cement of an eternal wedlock which no man can
rend asunder.
Abrupt termination of pregnancy constitutes in itself a diseased
process in the tissues of the womb. We have already learned of the
gradual growth of the body of the womb to accommodate the growth of the
child; when abortion takes place there is a sudden check to this growth
in the tissues of the womb, and a low grade of inflammation invades
the entire structure. This inflammatory process fixes or hardens the
womb so that this acquired enlargement often becomes permanent. The
result is, that women can often trace the beginning of a long series
of complaints and a shattered constitution to a so-called miscarriage.
For this reason, the after-treatment of an abortion is of much greater
importance, than after a regular normal delivery.
After the close of a natural gestation, the child is born, and nature
immediately sets to work to restore the womb to its healthy normal
size. No violence having been done to the organ, there is no extra
effort necessary on the part of nature to restore it. In a premature
expulsion of the fetus, it is altogether different, the cell growth
and the necessary physiological action to build up the womb, to house
the rapidly-developing fetus, was suddenly interfered with, and the
shock which the vital activity sustains, diverts their energies into
a diseased process. Inflammation is to be guarded against, for it
constitutes the root of all pathological conditions; chief among
them is its prevention of fatty degeneration and absorption of the
superfluous tissues of the organ, so that the womb remains heavy and
enlarged. This entails a series of consequences; its size and weight
may force it to occupy an unnatural and painful position, such as a
falling of the womb or _procidentia_, or it may turn or even bend on
itself into abnormal positions, called _versions and flexions_; these
become obstinate to treatment in proportion to the time which elapses
from the occurrence of the disease to the time when they fall under
proper treatment.
Inflammations are limited sometimes to only portions of the organ; this
may be to the lining mucous membrane of either the body or neck. It may
also invade the entire organ and even extend to the neighboring tissues
and ligaments. From the uterus along the Fallopian tubes to the ovaries
inflammation may spread itself, causing abscesses in its wake and other
complications which may require surgical skill of a special nature to
give permanent relief.
Sterility is often the result of disease caused by abortion, and this
should be another warning to thoughtless, giddy women, who desire no
children in their early married life, because it would interfere with
their regular pleasure rounds, and so resort to abortions, which will,
in all probability, make them entirely unfit to ever become pregnant
or bear children. I have made an attempt to impress on the reader
two things; one of these is the flagrant violation of ordinary and
simple rules of health, the other the enormity of the crime of induced
abortions, and to accomplish this I have avoided screening the subject
by employing ambiguous or finely-selected phrases, but have used plain
terms which will not shock the pure or noble in heart and mind, but may
the hypocritical, under the gauze of a false modesty.
[Illustration: PLATE I
The Bony Pelvis in its relation to the entire body.
From the author’s original drawing.]
CHAPTER VIII.
ANATOMY OF THE FEMALE ORGANS.
THE bony part of the skeleton which is of particular interest to women,
is the pelvis, so called, because it forms a basin or cavity which
contains the most important female organs of generation.
All the organs that are liable to the diseases of women, bear certain
anatomical relations to the pelvis, so that the phrase, _pelvic
diseases of women_, is often employed instead of the phrase, _diseases
of women_, and pelvic surgery means also, surgical procedures, that may
be employed for the relief or cure of these diseases.
In confinement, the pelvis again comes into more or less prominence,
for when the diameters of the pelvic canal have not their normal
measurements, there is likely to be an obstruction to the passage of
the child into the world, so that mechanical means must be employed to
overcome the obstacle. A broad pelvis in a woman is always a guarantee
that there will be no insurmountable difficulty in the parturient act.
PLATE I shows the shape and locality of the bone in the human body, and
gives also an approximate idea of the relation of the pelvis to the
rest of the body.
While the pelvis was referred to above as a basin or cavity, this is
only partly true, for it is also a canal or passageway, through which
the child is born. The pelvis is divided by a prominent line into the
false and true pelvis.
The False Pelvis is all that expanded portion of the pelvic cavity
which is above the rim or line that forms a circular ridge, which
marks the beginning of the bony canal to which the term true pelvis is
applied.
The True Pelvis constitutes the lower subdivision of the pelvic cavity.
The circular ridge, which marks the division, constitutes also the
_inlet_ of the true pelvis, which is much smaller than the upper or
false pelvis. Its walls are more perfect and their lower circumference
is very irregular and forms what is called the _outlet_. Between the
_inlet_ and the _outlet_ we have what is called the true pelvic cavity,
in which the internal female generative organs are contained.
These organs are located in the following order from before backwards:
first, behind the pubis there is the bladder, and behind this is the
uterus, and thirdly and a little to the left is the rectum.
On each side of the womb, but also in the small or true pelvis, are the
Fallopian tubes and ovaries.
In this order the anatomical relations are easily remembered, and I
believe that every woman should make it an object to learn at least
as much of her own anatomy as I have laid down; because there is just
little enough, so as not to make it tiresome, and quite enough to
insure intelligent reading in the subsequent chapters.
The points of differences between the male and female pelvis are
entirely on the principle of adaptation to natural functions. The
female pelvis has a broadness or greater prominence of the hips and
a correspondingly greater pelvic cavity, while that of the male is
altogether more massive.
Its cavity is deeper and narrower, and the muscular eminences and
impressions on the surfaces of the bones are much stronger marked.
PLATE II. This illustrates a cut or section, through the middle of
the pelvis, from before backwards, so as to give a side view of the
capacity of the true pelvis and of the organs that it contains. A
careful study of this plate will permanently fix the anatomy in the
reader’s mind.
[Illustration: PLATE II
A Median Section of the female Pelvis and of the Organs that are
centrally located.
This plate is anatomically correct; the uterus resting normally on and
being elevated by the distended bladder.]
The lines _a_ and _b_ show the planes of the inlet and outlet of the
true pelvis, and it will be seen that within these lines the most
important organs of the female are located.
THE BLADDER.
The bladder is situated at the anterior part of the pelvis. It is in
relation, _in front_ with the _symphysis pubis_, behind with the womb,
some convolutions of the small intestines being interposed; its base
lies in contact with the neck of the uterus and with the anterior wall
of the vagina. The bladder is said to be larger in the female than in
the male, and is very broad in its transverse diameter.
THE URETHRA.
The urethra is a narrow membranous canal, about an inch and a half in
length, extending from the neck of the bladder to the external orifice.
It is placed beneath the symphysis pubis, embedded in the anterior wall
of the vagina, and its direction is obliquely downwards and forwards.
Its diameter, when undilated, is about a quarter of an inch; behind the
bladder and urethra, there is in regular order the uterus and vagina,
and behind both of these, the rectum.
THE PERINEUM.
The Perineum is the muscular triangular body between the vagina and
rectum; it constitutes a segment of the female pelvic floor; it is
the _prop_ for all the pelvic organs, and for that reason every woman
should know precisely what it is, and study the plate carefully until
she understands it. The skin covering it is of a dark color, thin and
freely movable over the underlying parts. There is no part of the
pelvic anatomy so vulnerable, because in confinement during the passage
of the child’s head into the world, the perineum is put on a great
stretch, and if the delivery progresses too quickly or is hurried, then
the tissues have no time to stretch themselves so as to accommodate the
child’s head, and they must naturally tear.
The awkward and officious use of instruments will do the same thing. I
have seen the perineum torn asunder from this cause, from the vagina
and back into the rectum.
PLATE III is one of the most instructive drawings that I could devise.
It gives the reader a practical illustration of the internal generative
organs and their anatomical relations to each other. This was a drawing
from my own dissection, and the clearness and artistic reproduction is
due to the skill of the engraver, Mr. H. X. Van de Casteele, of this
city.
THE VAGINA.
The vagina is a membranous canal, extending from the vulva or
_introitus_ to the uterus. It is situated in the cavity of the pelvis,
between the bladder in front and the rectum behind; its direction is
not in a straight line, but curved from below backwards and upwards.
When distended it is cylindrical in shape, but naturally it is
flattened from before backwards, so that its walls are ordinarily in
contact with each other. In length it averages about four inches in
its anterior wall, while its posterior wall describes a segment of a
larger circle, that makes it between one and two inches longer. At its
commencement it is constricted, and at its upper extremity, where it
is attached to the womb, it is dilated, so as to surround the vaginal
portion of the neck of the womb (_see_ Plate III, _c_) this is a short
distance above the mouth of the womb. The attachment extends higher up
on the posterior than on the anterior wall of the womb, which makes the
posterior lip of the womb longer than the anterior.
The mucous membrane is continuous above with that covering the
vaginal portion of the uterus; below it begins at the vulva. Running
longitudinally along the anterior and posterior walls are distinct
ridges or raphe; these are the columns of the vagina.
The relations of the vagina to the neighboring organs can be studied to
better advantage by referring to Plate I.
[Illustration: PLATE III
The Vagina slit open to the neck or Cervix of the Uterus, showing the
insertion of the latter into the former.
From the author’s own design, beautifully illustrating:—
_a._ Fundus (or Base) of the Uterus.
_b._ Uterus’ Body.
_c._ Cervix, or Neck.
_de._ Vaginal part, forming the Anterior and Posterior Lips.
_f._ Mouth of the Womb.
_gg._ Interior of Vagina, illustrating the Vaginal Folds.
_h._ Perineum.
_ii._ Round Ligaments.
_kk._ Broad Ligaments.
_ll._ Uterine Vessels and Nerves.
_mm._ Fringed Extremity of the Fallopian Tubes.
_nn._ Fallopian Tubes.
_oo._ Ovaries.]
Its anterior surface is concave, and is in relation with the base of
the bladder and with the urethra. Its posterior surface is convex
and connected to the anterior wall of the rectum for the lower
three-fourths of its extent, the upper fourth being separated from the
tube by a fold of the peritoneum, the _recto-uterine fold_, which forms
a _cul-de-sac_ between the vagina and rectum. Its sides give attachment
superiorily to the broad ligaments, and inferiorily to the Levatores
Ani muscles and recto-vesical fascia.
THE UTERUS OR WOMB.
The uterus is the organ of gestation, receiving the fecundated ovum in
its cavity, retaining and supporting it during the development of the
fetus, and becoming the principal agent in its expulsion at the time of
parturition. In the virgin state it is _pear-shaped_, flattened from
before backwards, and situated in the cavity of the pelvis, between the
bladder and the rectum. It is retained in its position by the round
and broad ligaments (Plate III, _ii_ and _kk_) on each side, but _also
by virtue of its anteverted position, and by the vagina and perineum_.
Its upper end or base (_a_) is directed upwards and forwards; its
lower end, or apex, is directed downwards and backwards in the line of
the axes of the inlet of the pelvis. It therefore forms an angle with
the vagina. The uterus measures about three inches in length, two in
breadth at its upper part, and an inch in thickness, and it weighs from
an ounce to one and a half ounces in its healthy condition.
The fundus or base is the upper broad extremity of the organ (_a_); it
is convex, covered by peritoneum, and placed on a line below the level
of the brim of the pelvis.
The body (_b_) gradually narrows from the fundus to the neck. Its
anterior surface is flattened, covered by peritoneum in the upper
three-fourths of its extent, and separated from the bladder by some
coils of the small intestines; the lower fourth is connected with the
bladder.
The posterior surface of the body is convex, covered by peritoneum
throughout, and separated from the rectum by some convolutions of the
intestines.
Its lateral margins are concave and give attachment to the Fallopian
tubes (_n_), above.
The round ligaments (_i_) are attached below and in front of these,
while the ligaments of the ovaries (_o_) are attached behind and below
these structures.
The cervix or neck of the womb (_c_ _d_ _e_) is the lower rounded and
constricted portion of the uterus; around its circumference is attached
the upper end of the vagina, which extends upwards a greater distance
behind than in front.
At the vaginal extremity of the uterus is, in the virgin womb, a round,
but after childbirth a transverse aperture, the _os uteri_ or mouth
of the womb, bounded by two lips, the anterior of which is thick, the
posterior narrow and long.
THE FALLOPIAN TUBES.
The Fallopian tubes, or oviducts (_n_) convey the ova from the ovaries
to the cavity of the uterus. They are two in number, one on each side,
situated in the free margin of the broad ligament, extending from each
superior angle of the uterus to the ovaries. Each tube is about four
inches in length; its canal is exceedingly minute, and commences at the
superior angle of the womb by a minute orifice, the _ostium internum_,
or internal mouth, which will hardly admit a fine bristle; it
continues narrow along the inner half of the tube, and then gradually
widens into a trumpet-shaped extremity, which becomes contracted at
its termination. This opening is called the _ostium abdominale_, or
abdominal mouth, because it communicates freely with the abdominal
cavity. The margins of this extremity are surrounded by a series of
fringe-like processes, termed _fimbriæ_, and one of these processes is
connected with the outer end of the ovary. This part of the Fallopian
tube is called the fimbriated or fringed extremity (_m_).
THE OVARIES.
The ovaries are analogous to the testes in the male. They are two
oblong flattened and oval bodies, situated one on each side of the
uterus, in the posterior part of the broad ligament behind and below
the Fallopian tubes. Each ovary is connected, by its anterior margin,
to the broad ligament, by its inner extremity to the uterus by a proper
ligament of the ovary, and by its outer end to the fimbriated extremity
of the Fallopian tube by a short ligamentous cord. The ovaries
are of a whitish color, and present either a smooth or a puckered
uneven surface. They are each about an inch and a half in length,
three-quarters of an inch in width, and about a third of an inch thick,
and weigh from one to two drams.
CHAPTER IX.
MENSTRUATION AND MENSTRUAL DISORDERS.
THE first appearance of the menses marks an epoch in the life of the
girl which ushers in womanhood. It is the harbinger of the fruitfulness
of the maiden, whose limbs now become rounder, and her hips widen out,
while the breasts increase in size and the entire aspect undergoes
peculiar changes, which all point to the approaching condition of
maturity.
The term is derived from the _Latin_ plural _menses_, meaning month,
from moon, and it is an actual fact that the lunar forces seem to
influence this physiological function, inasmuch as it recurs every four
weeks; most women menstruate during the first quarter, and only a very
few during the new or full moon.
During infancy and childhood, the sexual system of the female is
inactive. The menstruation begins, in a temperate climate, about
the fourteenth or fifteenth year of life, and ceases at the age of
forty-five or a little later.
The climate exerts a marked influence in determinating the first
appearance of menstruation, which is further influenced by the
conditions of life and society in which the child is brought up.
The diversity in the ages at which children menstruate in different
countries cannot be laid to any constitutional peculiarities of the
races. Observation has established that, when children of the same race
and family are brought from a hot to a colder climate, the advent of
the first menstruation changes. These girls menstruate not so young as
their older sisters, but begin about at the same age as those who are
born in the colder climate.
In hot countries, for instance in Africa, the negroes and girls in East
India begin to have their periods at the age of ten to twelve years.
In Sweden and Norway the average age for the first menstruation is
sixteen, while further north, in Lapland, the ages vary from eighteen
to twenty years. Next in order of importance, influencing the menstrual
epoch, are the surroundings and food.
In the same climate there are differences in the ages of children that
are entirely due to these causes. Children who are pampered and who are
nurtured in ease and luxury menstruate earlier than those of the poor
or even of the middle class, who are brought up in habits of industry.
We observe again a difference in the ages between those who are reared
in the country or rural districts and the dwellers in the cities,
whether it be in luxurious apartments or in tenement houses. The former
grow older and stronger than the latter before the _show_ begins.
The temperament also greatly influences the development of the
function; children who are nervous, irritable, and of a sanguineous
temperament, menstruate earlier than those of sedate habits.
The color of the hair and complexion are also indices of the respective
appearance of the menses in the _brunette_ and _blonde_. It has been
observed that the dark-complexioned girls menstruate sooner under
similar conditions than the blondes. Weakly children, who are delicate
from some constitutional habit, or whose organism has suffered from
disturbances of indigestion or suffered severely from teething in early
childhood, menstruate earlier than their stronger and robust sisters.
The quantity of the natural menstrual discharge, as well as the time or
duration, varies greatly in health with different individuals. We first
notice a slimy discharge, which soon becomes tinged with blood, and
after one or two days it is almost of pure blood. The flow generally
lasts three or four days, very seldom only one day, and sometimes a
week to ten days.
The monthly recurrence of the menstrual periods averages thirty years;
in temperate climates it may overreach this figure a little, while in
hot climates it comes much below this average.
It does not follow as a rule that because a woman began to menstruate
quite young, the change of life will take place earlier. This also
depends much upon temperament, habit and mode of life.
Physiologists have established, by carefully-prepared statistics, that
the average period of menstruation for women who began to menstruate
early is thirty-three years, while those who commenced late have an
average of only twenty-seven years.
When a woman is forty-five years of age, we may, however, as a rule,
look for the change of life to set in; if she goes beyond this age, she
may be taken as the exception.
The cavity of the womb is the principal source from which the blood
comes; while the ovaries and tubes are also greatly congested with
blood, the amount that comes from them must be very small.
The blood that comes from the womb is not different from blood coming
from any other source; the changes and peculiarity of the menstrual
show are due to its passage through the vagina, where it becomes
contaminated with vaginal secretions.
It is supplied from the blood-vessels of the womb, oozing through the
mucous membrane of that organ, just as in a case of nosebleed. The
entire womb is more or less swollen, and more especially the mucous
lining, so that it corresponds, in many instances, to an inflammatory
process, and for that very reason, a sudden check of the menstrual flow
will often result in a regular subacute or acute inflammation of the
womb. If the discharge of blood from the uterus is in small quantities
and a gradual, steady flow, it becomes so altered by the secretions in
its passage through the vagina that it does not coagulate, but when
it is poured out more rapidly or in larger quantities, the menstrual
blood coagulates or congeals in the same manner as if it were derived
from other sources.
If a woman becomes pregnant, the menses as a rule are suspended during
the child-bearing period, and usually remain absent after the child is
born so long as the woman nurses the child. I have known one woman who
menstruated during her entire pregnancy, and another who had had eight
children and never menstruated in her life, yet she was, and always
had been, in perfectly good health: thus we see, that there is no rule
without exceptions.
An essential part of the menstrual function is that in which the
ova or female germ cells ripen and are expelled from the ovary. The
menstruation is only a reflex or side issue, to a more important part
that is going on in the female generative system; this is termed
_ovulation_, or the ripening and expulsion of the human egg from the
tissues of the ovaries. In the physiological process that operates
in the economy of nature for reproduction, the _ovaries_ are the
principal organs. The other organs are simply accessory, and indeed
many of the lower animals have no other organs than the ovaries for the
perpetuation of their species.
In the human female, the ovaries consist of a tough fibrous tissue,
between whose meshes are little cysts, which are called _Graafian
vesicles_, and these little vesicles serve as the nests in which the
ova or little germ cells mature.
These ova which are imbedded in the Graafian vesicles are so small that
they can only be seen by a high magnifying power.
The activity of the ovaries begins at puberty, and ceases with the
change of life, or menopause.
The approach of the menses is signalized by a certain group of
symptoms, which clearly indicate a congestion of the pelvic organs.
There is generally a drawing sensation in the back and thighs, and a
sensitiveness upon pressure in the regions of the ovaries and the
womb. There is a feeling of lassitude and weakness of the limbs,
sometimes hot flushes changing off with chills, and often a feverish
condition, which will last until the flow is fully established.
Professor Dalton says: “In many birds, for example, the plumage assumes
at this period more varied and brilliant colors; and in the common
fowl the comb or ‘crest’ enlarges, and becomes red vascular. In the
American deer, the coat which, during the first year is mottled with
white, becomes in the second year of a uniform tawny or reddish tinge.
In nearly all species, the limbs become more compact and the body
more rounded; and the whole external appearance is so altered, as to
indicate, that the animal has arrived at the period of puberty, and is
capable for reproduction.”
In the human subject, the child now becomes conscious of the sexual
instinct, however chaste or virtuous her mind, for we must not dull our
intelligence with the idea that the sexual function is unholy; it is
no more so than to say our prayers; so that an additional duty is now
incumbent upon mother or guardian.
The child must be made to know that she must be more reserved and
guarded in her relations with the male sex; that she no longer can
romp or play on the knees of male friends or visitors, and that it is
dangerous and unbecoming to be left alone with them. A little later on,
she must be apprised that she too may become a _mother_, and that that
would be a great disgrace for one so young and not married. The child
thus learns to protect herself against the insidious smiles and snares
of the seducer, for he is ever abroad, and often family friend and
trusted adviser.
There are beings who are men in form only, but at heart are black
villains, and selfish brutes. When the mischief is done, then it is
too late to repent of a mother’s negligence, or to bewail a child’s
disgrace and man’s perfidy; the three combined make one of the most
distressing scenes that it has ever been my misfortune to behold.
Successive crops of eggs ripen, and are discharged by the adult female
at each menstrual period.
I have already said that the ovum is contained in the Graafian vesicle,
in which it grows and matures, as the fruit ripens on a tree, so the
Graafian vesicle gradually ripens for the expulsion of the ovum,
which gradually makes its way to the surface of the ovary. Within the
Graafian vesicle the serous fluid accumulates, so that it ruptures and
discharges its little ovum, which is taken up by the fringed extremity
of the Fallopian tube, and carried along the oviduct into the womb,
from which it escapes into the vagina, and is lost, provided conception
has not taken place.
Investigations have been made as to the number of ova certain mammalia
discharge, and it has been found to correspond with the number of young
that the animal produces at birth. Where a litter consists of from
three to twenty, as in the bitch and the sow, a similar number of eggs
ripen, and are discharged at the period of œstruation.
In the cow or mare, and in the human female, as a rule, only one egg is
discharged at each period of ovulation.
The discharge of ripened ova does, however, occur in exceptional
cases without any sign of the menstrual show, and the person may be
susceptible to conception, so that we may reasonably infer, that
ovulation constitutes the most important function of the menstrual
period.
MENSTRUAL DISORDERS.
These are designated by different terms, not because each name
signifies a particular disease, but simply an indefinite symptom of
a diseased condition. In other cases menstrual disorder may produce
symptoms that are common to widely different diseases. In other
words, the phrase menstrual disorder, without being qualified as to
its particular cause, means, from a practical standpoint nothing upon
which a treatment can be intelligently based. Not any more than a cough
which is simply an irritation of the bronchial nerves, and may be due
to a bronchitis or pneumonia, or it may not be due to any pulmonary
affection at all, as, for instance, in the case where an aneurismal
tumor presses on the bronchial nerves, and excites severe paroxysms of
coughing. A great many menstrual disorders are due, not to any disease
of the generative organs, but to an affection of the nervous system.
Menstruation may be precocious in some girls, and if the discharge is
not accompanied with the usual symptoms of backache and some of the
other symptoms that characterize the normal appearance of the menses,
or if the girl is otherwise not fully developed, and has in this
climate not reached her twelfth or fourteenth year, it constitutes a
sign of a disease. If, however, the show recurs at certain intervals,
it is not to be considered with the same degree of apprehension that it
would be if it recurred at irregular intervals.
The sanguineous discharge which shows itself at the genitals during an
acute attack of an infectious disease, has no relation whatever with
the menstrual function; this may take place in children at any early
age.
We often see girls who are not yet thirteen, who still wear short
clothes and go to school, that menstruate regularly, but with this
precocious menstruation there is also a corresponding development of
the body which gives them a womanly appearance. Such girls should not
be permitted to expose themselves to the inclemency of the weather,
because they are much more liable to take cold, which may result in
inflammations, than girls in whom the menses have not appeared.
Girls of a scrofulous taint or other hereditary habits of constitution,
often begin to menstruate prematurely; outdoor exercise and cod liver
oil with cold sponging on retiring at night are the proper resources
for building them up.
AMENORRHŒA.
This term is employed for the purpose of designating an absence of the
menstrual flow in persons who are old enough to menstruate, and in whom
there is no physiological reason for its suppression, such as being too
young, after the change of life, or during pregnancy and while nursing
the child on the breasts.
We find this disorder of the natural function of menstruation more
among the women of the rich and affluent whose lives are spent in
indolence and luxury; this is to be ascribed to lack of sufficient
exercise to stimulate the nervous and sanguineous systems to the
performance of their healthy functions.
The amenorrhœa, or a retarded menstruation in young girls, is oftener
the result of a general debility than of a disease of either the womb
or ovaries. We have here again about the same causes playing their
pernicious role as in precocious menstruation in weakly children;
that is, that the same causes produce directly opposite results. The
scrofulous and hereditary taints always interfere with the proper and
healthy development of the system; in amenorrhœa they appear to be a
hindrance to the formation and growth of the red blood corpuscles.
In some girls the suppression of the courses appears to be a wise
conservative provision of nature, because the girls are already
so weak and bloodless that even the loss of a very small amount
would only increase the anæmia, so that in these cases it is not so
much a question of “bringing on the courses” as of building up the
constitution, and enriching the blood in order to bring about the
desired result.
Chlorosis, or the green sickness, is not simply an anæmia or a
bloodlessness, but a physiological incapacity of the system to prepare
the required blood cells for the sanguineous fluid, and this is,
indeed, the most frequent cause of the disorder under consideration.
Chlorosis is a disease that is peculiar to the female sex, beginning as
a rule at the age of approaching puberty, between the fourteenth and
twentieth year, so that there appears to be a physiological relation
between the blood genesis on the one hand, and the development of
womanhood on the other.
In some cases we can trace the impoverished condition of the blood
to unhealthy dwellings, impure air, want of exercise, improper diet,
nervousness, the reading of exciting, amorous novels, and the practice
of masturbation or self-abuse. On the contrary, the disease is often
developed under the most moral and exacting discipline and hygienic
surroundings.
I have known girls who lived in the country, enjoyed horseback riding,
ate nutritious and wholesome food, and whose solitary moments were
beyond suspicion, yet at the age of puberty they commenced to fade in
color, and fail in strength, gradually growing paler and weaker, until
they became chlorotic and bloodless. This can only be explained on the
theory that the period in which nature was preparing the system for the
purposes she had in view, caused a shock to the nervous system, which
so disarranged the functions that the _sanguineous_ system did not
respond to the growth of the _generative_ system.
Then there is another class of cases, where girls menstruate before
they are old enough, and without their bodies showing any visible
evidence of developed womanhood, who belong to the most obstinate cases
for successful treatment.
The relative diminution of the red blood cells to the healthy standard
is in some cases truly alarming. In the average healthy blood, there
are, in one thousand parts of blood, one hundred and thirty parts of
red blood cells; this falls to sixty, and even forty parts in the
thousand in the chlorotic patient.
It is one of the peculiarities of this disease, that while the muscular
tissue wastes away, the fatty tissue is not only preserved, but it
sometime increases, so that in a family of several girls, the chlorotic
girl is considered the ‘_most fleshy_,’ but as fat is not flesh, the
appearance is deceptive.
When we stop to think a moment, that the _red blood corpuscles_
are the messengers which absorb the oxygen in the lungs during the
respiratory movements, and carry it to the different organs and tissues
of the body, without which all tissue change would cease. And that the
same red blood cells must return again to the lungs for exhaling the
carbonic acid, one of the waste products of tissue growth, then the
diminution of the red blood cells in the proportion above given, must
affect the entire system very injuriously.
This is indeed the case; the natural respiratory movements are
insufficient on the slightest exertion, so that patients tell us that
when they walk a little fast, go up the stairs, or even sweep the room,
they feel a shortness of breath.
There are other symptoms that point to carbonic acid poisoning, which
it will be interesting to review. A great majority of these symptoms
are to be found in every case of chlorosis. The muscles become weak at
first, because their nutrition is interfered with, and they waste away,
and secondly they become irritable from the poisonous presence of the
carbonic acid, and so are often very painful. The patients are easily
tired out; some, indeed, feel tired all the time, getting up in the
morning as worn out as when they retired at night.
The nervous system suffers as much, because the principal nerve
food is oxygen, and if there is no blood, there can be no oxygen; a
starved nerve is a painful nerve. We find neuralgias, affecting the
different parts of the body, the rule; when these are located in the
external muscles, they are easily recognized, but when located in the
deep organs, as the ovaries or the womb, they are generally mistaken
for something else. The nerves of these individuals being in such an
irritable state, it is natural to infer, that hysteria is often to
be found as one of the complications, so that habitual sadness, and
abnormal longings after chalk, lead pencils, and other indigestible
articles are prominent symptoms.
The circulatory system suffers derangements that are characteristic
of chlorosis. Palpitation of the heart is a prominent symptom; this
is partly due to the irritation of the carbonic acid on the cardiac
nerves, and partly to sensitiveness of the patient, owing to a
morbidly-increased sensibility of the whole body. Chlorotic patients
blush up at times, only to be followed by a green paleness that
is peculiar to the disease. Pain in the region of the heart, and
disturbances of the digestion, are sometimes prominent symptoms. There
is no feeling of hunger; eating is not so much from hunger, but more
from a sense of duty to keep up the strength. A heavy or full feeling
is often experienced after a meal, and a sourish eructation will give
relief to the oppression, because the walls of the stomach are relaxed
and in sympathy with the general debility.
But in all cases of chlorosis the sexual functions are the seat of
the greatest disturbance; amenorrhœa or the suppression of the menses
is the most prominent symptom. The ovaries no longer seem to expel
ripened ova, for there are no indications that point to their activity,
because there is not only an absence of the show, but also an absence
of the other signs that were noted when we considered menstruation and
ovulation.
There are a great many other diseases of which amenorrhœa is a
prominent symptom; these will be referred to when separate diseases
become the subject of special inquiry.
The treatment of amenorrhœa is, indeed, in the great majority of
cases, the treatment of chlorosis, and that should be conducted on
common-sense principles. If the child has vicious practices, they must
be corrected, and everything else that has been mentioned as a cause
must be abandoned. Children who were once robust and strong require
electrical treatment, while those who were naturally weak require
nourishing food and tonics. If there is in the entire pharmacopœa a
remedy that deserves the name of a specific, it is to that one which I
suggest in amenorrhœa due to chlorosis or anæmia. Iron preparations are
very numerous; every physician has his favorite prescription; some are
to be praised more for their elegance and flavor than for any virtue
that they possess. If in these cases any positive and decided result is
to follow the administration of iron, it must be given in such a mild
form that it can be taken in great quantities without irritating the
stomach or interfering with digestion. If the contents of the whole
alimentary canal are saturated or impregnated with the ferruginous
medicine, there will be astonishing curative effects.
I have often observed chlorotic cases who have made the rounds of the
different iron springs, and who have taken the numerous and various
fancy elixirs, without the slightest perceptible effect, bloom up,
after being fed, so to speak, on some harmless iron preparation, which
was astonishing to themselves and surprising to their friends. The
following is my favorite prescription for chlorosis or anæmia:
NO. I.
Take: Powd. Carb. of iron, sacch. (Germ.) 1 ounce
Powd. Aloes. 20 grains
Powd. Tragacanth. 20 grains
Mix with sufficient water to make into a hard mass and divide into one
hundred and fifty pills, and roll in powdered cinnamon.
Take three pills three times a day and after three days increase to
four pills at one dose three times a day, then after another three days
increase to five pills as many times a day as before; if these doses
are not at first borne, begin with less, and if there is no costiveness
or tendency thereto, omit the aloes.
If there is reason to believe that the impoverishment of the blood is
partly or wholly due to scorfulous taints, then it is advisable to take
fresh, pure cod liver oil in conjunction with the iron pills; three
boxes of pills are, as a rule, necessary to effect a cure.
It happens quite often in chlorosis or anæmia that there is a
distressing dyspepsia or indigestion with loss of appetite. In these
cases I would first advise to put the stomach in order; this is done
by first avoiding all indigestible food, such as cakes, pies, and
puddings, and taking the following medicine:
NO. II.
Take: Bicarbonate of soda 2 drams
Subcarbonate of bismuth 2 drams
Tr. of nux vom. 2 drams
Fluid ex. of rhubarb 3 drams
Simple syrup 1 ounce
Peppermint water sufficient to make 8 ounces
Take a tablespoonful three times a day, and if the bowels move freely
take less.
Hygiene in the treatment of every disease is to be an important factor;
all vicious habits must be abandoned.
DYSMENORRHŒA.
Difficult or painful menstruation is the definition of the above word;
all painful menstrual disorders that take place either before or during
the menstrual flow come under this designation.
The seat of the pain, when of a colicky nature, is in the uterus; when
a continuously dull ache is in the small of the back, it is located in
the nervous plexus in the small of the back. The pain is very often
in the ovaries and in that portion of the peritoneal membrane which
folds over all the pelvic organs and extends on the sides of the womb,
constituting the broad ligaments; when the pain is confined to these
structures, it is principally felt below the stomach and over the lower
part of the bowels.
Painful menstruation is a prominent symptom of a great many diseases,
and it often strains the ingenuity of the most clever specialist to
trace the symptoms to their real cause.
Obstructive dysmenorrhœa, as its name implies, is due to some hindrance
or obstacle to the escape of blood from the cavity of the womb. The
obstruction may exist in the neck of the womb, at its mouth, or in
the vagina. When the obstruction is in the neck of the womb, it may
be congenital or date from birth. The constriction or narrowness may
be due to an acquired inflammation of the lining membrane of the neck
of the womb. Every inflammation causes a swelling of the tissues, and
if the inflammation continues, the swelling becomes permanent and a
_stricture_ is the result.
Such strictures are often the result of the applications of strong
_caustics_ and meddlesome tampering by the ignorant specialist and
abortionist. The application of the _electrical current_ by means
of the uterine electrode is the most modern and effectual method of
treating these cases successfully.
Flexion of the womb is understood to be a condition in which the uterus
is flexed or bent upon itself at a sharp angle, just as a rubber hose
that is bent sharply on itself becomes compressed at the kink so as to
shut off the flow, in this manner the flow of blood from the cavity of
the womb is partly shut off, and the obstruction is the cause of the
painful menstruation.
In some women who have flexion or a bent womb there is no obstruction,
because the probe passes the canal freely; in these cases dysmenorrhœa
must be traced to some other cause. If it is clearly established that
flexion is the cause of the obstruction, the most successful treatment
is the electrical current. I have often had cases where little mucous
growths no larger than a small marble, grew in the canal and obstructed
the free escape of blood; after these were removed, the dysmenorrhœa
ceased at once.
Other obstructions may be due to a stricture of the vagina or some
deformity of the hymen; a very slight surgical operation will
permanently relieve both of these hindrances.
There is a much larger proportion of cases that suffer from painful
menstruation in whom the uterine organs are perfectly healthy, but who
are systematically injured by dishonest or hungry specialists, by being
subjected to _local treatments_. I have had cases of this nature fall
into my hands very often. They had made the rounds of the specialists
and had been made the innocent prey of avaricious professional
competition, so that it is of the greatest importance to distinguish
this class of cases from those in which the pelvic organs are the seat
of the difficulty.
Nervous and congestive dysmenorrhœas are particularly adapted for the
hygiene of home treatment. Nervous or neuralgic dysmenorrhœa is very
often overlooked, and treated as a local lesion of the womb.
The psychical exaggeration which many women experience at the approach
of the menses is abnormally heightened in dysmenorrhœa. The pains in
the back, in the hips, and in the lower part of the abdomen disturb
the normal operations of the mind. The irritation of the nerves of the
womb is often reflected to distant organs, and pain is felt in remote
regions. Some women suffer only just a day or two preceding the flow,
while others suffer severely during the entire period, so that they are
forced to keep to their bed the greater part of the time.
Professor William Goodell, one of the most profound and original female
specialists in America, has this to say in a recent publication: “I
have learned to unlearn the idea— and that was the hardest task of
all—that uterine symptoms are not always present in cases of uterine
disease; or that, when present, they necessarily come from uterine
disease. The nerves are mighty mimers, the greatest of mimics, and
they cheat us by their realistic personations of organic disease and
especially of uterine disease. Hence it is that even seemingly urgent
uterine symptoms may be merely nerve counterfeits of uterine disease.
I have, therefore, long since given up the belief, which, with many,
amounts to a creed, that the womb is at the bottom of every female
ailment.
“Nerve strain, or nerve exhaustion, comes largely from the frets, the
griefs, the worries, the carks and cares of life. Yet although the
imagination undoubtedly affects it, it is not a mere whim or imaginary
disease, as all healthy women and physicians think; but it is the
veriest of realities. When some flippant talker or some slipshod
thinker scoffs at nervousness as a sham disorder, I say to him: ‘Can
the bribe of a principality keep you from blushing when you are
ashamed, or from blanching when you are afraid?’ Under the flitting
sense of shame or of fear these vasomotor disturbances are momentarily
beyond your control; and so they are in the nervous woman, whose vital
organs are, as it were—not transiently but—perpetually blushing and
blanching under deficient brain-control over the lower nerve centers.
“Strangely enough, the most common symptoms of nerve disorder in women
are the very ones which tradition and dogmatic empiricism attribute to
womb disease.
“They are, in the order of their frequency, great weariness and more or
less of wakefulness and inability to walk any distance, a bearing-down
feeling, headache, nape-ache and backache, scant, or _painful_, or
delayed, or suppressed menstruation, cold feet, and irritable bladder,
general spinal and pelvic soreness, and pain in one ovary, usually
the left, or in both ovaries. The sense of exhaustion is a remarkable
one; the woman is always tired, she passes the day tired, and she goes
to bed tired, and she wakes up tired, often, indeed, more tired than
when she fell asleep. She sighs a great deal, she has low spirits, and
her arms and legs become numb so frequently that she fears palsy or
paralysis.
“There are many other symptoms of nerve strain, but since they are not
so distinctly uterine, and, therefore, not so misleading, I shall not
enumerate them. Now, let a nervous woman with some of the foregoing
group of symptoms recount them to a female friend, and she will be
told that she has womb disease. Let her consult a physician and ten to
one he will think the same thing and diligently hunt for some uterine
lesion. If one be found, no matter how trifling, he will attach to it
undue importance, and treat it heroically as the offending organ. If no
visible disease of the external organs be discoverable, he will lay
the blame to the invisible endometrium, or on the unseeable ovaries,
and continue the local treatment. In any event, whatever the inlook or
the outlook, a local treatment is bound to be the issue.”
The nervous variety of painful menstruation is frequently due to
impoverishment of the blood, which, as we have learned, is often the
direct cause of irritable nerves. The same treatment as for chlorosis
will give the desired relief: the treatment with iron pills. If the
stomach is deranged from dyspeptic disorders, then my dyspeptic
mixture, No. II, is to be given. But there are cases that are purely
neuralgic without any apparently serious lesion of the blood; cases in
which the neuralgia of the womb or ovaries is probably due to exposure
to cold or some other indiscretion; here the following recipe will
effect a cure in the course of several months:
NO. III.
Take: Fluid ex. of black cohosh ½ ounce
Fluid ex. of ergot ½ ounce
Tr. of guaiacum ammoniated 3 ounces
Glycerine 2 ounces
Mix. Take a teaspoonful in a tumblerful of milk three times a day,
between meals.
Congestive dysmenorrhœa is oftener in the nature of an acute or sudden
attack, except when it is due to a chronic inflammation of the lining
membrane of the womb. It is often brought on by a sudden or inadvertent
exposure, just at the time when the menses should make their regular
appearance.
Persons of a plethoric habit and those who have been the subjects
of inflammations either of the womb or in the tissues surrounding
the womb, are more liable to this form of dysmenorrhœa than others.
It will often be ushered in with a chill, followed soon with fever.
There is headache, the skin becomes dry and hot, and often there is
considerable irritability of the bladder, straining of the rectum
and diarrhœa. Unless the pain is due to an obstinate displacement, it
yields to proper treatment. For the straining and irritable bladder a
hot sitz-bath should be employed for ten to fifteen minutes. In the
absence of a suitable vessel for a sitz-bath an ordinary bathtub can
be used by filling it six or eight inches with water, at a temperature
of 104°F., and while sitting in the bath allow the boiling water to
run slowly into it, so as to keep the temperature up. These sitz-baths
should be taken several times a day, and after each bath the patient
should rub herself thoroughly dry and wear flannel next to the skin.
The extremities and feet should also be kept warm by wearing woolen
hose.
Towels wrung out of hot water should be carefully folded and applied to
the lower region of the abdomen and then covered over with a thickly
folded flannel cloth so as to retain the heat and moisture; when the
towel has cooled off repeat the dipping in hot water.
The Femina vaginal capsules are of inestimable value in this class
of diseases. They relieve congestion of the womb by allaying the
irritation. The best time to use one is just before retiring, and after
taking a sitz-bath, or a vaginal injection of hot water, or both.
Persons who are of a costive habit should pay particular attention
that, about the time their monthlies come around, their bowels act
freely, and to accomplish this purpose the Femina laxative tablets
should be taken, one each night for several nights before the courses
are expected.
MENORRHAGIA AND METRORRHAGIA.
By _menorrhagia_ is meant, as the composition of the term implies,
an excessive flow of blood at the regular monthly period; by
_metrorrhagia_, a flow of blood from the womb at any time irrespective
of the regular menstrual periods. Neither of these forms can be called
a disease, as they are solely the symptoms of several kinds of uterine
affections. In the course of our investigations, we will find that one
of the most prominent and common symptoms of different womb diseases is
_hemorrhage_ of the womb.
If the hemorrhage is the result of general debility from protracted
nursing, the child must be weaned, and recipe No. I, with a nourishing
diet, will effect a cure.
Hemorrhage may be due to the presence of a fungoid inflammation,
tumors, or affections of the mouth or neck of the womb, or congestion
of the ovaries.
It is very often due to a “bad getting up” from confinement, where the
womb has never returned to its original size. Sometimes it is due to a
portion of the afterbirth that was retained in the cavity of the womb.
It is also a symptom of cancer. As I have already said, it may be the
symptom of so many different diseases that the proper course to pursue
is to find an _honest_ and competent physician to make a thorough
examination, for the purpose of deciphering the real cause, and when
that is discovered, it is as a rule, an easy matter to remove it and
thus afford the patient permanent relief.
There is no remedy which on the whole is so effectual in controlling
hemorrhage, no matter from what cause, as:
NO. IV.
Take: Fluid ex. of ergot 1 ounce
Dose: a teaspoonful in a little water every four hours until the flow
ceases, or until a physician is consulted to diagnose the case. In
pregnancy, the administration of ergot is not admissible; cold water
compresses are also useful in checking uterine hemorrhage, and the
utmost quietude should be observed.
Nervous exhaustion from protracted confinement, or mental worry from
the loss of a child or the death of a friend, may also cause uterine
hemorrhage. The ergot is useful in these cases, with a change of air
and scenery.
CHAPTER X.
HISTOLOGY OF INFLAMMATION.
INFLAMMATIONS of the various tissues assume different forms as far
as the gross appearances are concerned, but the underlying condition
is precisely the same. The various types of inflammations that are
produced by one and the same process are of considerable scientific
interest, but to the practical and inquiring reader, whose principal
object is to obtain sufficient information to be able to cure herself,
it would be confusing were I to attempt a description of their
differences.
There is no word that is so often employed as _inflammation_, as a
designation of disease, and when we learn that there is only one kind
of inflammatory process, whether of the brain, the lungs, liver,
kidneys or bowels, the entire subject of inflammatory diseases at once
becomes greatly simplified, because if you understand one you must
understand all.
I will in the subsequent chapters speak only, or principally, of
inflammatory affections of the different organs that come within the
province of this specialty, and I am convinced that if the reader will
bear with me, so that I may take sufficient time and space to explain
the most advanced scientific views of inflammatory processes, she will
be more than compensated, by a clearer understanding of what will be
said in succeeding pages.
Inflammation comprises a series of phenomena, which partly take place
in the vascular apparatus or blood vessels and partly in the tissues
comprising the structure of the organ. Inasmuch as inflammation is
not a single process, a definition of a few words is insufficient to
convey to the mind its real meaning. If I were simply to describe the
peculiarities of the circulation, that characterize the inflammatory
process, we should only have an incomplete idea of the changes that
were taking place.
Since the time of Galen, who lived two hundred years after Christ,
_inflammation_ was recognized by four cardinal symptoms, namely
redness (RUBER), _swelling_ (TUMOR), _pain_ (DOLOR) and the increased
temperature (CALOR). To these modern pathologists have added a fifth
symptom, which is lessened or diminished function (FUNCTIO LÆSA).
The above five cardinal symptoms can be established in the majority of
the acute stages of inflammation: in the chronic or subacute variety,
one or the other symptom may be absent, or so obscured as to escape
notice.
The nature and structure of the tissue materially modify some symptoms
and exclude others, so that redness, pain and even perceptible swelling
may be absent. Galen already in his time attributed the redness to an
increased blood supply and the swelling to an exudation of lymph or
serum, through the walls of the blood vessels: this was as near the
truth as scientists arrived, until within our own time. The discoveries
in this field of science have been greatly enriched in the last twenty
years through the researches of the German school. Various theories
have been advanced from time to time, as to the probable causes or
processes that are going on in the tissues while inflammation is
active. One observer believed that he had found the solution of the
inquiry in a supposed spasmodic contraction of the capillary blood
vessels, another in their paralysis, while still another adhered to the
belief of a neurotic affection. Professor Virchow, the father of the
modern school of pathological science, ascribed the conditions of the
tissues to an irritable state of the inflammatory process, inducing an
exaggerated cell growth; while his former pupil, Cohnheim, through an
extended series of newly-devised experiments, has conclusively proved
that none of the theories advanced are supported by demonstrable facts.
Our present thorough knowledge of the combined disturbances and
phenomena, that play their part in the vessels and tissues, of the
body during the inflammatory action in living tissue is due to the
unremitting toil of Professor Cohnheim. He was the first to speak from
facts, as they presented themselves to his eye under the microscope. It
was he who had the genius that suggested the examination of the whole
process of inflammation, in the living tissues under the microscope.
This he accomplished by narcotizing a frog, and while alive, but
insensible to pain, a portion of the peritoneum or mesentery, which
is almost transparent, so that the circulation may be plainly seen,
was fastened with pins upon an ingeniously-devised rack or stage. The
inflammation is now excited by etching the membrane with a little acid
and a sharp needle, and then the object is placed under the microscope.
If the operator is careful, so as not to tear or crush the vessels
or tissues, and preserves the moisture, by spraying with warm water
from time to time, the circulation and the abnormal processes of
inflammation that are going on, may be observed and studied with great
exactness for several hours. I will now describe what may be seen in
the field of the microscope.
The first change to be observed is in the vascular system and within
the vessels themselves; this begins with a widening of the small
arteries, then of the smaller capillaries and veins. This increases the
current of blood with greater velocity through the widened vessels.
Sooner or later this rapidity of the current lessens; there is a
marked slowness to be observed in the stream. The single or separate
blood cells, which in the beginning of the observation could not be
distinguished, can now be distinctly seen, especially in the veins and
small capillaries, in which, from the slowness of the current, the
blood accumulates. In the veins there now appears at the periphery
of the current a pellucid plasmatic layer, in which there are white
blood cells, that have separated themselves from the main current; the
white cells either float slowly along or adhere to the walls of the
vessels. This phenomenon the Germans term “Randstellung der Farblosen
Blut Körperchen,” which means, bordering of white blood corpuscles.
Not long after the “bordering” of white cells, a change takes place in
the cells themselves, that is very interesting. The white cells become
elongated and spear-shaped at one extremity, which pierces the wall of
the vessel, and after a little while the sharp extremities will appear
on the outer surface of the wall of the vessel, and a little later
on, indeed, the entire protoplasmic cell will have emigrated into the
tissue, outside of the vessel. Or, in other words, the colorless blood
cells will have passed through the walls of the vein or capillary, and
this constitutes an _extravasation_.
The first extravasated cells will soon be followed by others in great
quantity, so that in six to eight hours veins and capillaries are
surrounded with white corpuscles. In their normal destination these
become organized into fibrous or granulation tissue; and for this
reason, an organ that is the seat of chronic inflammation becomes
immensely enlarged from this inflammatory accretion. We can now readily
appreciate why the womb, liver or kidneys become augmented in size from
inflammatory processes. Indeed, this applies to all growths and even
to bone, and if a part is injured by a cut, accident or disease of
some sort, precisely the same processes are at work to repair the lost
tissue. It cannot fail to become apparent at once, that to understand
the phenomena of inflammation is to possess the key that opens to
our understanding the operations not only of most diseases, but of
the healing processes of wounds and injuries. In the course of the
experiment we see also red blood corpuscles transude, which are always
accompanied with more or less fluid or plasma.
The above detailed account seems to explain in a clear manner the
different cardinal symptoms that have become recognized features of
inflammation since the time of Galen. The great vascular activity
explains the redness, swelling and increased temperature. The pain can
be traced to the pressure from the exudation, to which the delicate
nerve filaments were exposed, while lessened function would be the
natural result of nerves or tissues so compromised.
I made an attempt to initiate the reader into the science of
inflammatory processes and if I have succeeded in making myself
understood, then I am satisfied with having imparted a most useful
lesson, because there is no process in the entire field of disease that
is so general; it is almost safe to say that with the exception of
functional diseases, there is perhaps no class of diseases with which
an inflammatory process is not more or less associated. This is true
of consumption, which is an inflammatory process excited by and around
the bacilli or micro-organisms, and these inflammatory nodules are
called tubercles. The growth of a cancerous tumor is associated with an
inflammation. The development of a common boil is an illustration of
an inflammation, breaking down or destroying part of the tissue which
is inflamed. It is the same in inflammation of the lungs or pneumonia
as it is in ordinary catarrh; the differences that are presented to
the eye are only modifications of degree and peculiarities that are
due to the difference of the tissues of which the organ or membrane is
composed.
CHAPTER XI.
URETHRITIS AND NEURALGIA OF THE URETHRA.
INFLAMMATION of the canal by which the urine is conducted and
discharged from the bladder is termed urethritis.
There is no organ of the female anatomy that is oftener the seat of
local inflammation.
The acute and chronic inflammations that affect the male urethra, also
affect that of the female, only perhaps to a more limited extent, owing
to the comparative smaller mucous surface of the tube, it being only
from an inch to an inch and a half in length.
Inflammation is oftener confined to this portion of the urinary
apparatus than is generally supposed, because any derangements of these
parts is at once attributed to the bladder, and it is an actual fact
that many women have doctored uselessly for years, for the one, when
it was the other that was diseased. Symptoms of urethral inflammations
are so very similar to inflammations of the bladder that the points of
distinction are easily overlooked.
The trouble begins with frequent desire to void urine and a continual
bearing down or straining sensation, which may be accompanied with
a sense of heat suggesting to the minds of the most chaste and pure
women, sexual desire, which the gratification of that indulgence does
not relieve nor satiate, but, on the contrary, the sexual passion
becomes only exaggerated. It is only the strongest force of character
and Christian fortitude that keep some of these unfortunate women
in the path of rectitude and virtue, and it is only the scientific
specialist who can appreciate the real cause. In many instances
women, truly noble in character, have fallen from their high estate,
because uncontrollable impulses swept them into the maelstrom of
licentiousness, which might have been averted, if they had known of
whom to seek proper advice.
This irritation is often innocently and ignorantly acquired in early
girlhood by fingering the parts, or practicing masturbation, which
sets up an inflammatory condition of the urethra that becomes chronic,
and in time may entail the terrible consequences to which I have
already alluded. For that reason mothers should not be over-delicate;
they should not only keep a watchful eye on their children when in
seclusion, but should make it their holy duty to gradually initiate
their children into a knowledge of physiology and of the diseases that
may result from any violation of youthful virtue.
Why is it that many children who have been reared in an atmosphere of
sanctity, children who have enjoyed from their earliest recollection
moral and spiritual administration, have fallen into vice and
depravity? The reader should stop to answer this question for herself,
while I too will answer it for her.
It is because moral teachers overlook the fact that human beings are
dual; that we are all animal, however spiritual, and that the functions
of the animal nature must be understood in order that the spiritual
nature can control them.
A false delicacy has entirely neglected this part of the education of
our children, which I stamp as the height of stupidity and hypocrisy.
Among other causes of this malady is hot and acrid urine, or gravelly
discharges from the bladder, cutting and irritating the mucous membrane
in its passage; abrasions of this nature often lay the foundation for
ulcers. When the urine is in that condition, it is probably due to a
complication of diseases of the bladder, the kidneys and the liver. A
chemical and microscopical examination of the urine will be the only
means of settling these questions.
The urethra often takes on the inflammations of the neighboring tissue
or organs; disease of the vulva or of the vagina will spread itself to
the urinary canal. I have seen cases in which the whole trouble was
traceable to a catarrh of the neck of the womb.
Gonorrhœal infection of the vagina will in the great majority of cases
extend itself to the urethra as well as to the cavity of the womb and
neighboring organs.
If treatment in these complicated cases is to be successful, it must be
directed to the disease in all of its strongholds; this, of course, can
only be done under the direction of a skillful specialist.
There is a predisposition on the part of the mucous surfaces to become
infected by eruptions of the eruptive fevers, and the urethra is
particularly liable to this invasion. Children who have had the measles
and scarlet fever will often be troubled with frequent and smarting
micturition and after convalescence from all the other symptoms of the
respective fevers, they are still more or less annoyed for weeks or
months with a urethritis. I have had cases of this nature that dated
back years. If the early treatment is neglected and the case becomes
chronic, it generally spreads to the bladder, which also becomes
similarly affected.
Smallpox pustules are apt to break out in the urethra during the acute
stage of the disease, and excite a very itching and painful urethritis.
Dysentery in children may give rise to the disease. In adults I have
noticed the affection in connection with typhoid fever, but this
generally passes off with convalescence. Hemorrhoids or piles give
rise to urethral inflammation which does not yield to treatment, but
subsides at once after the removal of the piles. The application of a
Spanish-fly blister to any part of the body may also cause a stranguary
or a urethritis.
Mothers may become uneasy, as to the cause of the muco-purulent
discharge from the urethra of their little girls. I have known them to
entertain suspicion of some specific infection being introduced into
the genitals, in some mysterious manner; a little inquiry into the
history of every case, dispels these absurd delusions, and it will be
found that pinworms have caused the inflammation. In adults, however,
the subject should be made the object of particular inquiry. During
delivery, the passage of the child’s head exerts great pressure on
the urethra, so that it may be crushed or torn across. Women may be
troubled with derangement from this cause for a long time, or for their
whole lives, if the real cause of their ailment is not recognized.
Displacements of the womb in different directions, principally when it
is tipped backwards so that its neck impinges on the urethra or neck of
the bladder, compresses the canal, so that its caliber is diminished,
and a painful obstruction and retention of urine ensue.
Papillated growths and mucous polypoids that were so small that they
were hidden from external sight, but readily detected by scientific
methods of examination of the urethra, by means of the urethral
specula, were the exciting causes of some cases that came under my
treatment. The unfortunate victims were under the impression that their
kidneys or their bladders were diseased. The numerous quack medicines
advertised for the cure of these maladies were copiously consumed,
doing, of course, more mischief than good. The removal of the growths
in each instance at once put a stop to any further inconvenience.
In pregnancy, after the third month, the womb rises out of the pelvis,
so as to accommodate its increasing size. This naturally drags the
bladder upwards, and so stretches the urethra that it becomes sore and
extremely irritable. To relieve this distress until the parts have
accommodated themselves to their new relations, the Femina vaginal
capsules are of the greatest value, and without the slightest ill
effect arising from their use. Vaginal irrigations of hot water are
also of decided benefit, especially before using a capsule.
Mix. A teaspoonful to be given to an adult every four hours till
relieved.
The symptoms of inflammation of the urethra are always very pronounced,
because the mucous membrane of the urethra is the most sensitive
part of the bladder. In the healthy state the coloring of the lining
membrane is of a pale red; when inflamed or catarrhal, it assumes a
dark red, or a cherry color. The membrane is also considerably swelled
and puffed, and feels hot to the touch, and imparts a burning sensation
to the patient. The muco-purulent secretion excoriates or chafes the
skin, so that the parts look angry and red in the neighborhood; this is
oftener observed in children. The characteristic symptom of frequently
urinating is never absent, while very little is passed at a time, yet
the straining to pass water continues, after the last drop is voided.
The treatment is cleanliness to begin with. In grown people, the
entire vulva and vagina must be rinsed out with a warm borax solution,
in the proportion of one teaspoonful of the powdered borax dissolved
in a quart of water. In little children the same object, that of
cleanliness, is to be accomplished with a small ear syringe.
After the external parts and the vagina are thoroughly cleansed, then,
by means of a hard rubber syringe, No. 1, three or four syringefuls
of clean borax water are injected into the urethra for the purpose of
cleaning that too. To relieve the straining and frequent desire to
micturate, which is accompanied with more or less pain, I give:—
NO. V.
Take: Fluid ex. of gelseminum 1 dram
Sweet spirits of nitre 7 drams
Mix. A teaspoonful in a wineglassful of water three or four times a day
for an adult; children in proportion.
The patient must confine herself to a bland liquid diet, principally of
milk, raw eggs beaten up in bouillon or broth. Vegetables may be eaten,
but they are not to be seasoned with anything but salt; and alcoholic
liquors, wine or beer must also be suspended for the time being.
NEURALGIA OF THE URETHRA.
The female urethra is sometimes the seat of simple neuralgia, by which
is meant a painful condition in which there is no apparent disease or
inflammation of the tissues.
This pain assumes often a spasmodic character; that there is a cause
for this is certain, but it is as a rule remote from the sensation
which attracts attention. It is often found to be the symptom of
some of the diseases to which I have already referred. These are
ulcerations, displacements, or inflammation and congestion of the
neighboring organs. Abnormal growths or tissues will often be painfully
reflected on the nerves of the urethra. I remember a case of internal
hemorrhoids, which was never suspected by the patient because there
were no painful symptoms pointing to the rectum, but in which the
urethra was very painful in its entire extent. The suffering from this
urethral neuralgia had lasted for years, but disappeared at once,
on the removal of the piles. I have called attention to a catarrhal
inflammation of the urethra, from stretching occasioned by the
ascending womb after the third month of pregnancy; there is a similar
pathological process after the seventh month of gestation, when the
pregnant womb begins to descend again into the pelvic cavity, and this
is particularly marked in the pregnancy with the first child, when the
pain is often very severe.
If in a first pregnancy there is no abnormal disproportion between the
dimensions of the child’s head and the maternal pelvis, or if there
be no abnormal position of the child, then there is an obstetric rule
that the womb, or rather the child’s head, begins to descend into the
pelvis after the seventh month of gestation, so that it can accommodate
or conform itself to the maternal parts. This occasions a drag on the
urethra downwards and backwards, which is painfully annoying, and there
is a constant inclination to pass water.
There are two mechanical methods of relieving this distressing symptom;
one is to obtain as much rest as possible in the recumbent position,
and the other is to wear an abdominal supporter or bandage around the
lower abdominal region, so as to take the weight off the urethra. The
internal medication consists of an occasional dose of a mild laxative
medicine.
In the newly married, the urethra becomes sometimes the seat of a
painful spasmodic contraction; this is due to a tense hymen, which
should be slightly nicked with a pair of scissors. Exposures to colds
will also cause neuralgia. Fresh beer and sour wine make the urine
irritating, and also occasion painful symptoms.
A thorough examination of the mucous membrane of the urethra which does
not reveal any inflammatory condition or abnormal growth, establishes
its neuralgic character. The next step will naturally be to make such
a careful examination of all the surrounding tissues and organs, for
the purpose of ferreting out the real cause. When the cause is removed
or cured, it will also relieve the urethral pain. In the absence of a
clear comprehension of the true nature of the malady, the treatment
must be palliative. The sitz-bath is always one of the most palliative
measures for all sorts of pelvic pains and aches. Vaginal injections of
hot water, not too hot, from 105 degrees to 108 degrees, are another
sort of general panacea,—the quantity of fluid should be large, from
half to one gallon, in which a teaspoonful of pulverized borax has been
dissolved. If the pain is very severe, then a Femina vaginal capsule
should be used every night before retiring, and immediately after
having used the vaginal irrigation. The bed should always be previously
warmed with a hot bottle, unless it is very warm weather.
If the urine is irritating, a cupful of buchu tea three or four times
a day, or German chamomile tea, should be drunk between meals. If
these measures do not give relief, then consult an honest, competent
physician, in whose integrity you can rely.
CHAPTER XII.
INFLAMMATION, CATARRH, AND OTHER DISORDERS OF THE BLADDER.
THE female bladder is easier approached than that of the male. This
is clearly illustrated in the anatomical Plate II, which should be
thoroughly studied before this chapter is read.
The bladder lies directly behind the symphysis pubis, above or in
front of the vagina. On account of the comparative shortness of the
female urethra, to that of the male, the cavity of the bladder is also
much more accessible through this channel, and if access through this
communication does not suffice, then the interior of the female bladder
may be exposed by an incision through the anterior wall of the vagina,
but this resource becomes rarely necessary. Formerly we had to content
ourselves with external appearances, that were confined to the external
anatomy of the urinary canal on the anterior vaginal wall, aided only
by a delicate sense of touch. Valuable as these means of examination
sometimes were, they were far from satisfactory to either physician or
patient. Now we are able to examine with the finger, aided with the
eyes, almost the entire lining of the bladder.
Professor Simon, of Heidelberg, was the inventive genius of this
improved method of examination, by means of a series of graded specula
or hard rubber bougies, which are known by his name. The specula are
simply small, smooth, pin-shaped, hard rubber bougies, about three
inches in length, beginning with a size that is three-tenths of an
inch in diameter, to the largest, which is eight-tenths of an inch
in thickness. These are carefully introduced into the urethra,
commencing with the smallest size, which is retained for a few minutes
and then withdrawn, and the next size inserted, and this continued
until the largest one has been inserted, or the required dilatation
accomplished, either for the purpose of introducing the finger into
the bladder, or exposing its lining membrane for inspection. While
this procedure does not fall into the sphere of home treatment, it
is of sufficient interest to women in general that they should know
what can actually be accomplished by the expert specialist. Were I
to review the malformations, or dislocations, of the bladder, or the
history of stones in the bladder, or other foreign bodies, that the
female specialist is very seldom called upon to treat, I should only
worry the patience of the reader with things that she would not readily
understand. The same is true of growths and tumors of the bladder,
which have principally a scientific interest for the practitioner of
medicine, but for the casual reader they are too profound in their
details for a clear understanding.
INFLAMMATION.
Inflammation of the bladder is in medical language termed cystitis.
It presents itself under two varieties or subdivisions, _acute_ and
chronic, depending on the duration, whether recent or protracted.
The disease begins in the mucous membrane, and the acute inflammation
comes on suddenly. It rarely occupies the entire mucous surface of the
bladder, but usually occurs in irregular spots. Some spots are as large
as the palm of the hand, while others are only the size of a ten-cent
piece. The parts that are most frequently affected, are the neck of
the bladder and its posterior wall, although no portion of its lining
membrane is exempt from inflammation.
It rarely happens that the inflammation spreads over the entire extent
of the bladder, or that it invades the muscular tissue; if it should
complicate the latter, it would involve the peritoneum; this would add
a very serious complication, namely, a peritonitis. Cystitis may be due
to an extension of gonorrhœal infection from the vagina and urethra,
or from other purulent affections. Women who are unable to pass water
after confinement, may be liable to the disease from retained urine,
decomposing in the bladder and causing inflammation. On the other
hand, a filthy catheter used by a midwife or doctor who is careless
or ignorant of the necessary antiseptic precautions, and who fails to
brush and boil out the catheters, and uses one catheter on different
patients, without the precaution of even thoroughly rinsing it, may
give rise to dangerous cystitis. The most serious case that I ever have
seen was directly traceable to this cause. If impure air gets into the
bladder this will also excite cystitis; to prevent that, is to close
with the finger the outlet of the catheter that is used for drawing
off the urine, when withdrawing the instrument, a precaution seldom
observed.
Newly-brewed malt liquors, alcoholic stimulants taken in excess,
diuretics of spirits of turpentine and cantharis, or highly-seasoned
and rich food, are among the exciting causes; irritating injections
into the bladder or vagina, and even cold-water injections into the
vagina, must be added as exciting causes of this painful affection.
Venereal excesses operate in exciting visceral inflammation, and when
the slightest symptoms are felt, prudence and good common sense dictate
continence. The first feeling that manifests itself is a dull, heavy,
aching sensation, immediately after urinating, and an involuntary
inclination to further relieve or empty the bladder by pressing or
bearing down. Soon after the first indication to void urine, there
is another desire to empty the bladder, and the same symptoms repeat
themselves, only in a more aggravated form. The distress of micturition
gradually becomes continuous so that during the short intervals between
the times that urine is voided, and as the disease progresses, the pain
becomes sharper. This is accompanied by a kind of gnawing uneasiness
in the region of the whole bladder, which has intermissions, but
is greatly increased when the desire to make water is felt. If the
disease progresses, the pain is now felt in the neighboring organs and
a general constitutional disturbance manifests itself. The patient
will now generally have a severe chill; this is followed with heat
and thirst and an increase in the pulse. The desire to void urine
at shorter intervals becomes more prominent and only drop by drop,
accompanied with distressing spasm and a burning sensation along the
urinary canal.
The region of the bladder becomes in the advanced stages of
inflammation extremely sensitive and tender, and if the peritoneum is
involved, even the weight of the bedclothes becomes intolerable. The
limbs are drawn up and the body is inclined forward to relieve the
tension of the abdominal muscles and their pressure on the bladder.
The neighboring organs begin to sympathize with the advanced state of
the inflammation at this stage; cutting pains are felt in the rectum,
while darts of pain shoot from the bladder towards the groins and
ovaries.
Owing to the spasmodic action of the urethra, the bladder is never
completely emptied so that the urine gradually accumulates in abnormal
proportions; the retained urea rapidly decomposes into ammonia and the
urine becomes very hot and irritating, thus greatly augmenting the
suffering. Under these circumstances, the bladder may become greatly
distended and feel as a sensitive globular tumor above the pubis. The
retention of the urine may be complete, owing to a partial paralysis of
the bladder and now complicated with spasmodic stricture. Nausea and
vomiting are rarely absent in this stage, the tongue becomes coated and
dry, while the expression is anxious and the fever very high.
In the commencement of the disease there is some difference in the
symptoms of inflammation of the bladder which arises from the nature
and seat of the inflammatory process.
If the neck of the bladder is mainly affected, the spasmodic desire to
urinate is more pronounced, and the pain is felt low down in the vagina
and anus, while the symptoms are higher up in the rectum, with constant
inclination to go to stool, if the base or posterior wall of the organ
is principally involved.
Acute cystitis runs its course in six or eight days; under favorable
circumstances and appropriate treatment all painful symptoms will in
that time have subsided, and the patient will have entered upon a
course of permanent recovery.
If through a constitutional habit, or through neglect or improper
treatment, the disease is not curbed, the result will be quite
different; the inflammation may pass into a suppurative stage or assume
the chronic form.
The treatment in the acute stage will resolve itself into two different
measures of relief; these are first to subdue the spasmodic pain and
nervous excitement, and secondly, to quiet the local irritation.
The pain is best controlled by morphine powders, one-fourth of a
grain each, given every four hours. Warm teas of German chamomile or
flaxseed, so as to dilute the urine, may be freely given. Hot vaginal
injections of borax water have a remarkably soothing influence; the hot
sitz-bath is another useful adjuvant. It has been customary in this
country and England, to apply hot water compresses or hot poultices
over the _hypogastrium_, which is that part of the lower abdomen
corresponding to the region of a distended bladder.
After eight years of extended experience in this country, and a
thorough trial of hot fomentations for inflammatory affections of
the abdomen, I became convinced that the German method of cold-water
compresses gives more relief and is more in the nature of an
_abortive_, hence curative.
I recommend to my patients, instead of the hot-water applications, a
rubber bag, filled with broken pieces of ice, and applied over the
region of the bladder.
The bowels should be freely moved with castor oil or a dose of salts
and senna, or by an enema of warm soapsuds.
The food should be bland and of a fluid nature as nearly as possible,
broths with an egg, milk gruels or bread and milk.
CHRONIC CYSTITIS.
If the acute attack of cystitis in the course of eight or ten days
becomes modified, but convalescence is not established, then it is
quite probable that the disease is drifting into a _chronic_ stage.
The mucus or slime that formerly accompanied the urinary discharge
is now assuming the character of matter or has become muco-purulent.
While this is a very rare symptom of the acute variety of cystitis and
usually of brief duration, in chronic inflammation it is one of the
characteristics of the malady, and often lasts for a long time; the
muco-purulent fluid is occasionally remarkably profuse.
The pus is not always furnished by the free surface of the mucous
membrane, but may be traced to small abscesses, situated in the tissue
between the mucous membrane and the muscular wall of the bladder. The
locality for the formation of these abscesses is principally at the
neck of the organ, although there is no part of the organ that is
entirely exempt from them. Fortunately, the abscesses generally point
inwards or towards the cavity of the bladder, but it not infrequently
happens that they break through and empty into the vagina or even into
the adjacent bowel or abdominal cavity.
The occurrence of pus or suppuration is by itself so grave a process
that it is always accompanied with certain well marked and stereotyped
symptoms, which are cold chills, alternating with flushes of heat,
increase of heat or fever, anxiety and restlessness. The pain now
becomes dull and throbbing in character, and the burning or stinging
is only felt when the patient urinates. When there are abscesses, the
nervous derangement may be so great as to cause the mind to wander in
delirium. Before the appearence of pus in the urine, nothing but a
skillful examination can establish the existence of an abscess.
The treatment for suppuration of the bladder, when limited to
the surface of the mucous membrane, is always curable with
intelligently-directed treatment, which is the same as that for chronic
catarrh of the bladder, to be detailed further on.
ULCERATION OF THE BLADDER.
This is perhaps seldom a condition by itself, but rather a complication
of the preceding disease. The ulcers occupy the place of what were
formerly little abscesses, that have broken into the cavity of the
organ. Foreign bodies in the bladder by their direct pressure on the
delicate tissues of the membrane have been the cause of ulcerations,
that gave rise to dangerous hemorrhage. Earthy concretions or stones
will naturally form in the bladder, and the end of a gum catheter
has also been found in the bladder broken off in the bungling act of
drawing off the urine, or, what is more likely, by boring and poking
within the cavity of the bladder, with a catheter or bougie, by persons
ignorant of pelvic anatomy or in the belief that the bougie was in the
cavity of the womb, for the purpose of inducing an abortion.
Ulcerations will always be accompanied with more or less inflammation
or visceral catarrh, so that the symptoms will fall under that head
which has already been considered.
CATARRH OR SUBACUTE INFLAMMATION.
The mucous membrane of the bladder, like that of the nose, mouth or
bronchial tubes, has its natural secretion of healthy mucous. When
any of these membranes become irritated or congested from any cause,
this natural secretion becomes so increased as to make a perceptible
_flow_ of the secretion of mucus, and this is what the term _catarrh_
signifies. Catarrhs always presuppose the existence of inflammation,
which in its nature is subdued or mild, so that it has been qualified
as subacute, which is intended to convey the idea that the tissue need
not be red nor hot and swollen as is always the case in the acute form
of inflammation.
Chronic catarrh of the bladder is traceable to any or all the causes
that have been enumerated in the acute processes, because every acute
inflammation of the bladder may terminate in a chronic form. It occurs
at any period of life, but it is most common in elderly subjects; it
is always an attendant of ulceration of the bladder or some abnormal
growth in the bladder. If the disease is once established and is due
to a complication, it is liable to become aggravated or re-established
after a brief subsidence by exposure to cold, excesses in diet and
drink, or diseases of the vagina, uterus or rectum.
The secretion of catarrh is white and glairy and resembles the
discharge of leucorrhœa or whites. When disassociated with acute
inflammation of the bladder, it comes on gradually, or in a slow,
insidious manner; for this reason the term subacute inflammation is
sometimes employed by authors, because there are no fiery symptoms at
the onset of the affection.
The urine is always more or less altered in character, because the
inflamed mucous membrane predisposes the urine to speedy decomposition.
There is frequent and difficult micturition, and the entire region, but
in particular the affected organ, is more or less sensitive and sore.
The quantity of mucus which passes off with the urine varies greatly
at different periods and in different cases. In the early stages it
may entirely escape notice, being so small that if the urine is not
saved in a vessel and accumulated for the twenty-four hours the mucus
can hardly be detected; thus, the entire quantity of the above period
may often not exceed two teaspoonfuls. When the disease becomes more
advanced, the quantity of mucus may be equal to the quantity of urine
that passes. The secretion is very thick and sticky, and settles to the
bottom of the vessel or adheres to its surface. If there is pus mixed
with the mucous secretion, it becomes a more serious question, and it
may then be inferred that other organs are involved, the conductors
of urine from the kidneys to the bladder, for instance, or the kidneys
themselves. If the disease is confined to the bladder, the prospects
for a cure are very favorable; only when diseases of other organs in
the neighborhood are the exciting causes of the malady are the chances
for a cure correspondingly limited.
The success of any treatment will depend in a great measure upon the
nature of the exciting causes. These require to be removed, if within
the possibility of medical skill, before the catarrh can be made to
subside.
Should the mucous or muco-purulent secretion be very abundant, the
bladder must be thoroughly rinsed out; first once every twenty-four
hours, and afterwards every other day, so that the mucous membrane will
be cleansed from all foreign irritating elements. I am employing for
this purpose Thiersche’s Boro-Salicylic solution. This of course can
only be carried out by a skillful physician.
When the disease is in its incipient stage it is amenable to
intelligently-directed home treatment.
The most perfect rest of mind and body is one of the essentials to
success, the entire suspension of stimulating drinks of an alcoholic
nature, of which beer is the most irritating, and tea or coffee must be
discarded. A milk and vegetable diet is the most beneficial to subsist
on, and all condiments, even salt, must be dispensed with.
If the bowels are costive they must be regulated either by means of
enemas of warm water, or what may prove of greater and more lasting
benefit is the use of Femina laxative tablets. One tablet should be
taken every night at bedtime, and if one operates too much, then one
every other night may be all that is required.
Demulcent drinks of flaxseed tea, or slippery-elm water, should
be drunk freely, and for the catarrh of the bladder there is no
prescription that ever gave me the same satisfactory results as this
one:——
NO. VI.
Take: Borate of soda 2 drams
Fluid ex. of gelseminum 1 dram
Fluid ex. of belladonna x drops
Fluid ex. of buchu 1½ ounces
Fluid ex. of senna 1½ ounces
Distilled water 2 ounces
Syrup of orange peel sufficient to make 8 ounces
Mix, and take a tablespoonful or less three times a day.
Wear flannel drawers and woolen hose, so as to guard against sudden
changes of the weather.
NEURALGIA AND NERVOUS IRRITABILITY.
The bladder is often the seat of functional derangements that are
characterized by a morbid sensibility and pain.
The principal symptom of this disease is a frequent desire to urinate.
A careful examination of the urine reveals nothing abnormal in the
fluid that would point to the slightest affection of the bladder, nor
are any of the symptoms that characterize inflammation present. There
is no mucous sediment, but in a large proportion of cases there is an
abnormal deposit of the phosphates that would point to nerve waste.
There is often a similar irritability in the vaginal canal, in fact,
there is such a mutual sympathy between the two, which can hardly be
located in any one particular organ.
Hemorrhoids and constipation are sometimes found to be the cause.
In women of a nervous temperament the bladder often becomes the seat of
a steady neuralgic pain. Sometimes this pain is periodical, recurring
every day and about the same hour and lasting the same period. This
pain is of a lancinating character, and radiates from the bladder to
the neighboring organs. I have noticed these symptoms, particularly in
women who had lived in malarial districts, and whose blood had become
impoverished by malarial fevers, or from excessive hemorrhages due to
some uterine trouble.
Sexual excesses and other abuses that lower the tone of the nervous
system will also develop a neuralgic condition of these parts. Persons
who seek relief from this distressing complaint must first abandon
their vices before they can expect alleviation from any treatment. This
affection is not in itself dangerous, but the frequent recurrence of
paroxysms of pain render life miserable. If the general system requires
toning up, I would recommend the iron pills after Formula I, with a
good liberal diet of eggs and milk. For immediate relief of the painful
spasms, the sitz-bath and hot vaginal injections are of great value.
And for the irritable bladder I can recommend:——
NO. VII.
Take: Bromide of sodium 3 drams
Fluid ex. of gelseminum 1 dram
Water sufficient to make 8 ounces
Mix, and take a tablespoonful three times a day.
The gouty and rheumatic bladder is so very rare that a detailed
description is hardly necessary. But it might be well to remind the
reader that if she is of a gouty or rheumatic disposition and has also
bladder trouble, it may be due to the bladder being compromised or
influenced by gout or rheumatism. In that case, appropriate treatment
directed to the rheumatic diathesis will also cure the bladder.
PARALYSIS.
The female bladder becomes paralyzed from various causes; some of these
are located in the organ itself, while others are due to disease of
the brain or spinal cord. An obstruction to the flow of urine through
the urethra causes the bladder to become overdistended with urine and
induces paralysis. A prolonged pressure from the child’s head during
delivery is oftener the cause of transient paralysis than any other. It
happens that lying-in women cannot pass their urine for several days
after confinement. Violence from without, as a blow or a kick, may have
a similar effect. This results from the pressure to which the bladder
was subjected. Operations on the rectum, vagina, or any of the pelvic
organs, are frequently followed by a partial or complete paralysis. In
all these cases, there is only one precaution to observe, and that is
to draw off the urine at regular intervals so as to avoid an enormous
accumulation of fluid.
The paralysis becomes dangerous and obstinate to treatment, in
proportion as the bladder becomes abnormally distended, and the length
of time that the muscular tissues are under the excessive strain.
In those cases where the paralysis is due to spinal or brain disease,
there is little prospect of a cure. In other cases, as for instance
after confinement or an operation on the rectum for piles or fistula,
it generally passes off in a few days.
Great care and cleanliness must be exercised in using the catheter,
so that the bladder is not infected from filth or virus from another
patient. A catheter that has been employed on a patient who had her
urine drawn off while she suffered from purulent catarrh or puerperal
fever, will inoculate a healthy person with the same disease, and in
this manner diseases are often communicated. The bladder is exceedingly
liable to infection.
HEMORRHAGE.
A discharge of blood from the bladder is not of frequent occurrence,
but it occurs often enough to make it noteworthy, and women should
at least know that there is such a thing. It oftener takes place in
men than in women, as a symptom of some grave or serious disease, or
it may be only a trivial disorder. Hemorrhage of the mucous membrane
takes place very readily, owing to the delicacy of the tissues and the
great vascularity of the submucous layer, and there is a much greater
tendency to hemorrhage in some persons than in others.
Persons who are weak and debilitated bleed much easier than strong,
vigorous ones, because the blood may become so thin or poor in fibrin
that it greatly loses its property of coagulating. Some diseases
bring this particular diathesis about, such as scurvy, also measles,
scarlatina or smallpox. Worms have been found to make their way from
the rectum into the cavity of the bladder, and caused profuse and even
fatal hemorrhage. A violent fall of the body, rupturing an artery in
the bladder, severe horseback riding, and venereal excesses, have all
caused almost fatal hemorrhages, to which must be added ulceration of
the mucous membrane. The most profuse hemorrhage of the bladder that I
was ever called upon to witness, followed drinking a strong decoction
of wormwood; irritating diuretics, like spirits of turpentine or
tincture of cantharides, are also liable to cause bleeding. Hemorrhage
is always accompanied with frequent desire to pass urine and spasmodic
pains at the neck of the bladder. The blood may also coagulate in the
bladder, causing an obstruction. The treatment consists principally
in keeping the patient very quiet, and a rubber ice bag should be
applied over the region of the bladder; nothing but bland liquid food
is advisable, but no hot drinks are permissible. If the urine does not
pass, a soft rubber catheter should be employed for the purpose of
drawing it off.
Hemorrhages of the mucous membrane, whether of the bladder, the bowels
or lungs, generally yield to the following mixture:——
NO. VIII.
Take: Gallic acid 4 scruples
Tr. of digitalis ½ ounce
Fluid ex. of ergot 1 ounce
Simple syrup ½ ounce
Mix, and give a teaspoonful in a little water every four hours;
children in proportion.
URINARY FISTULA.
By this is meant a permanent unnatural opening into the bladder from
without, through which urine escapes.
The situation of the female bladder, just in front and over the vagina,
and also its attachment to a portion of the cervix or neck of the womb,
exposes it to injuries, especially from pressure of the child’s head
during delivery. By referring to Plate II, it will be seen at a glance
how easily an accident can take place from this cause. It was at one
time supposed that delivery by forceps was the most fruitful cause of
this lesion. That this is likely to happen only where the instrument
is in incompetent or bungling hands, there is no reasonable doubt. A
thorough acquaintance with the entire subject has proved that there are
other causes that are the mainspring of this, sometimes very serious
accident.
Indeed, the opposite view is now entertained by the profession; that
is, that prompt delivery by forceps will prevent the parts from being
injured, when the soft parts, and particularly the bladder, is under
severe and prolonged pressure by the child’s head. There is no question
that there is greater peril to the mother and child, in undecisive
delay, provided the attendant has the requisite judgment and experience
to act intelligently.
The hypothesis upon which this is based is the restorative property
that living tissue possesses, to regain its vitality, after it has been
subjected to severe and inordinate pressure. This we may observe in
our daily experience; when, for instance, we jamb or crush our finger,
or a child has its fingers momentarily crushed between a closing door,
the fingers are sometimes crushed flat, but upon being released,
they rapidly regain their shape and vitality. If the pressure were
continued for any length of time, the blood in the tissues would have
become congealed, and the circulation permanently shut off, so that
recuperation would have been impossible, and the tissues would have
sloughed or mortified.
If the bladder, under the direct pressure of the child’s head against
the pubic bone, be subjected too long, the same results would
naturally follow: the tissues could not regain their vitality, and they
would either tear or subsequently slough or mortify, which causes the
_fistula_.
The vagina and bladder, like every other tissue of the body, except
that of the brain or nerves, will suffer a great deal of contusion for
a short time, but if protracted beyond a reasonable length of time, it
will be permanently destroyed or injured.
A urinary fistula is always a serious malady, since it exercises a
deleterious influence upon the patient’s health. If the opening is
only small, a spontaneous cure may take place, but if it reaches
considerable dimensions, it requires to be accurately adapted and
stitched together. The best time for the repair of the injury, is six
to eight weeks after the receipt of the injury.
Rupture of the female bladder is comparatively rare, for the reason
that women are not exposed to the same serious accidents as men; but
if women will persist in doing everything that men ought to do for
them, the statistics may be reversed. When the bladder is distended
and violence is brought to bear on the abdominal walls, corresponding
to the region of the filled bladder, a rupture is likely to result.
Surgical measures should at once be resorted to, so that the injury can
be repaired before inflammation of the peritoneum sets in.
CHAPTER XIII.
ACUTE AND CHRONIC INFLAMMATION OF THE VAGINA.
WHEN speaking of inflammation of the vagina, reference is had to its
mucous lining alone. It undoubtedly happens that structures or tissues
beneath the mucous covering become involved in the inflammatory action,
but this occurs so seldom that it is not of sufficient moment to make
it the subject of an inquiry in a practical work.
The mucous membrane of the vagina, like all other mucous surfaces,
has its natural secretion for the purpose of lubricating and keeping
its surface moist. In a perfectly healthy state, the color of the
vaginal mucous membrane is a pale red, this becomes scarlet red upon
irritation. In girls who are not irritated or women who have not been
abused by sexual excesses nor infected by disease, the normal secretion
is just sufficient to preserve the moisture of its surfaces, but not in
such an excess as to be noticed as a secretion or discharge outside of
the vaginal canal. There is a physiological exception to this normal
rule, a few days before and after the menstrual period, when the mucous
membrane of the vagina sympathizes with the general congestion of the
pelvic organs. The mucous secretion becomes then greatly increased,
amounting to a catarrh or flow, this, however, is only transient and
subsides with the cessation of the menses. This might with propriety be
termed a natural or physiological catarrh.
For convenience of description and corresponding with the anatomical
changes and the sources of their origin, inflammation of the mucous
membrane of the vagina may be _acute_ or _chronic_, simple or specific.
Acute inflammation in this instance is no different in its
characteristic symptoms from inflammations elsewhere; it develops
suddenly, and there is congestive swelling and pain. There is
considerable heat in the parts, increased redness, and the canal
is very sensitive. In the beginning the mucous membrane is dry and
contracted, but after a few hours or a day, relaxation and moisture
supersede. The secretion is very scant at first, but becomes more
abundant as the disease progresses, its character also changes from a
white, glairy mucus to a creamy, muco-purulent or yellowish discharge.
The urethra may also become involved, and then the symptoms that were
detailed in connection with urethritis are also present.
Acute vaginitis may arise from a great variety of causes, but the
worst case that ever came under my notice was the scalding effect of
a hot-water injection, given under the advice of a physician who had
ordered the patient to use the water “as hot as she could stand it,”
and also told her “the hotter the better.” This _profoundly wise_
suggestion was carried out by the patient with a vengeance, for she
used nearly boiling hot water, which she had tested by putting in her
finger and quickly withdrawing it. The steaming fluid so scalded the
vagina that a most pronounced acute inflammation of the vagina was
the immediate result. I have had other cases of the chronic form come
under my notice that were aggravated by similar advice, so that a word
of warning against the thoughtless and indiscriminate use of hot-water
injections will not be without value.
The vaginal irrigations of hot water, as a general stimulant to the
mucous surfaces, or as an alterative to stimulate the absorbents
to increased activity in removing old pelvic exudations, deserve
a recognized place as a useful therapeutic measure, often of the
greatest value, but too hot or “as hot as the patient can bear it,” is
superlative nonsense and absolutely injurious.
No water injections into the vagina that are kept up any length of
time should be warmer than 110 degrees Fahr. and never should vaginal
injections be employed without using a thermometer to gauge the heat.
When the solution is medicated, 103 degrees should be the average
temperature, but it should never exceed 107 degrees Fahr. Exposure to
cold and moisture especially during the menses is prominent among the
causes of acute vaginitis; injury from pessaries or coition, retained
putrefying secretions in the vagina, or the application of chemical
preparations, or injury during confinement, will all induce this
disease. Prolonged nursing causes anæmia, which predisposes the system
to catarrhs. During the child-bearing period catarrhs of the vagina are
quite common, and excessive coition excites a very painful inflammation
of the vaginal mucous membrane.
Gonorrhœal infection arising from a specific contagion gives rise to
a very painful and dangerous vaginitis. The character and nature of
the specific virus admits of no particular description, because its
infectious quality of a specific nature does not at all depend upon
the physical appearance of the infectious discharge from the male.
Whether it is yellow or greenish, muco-purulent or a glairy mucous
discharge, establishes no criterion, but the presence of microbes,
the _gonococcus_ of Neisser; this, of course, a careful microscopic
examination can alone establish. This much is true, that careful
researches in Europe, by competent and reliable authorities, have
established the fact, from carefully-prepared statistics, that this
is a far more fruitful source of uterine diseases than was formerly
dreamed of.
A specific vaginitis has a greater tendency to spread itself along
the mucous tract of the genital organs of the female than a simple
non-specific catarrh. In the former the womb and Fallopian tubes become
successively affected, as we shall learn more definitely when we have
occasion to inquire into the diseases peculiar to these organs.
Acute inflammation of the vagina has pronounced symptoms, and when
any one of them is felt by the patient, she should lose no time in
resorting to treatment.
The first symptom that is generally perceived by the patient is a sense
of heat and burning in the vaginal canal; this is also reflected in
the neck of the bladder during micturition. As the disease develops,
there is a constant desire to pass water frequently, and this becomes
sometimes a prominent sign. A dull aching weight is felt between the
vagina and rectum. After these have lasted for some days, an offensive
discharge from the vagina ushers in the second stage, excoriating the
skin around the vulva, and if the disease should spread itself to the
neighboring organs, there is a violent throbbing pain in the whole
pelvis.
Women who are suffering with acute painful vaginitis should take to
bed; all pelvic diseases of any acuteness at all are treated at a great
disadvantage when the patient is running around and on her feet. The
disturbance in the circulation, the exposure to cold from cold floors
or damp sidewalks, and the impossibility of preserving an equable
temperature of the body, when out of bed, only aggravate the malady.
The vagina is to be douched several times a day with half gallon
of warm water, in which a half teaspoonful or one tablet of Femina
antiseptic uterine lotion has been dissolved, and when the canal is
rinsed, a Femina vaginal capsule should be introduced, but only once
a day, and that is preferable at bedtime. The feet and extremities
should be kept warm, and in married women total continence should be
observed while the slightest irritation and soreness exists. By the
non-observance of this precaution, the best directed efforts will often
be frustrated and many female diseases which are readily curable in the
beginning become chronic, and a moment’s reflection ought to make this
clear to any person of ordinary intelligence.
If there is the slightest suspicion that the disease is of a specific
nature, the treatment must be antiseptic in its nature. Your physician
should be reminded of the possible nature of the disease, for doctors
as a rule are ignorant of the dangers that ordinarily accompany
gonorrhœal infection.
Oppenheimer in Germany made experiments for testing the germicidal
properties of various drugs on the specific germs of gonorrhœa, and he
proved that a corrosive sublimate solution of 1 part to 20,000 will
kill the gonococci. Corrosive sublimate is the corrosive chloride of
mercury, one of the most powerful of the mineral poisons, and while it
is perfectly safe in the dilutions that it is employed in, the greatest
precaution must be constantly exercised to keep the drug isolated and
out of the reach of children, especially the “antiseptic tablets,” of
which mention will be made below, because little children and adults
also might at first sight believe that they were candy.
I am accustomed to employ the _corrosive sublimate_ much stronger
than the Oppenheimer experiments demand, a practice which I base upon
practical observations, while in the Berlin clinics, and that is in
the proportion of 1 to 2,000. John Wyeth & Bro., of Philadelphia,
and other manufacturing chemists, make compressed tablets or wafers,
which are very convenient and easily handled by any person of average
understanding. These are sold by the druggists in little wide-mouth
bottles, properly labeled, so that the required strength, 1 to 2,000,
is obtained by dissolving one or two according to their strength in a
half gallon of warm water. Whenever gonorrhœa is suspected, the vagina
should be thoroughly rinsed out several times a day with the corrosive
solution. If the patient fears mercurial poisoning, the antiseptic
irrigation can be followed by plain warm-water rinsings as a safe
precaution against mercurial absorption.
CHRONIC CATARRH, LEUCORRHŒA OR WHITES.
An acute inflammation of the mucous membrane of any organ may drift
into the chronic or subacute form, so that any of the causes which
give rise to the acute variety are among those that are to be looked
for in chronic catarrh. The general characteristics of catarrh are
the same, whether acute or chronic or whether located in the nose,
throat, bronchial tubes or vagina. This fact greatly simplifies the
whole subject of catarrhal inflammations, so that the general reader
will find no difficulty in acquiring the necessary information for
successful home treatment of this very common class of diseases.
Chronic vaginal catarrh has been divided into two varieties, _vaginal
and uterine_. The distinction depends upon its origin or complication.
Vaginal catarrh has its origin in and is limited to the vaginal canal.
I have already called attention to a purely physiological catarrh that
accompanies the menstrual flow and which subsides with the cessation
of the menses; in addition to this, there is probably no woman who
goes through life without at some time during her natural existence
having this disease or symptom. Often the discharge is so scant that it
entirely escapes her notice, and not until it becomes annoying by its
constancy and abundance do women seek assistance.
In ancient times and until quite recently, it was considered as
a distinct disease, attributed to constitutional debility or an
indication of impure blood; these theories are now entirely discarded.
The modern school of Gynecology has given it quite a different
interpretation, and considers leucorrhœa rather a symptom of some
local disease than a disease itself. Experience, and careful research
in, the sick chamber fully corroborate the correctness of this view,
so that a simple local chronic catarrh is the exception to the rule.
The exception applies oftener to children than to adults. We find it
in young babies or little girls of all ages as a result of diarrhœal
discharges which are acrid and filter themselves into the vagina and by
their sharp, irritating action on the mucous membrane, excite at first
an acute, and afterwards a chronic catarrh of these parts. Eruptive
fevers have induced a similar effect upon the mucous membrane of the
child’s vagina and also upon that of the bladder; obstinate catarrhs
are frequently traced to these fevers. I have known pinworms to make
their way from the rectum into the vagina and by their irritating
presence excite in the little child a very distressing vaginal catarrh.
The irritation or itching which the inflammation and decomposed
secretion cause, makes the child involuntarily dig or scratch her
vulva, which of course only aggravates the disease, and which has
already been mistaken for precocious masturbation, and will undoubtedly
often be so considered again by superficial observers. In later years
a subacute inflammation of these parts will undoubtedly develop this
pernicious practice, and I have known several cases myself where young
girls became physical wrecks from a combination of chronic vaginal
catarrh and self-abuse, no one ever dreaming of the real morbid
condition, but attributing their decline to everything else but the
right cause.
There is another complication that may arise from catarrhal
inflammation in little children, and that is an adhesive inflammation
of the vaginal walls; that means that the sides of the vagina may
partly or completely grow together, and thus change the normal diameter
of the vaginal canal. In after years this may entail frightful
suffering, either by mechanically obstructing the escape of the
menstrual blood or otherwise interfering with the normal function of
the canal. There are many diseases from which we suffer in adult life
for which the foundation was laid when we were young, through the
ignorance of our parents.
The stormy symptoms that usher in the acute form are absent in the
development of the subacute or chronic variety. This disease begins
sometimes so insidiously that the patient may not be aware of its
existence for quite a while. The secretion may not be at first changed
in its character, save that it is noticed in greater abundance. In the
course of time, the nature of the secretion will be greatly changed,
from a white glairy discharge into a grayish opaque secretion; this
will be tinged greenish some days and be of a muco-purulent aspect. In
the great majority of cases it is a whitish cheesy discharge from which
the names _leucorrhœa_ or _whites_ have been derived.
The color of the vaginal mucous membrane in chronic catarrh is of
a bluish red tint, and its surface presents in places granulated
patches, that bleed easily when they are touched. The vaginal walls
are relaxed, so that women often complain that they have a sensation
of “feeling open;” this is indeed the real state of affairs; the walls
of the vagina may become so relaxed as to constitute a prolapse of the
anterior portion or wall of the vagina, dragging the bladder and womb
down with it.
A great many of the so-called “_falling of the womb cases_” are no
falling of the womb at all but simply a relaxed vagina, in which the
wearing of pessaries or any other mechanical uterine supporter will
actually do a great deal of harm.
The treatment of vaginal catarrh is principally local, when there are
no constitutional complications. Of course there are rules of conduct
that apply to all catarrhal patients, whether the catarrh is of the
genitalia, of the nose or throat or of the bronchial tubes; these
rules constitute the hygiene of catarrh, a subject which is discussed
in a separate chapter in this work to which the intelligent reader is
referred.
The main feature of the treatment consists in thorough cleanliness of
the vaginal canal and in the use of a soothing lotion. This object is
best accomplished by the use of the Femina antiseptic lotion and in
the following manner: Dissolve one tablet or half a teaspoonful in a
cupful of hot water and then add this to a half gallon of warm water
of a temperature of 103° F., and by means of an elastic bulb syringe,
use the entire quantity at one time. If the discharge is profuse, or if
any offensive odor is perceptible, then the vaginal injection should be
made several times a day.
In case there is soreness and pain in the pelvis, and there generally
is, a Femina vaginal capsule should be introduced into the vagina, just
before retiring.
When the patient feels a dragging sensation, or such symptoms as would
indicate a prolapse (falling down) of the vaginal walls from weakness
or relaxation of the columns and muscular tissue which give them
support, then the Femina antiseptic uterine lotion should be used,
as before described, with this difference, that double the quantity
should be dissolved in the cupful of hot water, and then added to the
half gallon of warm water of the same temperature and used in the same
manner. When the Femina antiseptic uterine lotion is used in its double
strength, the remedy loses nothing in its healing effect but becomes
more astringent, strengthening, and disinfectant.
Be sure that the nozzle of the syringe sweeps the entire vaginal
cavity, and if the above quantity of fluid should not be sufficient to
thoroughly cleanse the vagina, then use double the quantity of fluid.
With this prescription I have cured cases of leucorrhœa of twenty
years’ standing which had gone through the ordeal of all the different
treatments that they were capable of undergoing.
I would recommend to those patients who feel their wombs dragged down,
the _knee-chest posture_, that means, to kneel down on the floor with
the hips elevated as high as possible and the chest close down to the
floor. This position rolls the abdominal organs upwards and forwards,
and thus naturally draws the womb and vagina into their normal
positions, much better than any mechanical appliance or operator can
possibly accomplish it. It simply allows the relaxed organs, through
the natural law of gravitation, to gravitate where they belong. It is
necessary to retain this kneeling position for only ten or fifteen
minutes, repeated twice a day, say night and morning, and the curative
effect is truly wonderful.
When I speak of the curative measures of displacements in general and
of falling of the womb downwards and backwards in particular, I will
give a detailed description of the knee-chest position.
There should be a choice in selecting a vaginal syringe or a syringe
for vaginal bathing. The “fountain syringe” has several objections that
are insurmountable. In the first place, the quantity of fluid that is
to be used is limited by the capacity of the reservoir, or in order
to replenish it, the even tenor of the rinsing is disturbed. Another
objection is, that the convenient peg upon which to hang it is not
always present, or a shelf upon which to rest it not high enough; then
there is not the control over the stream that is desirable, so that
considerable confusion arises at times from the fluid wetting things
that had better be kept dry. For these reasons I prefer a bulb syringe.
CHAPTER XIV.
HYGIENIC MEASURES FOR CATARRHAL DISEASES OF THE FEMALE ORGANS.
NO treatment for catarrhal inflammations in general and of the pelvic
organs in particular is certain and complete without special attention
being given to certain laws or rules that are laid down for the
preservation and attainment of health, and these comprise one of the
collateral departments of medical science which is termed _hygiene_.
What the skin or integument is to the exterior of the body, the mucous
membrane which lines the respiratory passages and other organs is to
the interior of the body.
The mucous membrane is only a modification of the skin, and while it
differs in its glandular composition in the different organs that it
lines, in the main, it retains the common characteristics of the skin
or outer covering of the body.
The _corium_ or fibrous layer of the mucous membrane is analogous to
the _derma_ of the skin; and it is in fact a continuation of it at the
orifices of the body.
The corium of the mucous membrane supports an epithelial layer of cells
that are of various forms, differing in the different organs that it
lines.
Underneath the corium of the mucous membrane there is the fibrovascular
layer, which contains the blood vessels, lymphatics and nerves and
embedded in the epithelial cells supported by the corium are the
numerous mucous glands or follicles. In some portions of the mucous
tract and projecting out of it are little elevations called villi or
papillæ, analogous to the papillæ of the skin.
These glands and papillæ exist only at certain parts and are modified
according to the function that the organ performs. The mucous glands
of the stomach differ from those of the intestines, and those of the
mouth from those of the bronchial tubes. The mucous membrane of the
womb differs from all the rest, by having no submucous or fibrovascular
layer; the mucous glands of the womb are imbedded and extend directly
into the muscular tissue of the organ. The secreting glands, which form
a special feature of mucous membranes, are abundantly supplied by small
capillary blood vessels and nerves, so that any disturbance of the
general or systemic circulation or a derangement of the nervous system
will at once greatly influence the healthy or normal secretion of the
membrane, just exactly as the skin is affected by cold or fright.
In order to appreciate all the causes that operate for either good or
evil, we must pause for a moment and consider the sympathy with and the
close relation of the mucous membrane to the circulation of the blood
and the nervous system. The mucous membrane of the different organs
is often made the safety valve through which obnoxious materials or
morbid conditions of the blood are eliminated from the system, and for
that reason I have long ago discarded the usual harsh measures in the
treatment of sudden or acute catarrhs. I have found that, by carefully
watching and giving close attention to the details of certain rules
of health, catarrhs speedily disappear of their own accord: on the
other hand, if irritating local remedies are constantly used, catarrhs
continue to grow worse.
This demonstrated fact so very often repeated, impressed upon my mind
the importance of hygienic measures for the successful treatment of
catarrhal inflammations, whether they are of the respiratory organs
or of the female pelvic organs. The most prominent and efficacious
measures are to be found in intelligent precautions for preventing
colds and inuring the system to changes of temperature by appropriate
outdoor exercise.
By far the greater proportion of female complaints are catarrhal
inflammations, and these fasten themselves upon all the pelvic
organs—on the bladder, vagina, womb and Fallopian tubes.
We generally know how we contract a bronchial catarrh or bronchitis,
a nasal catarrh or sore throat; in precisely the same manner do women
contract most of their pelvic catarrhs, that is, from a common cold or
sudden chilling of the body or part of the body.
Dr. Thomas F. Rumbold, in his work on the “Hygiene and Treatment of
Catarrh,” says: “The history of every case of chronic catarrh attests
that the complaint commenced with colds in the head and that the
disease grew upon the patient almost imperceptibly, the first colds
being so trivial in character as to attract but little attention.”
This statement is as true of the great majority of cases of vaginal and
uterine catarrh as it is of catarrhs of the air passages, and for this
reason the measures and precautions for the prevention of colds must be
one of the features in the successful treatment of female complaints.
The particulars of the causation of colds and the hygienic precautions
for their prevention are hardly ever given the attention which their
importance demands in the treatment for catarrhal complaints of women,
so that a great deal of suffering is left unrelieved and a great deal
of expensive and useless doctoring is endured. Altogether too much
reliance is placed upon a wash or some local application made by the
doctor to the affected parts, and, indeed, the mainspring of the
catarrhal affection is entirely overlooked or neglected, which is, the
susceptibility to the recurrence of fresh colds.
The injurious effects of taking cold or chilling the body or any part
of it, have been the subject of special inquiry in Germany. The mucous
membrane and the skin seem the most sensitive to sudden changes from
a warm to a colder atmosphere, but observations have already proven
that besides the usual catarrhal inflammations, there are other
inflammatory conditions that are developed. The kidneys, lungs, and
liver have been found to be the seat of inflammations in a series of
experiments that were made with rabbits that were removed from a warm
to a much colder apartment, and from this may be inferred that these
conditions originate similarly in the human subject.
The logical conclusions of these researches have been, that the chilled
or cooled blood becomes chemically altered and acts as a direct
irritant in the small capillary vessels, and by that means all the
phenomena of inflammation of the tissues are excited, and these of
course develop wherever the cold may strike or locate.
When we speak of a slight or a bad cold, we cannot form the least
idea of the remote effects that the cold may bring about. It may lay
the foundation of a nephritis or Bright’s disease of the kidneys, or
some other lesion, and that it often gives rise to vaginal and uterine
catarrh is as certain as that it gives rise to nasal catarrh or a cold
in the head.
An aptitude to take cold grows with each repetition of the attack and
the prolonged duration of the acute catarrhal symptoms. And for that
reason persons grow into the habit of taking cold upon the slightest
exposure or change of temperature. At this stage of catarrh there is
an abnormal sensitiveness of the mucous membrane and skin, in which
the slightest draught of air or even passing from one room to another
occasions an attack of sneezing or a chill and other symptoms that will
indispose the patient for several days.
The great majority of individuals have a natural predisposition to
certain diseases.
In anatomy the body has been divided into systems. A system is an
assemblage of organs composed of the same tissues and intended for
similar functions, as the circulatory system, the nervous system,
the muscular system, the cutaneous system, etc.; these systems are
all liable to particular diseases. In one person the mucous membrane
of the respiratory system is the most sensitive part of the body,
while in another, and especially in women, it is the mucous membrane
of the genito-urinary system. In other words, one person will take a
cold and it will settle in the head or on the bronchial tubes, while
another from the same exposure will get a catarrhal inflammation of
the bladder or womb; this is only explained on the theory of natural
predispositions, and, perhaps, hereditary taints.
If a person once knows the weak or vulnerable points, he can outgrow
them, by employing such rules of hygiene as experience has taught to
be useful. There is much more benefit to be derived in an educational
treatment directed to the prevention of disease, for this is also in
the nature of a cure, than in a blind obedient faith in the treatment
or remedy of a physician who may be ignorant, and generally is, of the
laws of health or the science of hygiene.
To promote health and to antagonize disease is greatly within one’s
own power, because there is no doubt that most diseases are the result
of imprudence that cannot be attributed to ignorance, because persons
commit these errors with a full knowledge of their evil effects.
A healthy habitation, that has all the advantages of pure air and
sunshine, is an essential feature in regaining health and encouraging
a cure. There are hundreds of persons who have been sick and miserable
for years, and who have made the rounds of all the doctors they ever
heard of, without the least benefit to themselves, because they were
never told how to live, and their living rooms are dark and sunless and
poorly ventilated.
The even and equable temperature of all the rooms of a house should
be kept in constant view, so that sudden and extreme changes of
temperature are avoided.
Warming a dwelling artificially should be one of the important features
in the construction of a completely-furnished residence. This subject
has been neglected, owing to the temperate climate of California, yet
the moisture of the air, and the closeness with which dwellings are
built in cities, exclude the rays of the sun and make houses too cold
for health and comfort. In our climate we become more sensitive to the
cold air than those who live in drier regions.
In shaded houses and rooms, especially in damp weather, we need
artificial heating as much as they do in colder climates, so that
architects should make it a study to introduce a system of heating that
will insure an equable temperature throughout the entire building, at a
minimum of expense.
The fireplace or open hearth, which has become so popular with us
as the pleasantest and healthiest mode of heating and also insuring
ventilation, should be discarded for something much better. The fact
that the fire is directly beneath the chimney flue explains the fact
that eighty-seven per cent of the total heat yielded by coal or coke
and ninety-four per cent of that yielded by wood escapes through the
chimney. This enormous loss of temperature arises from the current
of air necessary for combustion, carrying with it a large quantity
of the heat produced which is lost in the atmosphere. This of course
is a means of _ventilation_, but a little reflection will convince
almost anyone that it cannot be the most practical, and in this State
where coal is very high it is equally expensive. The smoke, soot, and
ashes that are inseparable from the open fireplace make it troublesome
and dirty, not to say anything of the coal gas, which poisons the
atmosphere of a room, and I have often noticed its noxious influence on
infants.
There are objections against warming one or two rooms of a house and
leaving the others cold. A warm sitting room, while the halls and
bedrooms remain cold and chilly, is a very fruitful source of cold and
catarrhs.
There is a vast difference between heating for health, and heating to
have warm rooms; in the former, the warm rooms would be incidental to
health and comfort, while in the latter you might sacrifice health for
warm rooms.
Heating by hot air has serious objections that may be briefly stated as
follows: Fresh air passing through or around red hot furnaces, becomes
so rarefied that it no longer contains sufficient oxygen for healthful
breathing purposes.
The expansion and contraction of the furnace allows the escape of the
noxious gases of combustion which become unavoidably mixed with the hot
air that is to heat the dwelling, and thus vitiate the air that is to
be breathed, and should there be any malaria from defective sewerage in
the basement that, too, would be circulated with the heated air.
It seems also to be impossible to distribute hot air equally to all
the rooms of a house through long flues, for the hot air is choked off
at the registers by the counter currents of cold air from the rooms on
the side of the house exposed to the winds, while the protected side is
always overheated.
I have practically demonstrated, in my own residence, that hot water
is the most simple and efficient means of heating a dwelling for both
health and comfort, and for several reasons: There is no danger of
overheating, and there is no possibility of vitiating the air, because
the temperature of the hot water is always lower than even the boiling
point.
With a proper distribution of the heated water through pipes, and
radiators of sufficient heating surface, all rooms can be warmed to
an equal temperature. Another consideration is the economy in fuel
when properly constructed heaters are used, for the water readily
absorbs the heat and retains it for hours after the fire has ceased
to burn. Unlike steam heating, a moderate fire will warm the house
in moderate weather. Hot water heating does not exclude a practical
scientific system of ventilation. There is no danger from explosion,
nor from fire, the plant is absolutely odorless and noiseless, and
requires neither mechanical skill nor close attention to run it. There
is no doubt of the durability of a hot water system, for if properly
constructed it should last as long as the building, and the cost is
less than a number of mantels with the necessary flues.
The most comfortable average temperature for living rooms is from 65 to
70 degrees Fahr., for hospitals and sick rooms a higher temperature is
generally required, say from 75 to 80 degrees Fahr.
Dr. Horace Dobell, of London, in his work entitled “Winter Cough,”
makes some very practical and useful remarks, when he says: “But
before leaving the subject of sudden changes of temperature, I must
not forget to speak of sleeping rooms. It is quite astonishing what
follies are committed with regard to the temperature of sleeping rooms.
On what possible ground people justify the sudden transition from the
hot sitting room to a wretched cold bedroom, which may not have had
a fire in it for weeks or months, it is impossible to say, but it is
quite certain that the absurd neglect of properly warming bedrooms, is
a fruitful source of all forms of catarrh. We cannot too much impress
this upon our patients.”
There is another source of danger in artificial heating, and that is,
in having the air of the house always much warmer than the most favored
temperature of the open air. This is a great mistake because it is
under these circumstances almost impossible to go from an overheated
house or apartment into the open fresh air without catching cold, and
for this reason the thermometer should be found in every well-regulated
household. Women who are under treatment for female disease should
never get into a cold bed, even if there has been fire in the sleeping
room during the day. In damp and cold weather there should be greater
precaution in this respect. The best bed warmer is one or more
earthenware jugs, like the German seltzer water jugs, filled with hot
water. Earthenware radiates the heat better and retains the warmth
longer than glass, while there is no danger of the heat cracking the
jug, as it will glass bottles. One or two of these jugs filled with hot
water and put into a bed an hour or so before retiring will bring the
temperature up to an agreeable warmth.
Proper clothing is perhaps from a sanitary standpoint of equal
importance with that of artificial heating and ventilation. With
appropriate clothing, the body can be protected against the inclemency
of the weather and the sudden changes of the atmosphere so that no ill
effects are experienced from the great changes of temperature to which
we are exposed. Women are dressed less warmly than men, although they
do not possess the bodily strength to resist cold in the same degree
as men. Their garments are not only made of lighter material, but the
loose, fluttering manner in which they hang around the limbs does not
protect their bodies in the same thorough manner that similar material
made after the style of men’s clothing protects men.
This does not imply that women should don men’s clothing, because the
present costume or outside apparel of women of civilized countries, is
both graceful and modest. A reform, however, in her _underclothing_ is
not only desirable but in many cases absolutely necessary to insure
permanent relief from catarrhal affections.
All women who are suffering from uterine or pelvic diseases, and who
are still wedded to the injurious costume of open drawers and skirts,
have an important lesson to learn.
A warm and complete covering for the lower extremities and pelvic
organs is paramount to any medicine or treatment that can be given.
It is during the menstrual period that the pelvic organs are more
susceptible to congestion and inflammation from exposures than at any
other time, and from the manner in which women dress, it is surprising
that there is not more sickness among them than there really is. Wide
and open cotton drawers, and skirts hanging loosely around their
limbs, with cotton hose, are no protection against drafts and sudden
changes, so that it often happens that the extremities are chilled and
cold, which is in itself sufficient to cause uterine diseases. When
this exposure continues, with some already existing disease, it will
neutralize the best-directed efforts to accomplish a cure.
It is said of the celebrated Boerhave, that among his effects there
was a carefully-sealed prescription, which contained the secret for
preserving health and vigor to a ripe old age. In his last will and
testament it was provided that the prescription should be sold to
the highest bidder at public auction. A physician who was anxious to
procure the recipe of this renowned Dutch doctor, bought it for a very
high price. On breaking the seal and anxiously unfolding the paper,
he found these words: “Keep the head cool, the extremities warm, and
the abdomen free.” The buyer was greatly chagrined at the simplicity
of the supposed panacea, but, if the profession and the public only
appreciated the real worth of the advice, there would be much less
sickness.
This strikes at most of the evils in dress that pave the way for
diseases of women. It comprises the evil effects of tight lacing and
compressing the abdominal organs by improper support for the skirts.
A corset should never be worn so tight that the hand cannot be passed
through the waist line. In the absence of a waist or shoulder straps
for the support of the skirts from the shoulders, shoulder straps
should be fastened directly to the corset, so as to relieve the hips
and abdomen from the weight of the clothing.
The corset waist is not only a perfect substitute for a corset, in
supporting the bosom and preserving the form so as to give a handsome
figure, but it supports the skirts without restricting the circulation
and respiration, or compressing the abdominal organs. In buying or
making a waist or bodice, particular attention must be paid to the
shoulder bands, so that these bands are short enough to give the waist
or bodice support from the shoulders. If, then, the skirts are buttoned
to the waist, the weight is taken from the hips, where it injuriously
depresses the abdominal organs, and falls on the shoulders, where it
cannot do any harm. There is a good deal of humbuggery about these new
devices, and those who make it a business to sell them, never take the
pains, or are incompetent, to properly fit the waist. If one only
bears in mind that, if the waist does not support the skirts from the
shoulders, there is nothing gained over wearing an old-style corset,
imposition is impossible.
The dressing for the feet should be warm and comfortable. Women who
go to balls and parties should always wear overshoes in going to and
coming from an entertainment. Thin and light shoes must be avoided in
cold and damp weather; in fact, there is nothing that women should be
more careful about than too light and low shoes which do not keep the
feet warm. For comfort and keeping the feet warm, there is nothing like
a loosely-fitting leather shoe, with wide and thick soles, and a low,
flat, English heel. It is also the best “corn remedy” I know of.
When the weather is wet and cold, rubber overshoes should be worn,
and these should be removed when entering the house. Women who have a
tendency to cold feet, will find the cork or felt soles worn inside of
the shoes, a great source of warmth and comfort. The coldest stratum of
air is invariably on the floor of the room, and there is, perhaps, no
easier or more unsuspected way to take a cold than to exchange a pair
of high, warm shoes that fit closely around the ankles, for a pair of
light, low slippers. If you desire to rest your feet in a pair of light
slippers, then add a pair of heavy woolen socks over the stockings,
this will greatly lessen the chances of taking cold.
Women who are suffering from pelvic or womb diseases, and who
are anxious to get well, and those who are troubled with painful
menstruation, and menstrual irregularities, should wear woolen hose.
Thin cotton, silk-mixed, or silk hose are not sufficiently warm, nor do
they retain the natural heat of the body like woolen stockings.
Those who have once accustomed themselves to woolen hose, should not
discard them in the summer months for cotton, linen or silk goods,
and this is to be particularly observed on this coast, but the hose
should be exchanged for thinner and lighter goods of the same material,
corresponding to the demands of the season. It would not be wise or
prudent to wear the same quality and amount of clothing in warm weather
as in cold; otherwise the excessive clothing in the summer months will
induce perspiration on the slightest exertion, and thus the system
becomes most susceptible to cold when the weather changes or becomes
cooler.
Elastic garters to maintain the tops of the stockings in position
should be avoided. Rubber bands make a continuous compression on the
vessels and nerves, although almost every woman claims that she does
not wear her garters tight, yet at night when she removes the elastics
there are deep furrows marking the constriction of the garters. The
spring-wire garters are just as injurious, for they also exert a
continuous pressure.
The veins of the legs are, for the most part, superficial, and this
steady and gradual compression is very injurious to the venous
circulation, so that the blood is prevented from returning from the
limbs as readily as it should; this induces cold feet, and when the
circulation is already weak, it often imparts a feeling of heaviness to
the limbs, for which women doctor but without getting any relief. The
only proper support for the hose is elastic straps that are supported
from the waist; they are now so well known and for sale in every dry
goods store that a description of them is unnecessary.
To keep the legs and body warm is not a question of quality or quantity
of skirts or wraps. If the limbs under them are not separately
enveloped and are only covered with thin cotton or silk hose and open
cotton drawers, women are continuously exposed to the cold, damp
emanations from the ground and to the drafts caused by the motion of
the skirts, and blasts of wind.
The most intelligent suggestions for Dress Reform are those that are
directed towards reducing the weight or displacing the heavy, stiff,
and unwieldy skirts and clothing the extremities of the female in
divided garments, so that they are no longer exposed to the dangers of
cold and drafts. The divided skirt is in the direct line of a modest
and desirable improvement of woman’s dress, and it is growing in
popularity among the most intelligent of reading and thinking women.
If the specialists of female diseases were to study the interests of
their patients with the same ardor that they study the methods how
best to fill their offices with patients, on whom they perform useless
and dangerous operations, they would be of some actual benefit to
our wives, mothers, and sisters, and our women could be dressed as
gracefully as at present with less than half the underclothes to pack
around with them.
I am decidedly opposed to anything approaching in style or shape the
bloomer costume; the present style of outside dress cannot possibly
be improved for a comely garment, but it is underneath this that an
entire change should be speedily effected. The divided skirt is cut
like drawers that have a width of thirty to forty inches of goods in
each leg. I believe that the width of each leg should not be more than
twenty-five to thirty inches; this makes the skirt warmer and lighter.
This is not attached to a band to fasten around the waist, but to a
yoke, which should be buttoned to the bodice waist, suspending the
skirt from the shoulders. The material will be a matter of individual
taste; the two qualities that should be always looked for are softness
and warmth, and for that reason Jersey flannel and ladies’ cloth are
the most suitable material; in summer or warm climates, pongee or wash
silks may be substituted.
The skirt is cut on the bias to fit the hips, where it is fulled in and
attached to a yoke instead of a band and in the back it laps about two
or three inches. The advantage of the divided skirt is that it protects
the limbs and body against drafts and cold emanations, and takes the
place of _all underskirts and petticoats_. This skirt alone, however,
would be insufficient to accomplish all that is desired by way of
guarding against exposures; for this reason there is also a so-called
_Union suit_ worn under the divided skirt to complete the covering of
the limbs.
Union suits, as the name implies, unite a pair of closely-fitting
drawers with an undershirt. There is no particular advantage in
uniting the underdrawers with the undershirt, but there is certainly
no disadvantage. The principal object that is to be attained is not
in unionizing drawers and shirts, but wearing such _closely fitting
undergarments_ that the _extremities_ are permanently protected, and in
having them so lapped or closed that the _abdomen and pelvic organs_
are securely protected against cold.
Equestrian tights are made on the same principle and for a similar
purpose as union suits, namely, to properly and surely cover the limbs
and in a measure displace the great load of petticoats that women
usually wear. They come in drawers and also in combination suits with
the undershirts; a choice may be left to individual taste. There are
different _brands_ of these goods on sale in all the dry goods stores
of our large cities, the prices being regulated by material and quality
of the goods from which they are made. The woolen goods are preferable
for practical purposes.
Women who do not like the woven closely-fitting drawers can take their
choice between the latter and home-made flannel drawers, the French
flannel for the lighter and the English bully for heavier and warmer
clothing will be found to be the most serviceable materials; patterns
for making up closed or button drawers may be had at the leading
pattern stores of any city.
Women who cannot grow up to an appreciation of the divided skirt should
by all means wear equestrian tights or buttoned flannel drawers, under
cotton or linen ones; this will enable them to throw off one or two
petticoats or skirts because the drawers will safely substitute the
skirts and be much lighter. Some women dread the absence of skirts on
account of appearing too scant; a little extra fullness and drapery to
the dress make the absence of skirts not noticeable. If this were not
quite so, there appears no satisfactory reason why a woman should feel
embarrassed to modestly display the contour of her form any less than a
man.
CHAPTER XV.
METRITIS OR INFLAMMATION OF THE WOMB.
THIS is an inflammation of the entire substance of the womb, which,
like all inflammatory processes, is _acute_ or _chronic_.
Inflammation does not always affect the whole body of the womb, but
it is quite oftener limited to one or the other layer or membrane
that enters into its architectural whole. Then, again, there is the
anatomical division of the organ into a body or _corpus_, and a neck or
cervix; of these either one may be affected, without the other, so that
inflammation of the cervix should be the subject of a separate inquiry.
Most of the diseases of the womb are due to inflammation. This was the
opinion of J. H. Bennett, of London, as long ago as 1845, in which
year the first edition of his work on “Inflammation of the Uterus” was
published. Up to that time, the subject had never been practically
pursued to the same logical conclusions, so that the opinions of the
leading professional minds were far from unanimous on this question.
But the vigor and energy with which the young author defended his
views, forced attention and conviction upon the greater part of the
profession, in this country and Europe.
He started out with a view to prove: “1. That inflammation is the
_primum mobile_ in uterine affections, and that from it follow, as
results, displacements, ulcerations and affections of the appendages.
2. That menstrual troubles and leucorrhœa are merely symptoms of this
morbid state. 3. That in the vast majority of cases, inflammatory
action will be found to confine itself to the cervical canal and not to
affect the cavity of the body.”
Since the appearance of the first edition of Dr. Bennett’s work, which
is now forty-six years ago, there have been many careful and clever
observers in this field of pathology, but there is yet to appear a
successful contradiction of the truth of his inflammatory doctrine.
Twenty-six years after Dr. Bennett wrote the above book, he read a
paper before the British Medical Association on the same subject,
in which there is no modification of his first conclusions on the
importance of inflammatory lesions. He says: “1. Uterine displacements
are by many too much studied _per se_ (by themselves) independently of
the inflammatory diseases that complicate and often occasion them. 2.
That the examinations made to ascertain the existence of inflammatory
complications are often not made with sufficient care and minuteness,
as evidenced by the fact that I constantly see in practice cases in
which inflammatory processes have been entirely neglected, and the
secondary displacements alone treated. 3. That inflammatory lesions
are often the principal cause of the uterine displacements through
the enlargement and increased weight of the womb, or a portion of its
tissues, which they occasion. 4. That when such inflammatory conditions
exist, as a rule they should be treated and cured and then time given
to nature to absorb morbid enlargements before mechanical and surgical
measures are resorted to.”
If these propositions could be engrossed and a copy sent to every
doctor in the land, as a safe and sure guide in his treatment of
diseases of women, it would prove a great boon to the suffering women
of this country. One of the notorious abuses of the profession, is
the penchant for the employment of mechanical means, either by means
of instruments or the surgeon’s knife. Women are wantonly subjected
to painful and tedious treatments which in many cases only aggravate
their original suffering, while a few simple rules of hygienic
treatment would not only restore them to health and vigor, but would
save them the privation of paying fees to incompetent, unscrupulous
or avaricious doctors, who have only one ambition, that is, to get the
patient’s money. I have known an instance where this barbarous course
under the guise of scientific treatment, broke up the home of a once
happy and prosperous couple, and finally when the resources were so
low that the expense incident to housekeeping and a nurse could no
longer be defrayed, the household effects were disposed of, and, as a
last resort, the overdoctored woman was taken to a hospital, where her
last hopes were lulled into an artificial sleep, while the surgeons
performed an operation from which her depleted body and squandered
vitality could never recover. She died.
I am convinced from observations in large female clinics in Berlin,
and from my own studies in the pathological laboratory while a student
abroad, that Dr. Bennett’s conclusions are corroborated by actual
facts. The freedom with which dangerous operations are undertaken for
comparatively trivial complaints is degenerating into a license that is
criminal and which in some cases is nothing less than murder. In the
absence of a high moral sentiment which should control the profession,
but does not, the State must step in and say who shall practice
medicine and surgery, and by limiting competition, the evil propensity
to make the most of one’s opportunities will not be elevated into a
fine art, and men, although unscrupulous, may be at least indifferent
honest.
Acute metritis comes on suddenly, and this occurs quite often during
the menstrual period. Women as a rule are altogether too careless
during menstruation; they seem to forget that at this time the womb
is congested and swollen, and that if the natural flow of the blood
is interfered with, this congestion will turn into an inflammation.
Exposure to cold, or getting the feet damp, or inordinate exercise
that overheats the system, will bring this about. Sometimes there may
be a tumor or swelling in the womb which occludes the cervical canal,
so that the menstrual fluid cannot escape; this will also cause
inflammation. A stricture of the cervical canal, occasioned by the womb
being flexed, will interfere with the egress of the menstrual flow, and
this also may give rise to inflammation. Vaginal injections either too
hot or too cold, and particularly immediately after copulation, when
the pelvic organs are still in a high state of congestion, is quite
liable to excite metritis. Gonorrhœal infection is another source of
inflammation, but this is invariably preceded by an _endometritis_,
which I will consider separately.
Large, ill-fitting pessaries worn in the vagina for a supposed
retroflected or prolapsed uterus, or a stem pessary, are fruitful
causes of metritis.
Other causes are criminal abortion, complicated with blood poisoning
from the unclean probes or instruments, that the abortionist has
employed on previous operations without thoroughly cleansing and
disinfecting them; the application of strong caustics to the cervix
of the womb, as well as injections into the cavity of the uterus.
Meddlesome doctoring by means of the unskillful and unnecessary use of
instruments, like the probing of the womb without proper antiseptic
precautions, or the scraping, stretching or operating on the womb
without the essential antiseptic precautions which a scientific
comprehension of the subject demands, has frequently caused this
affection.
It occurs very often as a part of the general inflammation produced by
the absorption of putrid or septic matter during the childbed period.
This indicates a lack of cleanliness on the part of the attendants
during confinement; inflammations of this nature constitute one of the
types of _puerperal_ or childbed fever.
The most prominent symptom is pain. This is greatly aggravated on the
slightest pressure, or on moving or turning in bed. Upon a digital
examination, the womb is found enlarged or swollen, and when the organ
is tilted up on the examiner’s finger, there is a sharp lancinating
pain radiating from it in all directions.
The first symptoms of pain are always accompanied with fever, and
this may have been ushered in or alternated with a chill. The pain
may be first felt rather deeply in the pelvis, and this is increased
by a frequent desire to pass urine and a straining of the rectum. It
may further become complicated with a looseness of the bowels, or an
obstinate constipation. Nausea and vomiting is a frequent symptom
during the course of the disease, and if the metritis is developed
during menstruation, the flow may suddenly stop, but, on the other
hand, the hemorrhage may become alarmingly profuse. Standing, walking,
coughing and straining at stool excite the most excruciating pain, so
that a recumbent quiet position is the only comfortable way for the
patient to maintain herself, with the head as low as possible to insure
the most easy recumbency.
The treatment for acute metritis depends somewhat on the cause in each
individual case. There are, however, two indications that require to be
met, and these are common to all inflammations, namely, to relieve the
pain and check the inflammatory process.
The former is quickly relieved by introducing into the vagina a
Femina vaginal capsule in the usual manner; repeating every six to
eight hours, until the pain is sufficiently alleviated to occasion no
suffering; then one capsule should be employed every night until cured
or until restlessness requires that something must be done to calm the
patient.
If the metritis is due to suppressed or checked menstruation from
cold or exposure, then, and only then, are hot fomentations over the
entire abdomen the most appropriate application, and if the patient is
plethoric, I advise a half-dozen leeches to the inguinal region of one
or both sides to be of unequaled value for checking the disease.
Until my experience and observation in German hospitals, I was in
the habit of employing hot applications for all acute inflammations
of the abdominal organs. These were either in the form of hot-water
fomentations or flaxseed poultices. Hot applications undoubtedly
give relief, but I doubt whether they ever cut short or abridge the
inflammatory process in any case. I am inclined to believe that in a
great many instances hot fomentations have the tendency to encourage
suppuration, and that an abscess is often the result of their use. I
have seen decidedly better results from _cold applications_, and the
colder the better, so that I now employ them universally in all acute
inflammations of the pelvic organs except in the noted exception in
which the inflammation is due to a sudden check of the menses from
exposure. As a preventive of inflammations, after delicate operations
on the uterus, I apply the _rubber_ ice bag with invariable success.
The most suitable rubber bag for this purpose is a size of six by
twelve inches; it should be filled with broken pieces, and then
securely tied. I prefer to envelop the bag in a thin layer of flannel,
so as to take off the cold, clammy sensation which the rubber imparts
to the skin. There should be two of these bags, in case of accidentally
tearing one, and so that the reserved one may be in readiness when
the other is removed. The cold does not only check and control the
inflammation, but it also benumbs the nerves, so that it greatly
relieves pain. I keep these ice bags applied over the region of the
womb, until all the acute symptoms disappear. The vagina, however,
should be irrigated with medium hot borax water, once a day, so as to
remove any irritating discharge from the uterine cavity.
The digestive derangements that so often accompany acute metritis; the
nausea and vomiting of this and kindred diseases, are alleviated by
this formula:—
NO. IX.
Take: Subcarbonate of bismuth 2 drams
Bicarbonate of sodium 2 drams
Tr. of opium, deodorized 2 drams
Tr. of nux vomica 1 dram
Simple syrup 1 ounce
Peppermint water, sufficient to make 6 ounces
Mix, and take a tablespoonful every one or two hours, until relieved;
to allay the thirst and dryness, take small pieces of ice. Constipation
of the bowels should be relieved by taking a Femina laxative tablet
every six hours until the stools are freely moved; after that one
should be taken every night or perhaps every other night, so as to keep
the system regulated.
Some persons suffer from costiveness because they do not drink enough
water, and when taking medicines to correct this disorder it is always
well to drink a large tumblerful of water at the same time, and
especially at bedtime, three or more hours after supper, and early
in the morning is another good time for drinking water and taking a
laxative.
CHAPTER XVI.
CHRONIC METRITIS OR CHRONIC INFLAMMATION OF THE WOMB.
WHEN from neglected or improper treatment, the acute inflammation is
not checked, so as to restore the organ to its normal condition, the
inflammatory process assumes a chronic character. As inflammation is
an _abnormal vital activity_, which results in the proliferation or
building up of fibrous tissue, it must be naturally inferred that if
the inflammatory process is active in an organ for a considerable
length of time, the tissues of this organ must grow or increase, so
as to augment its size and weight. This is indeed so, hence the other
names that have been given to this disease to distinguish it from the
acute or transient form, all imply _tissue growth_, as hypergenesis of
the connective tissue, engorgement or inflammatory hypertrophy of the
uterus.
The entire organ may be thus affected, or it may be limited to either
one or the other anatomical divisions of the uterus, namely, the body
or the neck.
Of all the different varieties of chronic inflammation of the womb,
that of the neck or cervix is the most frequently met. This is due
to the fact that in married women and those who have born children
the cervix of the womb is exposed to mechanical injury from coition,
friction against the vaginal walls in walking and from lacerations
during delivery.
The body of the womb is further removed from all these mechanical
agencies to which the cervix is exposed, for the body is within the
abdomen of the female, and for that reason it is less liable to be
injuriously affected by influences that cause inflammatory enlargement.
But notwithstanding all this, it is a common disease.
A great many cases of womb complaint that do not yield to ordinary
treatment are really of this nature, but owing to carelessness or
incompetency are never recognized. The symptoms of this disease, which
are obstinate leucorrhœa, falling of the womb or displacements, are
mistaken and treated for the disease itself. Women who suffer with
this complaint are extremely liable to go on for quite a while feeling
comparatively well and in hopes that they are recovering, when some
extra exertion or exposure to cold brings on a relapse, which lights
up an acute inflammatory process. This passes into the old troublesome
disease and this resumes its chronic form. After a repetition of
the general routine treatment, the patient may again live under the
delusion that she is going to get well only to have her hopes blasted
by a sudden reappearance of the former painful symptoms, that are alike
discouraging to herself and a puzzle to her friends.
The cause of inflammatory enlargement of the uterus is usually
connected with _parturition_ or _abortion_.
There never can be either the one or the other without more or less
_vascular activity_, which is essential to the repair of the womb and
its restoration to its physiological or healthy condition. All the
uterine tissues are at this time in a high state of irritability, and
if there is a natural predisposition to inflammatory diseases, then
the slightest obstacle to an uninterrupted recovery will kindle an
inflammatory action, that will fasten itself on the uterus. In the very
nature of things this results in a deposition of inflammatory material,
with a consequent increase of intermuscular fibrous tissue which
increases the size and weight of the uterus.
What our mothers termed in former days “a bad getting up,” that is,
when women get up from their confinement weakly and with more or less
pain and dragging in the pelvis on walking or the slightest exertion,
is generally owing to the above-described condition. This disease is
now almost as common as ever. I can always trace these cases to a
confinement or an abortion.
It is very rare that it is due to a depreciation of vital forces from
improper food, over-exertion, a prolonged nervous depression or a
constitutional tendency to tubercle, scrofula or some other hereditary
diathesis, although these undoubtedly predispose the patient to the
disease.
Abortions stand at the head of all the causes that excite this
affection. When the uterus is pregnant and its natural growth is
abruptly checked by the destruction of the embryo, then the organ
becomes at once the seat of a congestion and great vascular activity,
for the purpose of repairing the injury that the premature expulsion of
the embryo or fetus inflicted.
If this congestion is delayed from improper care or treatment which
fails to recognize the important fact that an abortion or interruption
of pregnancy is a much greater shock to the system than a delivery
at full term, it must result in arrested _involution_ or permanent
inflammatory enlargement. This most persons fail to appreciate, and, as
a result, they do not take the same precautions that they would after
the delivery of a living or fully-developed child.
I am well aware that criminal abortionists are in the habit of
deceiving their patrons by assuring them that there is no danger or bad
results to be feared from their criminal operations. This is a vicious
falsehood, and, coupled with the statement that there is as yet no
living being in the womb, the crime of manslaughter is added to that of
malpractice. In every case of abortion, whether accidental or criminal,
the same care and attention must be given to the woman as during any
natural lying-in period.
There is a class of chronic inflammations that I have noticed in
women who have always suffered from painful menstruations or from
excessive or prolonged hemorrhage at the regular monthly period. This
is complicated with some ovarian disease, which yields, however, to
appropriate treatment.
There is quite a series of symptoms that denote the existence of
chronic metritis; these are not all present in each particular case but
quite enough of them to diagnose the disease. Some of these symptoms
are in the nature of complications, which in themselves may be mistaken
for an individual disease, but upon a careful inquiry they can be
traced directly to a chronic metritis, which if removed disposes of all
the lesser ailments.
The following are the most noted signs of this affection: painful
copulation, and pain on defecation; a dull, heavy, dragging pain
through the pelvis, much increased by walking; during menstruation
the mammæ are sensitive or painful; several days before the approach
of the menses there is a dull pain, which lasts during the menstrual
flow; around the nipples, there is pigmentation or darkening; sometimes
nausea and vomiting, and dyspepsia, headache, and languor; pressure on
the rectum with tenesmus and hemorrhoids; leucorrhœa from catarrh of
the womb; pressure on the bladder with tenesmus or straining.
This disease may continue for years uninterruptedly, and, if there is
not a cure accomplished, or successful measures for its relief are not
employed, it will continue until the menopause, or change of life,
which may effect a spontaneous cure.
The enlargement is most noticeable in the cervix or neck. This is
sometimes so great as to extend one or two inches into the vagina, and
this condition is often mistaken for falling of the womb or prolapse,
which is far from a correct diagnosis. A growing of the womb from
chronic inflammation is the proper explanation.
The hygienic suggestions given in a former chapter, form an important
auxiliary in the treatment of this complaint, and for that reason it
should be carefully studied.
The treatment of chronic metritis has been, up to within a very recent
period, anything but satisfactory in its results. This was owing to
an inadequate knowledge of the real nature of the disease, which was
marked by so many symptoms that were in themselves obscure and hard to
separate as such, from the main affection.
This confusion of the true nature of the pathological process, resulted
in a great many vague therapeutical resources, so that the treatment
is even yet far from uniform and thorough. Many of the recognized
resources laid down in the text-books, on diseases of women, are
not only useless, but absolutely injurious, and, in order to save
the reader time and money, I will make a brief mention of the most
prominent of them.
Depletion, or the abstraction of blood in chronic metritis, effects no
permanent benefit in the inflammatory process. I am convinced that,
in the long run, the patients grow worse, because this treatment
lowers the vitality and reduces the recuperative forces, which are so
important, in the treatment of all chronic complaints.
Scarifications or puncturing the cervix with a sharp lance or pointed
knife, will not sufficiently impress the morbid process, so as to
stimulate it into a healthy action.
Some authors speak very highly of cauterizations and blisters upon the
neck or lips of the womb; this I have repeatedly tried, and in not a
single instance was it of the slightest use, but it aggravated the
symptoms, and in one case it excited a severe, acute metritis that
proved almost fatal.
Specialists, as a rule, fall into routine practice, and exercise
neither originality or intelligence in practice, outside of the
text-book on their shelf. They inject strong fluids or caustics into
the cavity of the womb with a view of checking the inflammation in
that manner. This treatment is dangerous and delusive. If the patient
endures the treatment, she may be stimulated for a time with the idea
that something very curative is being done, but my experience has been
that the disease only becomes worse, because the womb is too delicate
and sensitive an organ to improve under these repeated irritating
assaults.
There is a _home treatment_ for mild cases which I recommend to my
patients, with satisfactory results. It consists principally of
dissolving one teaspoonful of the Femina uterine lotion in a cupful of
boiling hot water, after which this should be added to a gallon of warm
water of a temperature of 105 degrees F.; these irrigations are to be
taken every night, and if the water can be borne hotter the temperature
may be gradually increased to 107 degrees F. A napkin should be worn
and the bed warmed with a hot water bag before retiring. Ten to fifteen
minutes later a Femina vaginal capsule is to be introduced high up into
the vagina, by first quickly dipping the capsule into warm water.
In obstinate cases I have used electricity with the greatest success.
This is administered by means of a broad dispersing electrode applied
on the abdomen, and another electrode, covered with a sponge, is
carried up the vagina, to the womb. In this manner I employ an
intensity of sixty to one hundred and fifty milliampères, for ten to
fifteen minutes. This is repeated several times a week, and from three
to six weeks, and with other hygienic treatment the patient recovers.
When women are in moderate circumstances, and can spare neither time
nor money to visit the office, for the length of time that is required
for the electrical treatment, I follow the plan of the Berlin clinic,
which originated in Vienna, with Prof. Carl Braun, and is strongly
recommended and practiced by Dr. Martin, in Berlin. This consists in
an _amputation of the cervix_, or, in other words, the abnormally
elongated and enlarged uterus is trimmed down, and the diseased
membrane is scraped out. While the cervix is recovering from the
operation, there is also a diminution in the size of the body of the
organ, and the chronic inflammation subsides with it. This operation
is not dangerous to life, and in my experience I have as yet never
had a bad symptom to interrupt the recovery. In obstinate cases, it
is, perhaps, one of the most useful surgical measures that was ever
devised, and we owe it to the genius of Professor Braun, that all
obstinate cases of this nature are amenable to successful treatment.
CHAPTER XVII.
ENDOMETRITIS OR CATARRHAL INFLAMMATION OF THE WOMB.
_Endo_ means within, and metritis signifies _womb_ and _inflammation_,
and when all are combined, the compound term denotes inflammation of
the lining membrane of the womb, which is the affection that I am now
to consider.
It would be impossible to find a single person of middle age who has
not experienced sometime during life the discomforts of a catarrh or
cold of some part of the respiratory passages, whether in the head or
bronchial tubes.
The mucous membranes are especially sensitive to noxious influences,
and sound a timely note of warning by an _acute catarrh_, which, if
heeded, will in many instances save the person from a dangerous, if not
fatal sickness.
The adage, “Prevention is better than cure,” is one of the most
truthful sayings in the English language, and, if persons would profit
from the admonitions of a “_slight cold_,” many a fatal pneumonia or
bronchitis could be averted.
What is true of the mucous membrane that is common to both sexes is
true of that which is peculiar to the female organs alone.
There is no mucous membrane that is more liable to catarrhal
inflammations than that lining the uterus. There never was a woman
who was not some time in her life afflicted with a transient uterine
catarrh. It may have been of so mild a form that the symptoms which it
occasioned were hardly noticed, or, perhaps, ascribed to some other
ailment.
There are several varieties of endometritis; some of these are based
upon the length of time that the affection has lasted, while others
owe their classification to the anatomical division of the uterus into
body and cervix. Those that relate to the duration of the disease are
either acute or chronic.
Acute endometritis is the most common form; it has also been described
under the names of acute uterine leucorrhœa, acute uterine catarrh,
and acute internal metritis. It usually runs a rapid course, ending in
recovery or in the chronic form. It undoubtedly passes unrecognized in
many instances, and in this way many cases of painful menstruation or
suppressed menstruation are explainable.
It can be said that at each and every menstrual period there is a
_physiological catarrh_, which belongs to the natural process of the
menstrual function. During each menstruation there is a hyperæmia,
or congestion of the mucous membrane, so that the turgent blood
vessels rupture, and this constitutes the menstrual flow. Before this
congestion reaches the point of bursting the capillaries, and about
the time that the sanguineous flow ceases, there is an increased and
altered mucous secretion of the mucous membrane. If this secretion
is prolonged beyond the normal period that constitutes healthy
menstruation, or if it continues to be present at any time between
the menstrual periods, it constitutes a disease or a catarrh. Now
when we consider the close relation that the normal functions of
the womb have to those that are _abnormal_, and that the one may
be the stepping-stone to the other, we need not be surprised that
endometritis, or catarrh of the womb, is one of the most common
affections to which women are liable.
Chronic endometritis is where the disease has lasted for a long time;
some authorities consider it a rare affection, but this is a great
error. Any disease so frequent as acute endometritis must, in the very
nature of inflammatory processes, become chronic, in a large proportion
of cases.
Endometritis of the body of the womb, in contra-distinction to a
partial inflammation, located and confined to the mucous membrane of
the neck or cervix of the womb, forms another or third variety of
this affection. This disease has been described under the names of
chronic corporeal endometritis, uterine catarrh, uterine leucorrhœa,
and internal metritis, and the seat of it is confined to the lining
membrane of the cavity of the womb, without complicating the cavity of
the cervix; but there is no doubt that when either the one or the other
is the seat of a stubborn catarrh, the remaining portion of the uterus
must become sooner or later more or less compromised in the diseased
process.
Chronic cervical endometritis is where the inflammation affects the
membrane of the neck; this has been described under the names of
cervical catarrh, cervical leucorrhœa, and endocervicitis. These terms
are all derived in composition from the Latin word _cervix_, neck.
The uterus is really divided into two cavities that run into each
other; one of these is the cavity of the body, while the other is the
cavity of the cervix, a fusiform canal, measuring about one inch and
a quarter in length. The cervix partly projects into the vagina, and,
as a result, is liable to injury and irritation, to which the other
portion of the organ is not exposed. Friction and other influences
aggravate the inflammatory process, so that erosions, granular and
cystic degenerations, follicular ulcers and chronic enlargements,
become complications of the catarrhal inflammation of the cervix.
To return again to a consideration of the general aspect of catarrh
of the womb, for it is one and the same pathological process that
underlies the different forms. There is a simplicity in the relation
of cause and effect, that will strike the casual student as one of the
most instructive lessons that it is possible to learn, because it also
suggests the simplicity of the measures of which persons can avail
themselves for the prevention or cure of this affection.
From the physiological reasons that were mentioned as a cause
of endometritis, it follows, as a natural consequence, that the
predisposition to catarrh of the womb, varies greatly with the age of
persons, so that before the age of puberty, at a time when there are
no periodical congestions of the womb from the menses, it occurs very
rarely, while from the period of pubescence, and during the functional
activity of the pelvic organs, it is very prevalent, but at the
approach of the menopause and sexual decadence the predisposition is
again lost.
As far as the character and nature of uterine catarrh is concerned,
that which in technical language is termed the _pathological anatomy_
is no different from what it is in catarrhal inflammations in other
organs, so that the remarks that were made on similar affections of
other organs, apply with equal correctness to catarrh of the uterus.
There is, however, one exception of which I desire to remind the
reader, and that is a hemorrhagic or granular variety of inflammation.
In this form of the disease the mucous glands, and the blood vessels
that are distributed between these glandular tubules, increase or
multiply enormously, so that I have seen the mucous membrane in some
places a quarter of an inch in thickness. This is the most obstinate
variety to yield to ordinary remedies, and as it occasions excessive
and at times dangerous hemorrhage from the womb, it should not be
treated as conservatively as the other varieties of which I have spoken.
There is only one sure method of cure that proved in my hands a
success, and that consists in the entire removal of the diseased mucous
surface.
Dr. Düvelius of Berlin made the discovery and demonstrated the fact
that the mucous glands of the uterus project into the muscular tissue
of the organ, and that if the diseased mucous membrane is removed
or scraped off, down to the muscular layer, a healthy membrane is
regenerated from the terminal glandular ends that remain imbedded in
the muscular tissue. This seems to have been proved by experience, for
I have performed this operation in several obstinate cases of uterine
catarrh, and in several instances the woman became subsequently
pregnant, which proves at least that the regenerated mucous membrane is
capable of performing its physiological function, as though it never
had been interfered with. With proper antiseptic precautions and in
skillful hands, there is absolutely no danger in this operation, but
the technique should be thoroughly understood by the operator.
The etiology or causation of uterine catarrh resolves itself into
predisposing and exciting causes. Predispositions are defined as that
constitution or condition of the body which disposes it to the action
of disease under the application of an exciting cause. Persons who
possess a thoroughly healthy constitution may be exposed to exciting
causes without the slightest danger of contracting diseases, to which
others who are predisposed fall victims. The predisposing causes of
endometritis are a naturally enfeebled constitution; the existence of
a scrofulous or tuberculous habit; impoverishment of the blood from
chlorosis; prolonged mental depression; improper and insufficient
food; prolonged lactation; frequent parturition under unfavorable
surroundings; any indiscretion after delivery which interferes with the
regeneration of the womb; styles of dress that depress the uterus; want
of fresh air and wholesome exercise.
Professor T. G. Thomas, in his work on Diseases of Women, asks the
question why most of these influences should produce this affection
more than others. His answer is that “they do not do so.” “Sometimes
they cause chronic pneumonia; at other times granular lids, and again
at other times chronic endometritis.”
The exciting causes laid down by the same eminent authority are
“displacement of the womb; excessive or intemperate coition; the use of
intra-uterine pessaries; puerperal endometritis; exposure or fatigue
after confinement; efforts at production of abortion and prevention of
conception; vaginitis either simple or due to gonorrhœal infection;
painful obstructive menstruation; exposure during menstruation; sudden
checking of the menstrual flow; and tumors in the uterine cavity or
walls.” Some of the causes here enumerated are much more fruitful of
the disease than others. A woman whose constitution has been weakened,
and whose digestion is deranged, by habits of indolence and luxury,
whose style of dress so depresses the abdominal viscera that her uterus
is pressed down into the vagina, is particularly liable to develop a
catarrhal inflammation from connubial approaches. When these are not
without pain, then there is some predisposition that should be inquired
into and righted.
Uncleanliness is not spoken of by authorities as among the causes of
uterine catarrh, yet it is a very frequent one. I have succeeded in
curing so many catarrhal affections of the vagina and uterus by simply
advising the use of vaginal irrigations with _borated_ warm water,
that I am convinced that a lack of personal cleanliness is a very
prolific cause of this affection. The accessible generative organs,
both of the female and male, should be the object of thorough rinsings
so as to reduce the possibility of infection to the least degree.
All mucous membranes have their natural secretions, and these are on
light provocations abnormally increased. The vagina is always the seat
of more or less bacterial fermentation or decomposition, and if this
is retained for any length of time, it becomes not only putrid and
offensive, but also a direct source of infection to the mucous membrane
of the womb. This is more so in a married woman, who is exposed to the
carelessness of her male consort, who has not been apprised of the
dangers of septic infection, that may be innocently communicated to
the wife by negligence of his own person. The wife is exposed to all
and every impurity that the male has on his person, and thus she is in
constant danger of having her internal organs infected, from the outer
organs of the male.
There is no doubt that many women become infected from this source, and
that obscure and stubborn catarrhs of the vagina and womb are strictly
traceable to personal uncleanliness of the male. From the researches
of Dr. Noeggerath of New York, it would seem that in a great many
cases of pelvic diseases in women, the affections can be traced to a
_latent gonorrhœa_ in the male. This phrase means a gonorrhœa in the
male apparently cured, which even two years after the supposed cure
infects a healthy vagina, causing a discharge and a complication of the
uterine mucous membrane. I have seen some cases that fully corroborate
the views of Noeggerath, so that before we put the blame of uterine
disease solely on the shoulders of the wife, let us find out how much
the husband is to blame.
Specialists in particular, but doctors in general, often forget that
a woman has other organs besides a womb and ovaries; there is a
relation of cause and effect between valvular lesions of the heart or
diseases of the lungs, that obstruct the return of the venous systemic
circulation to the right cavity of the heart, and catarrhal diseases of
the pelvic organs.
Biliousness or an affection of the liver, that interferes with the
portal circulation, or the pressure of tumors or swellings on the
uterine veins, are also among the causes, while the accumulation of
feces or habitual constipation is often overlooked as too trivial to
deserve professional notice, and yet its removal is often the only
successful means to cure the patient.
The various eruptive and infectious diseases, like smallpox,
scarlatina, measles or typhoid fever, may excite in their course a
uterine catarrh, that will remain behind as a chronic complaint, after
the acute affection has subsided.
The acute variety of endometritis is much more prevalent as a disease
than is commonly supposed, but, owing to an absence of specific or
definite signs, pointing directly to the mucous membrane, which the
woman herself can recognize, it is generally mistaken for something
else.
The disease begins with signs of an active congestion in the pelvic
organs; such as drawing pains in the small of the back and in the
groins, and a feeling of fullness and weight at the bottom of the
pelvic floor. The urine is voided with pain and there is a sensation
of heat in some parts of the urethra. Pressure on the lower abdominal
region is painful, and the sensitiveness diminishes from the middle
towards one or the other side. In mild cases these symptoms are not
accompanied with fever, headache or a disturbance of the nervous
system; there may be diarrhœa due to reflex irritation of the rectum,
and the stools are accompanied with bearing-down pain. After three
or four days there is usually a discharge of a viscid liquid, which
in eight or ten days becomes creamy, purulent and often tinged with
blood. The fluids that are discharged from the vagina sometimes become
so acrid and irritating that, when they come in contact with the skin
of the vulva, abdomen or thighs, it becomes irritated and inflamed,
which leads to excoriations and an itching, that may spread over
the entire body. The reaction of this discharge is either acid or
alkaline, depending upon whether the discharge of the uterus or that
of the vagina predominates; as the discharge from the uterus is always
alkaline and that from the vagina always acid, there is nothing of a
practical diagnostic value in ascertaining the chemical reaction of the
secretion. The vagina will generally be found to be hot and more or
less swollen as in ordinary vaginitis. The womb itself, however, will
be enlarged and sensitive, while the cervix is gaping or open. Through
the speculum, it is seen to be red and congested, and from the gaping
mouth there issues a clear, albuminous-looking fluid or a muco-pus.
In the subacute or chronic form the symptoms are by no means always
so prominent as to indicate the existence of the affection, or they
are so marked, by some of the numerous complications, which are in
the nature of cause or effect, that its recognition will become
extremely difficult. The effect which the disease has on the general
organism varies greatly in different individuals. Some women of
robust appearance have an aggravated form of uterine catarrh without
any immediate ill effects on their nutrition or general health. Other
women lose flesh early and become weak and worn; they become pale,
and the face assumes a yellowish ashen hue with dark rings under the
eyes. Through reflex irritation from the nerves of the uterus other
nerve centers become involved, so that a general neurasthenia becomes
developed with its characteristic concomitants of neuralgia, muscular
spasms, uterine colic and hysteria.
With a third class the inflammation spreads from the lining membrane to
the substance of the womb itself, causing an enlargement of the uterus,
which induces displacements and a dragging sensation in walking, pain
in coitus and painful defecation. The inflammation does not limit
itself to the womb, but an ichorous discharge creates distressing
symptoms of vaginitis, inflammation of the bladder, and pruritus vulvæ.
When the uterine cavity is the seat of an abnormal vascular activity,
there often exist symptoms of pregnancy that may mislead the patient
or physician. Nausea and vomiting are sometimes present, the darkening
of the skin around the nipples, and an enlargement and sensitiveness
of the breasts, meteorism, or a swelling of the abdomen, caused by
the accumulation of air in the intestinal canal from reflex nervous
irritation, and when this symptom is added to the irregularity of
menstruation, it is easy to fall into the error of diagnosing pregnancy.
Sterility on the one hand, and habitual abortion on the other, should
direct attention to the probable existence of endometritis. Very often
barrenness has led to an investigation of the condition of the uterus
which disclosed the existence of the disease. A woman who conceives,
and then loses her child in the first months of pregnancy, is
afflicted, in all probability, with a chronic endometritis. In these
cases, where conception takes place, it is to be presumed that the
sensitiveness and irritability of the inflamed mucous membrane is not
suitable for the permanent fixation of the ovum, so that the slightest
shock will open the flood gates of a congested uterus, and thus the
embryo is separated from its attachment, and lost.
The cervix is sometimes the seat of a special feature of uterine
catarrh, that is due to the chronic inflammation of the cervical mucous
membrane, stimulating a growth or proliferation of its own tissue or
structure. This growth causes an enlargement and elongation of the
entire cervix, and a spreading of the lining membrane of the cervical
canal to the vaginal surface of the cervix. This encroachment of the
cervical lining on the vaginal lining is the displacement of the
pavement epithelial cells of the vaginal portion by the cylindrical or
columnar epithelial cells of the cervical canal, and this gives rise to
_erosions_ and follicular ulcers.
These erosions have a glandular arrangement, and are often mistaken for
cancerous or malignant growths. There is no doubt in my mind, that most
of the so-called successful cures of cancer were nothing but cures of
erosions.
The microscopists, whose lively imaginations make them see things
that do not exist, would make us believe that they can take a small
section of the suspected growth, and establish the existence of cancer
by microscopical examination; this is utterly impossible, because the
cancer cell is no different from normal cells, and in erosions we often
find the follicles so close to each other, and their cells so closely
packed, one on the other, that no candid mind can say whether it is a
malignant or an innocent growth.
The claim that “nests of epithelium cells,” as the stereotyped phrase
goes, constitute scientific evidence of cancer, is utterly absurd.
Such eminent authority as Professor Arnold, of Heidelberg, makes the
assertion that positive diagnosis of cancer, from a small section or
scraping, is impossible. I am myself fully convinced of the truth
of this assertion, for while I was making microscopical studies in
Germany, I had abundant evidence of the truth of this statement. It is
indeed very unfortunate, both for science and suffering humanity, that
as yet there is no absolute means of diagnosing cancer positively, and
for that reason the quacks, and those who are not quacks, will continue
to fleece their victims for supposed cancer.
I believe that the cause of cancer is either due to a _ptomaine_
or organic poison that is generated in the body, or to a specific
germ or bacillus. If it be due to the latter, and the germ theory of
disease makes that highly probable, there is no doubt that a method of
staining will soon be discovered, that will make the specific microbe
recognizable in the field of the microscope, but as yet most cancer
diagnoses by microscopy are only surmises.
TREATMENT.
Continence in sexual intercourse is one of the prerequisites to
the successful treatment of all uterine diseases. This is so often
overlooked by those giving advice in such matters, that their otherwise
appropriate suggestions for treatment are frustrated. The women who are
suffering, appreciate the value of this interdiction without further
argument, but the average man does not appear to have the common sense
to readily comprehend that the mechanical irritation incident to the
sexual act, and the accompanying physiological congestion, will surely
aggravate an inflammatory process, no matter of what nature. Men, whose
animal instincts dominate their entire being, so that reason, if they
ever had any, is dethroned, should stop to consider their immoderate
conduct, which perpetuates the suffering of their wives from ailments
which men themselves have often inflicted, and for which women are
innocent martyrs.
The acute variety of uterine catarrh is to be treated like all other
acute inflammatory diseases.
The patient should at once take to bed, so that she may keep herself
warm and quiet.
If the inflammation is due to cold or exposure during menstruation,
and the menstrual flow has been suddenly checked, then three or four
leeches, applied to the inguinal regions on both sides, will be of
decided advantage. Over the lower abdominal regions hot compresses
should be applied; these are made by wringing cloths or a large folded
towel out of hot water, over which a piece of oiled silk, rubber, or
oilcloth is laid to retain the heat and moisture. At other times, that
is, when the inflammation is not due to cold and a sudden stoppage
of the menses, the application of ice bags is preferable to the hot
compresses, in the manner elsewhere described.
The pains which are felt in different parts of the pelvis are relieved
by using the Femina vaginal capsules; say one every six to eight hours,
after a hot vaginal injection of plain water, or a hot sitz-bath.
If there is nausea or vomiting that too is often relieved from the
soothing influence of the capsule which allays the nervous irritability.
Should the stomach not be in a condition to take nourishment from
biliousness or other causes, prescription No. II on page 138 should
be taken in tablespoonful doses every four hours until the stomach is
settled and the system regulated; if any food is taken it should be
between times and of a liquid nature.
If there is straining or diarrhœa, I prefer to employ an _enema_ of
one pint of warm German chamomile tea, to which half a teaspoonful
of McMunn’s elixir of opium or laudanum is added. If the pain and
straining are very severe, one teaspoonful of either is not too much;
by requesting the patient to retain the enema for ten or fifteen
minutes, the medicine is directly absorbed, and the effect is both
soothing and healing. This may be repeated several times a day, if the
pain does not subside after the first injection.
The bowels are sometimes found to be in an opposite state, namely,
constipated; this must be relieved at once. An enema of warm soapsuds
answers the purpose, or a half-tablespoonful of warm water, in which
a half-tablespoonful of glycerine is dissolved, makes an excellent
injection for constipation.
Hot vaginal irrigations should be at once commenced, and repeated as
often as twice or three times a day. I always dissolve a teaspoonful of
powdered borax in the hot water, of which no less than half a gallon is
used at one time; this is antiseptic and healing. After six or eight
days, once a day will be sufficient.
Chronic uterine catarrh or uterine leucorrhœa does not require the
active treatment which was recommended for the acute form. It depends
quite often on causes, whose removal is absolutely necessary to the
intelligent and successful treatment of the affection.
The causes that have been enumerated must be carefully and repeatedly
reviewed, so that each individual case can be traced to its source.
Those causes that are improbable must be eliminated from those that
are probable, so that by a gradual process of exclusion we narrow the
number down to those that actually exist. This simplifies the treatment
to actual conditions that can be intelligently met.
Vaginal irrigations constitute in the chronic form of the disease an
accepted and most useful therapeutic resource. There is nothing that
will ever contraindicate a thorough cleansing of the vaginal canal,
so that the organ may not be bathed in its own morbid and irritating
secretion. It is a wholesome auxiliary to any course of treatment that
may be adopted. It avoids _self-infection_ and places the pelvic organs
in the best possible condition for the healing powers of nature to work
out a cure.
If the uterine catarrh is the result of a venous obstruction due to a
congested liver and a general derangement of the digestive apparatus,
then any local treatment will be of no avail without first removing the
hepatic derangement.
Costiveness or constipation is a very common complaint with women and a
very painful cause of womb disease, but it is so simple and ordinary in
its nature that the wise will not deign stoop to notice such trifles,
but if it required for its removal a surgical operation, for which a
handsome fee is the inspiring motive, then we should hear of it as
often as we do of lacerations or flexions of the cervix as a cause of
uterine catarrh, and its removal would then indeed become absolutely
necessary for effecting a permanent cure.
Why is it that the treatment of uterine disease has degenerated into
“professional faking” that is alike disgraceful to the profession and
a daylight robbery of the patient. A woman, for instance, is suffering
from what she supposes to be _womb disease_. She consults a doctor, or
what is still worse, a time-serving specialist, who examines her and
sees at once signs of uterine catarrh.
He at once applies a little tincture of iodine or carbolic acid diluted
with glycerine or a solution of nitrate of silver to the cervical
canal. The woman is now informed that this application must be repeated
two or three times a week, for which she must call at the office that
number of times every week, for an indefinite period. At each visit
she is subjected to the same routine humbuggery for local medication,
but does she get any better? In my early professional experience I
innocently and ignorantly tried these methods myself, and I say no!
But, as a matter of fact, this constant irritation and poking around
and into the womb will inflame any healthy uterus, and much more one
that is already slightly irritated, so that patients lose their hope
and become convinced themselves that they are no better, but feel worse
than when they first commenced treatment.
This inefficient treatment, like the examination, is conjectural and
mechanical and therefore incomplete and unscientific. The cause of her
entire trouble is never approached. The woman suffers for years from
constipation, which also inclines her to piles, because the pressure
of the hardened feces on the hemorrhoidal veins obstructs the flow
of venous blood and the same pressure on the uterine veins congests
the mucous membrane of that organ and gives rise to the symptoms of
endometritis. All these conditions should be inquired into, and many
others, before local treatment is decided on; simply running to the
doctor’s office and having these medical applications made to the
cervix or canal of the womb amount to nothing; this, as a general rule,
does only harm, and is as superfluous as if one were to take a nasal
douche of salt water or some other catarrh remedy, whenever he feels a
little cold in the head.
The proper course to pursue in this and similar cases is to prescribe
an appropriate diet, and regulate the bowels. It is precisely in this
way that women who have made the rounds of the doctors, happen to take
some patent laxative or nostrum that relieves their constipation, and
accomplishes the _wonderful cures_ of which we often hear and that
were no doubt Godsends to the sufferers that were cured, after all the
_first-class_ doctors failed. By far the greatest proportion of cases
of uterine catarrh are of a simple and transient nature and are only
intensified by probing and local treatment.
When I first began the practice of medicine, I made the same mistake in
following the advice of books and those who should have known better,
for they have had ample opportunity to be convinced of the _fallacy_
of these local measures in the great majority of cases, but some minds
are incompetent to learn from experience, for that requires close
observation, and logical reasoning.
I soon discovered that the catarrhal inflammations got worse, in
proportion to the trouble and pains I took to treat them locally,
so that I became ashamed of my ill success and abandoned the local
treatment entirely, and this I shortly discovered was the means of
curing them. Instead, I simply directed patients to rinse themselves
with quite warm salt water, that is, a tablespoonful of ordinary
cooking salt dissolved in a gallon of water. Now I prefer Femina
antiseptic lotion to the same quantity of water, which has greater
healing properties than either pulverized borax or common salt. I
particularly advised them to keep their feet and lower extremities
warm, regulating their diet and keeping their bowels open. I noticed
that the patients began to improve, and that the improvement continued
until they were fully restored to health and vigor. This method of
treatment would not keep an office overcrowded with deluded patients,
but it proved far more satisfactory to all concerned than meddlesome
measures, and illustrated one of the most common abuses to which
suffering women are liable.
In taking a _laxative_ patients must feel their way as to the proper
dose to take in their own individual case; constitutions differ very
much in this respect, so that it is impossible to lay down one and
the same rule for different persons. It is not good practice to give
medicines three or four times a day in cases of habitual constipation,
for it is liable to derange the digestion and interfere with the
appetite. The proper method is one dose at bedtime and this should be
increased or diminished until the suitable dose of the remedy has been
ascertained; when this is accomplished, the dose of the remedy should
be gradually lessened, a few drops every day, till it can be entirely
dispensed with. If the ordinary dose fails to relieve the bowels, an
additional treatment of glycerine enema at or about the time that the
stool is to take place is to be employed. One or two teaspoonfuls of
glycerine should be diluted with an equal quantity of water, and by
means of a hard rubber piston syringe thrown into the rectum. The
stimulating effect of glycerine on the nerves and mucous membrane,
materially assists in relieving the torpor of the rectum, which has
become insensitive to the irritation of its natural contents.
Patients who are costive must get into regular habits of relieving
themselves, that is, have a regular hour every day when to go to
stool, then the medicine will in time cure the most obstinate cases
of constipation, otherwise it is impossible to cure it. It takes a
constant amount of _effort to get well_, so that those who are too
indolent or think it too troublesome to exert themselves, cannot hope
to recover.
If there is great debility and impoverishment of the blood, then I
would advise prescription No. 1, which are the _iron pills_, of which
three pills should be taken three times a day. The moderate use of
wine, either claret or Riesling, with the food, instead of tea or
coffee, is very beneficial, between meals a glass of Porter to relieve
the _gone-in_ feeling, until the system has recovered sufficient
strength to do without it, that is when ordinary exertions are no
longer a burden.
The small percentage of cases that do not yield to the above treatment,
become legitimate subjects for an honest specialist, for there may be
extensive lacerations of the cervix that require surgical treatment,
or an elongated cervix that should be amputated, or a granulated
hypertrophied membrane of the uterine cavity that should be scraped
out; all these operations are without danger if the operator has
thoroughly _mastered the details_ of antiseptic surgery and has the
manual skill to do the work properly.
CHAPTER XVIII.
THE NATURAL POSITION OF THE UTERUS AND HOW IT IS SUPPORTED.
THE uterus is not a stationary fixture in the female pelvis, but enjoys
a mobility within physiological bounds, which in itself explains the
great diversity of opinions which may and do arise respecting the
normal or abnormal position of the womb in any given case.
When the surrounding organs and tissues of the womb are in a healthy
condition, and the abdominal walls are not compressed by the weight
and pressure of skirts, nor the liver or diaphragm forced down towards
the pelvis by a tight-fitting corset, the organ is movable in every
direction, without the slightest pain or suffering.
The uterus is not tied down by any ligaments, as one might imagine from
a description of the several ligaments that constitute only in a small
degree its support, for it changes its position in retching, coughing,
breathing, singing, walking and all other violent movements.
The question now naturally arises: What is the normal position of the
uterus, and what constitutes its natural supports? To answer this
interrogation is to controvert one of the most baneful fallacies
in gynecological practice, for the amount of torturing and useless
doctoring to which women are constantly subjected, owing to some
fancied displacement of the womb, illustrates the force of precedent
or of accepted opinions, that were fortified by years of erroneous
teaching.
It was supposed until quite recently that when the body of the womb
was inclined horizontally forwards, this was unnatural or a sign of
disease, until Prof. B. S. Schultze, director of the gynecological
clinic of Jana, successfully controverted this doctrine. In his work
“_Die Pathologie und Therapie der Lageverænderungen der Gebærmutter_,”
which is the most classical work extant on displacements of the
uterus, says: “From the _post-mortem_ findings it was inferred that
the uterus occupied in the _living_ woman the same position as in the
cadaver; such an assumption did not take into account the actions of
the muscles on the position of the uterus in the living subject nor
the intra-abdominal pressure which is entirely absent after death, so
that the dead organ naturally gravitated backward after the remains had
lain for several days on the back.” Another observer, Dr. Hach, found
in a number of cases that he had examined during life, the uteri bent
forward or antiflexed; twenty-four hours after death he discovered the
same uteri in an opposite direction or retroflexed.
This and similar subsequent researches have demonstrated the fact that
when the body of the womb rests on the bladder it is not in an abnormal
position as formerly supposed and called _anteversion_ or anteflexion,
but that it is natural for it to be so, and when the body is elevated
and its axis forms an obtuse angle with the horizon, the inclination is
a _post-mortem_ condition.
With these precursory remarks I am now able to answer the first clause
of our query, and would say that the uterus is in its normal position
when its long axis is nearly parallel to the horizon or at right angles
with the perpendicular or long axis of the body. The normal position of
the uterus is modified when the bladder is full or distended, for this
lifts the body of the uterus upwards, thus temporarily making an acute
angle with the vertical axis of the body, which was formerly considered
to be the permanent and natural pose of the organ.
In referring to the bony pelvis, Plate I, it will be observed that the
same is in the nature of a canal, for the passage of the child into
the world. At other times than during the child-bearing process, this
canal must be effectually closed to perfectly retain its contents. To
accomplish this purpose it is provided with a bottom or floor, which is
to give this necessary support, not only to the organs that the pelvic
cavity contains but also to the abdominal viscera that are superimposed
upon them. In order to accomplish this, its outlet must be as
effectually closed as the bottom of a box or barrel in which material
things are stored for the purpose of carrying them from place to place.
In the human subject this bottom is called the pelvic floor, because it
serves the purpose of a bottom or floor to the pelvic canal.
The _pelvic floor_ is not a simple structure but a complicated
arrangement of organs and tissues. If we begin to examine it from
below upwards, we first have its outer covering in the skin; then, the
superficial and deep fascias, the triangular ligament of the bladder
and a group of interlacing muscles. The organs that enter into the
composition of the pelvic floor and interwoven with the preceding
structures, are the bladder, the vaginal walls, the rectum and
connective tissue. Examine Plate II.
Through this floor there are several openings, which are guarded by a
special set of constrictor muscles that are termed _sphincters_. These
are sufficiently strong in the bladder and rectum but in the vagina
they would be entirely insufficient to close this canal effectually.
The vagina, or, for our purpose, it will be clearer if we say “_vaginal
canal_,” divides the pelvic floor into an anterior and posterior
segment, and it is by means of this division that the whole structure
of the pelvic floor is weakened; this will be perceived at a moment’s
reflection, when we compare it with the pelvic floor of the _male_,
who has no vagina; and for this reason men are never troubled with the
_prolapses_ to which women are liable. Nature, however, has made an
attempt to compensate this physical defect in a manner that reduces
the weakness occasioned by the vaginal canal to its minimum. The
vaginal canal does not enter the pelvic cavity in a directly upward or
perpendicular course, but obliquely upwards and backwards, as may be
seen by referring to Plate II. The result is that the intra-abdominal
pressure falls on the vaginal walls from above, and thus compresses
and approximates the anterior and posterior walls of the vagina
to each other, so that it constitutes a self-closing valve, but,
notwithstanding all these provisions, this slit or opening through the
pelvic floor still remains the weakest point of the inclosure for the
pelvic and abdominal viscera. When the causes are sought that underlie
the various displacements of the uterus, they are generally to be found
in an impairment of the pelvic floor, through some changes or accidents
that are peculiar to pregnancy and delivery.
As we are also to inquire in the succeeding chapter into the
displacements to which the womb is liable, it would greatly assist our
understanding if we first got an idea of what constitutes the natural
supports of the uterus? The word ligament is defined as anything that
ties or unites one thing or part to another; a bandage; a bond. This
is the _idea_ in the popular mind, so that when the terms broad and
round ligaments of the womb are employed it is supposed that they are
for the same purpose for which ligaments are usually intended. This
is, unfortunately for a clear understanding of the subject, a great
mistake, because these ligaments are an exception to the generally
accepted meaning of the term, for they neither tie nor support the
uterus in its natural position. One may readily imagine that this
erroneous conception would lead to a mistaken course in the treatment
of most cases of displacements, because too much importance is bestowed
upon structures that have no physiological bearing on the disease.
Drs. Hart and Barbour, of Edinburgh, in their “Manual of Gynecology,”
which is the most scientific and practical work that has lately
appeared in the English language, have this to say in speaking of the
support of the uterus: “The question of the support of the uterus
is still disputed. The broad and round ligaments have nothing to do
with its support, they are only useful as giving fixed points for the
contracting uterine muscles during parturition. The chief support is
the compact unbroken pelvic floor, on which the uterus rests just
as one sits on a chair. It is the whole pelvic floor that supports
the uterus and viscera, not the perineum alone.” The perineum (see
anatomical Plate II) is only a small though strong part of the pelvic
floor. If the reader will now patiently review the organs that,
together with the other tissues, constitute this floor, and this can be
most profitably done by studying Plate II, there can be no confusion of
ideas whatever. In the following pages I have occasion to refer to what
is understood by the term pelvic floor.
CHAPTER XIX.
PROLAPSUS OR FALLING OF THE WOMB.
IF one desires to familiarize himself with a thorough understanding
of this subject, it is absolutely necessary to bear in mind what was
said of the natural support of the uterus, for unless one has a full
knowledge of the foundation of a structure, how can he comprehend its
defects and remedy them when the structure falls? The workman who
potters on a building that has shifted from its foundation without
first devising means for a new and solid basis for it to rest upon,
would be considered a fool. The term “falling of the womb” has no
longer the significance that it once had, for it is only a symptom that
something is wrong, and in the present state of our knowledge it is
misleading and a misnomer, inasmuch as it conveys the impression that
it is due to an affection of the uterus, when as a matter of fact it is
not due to any disease of the womb at all. If the prolapsed uterus has
become involved in a morbid process, it is the result of the abnormal
conditions that have brought the prolapsus about, and in which the
uterus was in no way concerned.
Professor Schroeder, of Berlin, takes a similar view of these cases,
and he groups into one chapter three distinct varieties, yet, because
one is depending on the other, he considers them all as one disease.
These affections are: prolapse or falling of the womb; prolapse or
falling of the vagina, and an inflammatory elongation or _hypertrophy_
of the cervix or neck of the womb. He says “that the displacement of
the womb is very seldom a primary affection, but that it is oftener the
consequence of a prolapse or falling of the vagina, and a giving way of
other structures, or of the pelvic floor, and, as such, ‘falling of
the womb’ cannot be properly separated into an individual affection of
the womb.”
Falling of the vagina is principally due to a widening of the vaginal
canal, a relaxation of its walls, and injuries or lacerations of the
pelvic floor. Lacerations of the perineum generally occur during
confinement, in which the vagina tears through the vaginal orifice
backwards towards, or into, the rectum. This so weakens the pelvic
floor that it becomes inadequate to support the pelvic organs and
tissues, and this predisposes to all the varieties of _prolapsus_ that
have been enumerated above. It is during the period of gestation that
the vagina grows considerably longer and wider. In the latter months
of pregnancy the womb ascends and its body inclines greatly forwards,
which naturally tilts the cervix high up in the pelvis, and also draws
that portion of the vagina to which the cervix is attached with it, but
notwithstanding this upward dragging of the vagina, the lower portion
of the vaginal canal has so augmented its proportions that it often
protrudes between the lips of the vulva during the last period of
gestation. The normal relation of the vagina to the neighboring organs
is more or less disturbed, that is, its attachment to the bladder and
rectum is stretched and loosened, so that under the most favorable
circumstances the mucous membrane of the lower portion of the vagina
falls out of the vulva or prolapses, of course in the majority of
cases only in such a degree that it neither inconveniences nor is it
noticeable by the pregnant woman.
Immediately after confinement, in a healthy state of affairs, nature
should rectify these abnormal proportions, that were only designed by
her to serve a temporary purpose, namely, to accommodate the child
and provide for its safe passage into the world. Medical writers have
invented a special term to designate this process of regeneration,
namely, _involution_. This means to infold or grow less so as to
assume the former natural proportions of organs. Unfortunately,
nature is often contravened in her wholesome regenerative purpose, by
adventitious circumstances that completely frustrate her intentions,
and the reparative process being thus balked, the organs and tissues
remain in their abnormal proportions, which constitutes now a disease,
and this uncompleted effort to repair is termed _subinvolution_.
It takes at least from six weeks to three months after delivery for
the reparative process or involution of the organs and tissues to be
completed. And women cannot exercise too much care after confinement to
avoid any possible check to the regenerative process. If the involution
has been arrested, the vagina retains its large, flabby proportions, so
that its relaxed walls naturally protrude or prolapse, and that entails
all the other consequences.
Intra-abdominal pressure should be explained in connection with this
subject, for it constantly encourages prolapsus of the organs under
consideration. By that is meant the pressure which the contents of the
abdominal cavity exert on its walls, and this is greatest at its most
dependent part, which is the pelvic floor. This pressure is continuous
on the organs of the pelvic floor while the woman is standing, and
greatest at the point of least resistance, which is the relaxed and
enlarged vagina, so that it bulges out at the vaginal orifice. When the
patient resumes a recumbent position, this point is greatly relieved
from pressure, and the vagina may regain its normal relations, but
whenever the woman is in the upright position, the intra-abdominal
pressure will again force the weakened pelvic floor and vaginal walls
downwards. After a time the prolapse no longer subsides after the
pressure is reduced, for the tissues have lost their recuperative
power, and the prolapse becomes permanent. When the intra-abdominal
pressure is supplemented by the action of the diaphragm and the
contraction of the abdominal muscles, as occurs in a long paroxysm of
coughing, repeated vomiting, and inordinate and prolonged bearing down
at stool, a prolapse may take place quite suddenly, precisely as in a
rupture or hernia, and for these reasons some authorities (Drs. Hart
and Barbour, of Edinburgh) have described prolapsus of the womb as a
_sacro-pubic_ hernia.
A permanent distension of the bladder or an accumulation of feces in
the rectum facilitates the development of a prolapse of the vagina,
because the former pushes the anterior wall of the vagina downwards,
while the latter depresses the vaginal wall.
A large or subinvoluted uterus is by some considered as a fruitful
cause of prolapse; this Professor Schroeder denies, and I am convinced
from experience that he is right. A uterus that is simply enlarged is
not inclined to prolapse, because the enlarged pregnant uterus never
prolapses if the pelvic floor is in a normal condition. But a chronic
endometritis or uterine catarrh may in time involve the vagina in a
vaginal catarrh and this may induce a prolapse. A chronic vaginal
catarrh or leucorrhœa can so relax the vaginal walls that its lower
folds protrude from the vaginal orifice.
Women who are beyond the change of life and in whom the lost elasticity
of the tissues and a general absorption of fatty and connective tissue
has destroyed the natural support which retains the vaginal walls, may
be annoyed with partial prolapses of the vagina.
The most aggravated types of prolapses are found among the working
classes, who cannot avail themselves of the comforts and hygiene of the
lying-in chamber that are so essential for a complete and permanent
recovery.
Elongation or hypertrophy of the cervix of the uterus is the third
variety of prolapses that Professor Schroeder includes in the group.
This form is consequent upon a falling or prolapse of the vagina,
and it occurs in the following manner. The body of the uterus
being retained by its natural supports or by adhesion of a former
inflammatory process in the pelvic cavity, remains stationary where
it naturally belongs, while the upper end of the vaginal canal being
attached to and surrounding the cervix or neck of the womb, gradually
draws or stretches the cervix out, so that it grows one or two inches
longer than it is natural for it to be. The cervix of the womb projects
under these circumstances down into the vagina, and in some cases it
may be seen between the lips of the vulva. This condition is mistaken
for falling of the womb, when in reality it is a falling of the vagina
with an incidental lengthening of the cervix of the womb. To recognize
and make these distinctions is of the greatest practical importance,
for thus alone can the measures adopted for the relief of these
distressing complaints be successful.
The symptoms of prolapsus grow principally out of the changed relations
of the uterus to the surrounding organs and tissues. The mechanical
interference and pressure of the womb on neighboring parts, and the
changes that are induced in the organ itself by the altered circulation
in its tissues, cause the inflammatory enlargement or hypertrophy that
is characteristic of one variety of the affection.
In some persons the development of the disease is so gradual that it
has progressed for years without any serious inconvenience and the
symptoms that did exist were generally attributed to other causes. In
the course of time there is such a combination of morbid processes,
like painful menstruation, inflammatory enlargement of the womb and
erosions of the cervix with profuse leucorrhœa, as to render the parts
painful and sensitive to pressure and friction. These symptoms excite
in the end suspicion, so that the sufferer may seek advice that will
reveal to her the real condition of her case.
Other signs of these affections are a dragging down or a feeling as
though a weight pulled the pelvic organs downwards; there is also
traction on the bladder, making this viscus exceedingly irritable,
so that there is a frequent desire to micturate; the rectum suffers
also from similar traction. There is another sign that is very often
present, and particularly in the early stages, and this is a feeling as
if the vagina was open; this is due to the relaxation of the vaginal
walls. Walking for any distance becomes burdensome and causes great
fatigue; pain in the back and loins is hardly ever absent. There is
an inability to lift weights, because the pelvic floor cannot endure
the extra strain that is superimposed on the intra-abdominal pressure;
ascending or descending stairs aggravates the symptoms much more than
walking on the level floor.
TREATMENT.
This must be directed to the accomplishment of two ends, without which
no relief, much less a cure, is possible, and these are, _first_, to
return the displaced organ to its normal position, and, _secondly_,
to retain it there. The course first indicated is, as a rule, not
difficult to follow out; in fact, if the patient is placed in a
favorable position, the uterus replaces itself through the natural
forces of traction and gravitation, unless it has become so enlarged
that it is a physical impossibility.
The “_knee-chest_” or “_knee-elbow posture_” is the term that has been
given to this position, and it is assumed in the following manner.
The woman gets down on her knees, the thighs being kept in an upright
or vertical line; the object of this is to keep the pelvis as high as
possible, while the chest is bent or inclined forwards until the head
rests on the floor; the shoulders must be as low to the floor as it is
possible for the patient to endure.
This position at once reduces the intra-abdominal pressure on the
pelvic floor to the least degree, and besides this, the abdominal
viscera gravitating towards the diaphragm, the prolapsed uterus and
surrounding tissues are drawn upwards and forwards with it. If the
prolapse was complete or nearly so, so that the organ almost protruded
through the vulva, then the patient should retain this posture for ten
or fifteen minutes before an attempt is made to replace the organ; for
the intense congestion should be first allowed to subside.
No sudden or violent force should be employed, but a gentle, steady
pressure. In cases where the organ has simply descended into the
vagina, the knee-chest posture alone will replace the uterus. Those
displacements that are due to a chronic catarrh of the vagina are
particularly suitable for home treatment, because the patient can
surely cure her vaginal catarrh, and combining with this the knee-chest
posture, which should be practiced night and morning, for at least ten
minutes, and until the catarrhal inflammation has entirely subsided,
she has at her command the most useful and beneficial resource to
accomplish a cure.
If the reader will refer to page 179 and note carefully what was
said in this connection, she will learn that the phrase _falling of
the womb_ is sometimes nothing more or less than a relaxation of the
vaginal walls that is due to a chronic catarrh of the vagina. It is
quite natural that it should be so, for if the structures that make
up the pelvic floor lose their tonicity and strength, the womb must
naturally descend. If we now succeed in temporarily replacing the organ
by assuming the knee-chest position, and in the meantime cure the
catarrh and inflammation the patient must get well. The reader is again
referred to the chapter on vaginal catarrh.
The fatigue or lassitude which makes every physical effort of some
patients a great hardship, can be greatly relieved, if not cured, by
this formula.
NO. X.
Take: Tincture of nux vomica 2 drams
Fluid extract of ergot 4 drams
Fluid extract of golden seal 1 ounce
Compound elixir of calisaya sufficient to make 8 ounces
Directions: A tablespoonful three times a day, between meals.
When the prolapse is due to some of the structural defects that were
enumerated in the causation of displacements, and that were traced to
the accidents of childbirth, then no permanent relief can be hoped for,
until these defects are remedied.
Pessaries or rings that are introduced into the vagina for the purpose
of stretching or spreading out the relaxed folds of the vagina,
that they cannot prolapse or fall down, and thus indirectly support
the uterus, were suggested by the ancient fathers of medicine. In
view of the fact that they were wholly ignorant of the causes that
were responsible for prolapses, the remedy was quite practical and
ingenious, but to-day, when we are acquainted with the causes that
operate in bringing the prolapse about, they are, to my mind, a very
unsatisfactory _makeshift_, and afford only a temporary amelioration.
A woman who is compelled to wear a ring or pessary is certainly not
well, and if she has any hard work to do or must be on her feet a great
deal, the pessary will sooner or later so irritate the vagina that it
must be removed. Besides this, I always contended that, in the long
run, this extra strain on the vaginal walls would only relax them more,
and, instead of ever being able to dispense with the use of a pessary,
she must increase the size after a while.
There are a great many devices in the form of pessaries; some of them
are absurdly ridiculous, and more in the nature of instruments of
torture than of remedial expedients. Since I learned to know better,
I no longer recommend them, and those who desire a radical cure for a
prolapse of any kind, will surely be disappointed if they pin their
faith to them.
I am convinced that they are a great source of evil, and a sure
index of ignorance on the part of those who habitually recommend
them. The German school of gynecologists have of late years greatly
perfected the plastic operations of the vagina, in fact, it is almost
a sub-specialty in itself, to which they have given the term _prolapse
operations_. A specialist, who is competent in the details of these
prolapse operations, can hold out the very best possible chance for a
radical and permanent cure, and while the operation requires a certain
degree of skill and special training, which should be obtained by
practicing these operations on the cadaver, in order to save time,
and not bungle the operation on the living subject, as too often,
unfortunately, happens. In skillful hands, the operation is entirely
without danger, and under proper antiseptic precautions, the results
are very satisfactory.
The question is simply this: If the knee-chest treatment, and the
remedies that have been suggested, do not give permanent relief, then
there must be some such defect in the pelvic floor as I have heretofore
described.
If the vagina is too wide, it should and can be narrowed to its normal
dimensions, by removing the excessive tissue; if the vagina is torn
into the perineum, this too must be united. Should the cervix of
the uterus be abnormally elongated, so that it makes it physically
impossible to return it to its natural position, it should be shortened
or amputated, and if all these three complications coexist, then
an operation combining and remedying all these defects, should be
performed at one sitting. This method alone will restore the patient to
health and usefulness.
CHAPTER XX.
VERSIONS AND FLEXIONS OF THE UTERUS.
VERSION, in the nomenclature of diseases of the womb, means that the
entire organ without any deflection in its normal axis turns, inclines
or leans either forwards, backwards or sidewards.
The prefix _ante_ is used in the sense of forwards and in composition
with _version_ we have the word _anteversion_, which in conjunction
with the term uterus, signifies that the organ is inclined forwards.
The prefix _retro_, signifies backwards, and in composition with the
word _version_ and in connection with the word uterus, it implies that
the womb is turned backwards.
The word _flexion_ differs from _version_, inasmuch as it signifies
a bending or bowing, which breaks the normal axis of the womb. The
neck or cervix of the uterus may retain its normal position, while its
_body_ is abnormally deflected or bent in any direction. The prefixes
_ante_ and _retro_ are also used in composition with the word _flexion_
as they are with _version_. These distinctions should be remembered.
ANTEVERSION OF THE UTERUS.
In anteversion the uterus has so far changed its normal shape that the
cervix of the organ is stretched out or extended in a line with the
axis of the body. This occurs when the uterus is unusually swollen
from inflammatory enlargement. The normal location of the body does
not materially change in these cases. It is a little more depressed on
the fundus of the bladder and the cervix is correspondingly elevated,
so that the latter stands considerably higher than in health. If the
bladder is empty, and the patient bears down or does anything that
increases the intra-abdominal pressure, the body of the womb is forced
down, upon the anterior vaginal wall, which prolapses into the vagina,
while the cervix is raised, so as to point upwards and backwards. When
the bladder is full, the body of the uterus is naturally raised, and
the cervix correspondingly depressed. And this is attributable to a
rigidity or stiffness about the organ, that is characteristic of a
chronic inflammatory enlargement of the uterus. Sometimes the organ is
permanently fixed by inflammatory adhesions, that lessen or prohibit
these movements.
The symptoms of anteversion are what may be expected from an enlarged
congested organ. This enlargement is due either to a subinvolution of
the uterus or to an inflammation of the intermuscular substance, a
chronic metritis. One of the most annoying symptoms of the anteverted
uterus is the feeling of looseness in the pelvic cavity. This is partly
due to the relaxed state of the surrounding tissue, and partly to the
abnormal size of the womb. The patient feels the organ roll from side
to side, as she changes her position. This causes unnatural sensations
and mental suffering that disturbs the nervous system and induces
hysterical complications. And the patient complains about something
moving in her abdomen.
The inflammatory adhesions that sometimes tie down the organ in an
anteverted position, compromise the normal expansion of the bladder;
this induces an irritation, which causes a frequent desire to urinate.
The treatment must be directed to the removal of the cause. This
disease is really only a symptom or condition of chronic corporeal
metritis or subinvolution, and as such, it is only amenable to the
measures that will cure this disease. The employment of rings and
pessaries to remedy this evil is contrary to good sense and of no
permanent value.
The intelligent employment of electricity, so as to stimulate the
absorption of the hypertrophic enlargement of the uterus and cause the
absorption of the inflammatory adhesions, will often give permanent and
positive results.
ANTEFLEXION OF THE UTERUS.
This was considered at one time the most frequent of all uterine
displacements, not because it existed formerly oftener than at present,
but because the natural or normal position of the womb was confounded
with that which was supposed to be abnormal.
The discovery that in the living subject the body of the uterus
naturally inclines forward, so as to rest on the bladder, and that the
body makes quite an angle with its cervix, altered the conception of
things very materially. To-day an actual aggravated anteflexion, that
occasions no impediment to the menstrual discharge, is not a proper
ground for treatment, although this is as yet by no means familiar to
physicians in general, for many of them have not learned to make the
distinction.
The reader should carefully study Plate II, which diagramatically
illustrates how the body bows over the bladder so as to show its
natural anteflexion. If the angle between the body and neck of the
womb becomes too sharp or acute, so that the canal of the uterus
becomes compressed at the point of flexion, in a degree that obstructs
the escape of the natural secretions of the uterine cavity, then the
anteflexion becomes a source of disease. This degree of flexion is
happily very rare, and we find it in about equal proportions due to a
congenital defect, that springs into prominence when the girl arrives
at puberty, for then the obstruction to the menstrual flow is first
realized.
The other class acquire the affection in adult life, after a once
healthy or natural menstruation has been established. Of this class
there are two species, which must be separately analyzed, so as to
avoid a confusion of ideas, that often makes this subject, _which is
the most simple_, one of the most intricate, in the text books in
gynecological practice.
One variety of the acquired affection can be described, in common
with the congenital form, to which I first referred: because the
anteflexions in both cases are due to precisely the same pathological
conditions, namely, a loss of muscular tone in the uterine walls, so
that the organ becomes flabby and weak, like a green wilted stalk,
allowing the body of the uterus to topple forwards.
The relaxation of the uterine walls is usually more pronounced at that
portion which is distinguished as the _isthmus_ of the uterus, and
corresponds to that part of the organ where the cervix goes over into
the body, forming a sort of natural hinge joint between body and neck.
If the bladder is empty, the body of the womb will naturally drop, not
necessarily forwards, for it may fall backwards, but in the majority
of cases it drops forwards, because the womb is already inclined
forwards in its natural position, so all that is necessary to induce
an excessive anteflexion, is for the body of the uterus to sink lower
than it is natural for it to be. A kink or sharp bend will cause in any
canal an occlusion. Take a small rubber tube, for instance, and bend
it sharply at right angles; the result will be at the corner of the
deflection, that the tube will be flattened, and its walls will come
together. In the case of the uterine canal, where there is an abnormal
flexion, there is precisely the same condition, and as a result
an obstruction not only to the menstrual fluid, but to the mucous
secretions, which are pent up in the uterine cavity. The retained
fluids decompose and irritate the mucous lining; and this entails a
complication of inflammatory diseases, which can never be cured, unless
the flexion is remedied.
The other variety of the acquired flexion is due to a pelvic
cellulitis. This is an inflammatory process, entirely outside of the
uterus.
The womb is surrounded by a great deal of loose cellular tissue, that
fills out the interspaces between the different ligaments and pelvic
organs. This tissue often becomes the seat of an inflammation. The
exudation from the inflammation may be of such a nature that it forms
strands of _fibrous tissue_, running from the isthmus of the uterus
backwards to the sacrum. These strands contract or shrink in the course
of time, and this draws the isthmus of the uterus backwards, and fixes
or attaches it to the posterior pelvic wall. By this contraction of the
fibrous tissue the cervix is constricted and the body falls unnaturally
forwards.
The prominent symptoms of anteflexion are painful menstruation and
sterility. Dysmenorrhœa or painful menstruation is the first sign of
the existence of anteflexion at the age of puberty. It happens that
young girls are thus tortured for days with violent uterine colic, that
is occasioned by spasmodic efforts of the uterus to force through the
constricted canal the pent-up secretion. This lasts until the menstrual
fluid has sufficiently dilated the cervical constriction to allow its
escape. These painful paroxysms of uterine colic repeat themselves at
each recurring menstrual period, and through these repetitions of pain
and suffering, the general health becomes greatly deranged. The nervous
system becomes the seat of functional disturbances, and hysterical
disorders are not uncommon.
The organ becomes involved in chronic inflammatory processes that make
the uterus exceedingly sensitive, so that the colicky pains become
aggravated and prolonged far beyond the cessation of the menses. Some
of these patients suffer for several weeks, from the time the courses
ought to begin, so that they are actually sick half the time.
Sterility is not an absolute certainty in all these cases, but it is
traced so often to an aggravated flexion, that it may be accepted as
one of its most prominent signs. Conception has taken place in extreme
flexions, because the spermatozoa can gain admittance into the uterine
cavity for several days after the uterine colic and menstrual fluid
have forced the canal open. And if the uterus has not become involved
in inflammatory processes, then conception is the means by which nature
effects a cure through her own resources.
During the menstrual period, the anteflected uterus becomes greatly
congested and swollen, and, having already grown considerably larger
from the chronic inflammatory conditions which the anteflexion has
induced, it impinges on the bladder, so as to interfere with its free
expansion. This occasions a frequent desire to void urine, and this
becomes a very distressing symptom in a certain proportion of cases.
Treatment for this affection is not within the sphere of the original
purpose of this work, for the efforts at home treatment must be aided
by mechanical methods of the physician. From what we are taught of the
physical cause of this affection, the fact seems self-evident that
the acute or sharp flexion must be modified to give permanent relief.
The employment of rings, pessaries, sponges or medical applications
are nonsensical, and the method of introducing a stem in the uterine
cavity, for the patient to wear for an indefinite length of time, is
not without great danger. Even though a woman cannot give herself all
the proper treatment, it must be a great satisfaction to her to be
informed of the proper methods that should be adopted.
The vagina should be thoroughly rinsed before each and every treatment
of the uterus, so as to guard against the possibility of infecting the
cavity of the uterus.
If the manipulations that are required for the purpose of carrying out
some of the mechanical or surgical treatments of uterine diseases, were
always preceded with thorough cleanliness, which implies _asepsis_, or
without putrescence, then all these operations would be shorn of their
greatest danger, namely, that of exciting inflammation and suppuration.
If a probe of the usual curve can be readily introduced into the
supposed anteflected uterine cavity, then there cannot be sufficient
flexion to constitute an obstruction, hence the flexion is not the
cause of the disease. In genuine anteflexion, the cervix and body of
the uterus are doubled up on each other, often like the letter V,
the cervix representing one line of the V, and the body the other;
bi-mammal palpation in the hands of an expert clearly establishes this
conformation.
When the diagnosis is established, the treatment should be as follows:
The patient is inclined on a table, either on her back or side, a
Sims’ speculum is introduced into the vagina and the cervix exposed.
The posterior lip of the cervix is now seized by means of a tenaculum
forceps, and gently drawn downwards and backwards, which greatly
reduces or obliterates the angle or flexion between the cervix and
the body of the womb, this greatly facilitates the introduction of a
uterine electrode. After two or three treatments, the forceps are no
longer required because the electrode can then be readily introduced
into the uterine cavity without them. The other electrode is spread
on the abdomen. (See this illustrated on Plate V.) A current of
electricity is now passed through the uterine tissues for ten minutes;
this is gauged all the way from sixty to one hundred _milliampères_.
The operation is repeated only once a week, and the cure is effected
in six weeks to three months. Great care must be exercised during the
treatment, to avoid exposure and undue exercise.
Those forms that are due to inflammatory deposits and strands outside
of the organ, should be preceded with an electrical treatment twice
a week, somewhat modified from the preceding course. This is done
by employing a _vaginal electrode_, properly protected and gently
pressed against the adhesions. The other _electrode_ is applied to
the small of the back. A current some fifty _milliampères_ stronger
is passed directly through the adhesions; when these are absorbed,
the intra-uterine electrode is employed, as in cases that are not
complicated with them.
RETROVERSION OF THE UTERUS.
This consists in a posterior inclination of the uterus, so that the
body of the womb approaches the posterior walls of the pelvis, while
the cervix of the womb is raised against the base of the bladder.
[Illustration: PLATE IV.
Retroflexion of the Uterus, or the Womb, bent backward.
This plate elucidates the womb bent or turned backward and pressing on
the rectum. This condition is generally traceable to the vicious custom
of lying on the back after confinement or during childbed. The natural
position of the organ, inclined forward and resting on the bladder, is
also shown.]
As a permanent pathological lesion, this form of displacement is very
rare, but as a forerunner of retroflexion it is of frequent occurrence.
The length of time that elapses for a version to take on a flexion
depends on the degree of induration or stiffness of the uterine walls.
The chronic inflammatory enlargement of the uterus predisposes the
organ to posterior displacement, and the displacement favors the
development of flexion. This takes place in the following order: After
the uterus is displaced backwards, and its cervix has become fixed by
inflammatory adhesions, the body of the womb gradually glides down
on the posterior pelvic wall, from gravitation and intra-abdominal
pressure. And in this very simple manner a retroversion is converted
into a retroflexion. The causes, symptoms, and complications that
characterize this variety of displacement, with its subsequent
modification into flexion, are the same as those of retroflexion, to
which the reader is referred.
RETROFLEXION OF THE UTERUS.
This form of uterine displacement exists when the body of the womb is
bent towards the posterior wall of the pelvis, which is in an opposite
direction to that where it naturally belongs. I have already pointed
out, in speaking of the normal position of the uterus, that the body
is directed forwards and rests on the bladder, while its cervix points
downwards into the pelvic cavity. I now refer you to Plate IV, in which
I plainly show the uterus in a directly opposite position to that in
health, namely, turned back, resting on and depressing the rectum.
In retroflexion the cervix of the uterus continues to point downwards,
into the pelvic cavity, in almost the same direction as in the natural
position, while the body is directed backwards, or backwards and
downwards. We seldom, if ever, find this condition as a congenital
affection, but as an acquired displacement it is undoubtedly more
frequently met with in gynecological practice than all other
displacements combined. The round ligaments of the uterus were at one
time, and are even yet by some, supposed to be the means that retain
the womb in its normal anteflected position. Upon this theory a new
surgical operation sprung into prominence for the relief of this class
of cases. It was reasoned, that if the round ligaments actually tied
the uterus down, and retained it in its natural anteflected position,
that to shorten these ligaments by opening the inguinal canal in the
groin, and drawing them out, would remedy a displacement of the womb,
whether a prolapsus or a retroflexion. This operation was performed,
it was claimed successfully, and if the view that the round ligaments
retain and support the uterus were a correct one, it must be admitted
that the operation would have been _ideal_. I convinced myself,
however, of the utter fallacy of this position, in dissections on the
cadaver, where in several instances the round ligaments could not be
reached without opening the abdominal cavity, and even then it was
impossible to trace them. These views were expressed in an article
in the _American Journal of Obstetrics and Diseases of Women and
Children_, and as the operation fell shortly afterwards into merited
disrepute, I partly claim the credit of having been instrumental in
bringing that about. I said:
“That this ligament has nothing to do in fixing the uterus in its
normal anteverted position, is proven from many facts which occur in
daily practice. The insertion or origin, whichever one chooses to call
it, of these cords at the groin, is somewhat irregular and sometimes
so rudimentary that it cannot be found upon a most careful and tedious
dissection. It may be found divided into a number of processes, one
being connected with Poupart’s ligament in the inguinal canal, the
other being lost in the labia majora, and another may be traced to the
sheath of the rectus muscle.
“If these cords were so important as the advocates of the
Alexander-Adams operation try to make us believe, in binding the
uterus forward, and, as we are recently informed, have a strength
equal to support four and one-half pounds weight, a great deal of
uneasiness, if not actual pain, would be felt and located along the
inguinal canal, following this structure to its points of insertion,
in sudden dislocations of the uterus backwards. This is, however, not
the case; when sudden painful symptoms arise, they are invariably
referred to the sacral region. In sudden retroversions or flexions, as
in the pregnant uterus, occurring accidentally or those retroverted or
flexed uteri which are so often met with in a state of subinvolution
after confinements, there are no symptoms pointing to a tension of
these cords at all, but all symptoms point to uterine pressure on the
posterior pelvic wall, which can be precisely located. And these pains
disappear as soon as the offending member is put right.”
There is no doubt that the uterus retains its abnormal retroflected
position by the same forces that keep it in a normal or anteflected
state; these are (1) intra-abdominal pressure, and (2) the force of
gravitation of its own weight.
In some women there are certain predispositions to the occurrence
of a retroflexion. If the walls of the uterus are weak and relaxed,
especially that portion where the cervix unites with the body of the
womb, then the body may fall in any direction, and, as the bladder is
liable to be distended, and thus raise the body of the uterus upwards,
folds of intestine are likely to intervene, so that the organ is
inclined backwards, and the abdominal pressure, now falling on the
anterior surface of the body, presses the womb backwards and downwards
into a flexion.
A fall backwards or a violent push or jump may cause retroflexion
any time during life. Retroflexions of this nature are not as a rule
injurious, and if the circulation is not compromised, nor the uterine
canal obstructed, women may go through life without feeling any the
worse because their womb occupies an abnormal position. It is only when
the organ is congested and swollen, so that its own tissue is painfully
sensitive, and the surrounding tissues are compressed by the foreign
body, that it requires measures for relief.
In those women who have borne children, and those who have gone through
a miscarriage, retroflexion is frequently met. A little reflection
will make this clear, for when we remember how the pregnant uterus at
any time from conception to final delivery becomes congested and the
seat of a corresponding growth of its own tissue to accommodate the
growing fetus, we at once perceive that either after an abortion or on
delivery at full term, the enlarged and congested uterus is in the best
possible condition, to lose its normal place and sink backwards. The
pernicious custom in vogue in most countries, of keeping a woman on the
flat of her back after delivery, has never been as vehemently opposed
by the intelligent members of the profession, as the gravity of the
subject demands. Some women have an idea that the longer and quieter
they remain on their backs, the surer they are to make an excellent
recovery from the lying-in chamber. American and English practitioners
are inclined to recommend this as the most proper way to lie, but there
is no doubt that this not only favors the occurrence of retroflexion,
but that it actually causes it.
The woman who rests on her back gives to the heavy body of the womb an
opportunity to sink backwards, after the distended bladder has pushed
the organ high enough up so that its own weight may throw it over,
until it finds resistance on the posterior wall of the pelvic cavity.
Many nurses insist on the dorsal position for days, and never permit
the patient the privilege of lying upon one or the other side. Aside
from the injurious effect that this has on the position of the uterus,
it is exceedingly tiresome to be compelled to remain for several days
in one position. Women should be allowed to lie on all sides, after
delivery, and no longer on one side than on another. And to insure
against a retroversion or flexion, she must also lie on the abdomen a
certain length of time during each twenty-four hours.
Tight bandaging after delivery, for “preserving the figure,” greatly
aggravates the displacement; the binder should be so applied that it
feels comfortable but not too tight, its purpose being to offer a
gentle support to the suddenly relaxed abdominal muscles, and thus
stimulate them to contract to their normal form.
The symptoms of retroflexion are greatly varied by the pathological
conditions that affect the uterus, or by the complications that may
have caused the flexion.
It is indisputable that the uterus may be retroflected for an
indefinite length of time without causing any inconvenience. From this
it may be inferred that the retroflection itself does not constitute
the disease, but the inflammatory processes, in which the organ is
involved, or the relaxation of the adjacent structures, as we find
them immediately after confinement, constitute the actual diseased
conditions.
One of the most constant symptoms is pain in the back, and this is
severe in proportion to the swelling and sensitiveness of the organ,
when it presses on the sacral nerves and rectum.
As a result of the flexion, the circulation in the organ is interfered
with, so that the congested uterus feels heavy, and there is a
sensation of fullness and bearing down, that greatly hinders walking.
Uterine catarrh and hyperæmia place the organ in such an irritable
state that prolonged and excessive menstruation is the rule. This may
last for fourteen days, so that the patients become anæmic and greatly
debilitated from the excessive loss of blood. The menstruation is
always more painful, especially at the beginning of the flow; this
pain may be interrupted or spasmodic, so that it assumes the form of a
uterine colic; the lower abdominal region becomes painful and the pain
radiates towards the groins. The degree of suffering is very seldom as
great as that which characterizes anteflexion, because the obstruction
in the latter flexions are much greater than in retroflexions.
Those women who have borne children suffer less pain during
menstruation than those who have never been pregnant. It may be
presumed that, in the latter class, the flexion was congenital
or acquired in early childhood, which makes the obstruction or
constriction more complete and obstinate, and for that reason it
induces sterility. With those who have once borne and afterwards
acquired the flexion, the possibility of conception is much greater.
When the enlarged and swollen body of the uterus is pushed backwards
and downwards, it presses on the sacral plexus of nerves; this is a
bundle of nerves that supplies branches to the legs, and from this
pressure the lower extremities become lame or paralyzed either on
one or both sides. The paralysis subsides after the removal of the
offending body. There is quite a number of other neurotic affections
that can often be traced to a retroflected uterus. These are all of
a functional nature, and appear in the form of hysteria, epilepsy,
St. Vitus’ dance and neuralgias of almost any part of the body. Dr.
Chrobak, of Vienna, reported a case of asthma that had resisted all the
treatments that could be suggested, until it was finally traced to a
retroflected uterus; that being rectified, the asthma subsided.
Irritability of the bladder is not so frequent a symptom of this
variety of displacement as of others; should there be inflammation
complicating the bladder, then, of course, there would be considerable
annoyance from this source.
Habitual constipation is often very prominent and in some of the cases
it is the only sign that leads to an examination, which reveals the
retroflexion. Hemorrhoids or piles, due to a compression of the veins
of the rectum, are another complication included in the signs of this
displacement.
TREATMENT.
There is a small proportion of cases in which the system has become
accustomed to the retroflected position of the womb, and if the
abnormal condition is rectified, a great many painful symptoms spring
into prominence, that are attributable to the interference. This is
particularly the case in women who are in those years that we term
“change of life,” and for this reason they should be let severely
alone.
Excluding the above class of cases, the question arises in other cases
whether the uterus can be replaced without violence, or whether it is
fixed or grown to its surroundings by inflammatory adhesions. It is
not always an easy matter to dispose of this question at once, because
the enlarged and congested body is often so firmly wedged down between
the posterior pelvic wall and the vagina, that any attempt to dislodge
it is accompanied with such acute pain that one feels constrained
to desist for a time. When there is great pain or sensitiveness,
the patient should take to bed, so as to give the pelvic organs
every chance to get rid of the inflammatory irritability. Hot-water
compresses should be applied to the lower abdominal or pelvic region,
and hot vaginal irrigations thrown into the vagina; these should be
copious, no less than a gallon of water at once, at a temperature of
107 to 110° Fahr., repeated twice daily. The bowels should be kept
loose, say several operations each day, for three or four days; after
that once a day will be sufficient.
In the course of several weeks the congestion will have subsided,
so that, in the great majority of cases, reposition can be readily
accomplished. If the resistance of the womb still persists, then it is
reasonable to infer that the organ is tied down by old inflammatory
adhesions; these, then, should be treated with galvanism, after the
manner described for removing adhesions in anteflexions.
The statistics show that, out of every five women who are suffering
from female diseases, one has a posterior displacement, either a
retroflexion or retroversion. The greatest number of these are
traceable to their last confinement. All these displacements, as
well as those that are accidental or induced by a fall, jumps or the
like, should be replaced as soon as possible, otherwise inflammatory
adhesions may complicate and greatly obstruct the replacement.
The reposition or replacement of the womb may be accomplished through
natural agencies, that can be employed by the patient herself. These
are, in a great measure, the same forces to which the womb’s posterior
displacements are to be attributed, namely, intra-abdominal pressure
and gravitation. To employ these for the purpose of remedying the evil,
the so-called knee-chest position must be assumed by the patient. The
first step towards assuming this position is to get down on the bended
knee, the thighs in a vertical position, then the body is gradually
inclined forwards until one or the other shoulder touches the floor or
level of the knee. If this position is retained for ten minutes it will
alone replace the organ forwards, sometimes suddenly, at other times
gradually, provided the organ is moveable and not squeezed into the
pelvis or adhered by inflammatory exudation.
Dr. Henry F. Campbell, of Georgia, introduced this natural therapeutic
agent into the profession, but it appears to be very little known or
understood by the profession, perhaps because it is so very simple.
Dr. Mundé, in an article on “Uterine Displacement and Its Curability,”
in the _American Journal of Obstetrics_, indorses the knee-chest
or knee-shoulder position in the following language: “A moment’s
thought will demonstrate the utility of this combined _vis a fronte_
(gravitation of the abdominal viscera towards the diaphragm) and
_vis a tergo_ (air suction into the vagina and pressure against the
vaginal roof). This position is to be assumed several times daily, and
maintained each time as long as the patient can bear it, continued for
months, if necessary; the best time is at night at retiring, when the
lateral position is to be taken for the night.”
In a certain proportion of cases the knee-chest position alone will
not dislodge the retroflected uterus, so that manual aid is required
to effect that purpose. There is a number of methods that have been
suggested from time to time, but none are so good as that in which the
knee-chest position is combined with the manipulation of the operator.
Reposition may occur spontaneously, and it undoubtedly does in a large
proportion of cases, in which the retroflected organ becomes pregnant.
When the retroflected organ occasions symptoms of retention of urine,
the bladder should first be emptied with a soft No. 8 catheter, then
the patient is directed to kneel on both of her knees, her thighs
remaining perpendicular, while her body inclines forward until one
or the other shoulder touches the floor or level of her knees. The
operator may then gradually lift the womb and elevate the body
sufficiently so that it will fall forward into its natural place. When
there is no bladder trouble from compression, and the womb resists even
mild force to replace it, I have accomplished gradual reposition by
keeping the woman in bed for three or four weeks, with the instructions
that she resume the knee-shoulder position two or three times a day,
and from five to ten minutes, also that she shall lie on her side and
chest and never on her back. In this manner I have accomplished in time
and without force what could not have been accomplished with forcible
attempts without inducing an abortion.
It curiously happens that there are cases of retroflection which are
never suspected nor recognized until the patient has become pregnant.
After the woman is about three months gone, the growth of the
pregnant uterus can no longer be accommodated in the pelvis, because
the direction of its growth is in the direction of the retroflected
organ, namely, backwards and downwards (see Plate IV) which makes it a
physical impossibility to escape from or grow out of the bony pelvis.
The symptoms are retention of urine or a constant dribbling of urine
and a straining at stool or pain in the rectum or pelvis, and, of
course, the absence of the menses since the commencement of pregnancy.
Retroflection may be also acquired during the first three or four
months of normal pregnancy, from a jump or fall on the back, in which
all the symptoms that indicate this condition are suddenly manifested.
In pregnancy, the course that is to be pursued, in order to rectify
the displacement, must be obviously different from that pursued when
the woman is not pregnant. The pregnant uterus is a “touch me not;” it
permits of no tampering without running the fearful risk of inducing an
abortion, and no one but a tyro or an ignoramus will ever meddle with
the pregnant womb.
The replacement of the retroflected uterus, that is positively not
pregnant, and there must be no question about it either, will admit of
introducing a sound into its cavity. This sound is used as a lever upon
which the organ may be lifted out of its abnormal position and inclined
over the bladder in an anteflected position, which is its natural one.
The sound which I employ, and which is my own invention, for replacing
the uterus is screwed into a thimble, and from two and one-half to
three inches long. The object of this is to artificially elongate the
finger so that it can be introduced into the womb. The force which one
employs by using this instrument is keenly appreciated by the operator,
hence there can be no undue strain, that otherwise might be exerted
on adhesions which are too strong to be safely lacerated or even
stretched, while slight and recent adhesions might be torn without any
bad results. Truax, of Chicago, manufactures my repositor.
Before introducing any sound into the uterine cavity, it is absolutely
necessary that the vagina should be thoroughly cleansed with borax
water.
The inflammatory enlargements of the womb, subinvolutions, uterine
catarrhs, and any of the complications that may exist at the time that
the organ is replaced, should be treated on the same principles that
have been laid down in the respective chapters on these diseases; in
fact, these complications constitute part of the after treatment for
retroversion or flexion. The other treatment is to be directed toward
retaining the womb where it naturally belongs. The daily exercise in
the knee-chest position should never be neglected, and in cases in
which this is insufficient, it is very probable that the pelvic floor
or natural support of the uterus has been injured or lacerated during
confinement, and this may require a plastic operation as a preliminary
to a cure. In obstinate cases there is no cure so effectual as
pregnancy and a full-time delivery, provided precautions are taken so
that the mother will not acquire a new retroflexion during her lying-in
period, from the cause that has been already detailed. The patient
must accustom herself to sleep either on the chest with face turned to
one or the other side, or in a semi-prone position on either the right
or left side. Perseverance in sleeping in this manner for a few weeks
cultivates the habit that gives more refreshing sleep than lying on the
back, which most persons are inclined to do.
CHAPTER XXI.
DISEASES OF THE FALLOPIAN TUBES.
THE Fallopian tubes are the ovi ducts, along which the spermatozoids
pass from the womb to fertilize the ovum, and along which the
fertilized or non-fertilized ovum, as the case may be, is carried to
the cavity of the uterus.
They are two small canals, between three and a half and four inches
in length, and constitute the only means of communication between the
womb and ovaries; their caliber is exceedingly small and lined with a
delicate mucous membrane.
The diseases which affect the Fallopian tubes are inflammation,
stricture, distention and displacements.
The inflammation is distinguished as salpingitis, from _salpinx_,
Fallopian tube, and _itis_, in composition, inflammation; this consists
of a catarrhal inflammation of the lining membrane of the tubes, which
rarely if ever originates in the tubes themselves, but is secondary to
an inflammatory process in the neighboring organs.
Chronic endometritis or catarrh of the womb is undoubtedly the most
fruitful cause of salpingitis, although this is not absolutely the
rule, for there are some women who have had uterine catarrh for years
without its affecting the tubes in the least. But there is a type
of uterine catarrh that has a special tendency to spread from the
womb to the lining membrane of the tubes, and this is the infectious
endometritis. An infectious inflammation of the womb may be due to many
different sources of infection; the retained products of conception
after an abortion may become putrescent and furnish one source;
carrying putrefactive germs into the uterine cavity from the vaginal
canal by means of probes or instruments, that are in themselves
defiled by not having been thoroughly cleansed and purified since their
last employment, is another source of infection; the latter is perhaps
the commoner cause of blood poisoning in criminal abortions by the
abortionists. Gonorrhœal infection seems to have a greater tendency
than any other to spread itself from the uterus to the tubes; this has
been the subject of special inquiry, and has been thoroughly confirmed,
and this may arise many months after the infected male has imagined
himself entirely cured.
The diseases of the tubes that I have enumerated are in the relation
of cause and effect; a catarrhal inflammation is quite likely to
induce a stricture or an occlusion, and this causes a distention from
retention of the secretions, whether the secretions are a natural or
an inflammatory product. If the inflammation has an infectious origin,
then the retained secretion becomes purulent, or it may be a muco-pus
secretion from the commencement. The dilated tube may also contain
blood or serum; the latter constitutes tubal dropsy; or it may contain
a fertilized ovum; this gives rise to tubal pregnancy.
Tubal dropsy may be a distention of the tubes when both ends are sealed
by inflammatory adhesions; these distentions vary in size from the
thickness of a finger to a large ovarian tumor, from which it is not an
easy matter to distinguish it.
The most dangerous form of tubal obstruction and distention is where
the contents are pus or purulent matter; this is liable to be poured
into the peritoneal cavity from ulceration or rupture of the sac, and
excites fatal peritonitis.
Salpingitis can only be viewed as a complication of some prior
inflammatory process in some of the adjacent organs and tissues;
these are the uterus and ovaries and the pelvic peritoneum and pelvic
cellular tissue.
The symptoms of inflammation of the tubes are not so clearly defined
as to indicate the nature of the affection, because it is hardly ever
limited to the tubes alone, the surrounding tissue being always more
or less involved. These patients are so seldom free from pain that
their lives are a constant suffering. If the pain subsides, it is only
for a few days, and the slightest exertion brings about a relapse,
so that walking or standing must be avoided. During menstruation the
pain always increases, and the menses may be excessive at one period
and scant at another; these harassing pains make powerful inroads on
the patient’s strength; she becomes pale and debilitated, while her
emaciated form and careworn expression give us a picture of the typical
invalid. Fortunately, this complication is not as frequent as one might
expect from the intimate relation of the tubes to the womb and ovaries,
but the possibility of the Fallopian tubes becoming inflamed should
admonish women against taking any chances by neglecting the rules of
hygiene, that I have laid down in another chapter, for the old saying
that “prevention is better than cure” is only too true of this malady.
TREATMENT.
The curative measures for inflammatory diseases or abscesses of the
tubes have not been, on the whole, until within a comparatively recent
period, very satisfactory.
When this affection complicates uterine or vaginal catarrh, then
the treatment that is recommended elsewhere for the relief of these
complaints should be adopted; quietude is of paramount importance, and
total continence must be practiced by the sufferer. Hot sitz baths and
warm fomentations are important auxiliaries in the treatment. Vaginal
irrigations of hot water, night and morning, relieve the congestion and
stimulate the absorbents of the pelvic glands. Femina vaginal capsules
are a great assistance towards accomplishing the same end; one capsule
introduced into the vagina at bedtime should be combined with the other
treatment.
If these measures fail to accomplish a cure, then a surgical operation
may be required as a last resort, which consists in extirpating the
diseased tubes and ovaries.
This operation has given some brilliant results, but it has also
hurried a great many to an untimely grave. Fool-hardy surgeons or
operators are the rule; doctors of only mediocre talent worm themselves
into positions that give them prestige in the community. Where nature
refuses a capacity for the acquirement of solid wisdom, she seems to
compensate her creatures by endowing them with faculties for cunning
and intrigue, that galvanize the spurious into the apparently genuine.
They have charge of hospitals and are professors in colleges, and are
ambitious to imitate the operations of the European masters. On the
other hand are the statistics of able surgeons, who seem to have an
inborn genius for a special line of operations; such a one is Lawson
Tait, of Birmingham, and Martin, of Berlin. Tait has had phenomenal
success in cutting open the abdomen and removing diseased tubes and
ovaries. He possesses the faculty and skill to select only those cases
that are especially suited for an operation, and those that are not
adapted for the knife are excluded. In the exercise of this judgment
the danger of the operation is reduced to a, minimum. The tubes and
ovaries are often so matted and tied down with inflammatory adhesions,
that their removal means sure death, and does the average surgeon know
this? To have the genius of a Tait is to be one in ten thousand, and
for this reason his statistics should be neither a guide nor an excuse
for the other nine thousand nine hundred and ninety-nine, to attempt to
do as he does. To assume that they can, is as absurd as to admit that
our indigenous colonels of the State militia can plan or execute the
campaigns of Napoleon.
Galvanism or electricity has come to the rescue of this class of cases,
as a safe and reliable method of treatment; of course it takes more
time and patience. Should not this outweigh the selfish ambition of the
unscrupulous surgeon who desires to boast of the number of times he
has opened the abdomen, with little compunction of the confiding lives
that he has sacrificed?
I have myself had abundant experience to be convinced of the usefulness
of electricity as a curative agent in this class of diseases, but I
prefer to illustrate the treatment by quoting from a paper on “The
Value of Electricity as a Substitute for Laparotomy,” by Augustin H.
Goelet, M. D., in the New York _Medical Journal_. He says:—
“Mrs. T., aged twenty-six. Severe pelvic pain referred to left side;
profuse leucorrhœa; prolonged and painful menstruation. Diagnosis:
Pyosalpinx (or pus) in the left tube. Laparotomy (opening the abdomen)
advised at Woman’s Hospital. Treatment: Tube emptied into the uterus by
applications of positive galvanism to the left horn of the cavity of
the uterus. Intravaginal applications afterwards, completed the cure.
Duration of treatment, four months Complete relief of pain followed the
removal of the pus from the tube. At the end of the treatment she had
completely regained her health. Menstruation was normal, and symptoms
relieved.”
CHAPTER XXII.
DISEASES OF THE OVARIES.
THERE is an analogy in the reproductive apparatus, running through the
whole animal and vegetable kingdoms. The bulb at the lower extremity of
the pistil of a flower is called the ovary, and it contains the seed,
which in the course of development becomes the fruit.
In the human female, the ovary contains the seed, or germ, which,
becoming fertilized, develops into the human embryo, or the fruit of
conception.
The seeds of the ovaries are termed ova, or eggs, and the organ or
gland in which the germs, or eggs, are prepared is the ovary.
In the human female the ovaries are two follicular glands, about the
shape and size of small almonds, situated on each side of the uterus.
The follicles, or small sacs, of which the ovaries are composed, are
cemented together by delicate fibrillar connective tissue, which is
known as the _stroma_ of the ovary, while the follicle is termed
Graafian vesicle, after the name of its discoverer. Professor Barry,
another investigator, gave the follicles the much better and more
appropriate designation of ovisacs, because each of these capsules or
follicles contains a single ovule, or little egg.
It is carefully estimated that there are 30,000 Graafian follicles or
ovisacs in each ovary, of which only an insignificant number develop
and rupture at each menstrual period. It appears, from the researches
of Valentine and Pflueger, that the Graafian follicles are formed at a
very early period of embryonic life, from a series of minute tubules,
that gradually become constricted from surrounding stroma, at regular
intervals; the ova are subsequently developed in the interior of the
follicles.
Ovarian cysts or tumors cannot be considered in a work for home
treatment, but a desire must be awakened in the minds of thoughtful
readers, to learn the origin of these growths, and it seems to me quite
appropriate at this juncture of the subject, to state that Professor
Waldeyer, of Berlin, has discovered that ovarian tumors are developed
from the remnants of the little tubules from which the Graafian
follicles originate, so that the cause or source of these tumors is
already laid before the patient is born; hence cannot be attributed
to any fault on the part of the afflicted person. From the earliest
period of intra-uterine development up to the age of puberty, the
growth of the ovaries is entirely passive, but after that a continuous
change takes place in the substance of the ovaries; the contents of
the ovaries become active from the period of puberty, from which dates
the commencing aptitude for procreation, until the menopause, or
final cessation of the menses, which, in popular language, is termed
“change of life,” when the aptitude for conception ceases with the
proliferation of the ova.
The period of fruitfulness is characterized by the persistence of the
menses, and this terminates, on the average, in the forty-fifth year;
during all of this time the little ova, or eggs, continually ripen, and
at their maturity the ovisacs, or Graafian vesicles, rupture from an
increased secretion into their cavities. This ripening of an egg and
rupture of a follicle corresponds with the monthly flow. The human ovum
is very small; the largest does not measure above 1-120th of an inch in
diameter, and very often it measures only half that size.
The situation of the ovary is not fixed in the pelvic cavity with
any absolute degree of certainty, but it enjoys a degree of mobility
that is even greater than that of the womb itself, to which it is
attached by means of the ovarian ligament. Its usual place is about an
inch from the uterus and a little backwards. It is partly surrounded
by folds of peritoneum, and partly by the tissue that pads out the
interspaces between the pelvic organs. If we remember the physiological
fact, that at every monthly discharge of blood from the uterus, which
is called menstruation, an ovum or egg ripens and an ovisac bursts,
we cannot fail to appreciate the importance of the intimate relations
that these functions must have, to the health of the individual and the
perpetuation of the species.
This process of ovulation has the peculiarity of the first stages of an
inflammatory action, because the ovaries become congested whenever an
ovisac ruptures.
Through the nervous sympathy existing between the ovaries and uterus,
this too becomes congested, so that the network of uterine vessels
becomes so engorged that the capillary blood vessels of the mucous
membrane of the womb rupture, and the hemorrhage that is the result
constitutes the menstrual flow.
There are three physiological processes concerned in the menstrual
phenomena: first, irritation and congestion of the ovary, rupturing the
ovisac; second, congestion of the Fallopian tubes and uterus; third,
consequent rupture of the blood vessels of the mucous membrane of the
uterus and probably of the Fallopian tubes.
There may be one or more supernumerary ovaries without disturbing the
normal functions; one or both ovaries may be congenitally absent. The
entire absence of both ovaries is generally accompanied by deformities
of so serious a nature that the newly-born infant is incapable of
living.
If the defect is principally limited to congenital absence of the
ovaries, then there is an absence of the changes in which puberty is
recognized; the mammary glands remain flat; there is not the roundness
and fullness of the girl’s figure that signalizes budding maidenhood.
The apparently undeveloped form and girlish characteristics are
prolonged into the years of adult age, and she remains weakly and
small.
In an incomplete or rudimentary development, from an arrested or
imperfect evolution of the ovaries, there is often a condition that
resembles the above very much; neither are these cases nearly so
infrequent as those whose organs are entirely absent. The ovaries may
persist in their fetal state, or their growth may be arrested at any
time before the expected period of puberty. The diagnosis of this
pathological condition must be inferred from the undeveloped state of
the different organs and from the absence of those signs which the
approach of the menses communicate.
Displacements of the ovaries are often the cause of suffering and
disease, that may excite symptoms quite remote from the seat of
trouble. I remember the case of a young woman, who had suffered from
obstinate dyspepsia, which subsided at once after the removal of the
prolapsed ovary. It has been already alluded to, that these glands
are naturally very movable. Anything which increases their weight,
whether inflammatory enlargement or a dragging in connection with
some inflammatory adhesion to a neighboring organ, may cause their
displacement in various directions. It happens that the ovary may form
the contents of a hernia or rupture. A prolapse or descent is the most
common form of an ovarian displacement. We often find one or the other
ovary resting in the pouch between the uterus and rectum, and if the
patient should be troubled with constipation, the hardened feces may
give rise to painful symptoms in the ovaries, and pain in the rectum,
while it also is one of the causes of painful sexual relations. The
irritation to which the dislocated ovary is exposed gives rise to
inflammatory affections, that may be the cause of continual suffering.
INFLAMMATION OF THE OVARIES, OR ACUTE OVARITIS.
What inflammation is elsewhere, it is again here in these glandular
structures.
I endeavored to point out in the beginning of these articles, that the
difference of inflammatory diseases was not due to any difference in
the inflammatory processes, these are identical, but the modification
of the processes are due to the nature of the structure of the tissues
that are involved.
If the intelligent reader will bear this in mind, she will form a clear
idea of all the inflammatory diseases that come under consideration.
Pathological microscopists have recognized two forms of _ovaritis_,
the follicular or parenchymatous, in which the Graafian follicles
or ovisacs are the seat of the inflammatory process, and the
_interstitial_, in which the intervening or interstitial connective
tissue, the _stroma_, between the follicles is inflamed. This
distinction has only a scientific interest because it is impossible to
distinguish one variety from the other in the living subject; this can
only be done with the aid of a powerful microscope after the suspected
ovary is removed from the body. Whether the inflammation is follicular
or interstitial or both combined, it is liable to destroy all the
follicles or ovisacs which contain the ova, that are essential to
procreation, and the consequence will be sterility.
The great functional activity to which the ovaries are subjected at
each menstrual period, make them extremely liable to an inflammatory
process, so that women cannot be too careful of themselves at this
precarious period. It is during menstruation that the ovaries
become periodically congested, and this alone offers an excellent
predisposition for inflammation. As a complication of other
inflammatory diseases, ovaritis is very common; it seems hardly
probable that there can be an inflammation of a pelvic peritoneal fold
or of the pelvic cellular tissue in close proximity to or surrounded
by it, without involving the corresponding ovary. There cannot be a
serious inflammation of the womb or of the Fallopian tubes without
being communicated to the ovaries, and this is always true of the
infectious catarrhs, especially the gonorrhœal form.
There is a great tendency in inflammation of the ovaries to suppurate
and change the entire tissue of the ovary into an abscess. Ovarian
abscesses are not much different in their behavior from abscesses
in the Fallopian tubes or cellular tissue. It is claimed that they
have a greater tendency to break into the bladder than other pelvic
abscesses; this may be due to a displacement of the ovary, which
locates the gland near or between the bladder and uterus, before the
advent of the inflammation. There are no infallible signs that point
to the existence of acute inflammation of the ovaries, owing to the
complication of other inflammatory processes in the majority of cases.
The characteristic pain of an inflamed ovary is of a throbbing or
pulsating nature.
I cannot imagine an ovaritis without at least a circumscribed
peritonitis, and one can hardly suppose a pelvic peritonitis to exist
without in a certain degree compromising the ovary.
If the ovary has once become inflamed, whether alone or as a
complication of other diseases, then the most important question to
decide is the existence of an abscess. This can only be recognized by
an experienced and careful specialist, who has trained his sense of
touch, so that he can feel the abscess between the fingers of one hand
in the vagina, and the other making counter pressure on the abdomen.
The history of each case must in a measure decide the nature of the
fluctuating tumor, whether it may not be an ovarian cyst instead of an
abscess, although an abscess may have been a small cyst.
The development and course of different cases, present various
aspects for consideration. The enlargement may become obstinate to
the ordinary methods of treatment and assume the chronic form of
subacute inflammation. The inflammation may spread from the ovary to
the peritoneal membrane that partly covers it; these are the broad
ligaments of the uterus. This may be the means through which the organ
may grow to the surrounding tissue and adjacent organs, so that it
becomes utterly impossible to move it or even successfully extirpate it
from its intimate attachments.
In other cases the ovary remains entirely free from attachments or
complications, and while it can be generally felt lower down pressing
perhaps on the rectum, it is readily movable or replaced. In the
majority of cases only one ovary is involved, but in these cases
there is a predisposition which in a large proportion sooner or later
compromises also the other ovary in a similar diseased process.
TREATMENT.
The treatment of this affection is greatly modified or influenced by a
knowledge of the causation of the inflammation. In every case, however,
the patient should take to her bed. If there is a profuse vaginal
secretion it should be ascertained if the disease is of infectious
origin, and where this is suspected, the vaginal canal should be
thoroughly rinsed with an antiseptic solution of corrosive chloride of
mercury in the proportion of one grain of the sublimate to two thousand
grains or parts of water, or about fifteen grains to the half gallon
of water. There are tablets to be had at the drug stores which contain
the requisite amount of corrosive when added to a given quantity of
water; these are preferable and more convenient than the crude drug,
and as they are a _deadly poison_ they should be kept under lock and
key. There is nothing to equal the corrosive for an offensive vaginal
discharge, for it is the most reliable disinfectant there is in the
entire pharmacopœa. Half a gallon of this solution should be used at
a time, and after the vaginal canal has been thoroughly disinfected,
about a pint of the same solution must be passed through the uterine
cavity by means of a double catheter, that has a reverse flow and is
especially made for the purpose. To insure against mercurial poisoning
I am in the habit of following mercurial irrigations with warm water,
that was previously sterilized by boiling. One pint of the simple water
is generally sufficient to displace all the mercurial water that might
have remained in the uterine or vaginal cavities. These medicated
irrigations should have an average temperature of 105 degrees Fahr. and
be repeated daily for about a week.
If the vaginal secretion is not of a specific nature, then the Femina
antiseptic uterine lotion is a safer remedy.
Ice bags applied over the regions of the painful ovaries check the
acute inflammation from going into suppuration and forming an abscess.
Should the latter be found to exist, it should be opened by means of a
trocar or aspirator. The bowels should be kept free by taking a daily
dose of Femina laxative tablets.
CHRONIC OVARITIS.
If an acute inflammation does not terminate in prompt recovery or an
abscess it may lose its fiery nature and tone down into a low grade
of prolonged congestion which does not go on to the production of
suppuration. This would constitute the chronic form of inflammation.
It does not follow that all chronic inflammations are preceded by the
acute form, for there are inflammations that are subacute from the
beginning, that is, that there is not the heat nor feverishness in the
tissues which is one of the principal features of the acute process.
Chronic inflammation of the ovaries is much more frequent as an
original or individual affection, than the preceding form. A peculiar
feature of this affection is a gradual growth or enlargement of the
ovary, all the way from a moderate swelling to a good-sized orange.
There has been some discussion as to the particular tissue of the
ovaries that is involved in the inflammatory process, whether it is
the interfollicular structure or the follicules or ovisacs themselves;
practically the solution of this question has no bearing on the
treatment, although it may have an influence on the function of the
organ, which may be more injuriously affected by the latter than the
former variety. The disease occurs almost exclusively after the age of
puberty and during the period of sexual activity. It is not as often
met in the unmarried as in the married, and with the latter it is
more prevalent in the first years of married life. Inordinate sexual
indulgence is a frequent exciting cause, and when this is coupled
with pernicious means that are employed for preventing conception, it
becomes still more frequent.
Chronic inflammation of the vagina, womb, and of the Fallopian tubes is
often transferred to the ovaries.
The infectious catarrh to which the genital tract of the female is more
or less exposed from a lack of proper cleanliness of her own person,
or a gonorrhœal infection from her male companion, show a peculiar
tendency to gradually spread the inflammatory processes to the ovaries.
Some careful observation has established the fact that an apparently
cured gonorrhœal infection in the male may, after a year or two, excite
a gonorrhœal catarrh in the genitals of the female; a great many
diseases of the ovaries have been traced to this source of infection.
As gonorrhœa is not an uncommon affection among the male portion of
the community, it is not sufficient for the intelligent members of the
medical profession to know of these dangers of infection, but every man
and woman should be apprised of the great danger there is of infecting
the marital chamber with the pollution of the brothel.
The symptoms of chronic ovaritis are more or less dependent on the
causation of each individual case.
Sometimes it is traced to the fiery stage of the acute affection,
while in other instances it can be laid to some indiscretion during
the menstrual flow, then, again, it may have developed itself so
stealthily that the greatest acumen and skill are required to detect
its origin. The most important and constant sign is a steady pain in
one or both ovaries. When this pain is violent, it shoots toward the
back and rectum and down the thighs. The pain becomes heightened from
an accumulation of feces in the rectum, which a habitual constipation
entails. Marital excesses near the approach of the menstrual period
or shortly after the disappearance of the menses are quite likely
to precipitate the painful symptoms. The bladder sympathizes in a
certain proportion of cases, so that there is a frequent desire to pass
water. In the course of time the distressful symptoms that have been
enumerated derange the digestive apparatus; the patients lose their
appetite and decline into a debilitated and nervous state, so that one
or the other hysterical phenomenon become more or less prominent in
persons of a nervous temperament.
Sterility is a rule with this class of women, even if there is only one
ovary affected; this would indicate that the apparently healthy one
sympathizes with the other, or an accompanying catarrh of the uterus or
tubes may prevent the passage of the fertilizing germ. If both ovaries
are inflamed, then it is quite natural to suppose that the delicate
follicles and their contents, the ova, become destroyed or so altered
that they no longer answer the purpose of reproduction. It is seldom
that one meets a chronic ovaritis without a uterine catarrh, and how
much this contributes to the sterility is not easy to tell.
TREATMENT.
The course of this affection in the majority of cases is favorable. If
the treatment is intelligently administered, the pain and congestion
gradually subside, and as this class of patients have generally learned
from sad experience that negligence or indiscretion on their part will
excite a relapse, they soon learn to avoid these, so that they enjoy
comparative immunity from suffering for a considerable length of time.
There is a smaller proportion of cases whose unfortunate surroundings
or lack of intelligence makes remedial measures of no avail. These poor
women have neither respite from physical labor nor freedom from the
animal passions of their husbands, and thus living in constant pain
they become drooped in spirit and reduced in vigor, so that they fall
an easy victim to any intercurrent affection that may attack them.
In proportion as the patients can give their diseased ovaries freedom
from irritating influences are the chances for their complete recovery
increased.
To accomplish this object, quietude in the recumbent posture, sexual
abstinence and a free daily stool form the basis for recovery. If there
is much pelvic pain, this is best controlled by means of the ice bag,
4x6 inches in size, of which one on each side, wrapped in one thickness
of flannel, should be applied to the groin or region of the ovaries;
cold-water compresses, thoroughly wrung, so as not to drip, and covered
with flannel so as to keep the bed covering dry, are also advisable,
but only a poor substitute for the ice.
Iodoform suppositories greatly stimulate the absorption of the
inflammatory exudation; one of these should be introduced into the
vaginal canal each day. If the patient can get up without any painful
symptoms, she should take the hot sitz bath for ten or fifteen minutes
daily, and as a general tonic, this is a useful prescription.
NO. XI.
Take: Bromide of sodium 2 drams
Iodide of potassium 1 dram
Comp. tinct. of gentian 2 ounces
Water, sufficient to make 8 ounces
Mix. A tablespoonful three times a day.
There is no affection in the entire category of diseases of women, in
which the confidence of women has been more abused by specialists,
than by meddlesome surgical invasions, for the extirpation of one or
both ovaries, to cure real or imaginary diseases of these glands.
There is a veritable mania among surgeons for this operation, but the
conservative portion of the profession are awakening to a conviction
that this is entirely wrong, and a presumption on professional license
that is altogether unpardonable.
If these castrations were confined to the removal of ovaries that are
unmistakably degenerated or diseased, and that had resisted intelligent
treatment for some time, there would not be the same objection, but
when ovaries are removed that are apparently healthy, but through
ignorance or incompetency are supposed to be the offending members,
then, I say, that is an outrage.
There are a great many women who have been subjected to the dangers of
a so-called normal ovariotomy, without being in the least benefited by
the operation. The symptoms which the extirpation of their ovaries was
to relieve, persisted as before, and they discovered, when it was too
late, that spaying is not a panacea for the ills that suffering women
are heir to.
The ovaries are in delicate sympathy with all the other pelvic organs,
and when these are affected there may be more or less pain in one
or both of these glands. They may be even the seat of a neuralgic
affection without any structural change in the organ or in the
neighboring organs. This would be simply a reflex sign of a general
debilitated condition, and to mistake all these for ovarian disease and
to make it an excuse for their removal, is not warranted by careful
observation. Electricity is now coming to the front as one of the most
valuable remedies for just this class of affections, and I will give
a detailed account of the nature of this remedy and the requirements
for its successful application, which persons who speak lightly of its
virtue, never acquire nor take the pains to possess.
CHAPTER XXIII.
PERIMETRITIS AND PELVIC PERITONITIS.
THE peritoneum is a delicate, thin, serous membrane, that lines the
whole internal surface of the abdomen and envelopes more or less
completely all the abdominal organs, so that the viscera glide smoothly
against each other with the least possible friction. The peritoneum
dips down almost midway into the true pelvis, and its boundaries
constitute also the limit of the abdominal cavity. That portion of
the general peritoneum, which partly invests all the pelvic organs,
is distinguished from the other by the term _pelvic peritoneum_. When
the entire membrane becomes the seat of inflammation, the affection
is a general _peritonitis_, but when the inflammation is limited to
the organ that it infolds, the prefix _peri_, signifying _around_,
is compounded with the name of the organ, and the suffix _itis_ is
added, which indicates that the peritoneal covering of such an organ is
inflamed, hence, the term _peri-metra-itis_ means inflammation of the
peritoneum around the womb.
Pelvic peritonitis means that the peritoneum of the entire pelvic
cavity is involved in the inflammatory process. This may include the
peritoneal covering of all the other pelvic organs besides that of the
womb as well as the peritoneal folds, that enter into the formation of
the broad and other ligaments of the pelvic organs.
Perimetritis is rarely an independent uncomplicated disease, but
oftener a complication of inflammation of the womb, the Fallopian
tubes, ovaries, or of the cellular tissue that surrounds the organs
and in which they are imbedded. The pelvic peritoneum and the cellular
tissue are so intimately connected with each other by means of their
vessels, nerves and lymphatics, that an inflammation easily runs from
one tissue to another.
If we now inquire into the causes which induce this disease, we shall
find that there is not a single inflammatory disease of any of the
pelvic organs that may not lead to its inauguration. Metritis after
an abortion or a confinement is a fruitful source, so are all the
other causes that operate in exciting metritis indirectly concerned
in this affection. Since etiology or the causation of diseases has
been made a special study in connection with this subject, some
startling discoveries have been made in regard to the origin of pelvic
peritonitis.
Dr. Noeggerath, of New York, has found in the majority of cases that
came under his observation, that pelvic peritonitis, either acute or
chronic, is due to gonorrhœal infection. He claims that gonorrhœa in
the male is in the majority of instances incurable; although it may be
apparently cured, it continues as a latent affection which regularly
infects his female companion. This shows itself at first as a slight
vaginal catarrh, which gradually and stealthily spreads to the cavity
of the womb, thence to the Fallopian tubes and ovaries and afterwards
involving the pelvic peritoneum, for it must be remembered that the
Fallopian tubes open directly into the peritoneal cavity.
Dr. Noeggerath has collected statistics that agree with those of
the celebrated French physician, Ricord, which show that on an
average 80 per cent of the male population have had gonorrhœa, and,
believing themselves cured, when not, enter into married relations,
and unwittingly infect their wives. He says that “it has come to pass
that young ladies dread to marry, because all their friends become
invalids soon after the nuptial rites.” The late Professor Schroeder,
of the Berlin Gynecological clinic, says that “the assertions of
Noeggerath are extravagant, but that he must particularly emphasize
that chronic inflammatory conditions of the internal female genitals,
like catarrh of the vagina and uterus, metritis and perimetritis, are
extraordinarily frequent results of gonorrhœal infection.”
I am inclined to think, from my own experience, that the more
conservative view of Professor Schroeder is perfectly safe and true,
but if Dr. Noeggerath made due allowance for the number of invalids
among newly-married people whose uterine diseases, especially pelvic
peritonitis, were traceable to criminal abortions and monthly probing
of their uterine cavities to induce the menstrual flow, his views would
about coincide with those of the distinguished Berlin authority. These
catarrhal affections cause sterility, and if conception supervenes,
then there is a likelihood of a miscarriage or a premature birth, or a
perimetritis during pregnancy or confinement.
Menstrual disorders in which the flow is either obstructed or
suppressed may also give rise to perimetritis.
Blood poisoning from criminal operations contributes its share in the
causation. Traumatic agencies, like blows, falls, lacerations, and
other injuries during labor, may result in pelvic peritonitis.
Either too hot or too cold vaginal irrigations have given rise to this
affection, and injections into the cavity of the womb for medicinal
purposes, in which some of the fluid escaped through the Fallopian tube
into the peritoneal cavity, has caused, in several instances, fatal
peritonitis. The inflammation of the womb after childbirth invariably
involves the peritoneum. The course and duration of this disease is by
no means uniform.
The disease under consideration is an example of an acute inflammation
affecting a serous membrane.
I have taken pains to inform the reader that the phenomena of
inflammation are always the same, but that the results are modified by
the peculiarity of the structure of which the tissues are composed.
A serous membrane differs completely from a mucous membrane, inasmuch
as it contains neither mucous glands nor mucous cells, and for that
reason can never be the seat of catarrh; instead of this, it possesses
the power to secrete or transude the serous portion of the blood,
hence its name. The serous membrane in a healthy condition has only a
sufficient quantity of secretion to moisten the membrane, but not to
furnish any appreciable quantity of fluid. If the secretion takes place
as a result of congestion, especially when this congestion is due to an
obstruction to the return of blood from heart or liver disease, it is
secreted in such large quantities that it constitutes dropsy.
Under the stimulating influence of the inflammatory process, a similar
secretion is the result, only that it contains also _fibrin_, which
renders the secretion or exudation spontaneously coagulable, and,
further, possesses the capability of passing into the condition of an
organized tissue, either fibrous or granular, and thus forming false
membranes on inflamed surfaces, or solidifying into tumors or swellings.
These inflammations have their various degrees of severity, from a
temporary reddening of the membrane with barely enough effusion of
inflammatory material to cause a thin layer of deposit, to extensive
and violent attacks, that pour out enormous quantities of effusion or
exudation, so as to fill the entire pelvic cavity with a solid mass.
The nature of the inflammatory material may be purulent from the
beginning, because its origin was of an infectious or septic nature.
Suppuration may develop slowly and lead to an abscess; this may open or
break into the peritoneal cavity, causing general septic peritonitis,
which will cause death in a few hours or days. The abscess may also
suppurate and break into some of the adjacent organs or tunnel its
way in different circuitous routes, being guided in its course by the
pelvic and muscular fasciæ, so that it may perforate at the groin,
show itself at the inside of the thighs, or in the lumbar region near
the kidneys. It ruptures most frequently into the rectum, next in
frequency into the vagina and into the bladder. I had a case, that came
under my treatment, in which both rectum and vagina were perforated,
and purulent matter discharged from both fistulæ; under appropriate
treatment the patient recovered completely.
If the inflammation is not of infectious origin, the exudation
gradually becomes absorbed, and each day grows less, until finally
nothing but a few fibrous bands can be felt, and these too may
disappear in time.
The symptoms of perimetritis depend in a great measure on the nature
and severity of the attack.
There are three distinct stages of this disease, and each has its
characteristic symptoms. The first stage is that of inflammatory
congestion, which is generally ushered in with a distinct chill or a
chilly feeling, which is speedily followed by a high fever and a rapid
pulse. The lower abdominal region becomes exceedingly sensitive and
very painful on pressure; the abdomen becomes tympanitic or bloated,
and it is a relief for the patient to draw her limbs up, so as to relax
the abdominal walls. A vaginal examination in this stage gives only
negative results; there is nothing but a painful sensitiveness, great
heat, and the vaginal walls are puffed or swollen; there is as yet no
inflammatory exudation that can be felt by the finger.
After the affection has lasted one or more days, the second stage of
the disease is recognized, this is the effusion or exudation. The
characteristic physical signs of effusion are the only absolute proof
of the existence of this disease. These signs are (1st) an immovable
fixed state of the womb, which is quite the contrary to its natural
healthy state, that permits of a mobility in all directions; (2d) a
hard, non-bulging condition of the tissues that surround the womb,
so that the impression which one receives gives the idea of all the
pelvic organs being cast or set in wax, because everything is glued
down and immovable; (3d) an indistinct fullness is felt by the patient,
high up in the pelvis; this is the free exudation of the inflammatory
material, which has now become solidified and has some characteristics
of a tumor. This may push the organ forward or to either side or
surround the womb on all sides.
The third stage is that of absorption or the gradual disappearance of
the exudation; this is usually a slow process, and may take from three
to six months. I have known residues of the exudation, in the form of
fibrous bands or adhesions or solid lumps to remain for years in the
pelvic or peritoneal cavity. These bands may tie or fix the uterus to
the rectum or to the pelvic walls, so that it will resist all ordinary
efforts to replace it. Pelvic hematocele, or an effusion of blood into
the pelvic peritoneum, inclosed either by anatomical structures or
previously-existing inflammations, greatly resembles the sero-fibrinous
exudation of perimetritis. The pallor of the countenance aided by other
signs of hemorrhage must assist in distinguishing the affections.
Chronic perimetritis is developed in numerous affections of the womb
that exert a continuous irritation of its peritoneal covering. These
are fibroid and malignant tumors, painful and difficult menstruation,
as well as enlargement of the tubes and ovaries. Inflammation of the
uterus and a discharge of blood or matter through the tubes and into
the peritoneal cavity, may bring about a chronic pelvic peritonitis
from the beginning.
Chronic perimetritis or chronic pelvic peritonitis, for the terms are
often interchangeable, is most abrupt in its development, because it
is not heralded by fiery, acute febrile symptoms, but a close inquiry
will usually recall to the minds of patients the commencement of the
trouble. The fact that the peritoneum is also reflected on the bladder,
causes an irritability of this organ, to be the first and only symptom,
for quite a while. There is nothing stereotyped in the development of
any disease, so that the symptoms may or may not be painful from the
beginning. The pains in the pelvis are more or less continual, there is
an incapacity for bodily exertion, the bowels are out of order, either
there is constipation or a chronic diarrhœa; these morbid conditions
destroy the appetite and the patient becomes lean and weakly. From
time to time all these abnormal signs become aggravated, so that the
sufferer may be forced to take to her bed.
Some women have great powers of resistance and endure suffering with
great fortitude, so that they are comparatively free from harassing
pain, although their pelvic organs are tied down by inflammatory
adhesions, and unless they lift or make other unusual muscular efforts,
that increase the intra-abdominal pressure, so as to drag on the
adhesions, they suffer little or no pain. Another sign of chronic
perimetritis is painful intercourse, which jars the adhesions, and this
is particularly the case if the womb comes down quite low. The danger
to be apprehended is that no one knows at what moment some indiscretion
will light up an acute attack with all its serious consequences.
In view of the possibility of any local or circumscribed peritonitis
becoming general, and as such may prove fatal, the importance of
recognizing it in its first stage, or early, becomes readily apparent.
Preventive measures of circumscribed or local peritonitis are to be
found in avoiding the causes that have been referred to as inducing
the affection under consideration, among which, criminal abortions
are the most fruitful. It seems to me that if women were cognizant of
the dangers that threaten them, they would not only be more careful
in observing the ordinary rules of health, but they would voluntarily
shrink from committing crimes that not only stain their souls with the
blood of their own kindred, but also entail disease and death, that
unexpectedly waft their spirits into the presence of their Creator,
whose laws they have outraged. How often have I been told by women who
lay prostrated on their death bed, “O doctor, I did not know that the
induction of an abortion was a crime and dangerous, because the person
who performed the operation told me that it was neither dangerous nor
criminal.” Alas! poor woman, there is no greater crime, and nothing
more pernicious to your health and life; would that others would only
learn and profit from the inexorable fate into which your delusions
enticed you.
TREATMENT.
The treatment in this affection, when prompt and intelligently
administered, offers every chance of success. In the acute stage of
pelvic peritonitis, we must resort to remedies that promptly counteract
the inflammatory action. The internal administration of opium or some
morphine preparation is invariably demanded, not only to relieve the
pain, but also to completely check or constipate the bowels, so that
their peristaltic action is entirely suspended, for their motion would
irritate the peritoneum. Dr. McMunn’s elixir of opium in one-half to
one teaspoonful doses should be given every four hours, until the pain
is relieved and the bowels controlled.
Rubber ice bags should be applied to the lower abdominal region. This
course of treatment will generally limit and check the inflammatory
process in a few days; then the bowels should be gently moved every
day, with an enema of warm water impregnated with a little soap; after
which, complete quietude in bed for another week or two, will complete
the cure.
Chronic perimetritis must be treated according to its complications;
should there be a gonorrhœal infection, then what was said of the
treatment of this complaint elsewhere, applies with equal force to
these cases. The patient’s strength must now be an object of jealous
solicitude. The diet must be of the most nourishing nature, and milk or
egg punch should be the principal food, at regular intervals of four
hours, alternating with strong soups or beef teas, to which a raw egg
thoroughly beaten should first be added.
Vaginal and uterine catarrhs, if they exist, require the attention that
is recommended in the preceding pages.
Warm compresses or fomentations and daily hot sitz baths are of great
value in chronic perimetritis, for they stimulate the healing process
and the absorption. The bowels must now be daily moved, and here I
prefer the patient to employ simply warm water enema in tolerably large
quantities slowly injected, until a quart or more of the fluid has been
thrown into the rectum; these enemas will not only move the bowels,
but also stimulate the healing process. If the patient lies on the
left side while these injections are taken or given, the enema flows
higher up, and it should be retained for a reasonable length of time.
These enemas should only be taken every other day, and between days a
suitable dose of purgative elixir. Tincture of iodine can be applied
to the groins every second day, or iodoform suppositories introduced
into the vagina. Mud baths are also very beneficial in removing old
inflammatory adhesions.
If the exudation suppurates and an abscess forms, it should be freely
opened as soon as possible. This can generally be best accomplished
through the vagina, but if there be a tendency of the abscess to point
towards the groin, then this situation would be preferable, although I
prefer, in even these cases, to make a counter opening in the vagina,
for this precludes the possibility of the abscess sacking or burrowing
further into the tissue. The cavity of the abscess should be thoroughly
rinsed out with a 2 per cent carbolic acid or a 1 to 2,000 corrosive
sublimate solution, and if there is a tendency in the abscess to close
before its cavity is healed out, a rubber drainage tube should be
inserted, so as to give the pus all the possible facility to escape. If
the abscess breaks into the bladder or into the rectum, then a counter
opening into the vagina will greatly insure and expedite recovery.
Sometimes the ovaries and tubes become diseased as a result of the
perimetritic inflammation; this, then, becomes a subject of special
inquiry and treatment. It should hardly be necessary to remind the
reader that sexual relations are to be suspended while there is the
least sign of the affection to be discerned. Although old adhesions and
displacements, the result of old chronic pelvic peritonitis, are often
naturally and permanently removed through a supervening pregnancy, the
intelligent use of the galvanic current will also accomplish that end.
CHAPTER XXIV.
PELVIC CELLULITIS OR PARAMETRITIS.
THE term _cellular_ was given to this tissue, because under the
microscope it shows large meshes or cell-like cavities, that are also
termed areolæ, hence, the tissue is often called areolar tissue; it is
also called connective tissue, because it combines all the different
organs and structures of the body together. It is very elastic and
contractile, and by the fluid which it contains in its areolæ, motion
of parts on each other is facilitated.
Professor Virchow has applied to it, in the region of the womb or
pelvis, the term _parametric_ tissue, from the Greek prefix _para_,
beside, and the Latin _metra_, the womb, signifying the tissue near and
around the womb, from which the Germans derive _parametritis_, instead
of the English, who employ _pelvic-cellulitis_, each meaning one and
the same thing, namely, inflammation of the cellular or connective
tissue in the pelvis or around the womb.
The female pelvic organs have interspaces between the bladder, vagina
and uterus in front, and the uterus, vagina and rectum behind, also
on both sides, between the womb, ovaries, and the folds of the broad
ligaments, and lastly, between these organs and the walls of the pelvic
cavity are interspaces. These interspaces are filled in or padded out
by loose cellular tissue. M. Nonat, a celebrated French authority, has
described this in a beautiful figure, by saying that “the organs of
reproduction float in an atmosphere of cellular tissue.” This is indeed
so, and a consideration of an inflammatory condition of this structure,
is to conclude the inquiry into the inflammatory diseases peculiar to
women.
Pelvic cellulitis is one of those diseases for the comprehension
of which we are particularly indebted to the researches of modern
pathologists, who have discovered that infectious germs are the cause
of numerous diseases; pelvic cellulitis is one of these, because it
originates as a secondary result of septic absorption.
The bacteria or putrefactive germs belong to Protophytes—the smallest
and simplest of all plants, some of them are so small that it requires
the highest powers of the microscope to make them visible. Their growth
and multiplication have been experimentally demonstrated by artificial
cultivation, and this now constitutes one of the most interesting
studies of modern pathology.
Pasteur, Lister, Nægle and others, regard the decomposition in
the tissues as a direct result of the vegetation of the bacteria.
“Decomposition and fungus are inseparable; the one ceases when the
other is removed. Processes of this nature set up by bacteria are
best distinguished as _fermentations_.” Professor Ziegler, of the
University of Tuebingen, says: “The healthy organism is always beset
with a multitude of _non-infectious bacteria_. They occupy the natural
cavities accessible from without, and especially the alimentary canal.
They feed on the substances lying in their neighborhood, whether
brought into the body or secreted by the tissues. In so doing they
set up chemical changes in these tissues. While the organs are acting
normally, these fungi work no mischief to the tissues in which they
lie, or to the system generally. The products of decomposition set
up by such non-specific micro-organisms are either harmless or are
conveyed out of the body before they begin to be active.
“Settlements of this kind may, however, become of importance, if the
bacteria proceed to develop to any unusual extent. This happens when
the contents of the natural cavities in question remains unchanged for
any great length of time, or when (as in catarrh) the normal secretion
undergoes some alteration. The products of bacterial fermentation
may then accumulate to an excessive amount, and products may be found
which do not normally occur. Highly poisonous substances are formed in
many of the bacterial decompositions. One of the most speedily fatal
diseases, septicæmia, is due to blood-poisoning of the system with the
products of bacterial putrefaction, or sepsis.
“Putrid or septic poison may be absorbed by wounds as well as by mucous
surfaces. Septicæmia, which has just been cited as an instance of
septic poisoning, is generally due to wound infection. It is due to the
absorption of products of bacterial decomposition formed in a wound
contaminated by bacteria.
“_Infectious bacteria_ have the power of settling, not merely in
the ingesta and secretions or in dead tissue, but also in living
tissue. This happens chiefly in the mucous membrane of the lungs. The
uninjured skin is protected against invasion by the horny epidermis.
Many bacteria can settle in perfectly healthy mucous membrane. In the
case of others we must imagine that they do not find a proper soil for
their development, unless the mucous membrane is injured or altered. Of
course, injury or alteration of this kind may serve to make the outer
skin or any other accessible tissue, the starting-point of a bacterial
invasion (wound infection). All that is necessary is that a bacterium
should reach a spot that affords the conditions for its development.
If this occurs, it multiplies and forms colonies or swarms. These may,
according to the species of the fungus and the nature of the soil,
remain in aggregation, forming heaps or masses, or may spread through
the tissues. In general terms we may say that local settlements of
bacteria will sooner or later bring about degeneration and necrosis of
the affected tissue. When this may occur, and how widely it may spread,
are circumstances depending on the nature of the bacteria and of the
tissue.
“The inflammatory processes set up by bacterial action may be of very
different intensity and extent in different cases. It may be slight or
transient, or may be severe and issue in suppuration and an abscess.”
The above quotation is perhaps as concise and complete an explanation
as the space in this article will permit, and if thoughtfully
considered, it will be the means of understanding what is to be said of
the disease under consideration.
Pelvic cellulitis is oftener found in childbirth, premature labor and
abortion, for the reason that it is a wound infection, and the female
organism, is always more or less wounded under these circumstances. In
confinement the cervix is always more or less torn, and septic matter
deposited there often speedily spreads along the lymphatics and veins
to the pelvic cellular tissue, in fact, the entire uterine surface
forms a suitable soil for bacterial growth. The vagina is also more or
less injured or bruised through parturient efforts; this may be in the
nature of a laceration or an abrasion of its mucous surface.
Outside of the above causes, the infection may be of traumatic
origin, the most common causes being operative measures on the vagina
or womb of a cutting, scraping or stitching nature, that were not
carried out under strictly antiseptic precautions, guaranteeing the
exclusion of septic germs. Dilation of the cervix with sponge tents or
with instruments or probes that were not perfectly cleansed, causes
infection and a decomposition of the retained secretions, which,
becoming absorbed, leads to pelvic cellulitis. In surgical operations
and puerperal conditions in which infection has been positively
excluded, by careful antiseptic measures, pelvic cellulitis is
impossible.
The inflammation in this disease is excited by the irritating
influences of products of septic decomposition; these may have been
introduced into the system at the time of confinement or of an
operation, or they may have been in the vaginal tract before the
operations were commenced. This teaches an important lesson, which
few seem to have learned; it is this, that _the strictest antiseptic
regulations in a confinement or operation are of no avail, if the
patient herself is not first thoroughly disinfected before the
operation begins_.
In the German Empire there is a legal provision giving full
instructions for the necessary disinfection of the lying-in woman and
her attendant; if there were such a wise provision in this country,
we would not hear of so many deaths of women in childbed, from blood
poisoning. At the Copenhagen International Medical Congress (1884),
Professor Esmarch, one of the most celebrated of German surgeons, said
that “humanity demands antiseptic treatment of wounds and wounded.” I
believe that the time will soon come that antiseptic regulations in the
treatment of diseases will not only be compulsory, but that a neglect
of the same, causing death by blood poisoning, will make the attendant
liable for exemplary damages.
Pelvic cellulitis generally develops itself in an acute form, and the
symptoms are very similar to those of pelvic peritonitis, and, like the
latter affection, there is always an exudation of inflammatory material
in these cases, so that the meshes of the tissues become soaked
like a sponge with water. The invasion of the infection is usually
signalized by a distinct chill or rigors followed by an increased
bodily temperature and a correspondingly rapid pulse. The commencement
of a parametritis is not often without distinct symptoms that affect
the nervous system. The patient feels uncomfortably depressed, a tired,
worn-out feeling overcomes her, she loses her appetite, and there is
pain in the pelvic cavity. This pain is partly due to an accompanying
peritoneal irritation, or in some cases to a circumscribed inflammation
of the peritoneum. Often the pain runs down the groin, along the course
of the great vessels and nerves; this is occasioned from the exudation
pressing on the trunks of these structures in the pelvis. Pain in the
small of the back, and painful defecation, with an irritable bladder,
are due to the same cause.
Phlegmasia alba dolens, or what was called before the dawn of
modern pathological science, _milk leg_, is only another form or a
complication of pelvic cellulitis. This occurs where the infectious
inflammatory process runs along the cellular or connective tissue of
the large vessels and nerves, to the connective tissue of the thighs;
this is a very easy matter, because the vessels and nerves are imbedded
in cellular tissue, and as the vessels leave the pelvis at the groin,
this tissue is continuous with that of the extremities. When the
inflammation gets into the thighs, it invades either the subcutaneous
cellular tissue, that is, the connective tissue under the skin, or it
runs along the trunks of the nerves and vessels; the affected limb
becomes then edematous or swollen, hence the vague term of milk leg,
because the milk has never anything to do with it. One time it was
supposed that this affection is only possible after confinement, but
this is an error, because phlegmasia alba may develop at any time from
purulent infection, originating from any cause.
The so-called puerperal or childbed fever is also nothing more nor less
than an infection of purulent secretion.
The extent of the exudation varies greatly, both in the pelvis and in
the limbs. In the pelvis it is sometimes only a little swelling on each
side of the womb, and between the folds of the broad ligaments, small
nodules the size of walnuts can only be felt, while in other cases
the entire pelvic roof is covered and soaked with the inflammatory
effusion. The consistence of these swellings or tissues feels at first
doughy or soft, but after the absorption has been going on for a while,
it becomes as hard as a board. If the exudation begins to suppurate and
an abscess forms, then the surrounding tissue becomes soft again, so
that the fluctuation of an elastic tumor becomes recognizable.
In the majority of cases the inflammatory process becomes circumscribed
in the pelvis, the fever subsides, and the pain and sensitiveness in
the pelvis disappear. The exudation has also a circumscribed limit,
becoming harder and smaller, until it finally has become entirely
absorbed. In another class of cases, the swelling remains stationary
for a long time and a solid tumor remains in the pelvic cavity, that
may be mistaken for an ovarian or fibroid growth, but in the course of
a long time, it may gradually become absorbed. In a certain proportion
of cases the course of the disease becomes protracted or chronic,
because the effusion is very slow to disappear. In these cases there is
danger of general septic infection or septicæmia, and of a spreading
of the cellular inflammation to the general peritoneal membrane, which
would prove, quite likely, fatal. If the inflammation is violent and
the infection intense, suppuration and abscesses will destroy the
cellular tissue, and if the lower extremities become involved, the
circulation in the affected limb may become permanently injured. The
cellular tissue around the veins, or even the veins themselves, become
more or less affected by the inflammatory process, so that the veins
become compressed or constricted from the cicatrization around them,
or their caliber may become obliterated from inflammation of the walls
of the veins, thus offering a permanent impediment to the return of
the blood to the heart; the affected limb now remains swollen, and the
swelling may entirely subside in the recumbent posture at night, but
during the day it returns again, to make the leg thick and clumsy.
TREATMENT.
Prevention in these affections is much better than cure. The treatment
of a recent case of pelvic cellulitis must be energetically antiseptic.
The seat of the infection must be discovered; the vagina or cavity
of the uterus, as the case may be, must be thoroughly washed out
with a 1 to 2,000 corrosive sublimate solution. After a thorough
disinfection, the inflammation and pain can be checked or controlled
by the application of ice bags; this is the remedy _par excellence_
to check acute inflammatory processes. These bags are preferably of
rubber, about 4x6 inches in size, and when filled with ice and before
applied it is more comfortable to the patient to envelop the bag in a
thin layer of flannel, which takes off the clammy coldness. The patient
should be kept perfectly quiet and the bowels daily moved by a mild
purgative. After the sensitiveness and the fever have subsided, the
absorption of the hardened inflammatory remnants is promoted by the
daily employment of hot sitz baths and the application of tincture
of iodine to the inguinal regions, as well as the use of iodoform
suppositories.
The employment of blistering fluids or plasters is of no particular
value either to check the inflammation or promote the absorption.
If there are symptoms of suppuration forming abscesses, these should be
freely opened into the vagina and their cavities thoroughly rinsed out
with a disinfecting solution.
In the case of phlegmasia dolens alba I have used cold water compresses
fortified by ice bags with brilliant results, but only after all the
other treatments that are laid down in different treatises had been
tried, and failed to give the slightest relief. Among these were hot
fomentations, large repeated doses of morphine, and liniments of
everything that is usually prescribed to relieve pain; for the pain in
phlegmasia is sometimes excruciating.
My experience of the beneficial effects of ice bags and cold-water
compresses in the acute stages of pelvic cellulitis and perimetritis,
led me to believe that the same measures would be useful when the
cellulitis was in the cellular tissue of the extremities, which
constitutes phlegmasia dolens, ignorantly termed milk leg. This
appeared to be heroic treatment to the patient, who dreaded the shock
and feared bad consequences, but she finally consented.
The following was my method: an ordinary large towel was dipped into
iced water, wrung out and clapped around the affected limb, a heavy
flannel roller bandage was then applied from the toes upward to the
groin; flannel is preferable, because it does not get hard when moist
and remains softer under similar conditions than cotton material. On
the most painful parts, like the inner aspects of the thighs, the back
of the flexure of the knee, or popletial region, and the calf of the
leg, I laid rubber bags filled with ice in addition to the cold-water
compresses; these were kept in place by a circular binder independent
and outside of the roller bandage.
The patient is naturally a little shocked when the cold towel is
first applied, but the unpleasantness is only momentary, and then the
reaction brings ease and comfort, so that she desires the ice bags to
be renewed quite often at first, for the patient has now found a remedy
that relieves the pain as nothing else has ever done before. When the
towels become dry and hot, the painful symptoms return, so that they
should be dipped four to six times in the twenty-four hours. If the
sensitiveness on pressure and other indications denote that the acute
inflammatory process is checked, then the compresses and ice may be
discontinued. This treatment avoids suppuration and the formation of
abscesses, while hot applications encourage them.
A mild stimulating diet of milk and egg punch with ten to fifteen
grains of quinine each day should be given in all infectious
inflammations.
CHAPTER XXV.
ELECTRICITY AS A REMEDY.
IN a brief reference to the medical virtues of electricity in the
treatment of diseases of women, only an outline of its physics can be
given, so as to give the reader an approximate idea of its origin and
phenomena.
The use that is being made of electricity in the arts has convinced
everybody that it is a most powerful agent, which manifests itself in
so many different phenomena that it is as mysterious to-day as it was
centuries before Christ, when the Greeks first observed it in amber
when rubbed with silk, and from which the term has been derived.
Electricity is developed in bodies from a variety of causes, among
which are friction, pressure, chemical action, heat, and magnetism.
We are acquainted with it only through the peculiarity of its action,
and it behaves as a subtile, imponderable fluid of a compound nature,
possessing opposite polarity when excited, giving rise to positive
and negative electricities, but when at rest these forces seem to
neutralize each other, and as such pervade all matter.
Chemical action is usually the most convenient for obtaining
electricity for medicinal purposes, and the arrangement through which
this is accomplished is called a cell or battery.
A battery in its simplest construction is made of a plate of zinc
and a plate of copper partially immersed in dilute sulphuric acid. A
disturbance of the neutral electricity now ensues, and by means of a
delicate instrument, it may be observed that the zinc plate possesses
a feeble charge of negative and the copper a feeble charge of positive
electricity; at the same time there is a slight escape of hydrogen
from the surface of the zinc. If now the plates are connected by means
of a metallic wire, the chemical action increases and the hydrogen
gas is now discharged from the surface of the copper. The wire is now
traversed by an electric or voltaic current, which imparts to the
connecting wire, thermal, magnetic and other properties.
[Illustration: PLATE V.
Apostoli’s method of employing intense galvanic currents without
discomfort or injury to the patient.
The internal electrode, which he calls the _excitateur intrauterin_ is
held in the hand of the operator. The _dispersing_ electrode covers the
abdomen.]
The electricity does not, however, correspond to that which was
peculiar to the metallic plates before they were connected by the
wire, but the opposite electrical conditions discharge themselves from
the wire: the direction of the current in the fluid, being from the
positive or copper plate to the zinc or negative plate, and vice versa,
so that the wire of the zinc plate is now positive, while that of the
copper is negative.
Poles and electrodes. The wires or terminals are called the poles of
the battery; instead of the term _poles_, the word _electrode_ is now
generally used. From what was said of the origin and direction of the
current in the fluid, it is important to remember that the positive
electrode or wire is connected to the negative plate, while the
negative electrode is connected with the positive plate.
According to the extent of surface of both zinc and copper plates,
exposed to the chemical action of the diluted sulphuric acid, or to the
number of cells that are employed, by connecting the copper plate of
one cell to the zinc plate of the next, the force and quantity of the
electric current is correspondingly increased.
Batteries which consist of one solution and two metals rapidly lose
their intensity, partly from the decrease in the chemical action owing
to the neutralization of the sulphuric acid by its combination with
the zinc, and partly from secondary currents, depositing a layer of
hydrogen and metallic zinc on the copper plate, which destroys the
dissimilarity of the metals, so that the electrical action ceases or
the plates become polarized.
For this reason these single fluid batteries have almost entirely gone
out of use, and batteries with two liquids have taken their place.
Electrolysis means to dissolve or decompose, by means of electricity,
an organic or inorganic substance into its original elements. If, for
instance, a current of electricity of four or five Bunsen’s cells is
conducted to two inverted glass tubes, filled with water slightly
acidulated to increase its conductivity, gas bubbles rise from the
surface of each pole, and upon examination it is found that hydrogen
is liberated at the negative pole and oxygen at the positive pole; and
as the volume of hydrogen liberated is about twice that of oxygen, the
experiment gives at once the qualitative and quantitative analysis of
water.
Professor Bartholow, in his treatise on Medical Electricity says: “As
animal tissues are composed of substances amenable to electrolytic
decomposition, it is obvious that they must yield up their component
elements in accordance with the laws of electrolysis. Albumen is
coagulated, salts are separated into acids and bases, and water is
resolved into oxygen and hydrogen. When the salts contained in the
animal tissues—soda, potassa, lime—and water, are decomposed, the
acids and oxygen appear at the positive pole, and the alkalies and
hydrogen at the negative. It follows that if the positive electrode
be composed of metal, it will be corroded by the action of chlorine
and the acids, and the negative will remain unacted on and smooth. The
tissues in the vicinity of each electrode are necessarily affected by
the elements brought to them in accordance with chemical laws. About
the positive the mineral acids and chlorine form combinations, and
hence do not attack the tissues with the same energy as those about the
negative pole. If, however, the positive electrode is composed of zinc,
for example, the chlorine attacking it will form chloride of zinc, a
very corrosive material. This principle has been utilized to produce
caustic effects at the positive pole. Although the negative electrode
remains smooth, much more than at the positive are seen these
destructive effects from the action of the free alkali liberated in its
neighborhood. When an ordinary electrode of carbon covered with soft
sponge is made to conduct a strong galvanic current, the skin speedily
becomes reddened, and may be made to ulcerate if the contact is
sufficiently prolonged. If the carbon is applied directly, an intense
burning is produced and the tissues are destroyed, leaving a slough,
which is slowly detached and the ulcer remaining is difficult to heal.
The caustic action is due chiefly to the soda, potash, and lime. Some
effect must also be allowed to the disassociation of the tissues, to
their transference from point to point and at the negative pole to the
mechanical action of the liberated hydrogen.”
Interpolar regions. The reader must have been impressed with the
peculiarity of each pole in possessing affinity or attraction for
certain elements that constitute the animal tissue. Oxygen and acids
accumulate around the positive pole, while alkalies are attracted to
the negative pole; thus it must be an absolute fact that an actual
transfer of particles in both directions to each pole must traverse the
tissue lying between the two poles; this accounts in a great measure
for the difference of the local effect on the tissues around the poles,
one being in the nature of an acid the other of a caustic alkali. This
naturally gave rise to an inquiry as to the effect that the galvanic
current has on the structure between the two poles.
Dr. G. Betton Massey, author of “Electricity in the Diseases of
Women,” asks and answers this question in the following manner: “What
can be therapeutically accomplished when the seat of the disease is
necessarily situated beyond the direct reach of the electrode? An
answer drawn from both neurological and gynecological experience is
that much can be accomplished; and this is doubtless due, in the
first place, to the influence upon nutrition of the chemical changes
that occur throughout the circuit, in the onward progress of the
particles that appear free finally at the poles to the influence
upon nutrition of the circulatory changes that result from vasomotor
stimulation, and to the contractions produced in unstriated muscular
tissue by heavy currents even at a distance. These results of quiet
current transmission are governed in magnitude at a given spot by
the _density_ of the current at the situation and by the _duration_
of the application. To accomplish much in the more distant parts of
this region considerable strength must be employed, hence a delicate
judgment is demanded in the selection of the size of the active pole to
avoid cauterization on the one hand, and too great a diffusion on the
other.”
To within a comparatively recent period, the methods of applying the
electric current for the removal of abnormal growths have been somewhat
crude if not dangerous. It appears that formerly altogether too much
stress or weight was laid on the chemical or electrolytic effects that
the electrodes wrought in the tissues, and very little or no credit
was given to the _passive_ current of galvanism as it traversed the
tissues from pole to pole. Dr. Ephraim Cutter, of New York, advocated
the so-called electro-puncture, and in the galvanic treatment of
fibroid tumors of the uterus, these punctures were made through the
abdominal walls. The electrodes for this purpose were stiletto shaped,
with blades five inches long and three-eighths of an inch at their
widest part; these were inserted into the tumor from opposite points.
Wounds that were thus inflicted, necessarily involved more or less
danger, and, although Dr. Cutter reported a great number of cures,
the percentage of mishaps was too great to make electrical treatment
popular among the profession.
It was not until Apostoli, a French physician, greatly modified the
methods of employing electricity in the treatment of fibroid tumors,
and sheared it in a great measure, not only of its dangers, but also
of pain, that the medical profession took the question of electrical
treatment in real earnest. The practice of Apostoli and his results
were published in a monograph by Carlet, entitled, _Du traitement
electrique des tumeurs fibreuses de l’uterus, Paris, 1884_. Apostoli
evidently started out with a view to modify the most objectionable
features of the electrical treatment. This consisted in reducing the
number and size of the punctures and to lessen the painful sensation
of the electric current to its minimum, so that the main points of
difference are the shape and size of electrodes, and the site that is
chosen for the puncture. In the first place he uses only one piercing
or needle electrode, which is much smaller than that of Cutter, this
may be attached to either the positive or negative cord of the battery,
according to the accompanying symptoms. When hemorrhage is a symptom,
the positive pole is used internally or carries the needle on account
of its anti-hemorrhagic property, otherwise the negative pole carries
the piercing electrode. This electrode is always used internally to
puncture through the vagina or through the cervical tissue into the
tumor; this is not nearly so painful as piercing the abdominal walls,
nor does it wound the peritoneum.
The other electrode is called the _dispersing_ electrode, because its
purpose is to so disperse or scatter the current of this pole that it
is hardly felt by the patient, much less produces any electrolytic
or chemical effect on the skin. This electrode is made from a sheet
of lead or copper nine by ten inches and covered with a layer of wet
absorbent cotton; it is applied over the abdomen. This method is much
safer than that formerly advocated by Dr. Cutter, and the results are
much better. Dr. Engelman, who has accepted this method, says: “In
electrolysis an intensity of 50 to 250 milliampères may be used for
from three to eight minutes. All possible precautions must be taken
in the first sitting in order to discover any idiosyncrasy of the
patient, and a current of 50 milliampères will suffice, attained by
slow increase. The patient should lie down quietly for several hours
after the application. If an intensity as high as 100 milliampères is
used at the first sitting, it is preferable that she remain in bed for
the first twenty-four hours, and that a cold compress or an ice bag
be placed upon the abdomen, to overcome any tendency to inflammatory
reaction which may occur; hence the attention to details which is
necessary, and the precautions desirable in a first puncture, until
the sufferance of the individual patient is tested. The application is
repeated, according to the demands of the case and the severity of the
treatment, once or twice a week.”
The milliampere meter is a galvanometer to measure the quantity
of electricity that is applied, and as a chemical battery will of
necessity change, a meter is the only means of judging the intensity
of the current; so that without one there is danger of applying the
current too strong, or an injustice may be done to the patient, and
reproach cast on the treatment by not using it strong enough.
At the annual meeting of the American Medical Association, at Chicago,
in 1887, Dr. Martin read a paper, in which he reported three cases
that were treated with the most satisfactory results without puncture.
The positive or external electrode was applied over the abdomen after
the manner of Apostoli, and the negative electrode was placed in
the rectum, vagina or uterus, in such a way as to cause the current
to traverse the largest diameter of the tumor; this method is to my
mind the _ideal_ of an electrical treatment, it is galvanism without
corrosion or electrolysis.
The number of eminent authorities that I have quoted, can hardly fail
to convince the reader that electrical therapeutics in the treatment
of fibroid tumors are not only efficacious, but in the infancy of
experimental growth, so that every day will add new proofs and improved
methods to the history of this most interesting subject. But this
treatment is not limited in its usefulness to the removal of abnormal
growths, for it has proven itself equally as effectual in the treatment
of chronic inflammatory conditions of the pelvic organs. I have myself
attained great success in curing certain forms of these diseases since
the publication of “A New Treatment of Chronic Metritis,” by the same
indefatigable author, Georges Apostoli, of Paris.
The value of electricity is now so firmly established that a physician
who, ignorant of its virtues, and laboring under this self-imposed
ignorance, brushes aside any reference to or desire for electrical
treatment with a supercilious air, claiming “that there is nothing in
it,” advertises himself as incompetent or insincere.
It must be apparent to anyone who has followed this brief outline from
the beginning, that this subject requires a special and individual
devotion, so as to become familiar, not only with the elementary
principles of the physics of electricity, but with the _technique_
of applying the treatment in each individual case. This, few persons
have the honesty or ambition to acquire, and if they own a battery,
it is more for show than for use. I am convinced that there are great
possibilities in store for the curative value of the galvanic current,
but it also requires a high order of intelligence to employ it, in
order that those hopes may be realized.
“_The positive pole_ is anodyne, sedative, anti-congestive, and
anti-hemorrhagic. It combats and prevents the tendency to excessive
vascularization, and consequently relieves congestion and inflammation
and the pain depending upon these conditions. Its local or polar
action, when used within the uterus, is hemostatic or styptic, and
caustic, with high intensities of current.
“_The negative pole_ is stimulating and has a marked electrolytic
action. It tends to produce congestion, and a derivative effect which
favors absorption of tumors, inflammatory deposits and adhesions. But
great care must be observed in using it in some conditions, lest a new
inflammation be rekindled.”
I have the record of a case where the womb was retroflexed and tied
down by old inflammatory adhesions for nine years; the retroflexion
dated back to a miscarriage. This woman had been an invalid since
that time; her appetite was poor, and her digestion poorer, she was
excessively constipated, suffered from pain during menstruation, but at
other times there was a constant pain in the small of her back, which
ran down the right thigh, the bladder was irritable, and there were
neuralgic pains shooting from the ovaries down the groins. All these
symptoms became more or less aggravated every few weeks or months. The
womb was so firmly fixed or glued down on the lower portion of the
spine, that it could not be moved an iota. This woman had tried all the
remedies that I could suggest, except galvanism. This I concluded to
try, by placing a large dispersing electrode on the small of her back,
and the other electrode, properly prepared, so that it did not burn or
cauterize, was introduced into the vagina, against the posterior aspect
of the uterus. A current strength of from 90 to 120 milliampères was
applied every other day for ten minutes; in six weeks the organ was
quite movable, and in five months all adhesions had melted away, and
the womb occupied its normal position, and the patient was in every way
restored to health.
The diseases that are curable by galvanism are the different forms of
subacute or chronic inflammation of the ovaries, and the consequent
enlargement of these organs, small cysts or fibro-cysts of the ovaries
are also amenable to the galvanic puncture.
Catarrhal inflammation of the Fallopian tubes, or when either or
both ends are agglutinated with inflammatory exudation, so as to pen
up their contents, which may be mucous, water, pus or blood, these
fluids should be first aspirated or drawn off, and then, by means
of appropriate galvanism, the normal conditions of the tubes may be
restored.
Chronic catarrhs of the womb are especially suited for galvanic
treatment, and when the inflammation invades the muscular structure
of the uterus, giving rise to what was described as chronic metritis,
there is no remedy that will yield the same positive and satisfactory
result as electricity. Plate V gives a practical illustration of the
employment of electricity for chronic inflammation of the uterus; the
internal or negative pole is introduced into the uterine cavity and
held there by the operator, the external or dispersing pole spreads
over and rests on the abdomen.
Subinvolution of the uterus. I have already referred to this affection
as an arrested involution of the womb after confinement at the end
of the natural term, and after abortion. The womb in this condition
remains permanently and preternaturally enlarged, and its entire
tissue becomes the seat of a subacute or chronic inflammatory process.
The vagina is also more or less relaxed, so that the heavy uterus
sinks down into the pelvis, imparting to the patient a dragging or
bearing-down sensation, which makes walking or any other exertion
exceedingly difficult. In subinvolution an extra uterine electrode is
not required, but only a vaginal electrode, so employed that a current
of high intensity is passed through the uterus; this varies from 50
to 150 milliampères. The duration of each galvanization is from eight
to ten minutes, and should be repeated every third or sixth day. I
succeed as a rule in six to eight weeks in restoring the organ to its
normal size, which I ascertain through comparative measurement at the
beginning and end of the treatment.
If the subinvolution is complicated with _retroflexion_, then
intra-uterine galvanization after the organ is replaced is the most
effective treatment. Old pelvic adhesions and exudations as a result of
pelvic cellulitis or peritonitis are amenable to galvanization after
hot douches, sitz baths, and other discussives have failed to excite
absorption.
Hemorrhoids and prolapse of the rectum; the former is a frequent
concomitant of constipation, and the latter may be the result of an
imperfect involution after confinement. I have employed galvanism for
either with the most brilliant results.
It would be interesting for the reader were I to continue to cite
different diseases in which electricity has been successfully employed,
but that would require a systematic arrangement of the subject, which
would be incompatible with the original purpose of this book. I simply
desire to awaken an interest in a comparatively new remedial agent, in
its present field of employment. There may be a great many ways to get
relief, but that course which offers the least risk to _life_ and the
least suffering to the _living_ is the one that should recommend itself
to the sufferer. What patients need is not brilliant surgical exploits
to make the reputation of an ambitious operator, but the conscientious
aid of the conservative physician who is content to labor in the less
pretentious capacity of an assistant to nature’s curative energy.
CHAPTER XXVI.
SIGNS AND SYMPTOMS OF PREGNANCY.
PREGNANCY is the condition in which the female has within her an
impregnated, _fecundated_ germ, which gradually becomes developed in or
out of the womb. In a perfectly normal state of things, the impregnated
ovum becomes attached to the inner surface of the womb by virtue of
a preordained vital force by which the ovum becomes animated at the
moment of conception. It obtains its nutrition from a plexus of blood
vessels, by means of which the ovum is attached to the inner side
of the walls of the uterus, and this complex of vessels grows with
the development of the fetus, and constitutes the _placenta_, which,
together with the membranes and the umbilical cord, is called the
afterbirth.
The growth of the embryo, which is the predestined child in the
mother’s womb, occupies a period of ten lunar months, or two hundred
and eighty days—this is the average term of pregnancy, although the
duration of pregnancy is prolonged in a large proportion of cases to
three hundred days, and even longer, while in a small proportion of
pregnant women the period of gestation falls naturally shorter than two
hundred and eighty days.
In a small number of pregnancies the impregnated ovum is arrested at
the ovary, or on its passage from the latter through the Fallopian
tubes; it then does not arrive in the cavity of the uterus. This state
of things is unnatural, hence termed _preternatural_, because the
growth of the fetus takes place out of the uterus, and this is also
called _extrauterine_ pregnancy, which may take place in the ovary,
Fallopian tubes, or cavity of the abdomen. False pregnancy implies
that there was no pregnancy at all, or in other words, that there was
no fetus, and that the enlargement was due to something else.
In pregnancy the female experiences signs and symptoms resulting from
changes in the condition of her organs and functions. The suppression
of the courses or menstrual discharges is considered in the popular
mind an unerring proof of pregnancy, yet, as a matter of fact, this is
far from the truth. I have known of two women who menstruated regularly
during the entire period of their pregnancies, and there are a number
of reliable cases recorded of women who menstruated during pregnancy
and at no other time.
It is a rule, that the menses cease during pregnancy, but it is equally
certain that the menstrual function becomes suspended from other
causes, and these are quite numerous, so that taken by itself, the
sign is of little importance. Young married women not infrequently
have a slight menstruation for two or three periods after their first
conception, and on the other hand, newly married women will have their
menses occasionally arrested, and this may continue for two or three
months and indeed no pregnancy exist.
Nausea and vomiting is also presumptive evidence of gestation. Some
women are affected with sick stomach almost from the moment of
conception, and from actual experience they are so certain of their
condition, that they can calculate with certainty the day of their
confinement from the time when they had their first feeling of nausea.
Experience seems to teach that a certain amount of nausea, _the
morning sickness_, and the vomiting which accompanies or follows it,
is to be met in women who go through a natural or healthy pregnancy,
so that many eminent authorities have looked upon this symptom as a
physiological accompaniment, and one of the most constant and reliable
symptoms. The vomiting and nausea of pregnancy is different from
that which is an indication of general ill health; in pregnancy the
vomiting is followed with a sense of relief, and the patient is for
the time being quite easy. The length of time that women feel this
gastric irritability varies in different individuals; ordinarily it
will cease about the fourth month, sometimes sooner, and it may return
again during the last two or three months of gestation. It is supposed
to be due to a reflex action of the spinal cord from the uterus to the
stomach. It must be remembered, however, that a disease of the uterus,
a fibroid or ovarian tumor, and a suppression of the menses from other
causes than pregnancy will occasion nausea and vomiting.
A capricious appetite is another of the peculiarities of pregnancy, a
longing for unnatural food, so that some women will enjoy eating such
things as chalk, slate pencils, and similar indigestible stuff; this
I have always considered a form of hysteria, that is, a functional
derangement of the nervous system, for which I gave ten grains of
bromide of sodium three times a day, with the best results; others
again became passionately fond of sour salads, or strong condiments
like mustard, Worcestershire sauce, and salt fish, while others again
long for fruits.
Salivation of the mouth is another very unpleasant symptom which annoys
some women when they are pregnant, for they will secrete such enormous
quantities of saliva, that they cannot help drooling from the mouth
when they speak. In salivation of pregnancy the gums do not become
sore as in the salivation from mercury; in the former the irritation
is confined to the salivary glands alone. The wonderful sympathy that
exists between remotely situated organs of the body is here strikingly
illustrated between the sexual organs and the salivary glands in both
sexes. In mumps also, which is an inflammation of the salivary gland,
it is not unusual for the testes in the male and the mammæ in the
female to become swollen and painful, and as soon as this swelling
takes place, the inflammation of the salivary gland disappears.
The breasts become enlarged and otherwise altered in pregnancy, the
enlargement is accompanied with more or less sharply shooting pain,
they also become harder and are more movable than otherwise. The nipple
becomes more prominent and painfully sensitive, the veins that run
from the breast become distended so that they can be readily traced by
the eye. The presence of milk in the mammæ is another sign, but that,
too, is only presumptive, because the secretion of milk takes place in
other conditions than that of pregnancy; even the newly-born infant
has sometimes milk in its breasts, and milk has been recognized in the
breasts of some males and not infrequently in those of young virgins.
Pigmentation or the deposit of coloring matter in pregnancy has long
been observed as a prominent symptom and when taken together with
other signs it is worthy of careful consideration, but here, too,
we encounter the obstacle to anything of a positive nature, for
discoloration is also met with in females who are suffering from pelvic
diseases and who are not pregnant. Areola is the technical name of that
peculiar circle which immediately surrounds the nipple. In a healthy
virgin this circle is characterized by a beautiful rose-tinted blush,
but under the influence of disease, even in the virgin the circle
becomes more or less discolored. When pregnancy has occurred the areola
around the nipple becomes darker and darker; other parts of the body
become similarly discolored, this occurs on the abdomen and perineum.
The womb descends during the first two months of pregnancy, this
constitutes a kind of physiological falling of the womb and indeed
the accompanying symptoms of a pregnant woman are often similar
or identical to that diseased and permanent condition of physical
suffering, namely, falling of the womb. Perhaps the most common
symptoms of the descent of the uterus will be more or less frequent
desire to pass water, because of the dragging of the womb on the neck
of the bladder; sometimes there is also a straining or inclination to
go to stool, owing to pressure on the rectum from the same cause.
The umbilicus or navel becomes painful and even depressed from traction
of the superior ligament of the bladder, which is attached to the
umbilicus, thus illustrating the operation of cause and effect, namely,
as the bladder is depressed by the descended uterus, the bladder in
turn pulls on the umbilicus to which its ligament is attached. The
pregnant uterus remains only the first few months in this depressed
state; at the third month, as a result of its continual growth and that
of the fetus, the uterus ascends out of the pelvis and as a natural
consequence the symptoms of the bladder and rectum subside. Towards
the end of the ninth month the womb again descends into the pelvis and
with this there may be a return of the irritation of the bladder and a
feeling of bearing down or tenesmus of the rectum. The descent of the
uterus toward the close of pregnancy diminishes the prominence of the
abdomen, and as the diaphragm has freer play, the respiration becomes
easier; if there was any cough that, too, disappears, and on the whole
the woman feels herself more comfortable and in happy spirits. This
may even arouse suspicion in her own mind as to her condition, because
she does not know the cause of the change; it may portend to her that
something is not right, that she is not pregnant or that her child may
be dead. In women who have borne one or more children in a natural
manner, the descent of the womb is of no particular moment in the last
months of gestation, because the abdominal walls having been stretched
by previous pregnancies the body or fundus of the womb may fall forward
and give the lungs and other organs relief from pressure, but in the
first pregnancy this is never the case, because the abdominal walls are
too tense to allow this normal anteversion.
The German school of midwifery has laid down an important rule as a
consequence of this observation, and I have never known an exception
to occur in my experience. The rule is that when the uterus does not
descend into the pelvis toward the close of the first pregnancy, it
is because there is a disproportion between the child’s head and the
maternal pelvis, or in other words that either the child’s head is
too large for a natural or unaided delivery to take place, or that
the pelvis of the mother is too small for a natural delivery to take
place, and this is true, and knowing this to be true at the outset or
commencement of a confinement it would be only torture and a valuable
loss of time to wait at the bedside of a woman suffering with the pangs
of childbirth in the vain hope that she might deliver herself—when in
truth and as a fact that cannot be done without the aid of scientific
assistance.
The vagina and external organs are more or less modified in pregnancy.
The vagina becomes wider and shorter and as there is an increase of
spongy tissue, it presents a swollen appearance. The mucous glands
become larger and secrete a greater abundance of mucus. The internal
surface of the vagina becomes discolored in consequence of pregnancy
and I believe that it is one of the most reliable presumptive signs;
the mucous membrane presents a sort of bluish tint, a French authority
calls it a violet hue, not unlike the lees of wine.
Quickening is a term that is employed to designate the particular
length of time that pregnancy has existed, and at the same time to
furnish evidence to the mother through the movements of the fetus that
she carries within her womb a living being. In a former chapter I have
already detailed the theory of the ancients upon this subject, which
was as absurd as it was fanciful. The late Professor Bedford defines
“quickening as nothing more than the ordinary result of progressive
increase when the physical organization of the fetus has reached a
state of development which imbues it with the power of movement—a
movement dependent upon muscular contraction.” The period of quickening
is usually about the fourth and a half month or the middle term of
pregnancy.
Pulsation of the fetal heart, when heard, is no longer presumptive but
absolutely positive evidence that pregnancy exists. That the heart of
the child can be distinctly heard to beat in its mother’s womb was one
of the greatest discoveries in midwifery. The pulsations of the fetal
heart are much faster than those of the mother’s heart, hence there is
no danger of getting them mixed; while the child’s heart averages from
one hundred and ten to one hundred and sixty per minute, the heart of
the mother averages from seventy-five to eighty beats. There are cases
where the mystery of a pregnancy can be solved beyond a possibility
of a doubt, through the recognition of the pulsations of the fetal
heart, and yet a woman may be pregnant in whom it will be impossible to
distinguish the action of the child’s heart, at the termination of her
period of gestation she will bring forth a healthy child.
The question whether a female is pregnant will, from the very nature of
the symptoms always remain debatable in a certain proportion of cases,
or, in other words, there is no sign or symptom that is reliable and if
reliable it is not uniformly present. From a medico-legal standpoint
the question will always be of great importance, as it frequently
involves the guilt or innocence of the accused; the social standing
of one, or the merited punishment of the other, and it does seem like
a travesty on both science and justice that at certain stages and
in certain conditions no signs or symptoms are absolutely reliable.
The unfortunate creatures whose illness may imitate or simulate the
symptoms of pregnancy must always receive the benefit of the doubt,
this would avoid the possibility of wrecking innocent lives. Professor
Bedford reports a case in his work on obstetrics which is as sad as
it is instructive, he says: “I was requested to visit a lady who was
residing in the State of New Jersey, about thirty miles distant from
New York. On my arrival I was received by her father, a venerable and
accomplished gentleman. He seemed broken in spirit, and it was evident
that grief had taken a deep hold of his frame. On being introduced into
his daughter’s room, my sympathies were at once awakened in beholding
the wreck of beauty which was presented to my view. My presence
did not seem to occasion the slightest disturbance; she greeted me
with these words: ‘Well, doctor, I am glad to see you on my beloved
father’s account, for he will not believe that I cannot yet be restored
to health. Life, however, has lost all its charms for me, and I
impatiently long for the repose of the grave.’ These words were spoken
with extraordinary gentleness, but yet with an emphasis which at once
gave me an insight into the character of this lovely woman.
“Her father was a clergyman of high standing in the English Church,
and had a pastoral charge in England, in which he continued until
circumstances rendered it necessary for him to leave that country, and
seek a residence in America. At a very early age, this young lady had
lost her mother, and had almost been entirely educated by her father,
whose talents, attainments, and moral excellence admirably fitted
him for this important duty. When she had attained her eighteenth
year, an attachment was formed between her and a young barrister of
great promise and respectability. This attachment soon resulted in
a matrimonial engagement. Shortly after the engagement she began
unaccountably to decline in health; there was a manifest change in her
habits; she was no longer fond of society; its pleasures ceased to
allure and prove attractive; the friends whom she had caressed with
all the warmth of a sister’s love, now became objects of indifference;
in a word she was a changed being—her personal appearance exhibited
alterations evident to the most superficial observer; her abdomen
enlarged, the breasts fuller than usual, the face pale and careworn,
and the appetite capricious, with much gastric derangement. Many
were the efforts made to account for this change in the conduct and
appearance of the young lady in question. Speculation was at work, and
numerous were the surmises of her friends. The rumor soon spread that
she was the victim of seduction, and her altered appearance the result
of pregnancy.
“The barrister to whom she was affianced heard of these reports, and
instead of being the first to stand forth as her protector, and draw
nearer to his heart this lovely and injured girl thus measurably
assuaging the intensity of grief with which she was overwhelmed,
addressed a letter to her father requesting to be released from his
engagement. This was, of course, assented to without hesitation. The
daughter, conscious of her own innocence, knowing better than anyone
else, her own immaculate character, and relying on heaven to guide her
in this her hour of tribulation, requested that a physician should
be sent for, in order that the nature of her case might be clearly
ascertained. A medical man visited her, and after an investigation of
her symptoms, informed the father that she was undoubtedly pregnant,
and suggested that means should be taken to keep the unpleasant matter
secret. The father, indignant at this cruel imputation against the
honor of his child, requested an additional consultation. This resulted
(as usual) in a confirmation of the opinion previously expressed, and
the feelings of that parent can be better appreciated than portrayed.
“That good man resigned his pastoral living to proceed with his
daughter to America. On her passage to this country, the daughter
became extremely ill, and the advice of the physician on board the
vessel was requested; he too told the father that there was danger of
premature delivery, for he simply took appearances as his guide, and at
once concluded that she was pregnant.
“This is about the substance of what I learned of this interesting
and extraordinary woman. I proceeded with great caution in the
investigation of her case, and after a faithful and critical survey,
most minutely made in reference to every point, I stated in broad and
unequivocal language that she was not pregnant. The only reply the
gentle creature made on hearing my opinion, was—‘Doctor, you are
right.’ The father was soon made acquainted with the result of my
examination, but he indicated not the slightest emotion. He asked me
whether something could not be done to restore her to health, and I
thought that the old man’s heart would break when I told him that his
daughter was in the last stages of consumption.
“It was the misfortune of this young lady to labor under an affection
of the womb, which simulated, in several important particulars, the
condition of pregnancy, and which the world in its ignorance and
undying thirst for scandal, might have readily supposed did in fact
exist; yet, there was no excuse for the physician, guided as he should
have been by the lights of science, and governed by the principles of
sound morality. The result of my investigation impressed me with the
conviction beyond any shade of doubt, that the entire train of symptoms
indicating pregnancy was due to the presence of a large _fibrous tumor_
occupying the cavity of the uterus. About four weeks from this time I
received a note announcing her death and asking that I would hasten to
the house for the purpose of an examination. Dr. Ostrom, now practicing
in Goshen, assisted me in the autopsy. As the father stood before me he
was not unlike the stricken oak in the forest, which, though stripped
of its branches, was yet upright and majestic. The moment I removed the
tumor from the womb he seized it convulsively, and exclaimed, ‘This is
my trophy; I will return with it to England, and it shall confound the
traducers of my child!’
“Here, you perceive, both character and life were sacrificed by error
of judgment on the part of those whose counsel had been invoked.
Without a due responsibility, heedless of the distressing consequences,
the medical gentlemen rashly pronounced an opinion which consigned
to an early grave a pure and lovely being, and broke the very heart
strings of a devoted and confiding parent.”
CHAPTER XXVII.
PRECAUTIONS AND SUGGESTIONS TO PREGNANT WOMEN.
THERE is a hygiene of pregnancy which the enceinte female should
observe, for by so doing, she will not only make the period of her
gestation less onerous to herself, but she will be able to materially
contribute toward the accomplishment of a natural childbirth. Although
pregnancy is a physiological process, the conditions in the female
economy, under which this is carried on, are at variance with those
which are to be found in the unimpregnated state, and as a consequence
it rationally follows that the pregnant female should endeavor to
conform to the demands which the altered relations require.
If the pregnant woman is properly clothed to begin with, she will
greatly mitigate some of the symptoms which very often mar her
well-being. The clothing should neither be too heavy in summer, nor
too light in winter, she must dress so as to conform to the season
and feel comfortable; but by all means the chest and abdomen should
be kept free from pressure, the skirts must be supported from the
shoulders, and the corset also, should be dispensed with, and a waist
worn instead, one that partly answers the purpose of a corset, and
to which the skirts can be fastened or buttoned at the same time. I
have no respect nor patience for those women who desire to conceal by
tight lacing, the appearance of their pregnancy. Motherhood, whether
active or prospective, is a divine function, and as creatures are
the instruments of the Creator, there is nothing to be ashamed of by
those who have complied with the usages of civilized peoples, and
wherever an exhibition of pregnancy becomes indelicate, a person who
hopes or expects to be a mother should not be. If a woman has the true
characteristics to make a good mother, she cannot, nor will she trifle
with her own health or that of her child; in truth, mothers cannot
begin too soon to consider the welfare of their offspring.
To guard against taking cold is one of the maxims, that the pregnant
woman should heed, especially during the last half of gestation when
the prominence of the abdomen shortens the skirts in front and removes
them off from the limbs. Flannel drawers properly adapted to the limbs
and worn underneath the muslin ones affords the best protection that
can be adopted, and it replaces cumbersome skirts. Sudden extreme
variations of temperature should also be avoided, like going from an
overheated apartment into the cold outside air, or into another cold
chilly room. In making these changes, one should gradually cool off,
and then by putting on additional clothing, wraps or shawls, the danger
of taking cold may be removed. Hot coffee or tea or hot alcoholic
beverages are equally as dangerous as overheated apartments, for
anything which stimulates the circulation of the blood in an inordinate
degree is liable to produce a congestion of the placenta, and thus
incite an abortion; hence fevers of all kinds are known to have brought
about an expulsion of the fetus. On the whole, either very hot or very
cold temperatures are to be avoided, for instance, prolonged staying
in cold weather or lengthened exposure to the rays of the sun should
be prudently guarded against by the pregnant female. Of course this is
not to be construed as meaning, that she should not partake of exercise
in the open fresh air—far from it, but the exercise shall not be
forced or driven, it shall at all times be voluntary and passive, so
that when a tired feeling comes on, she can rest and refresh herself.
The best time for these little walks is in the morning and evening
in the summer season and in the middle of the day in cold weather. A
rough, uneven walk should be avoided because she may stumble; jolting
in either street cars or wagon is equally pernicious. A great deal of
stair climbing is injurious, and when it becomes necessary it must be
done slowly; running the sewing machine has caused many miscarriages.
Avoid running, jumping, riding on horseback, and lifting heavy weights,
hanging laundried clothes on lines, in fact everything that can strain
the muscles, bear down, increase the intra-abdominal pressure and
excite the nervous system.
The prospective mother must resign her amusements at evening
entertainments in crowded halls or theaters, in which the air becomes
foul and overheated from large congregations of persons. Here she is
also threatened to be jostled and jammed, and perhaps injured in other
ways. Her sleeping apartments should be thoroughly ventilated through
the day, and coition, if not entirely suspended, at least restrained
and only passively exercised, for any excess of this nature is not only
injurious to the child, but may cause a miscarriage. It is not expected
that the pregnant woman should sit in the arm chair during the period
of gestation, far from it, but it is even greatly desired that she
continue her usual vocation. Exercise of a passive nature is always
wholesome, and for this reason it will be conducive to good health
if enough work is done over every day to keep the system in gentle
activity; the domestic duties of a household will or should always
furnish that. All good women take a pride in their household affairs,
if they do not they are not good; and those who boast that they never
put their hands to anything in the house, have mistaken their vocation
as women, and are either indolent or worthless, and often both. No one
should boast of idleness, rather be ashamed of it. Employment makes
character; it gives buoyancy to the spirit and tranquillity of mind.
The influence that an equable temperament exercises over the nervous
development of the unborn child may eventually be demonstrated by its
resistance to the shock of diseases which superinduce convulsions and
death. It is not advisable to sleep during the day, it is better to
retire early after a light supper, so as to rest a few hours before
midnight. This makes one fresh and spry in the morning, being on hand
early in the morning, it gives ample time to dispose of domestic
duties, and thus avoid confusion and rushing during the day.
Cleanliness is one of the cardinal virtues of the pregnant woman—as
pregnancy will be followed with childbirth, and as cleanliness is but
another name for _antiseptic_, and that will guard against childbed
fever, the importance of _cleanliness_ springs at once into unusual
prominence. No person can be filthy and slovenly during the entire
period of gestation, and then at the moment of confinement become
clean, even if in the last moment the person becomes bathed and
brushed, everything else around and about her is soiled and dirty,
unless she be taken to a lying-in home. Cleanliness must be cultivated,
and finally it becomes second nature. The daily ablution of the
external genitals should not be neglected, and general bathing in water
not altogether too warm, say 90 to 94 degrees F., twice a week will
prove beneficial in many ways. The linen that is worn, and that which
is in the bed should be kept sweet and clean, and cleaner than ever on
the day of confinement.
The mammæ of the pregnant woman are sometimes very painful; as
pregnancy advances they enlarge, the lacteal glands become congested
and swollen. To relieve this I recommend the application of a liniment
of equal parts camphorated oil, laudanum, and tincture of belladonna
gently applied several times a day. The breasts should always be extra
well covered with flannel so as not to take cold in them, otherwise an
abscess may form in them long before the child is born. If the nipples
are sensitive it is advisable to begin to harden them during the last
few months of gestation. Tannate of glycerine is perhaps the best thing
to apply for this purpose; it is best done by means of a small camel’s
hair brush. If the nipples are sunken into the breast, and too short
for subsequent use for the baby, it is well to draw them out by means
of a breast pump, the bowl of a new clay pipe, or by employing a bottle
from which the air has been replaced by filling it with hot water and
then pouring it out; the mouth of the hot bottle is applied over the
depressed nipple, and as it cools off, the vacuum thus formed draws the
nipple out.
Nausea and vomiting in pregnancy is often so annoying and weakening
that the strength of the patient becomes seriously threatened, and
hence some measures must be employed to counteract it. A great
variety of agents have been suggested for this purpose. Tincture of
nux vomica in two or three drop doses every three or four hours is a
useful remedy; the oxalate of cerium is another valuable agent for
this purpose, in five to ten grain doses three times a day, but a more
valuable remedy than any other that I know, is the Femina vaginal
capsule, to be used every night at bedtime, and in severe cases, also
in the morning.
Salivation is not constantly an attendant upon pregnancy, but when it
does occur it is weakening and debilitating. There are many remedies
for this disorder, but one of the most effectual ones is an occasional
dose of Epsom salts, say a teaspoonful in a half tumbler of water every
other morning, so as to produce free discharges from the bowels; when
salts are found objectionable, the Femina laxative syrup taken in doses
that have a similar effect will be a most excellent substitute.
Constipation is one of the most common derangements of the pregnant
woman; it is the rule in which the exceptions are few and far between.
I do not include those cases of costiveness which are habitual, and
which are to be attributed to carelessness in not responding to
nature’s call when there is an inclination, but to those in which
constipation is contemporaneous with pregnancy. We have already seen
the sympathy between the stomach and other organs in pregnancy, and
that a similar derangement should exist between the uterus and rectum
is not at all unreasonable, and, indeed, it can be explained in that
way. In the early months of pregnancy, the torpor of the bowels may be
due to the general derangement which follows digestive disturbances;
in the latter months, the enlarged uterus presses against the large
intestines, so as to obstruct more or less the descent of the feces
into the rectum. This torpor of the bowels should not be allowed to
be unrelieved, for if permitted to continue it may not only induce
a miscarriage, but it is apt to cause fever, headache and loss of
appetite. Harsh cathartics must not be employed; and if a simple enema
of warm water early every morning does not give the desired relief, I
would recommend a daily dose of Femina laxative syrup. If it is found
that in attempting to administer an enema, the fluid is immediately
returned, then it will probably be owing to lumps of fecal matter
which clog up the rectum; this will likely give rise to more or less
straining or bearing down in the back passage, and to pains in the
pelvis and lower limbs, all of which is not without danger of exciting
premature labor pains; the fecal lumps must be removed even if it
becomes necessary to use the finger.
Diarrhea is the opposite condition of things, namely a looseness of
the bowels. This may be occasioned by improper food, cold or any other
cause capable of producing diarrhea when pregnancy does not exist.
Habitual costiveness is often followed by diarrhea from the irritation
which the hardened feces excite. A dose of castor oil is sometimes an
efficient remedy for this variety of diarrhea, but when the disease
becomes obstinate and painful, the following remedy can always be
depended upon for relief:—
Take: Tr. of catechu.
Tr. of kino, of each 4 drams
Paregoric 1 ounce
Chalk mixture 2 ounces
Mix and take a tablespoonful every four hours until relieved.
Bladder trouble is not infrequent in the early and last stages of
pregnancy; the causes of this were pointed out when the symptoms of
pregnancy were inquired into. Recipe No. V is sometimes very useful to
relieve this irritability, or a Femina vaginal capsule introduced into
the vagina every night at bedtime, is sure to give the desired relief.
The kidneys of pregnant women should not be neglected. On this question
Dumas, an eminent French authority, says: “Physiological pregnancy,
by modifying the quality and quantity of the blood is a predisposing
general cause of albuminuria or Bright’s disease. But to produce the
last a cause must be added, and this may be due to a true pathological
state of the blood, a morbid condition of the kidney, an accidental
cause or mechanical pressure exerted by the uterus, where it has
acquired a sufficient size.” If the pregnant woman notices that her
urine becomes thick and foamy, that her head aches and her limbs swell,
she should pay particular attention to keep her bowels free, and
besides drink a cupful of buchu tea every night at bedtime.
Palpitation of the heart is a source of great annoyance to some women
in the earlier months of pregnancy. Women of a nervous temperament
and those who are of a full plethoric habit are most likely to suffer
from distressing palpitation. Nervous women should take ten grains of
bromide of sodium in half tumbler of water at bedtime, and only a very
light supper, while those who are full blooded should keep their bowels
freely opened and remove all pressure from the chest and abdomen by
wearing the clothing loose.
Pain in the abdomen walls from the sixth to the ninth month is
particularly apt to occur in the first pregnancy. The abdominal walls
offer a firm resistance to the growth of the uterus, and being thus put
on the stretch by the combined development of the child and the womb,
the muscles and skin become excessively tender and painful. I have
recommended for this complaint:—
Take: Tr. of opium (laudanum).
Glycerine, of each 1 ounce
Mix and apply by means of gentle friction every night at bedtime or
night and morning.
Itching of the external organs will sometimes make the life of the
pregnant woman miserable. I have seen it in so aggravated a form that
the constant scratching to which the patient had recourse in the hope
of being relieved, lacerated the parts so that they became ulcerated.
The causes of this condition are numerous, the patient from motives of
delicacy conceals her suffering until she can endure it no longer. It
also happens that pregnancy has nothing at all to do with the itching
for it may be due to diabetes, inattention to personal cleanliness, the
presence of small parasitic insects, acrid discharges from the vagina,
or from pinworms in the rectum.
If owing to parasites, mercurial ointment will cure the disease, if
from vaginal discharges warm vaginal douches in which the Femina
antiseptic tablets are dissolved will be the efficient remedy, and
after a thorough ablution, the application by means of a camel’s hair
brush of a solution of cocaine will relieve the itching.
Hemorrhoids, or piles, frequently torment the pregnant female beyond
reasonable endurance. Piles may be either external or internal, in
either case they are exceedingly apt to be very painful. When they
occur in pregnancy they are due, in the first place, to an obstruction
to the free return of blood to the heart by the enlarged uterus
pressing on the large venous trunks and secondly, to constipation,
which as we have learned is so frequently an attendant upon pregnancy.
If the piles bleed it may give temporary relief, but if the bleeding
occurs too frequently, the patient becomes pale and weak from the loss
of blood. I know of no painful and troublesome malady in which the
application of a little common sense has greater brilliant results than
in piles, yet of all maladies, with perhaps the exception of catarrh of
the nose, it is the most abused by senseless and meddlesome doctoring.
The first step to engage the attention of the patient is to regulate
the bowels and overcome the constipation; the passages must be kept
soft and soluble, unless this is accomplished all the other efforts
fail. The constipation must be partly relieved by proper dieting, and
partly by suitable remedies. A simple bland diet, for a short time at
least, is very useful; bread and milk, thin milk gruel, fruits and
vegetables are to be preferred; abstain from solids, from meat and eggs
and everything of the nature of beer and wine or alcohol, even coffee
is irritating; while the disease is at its height eat sparingly of
everything, but drink plenty of water, warm or cold, but not iced cold.
The bowels should be regulated by taking a mild, efficient laxative,
none being better than the Femina laxative syrup. Another precaution,
very essential to success, is that after each stool the parts are
gently bathed and washed with tepid or cool water by means of a soft
sponge; gentle pressure can be exerted at the same time so as to assist
the piles to return into the rectum. If they cannot be returned in
this manner, the patient must learn to use her index finger and with
it oiled with a little sweet oil or vaseline the piles are gradually
shoved back into the rectum which alone relieves the suffering, because
it relieves the strangulation and swelling which the sphincter muscle
of the rectum causes. The pushing back after each stool and even
between times is one of the essential features of a successful home
treatment for piles, and it must be kept up for years, if necessary, to
insure comfort and to guard against a relapse. Better than plain oil or
vaseline is the nutgall ointment to be had at any drug store, but if
the pain and distress continue use the following recipe:—
Take: Cocaine.
Ex. Belladonna, of each 10 grains
Vaseline 4 drams
Mix and make into an ointment; apply to the piles at bedtime or
whenever they come down and have to be returned; a few days in bed
will materially aid in the recovery.
The diet of the pregnant female should be made a special study for
upon the regimen of food not only depends her immediate comfort, but
its ultimate effect on the process of parturition is equally marked.
I do not agree with the opinion, laid down by some of the highest
authorities, that “as far as eating and drinking is concerned, the
pregnant woman may continue her accustomed diet.” I believe that there
is a diet peculiarly adapted to the pregnant woman and very beneficial
to her if she lives up to it. Stimulants of every kind are not good;
wine, beer, whisky and even strong coffee and tea, as well as highly
seasoned food, salty or sour salads should not be eaten.
How very often does it happen that a very strong, muscular, robust,
healthy young woman, who, during her entire period of gestation, was
in the best of health and spirits, and from whom, from all appearances
one may predict that she will have an “easy time” in her confinement,
quite the opposite occurs. And why as a matter of fact and experience
is this not so, is indeed an interesting inquiry. I believe that the
answer to this question can be made so plain and reasonable, that a
mere statement of a few simple facts will make it apparent.
The process of delivery, presupposes the contraction of the uterus and
the descent of the child down into the pelvic canal and its further
passage through the floor of the pelvis.
The pelvic floor (see page 228) forms the bottom of the pelvic canal
through which the child must be forced. The vagina is the opening
through this floor, and this is composed of the muscles and membranes
of the vagina, the skin, two layers of fascea, the triangular ligaments
of the bladder and a group of interlacing muscles. In the birth of
the child all these tissues are forced to relax to such an extent,
that the vaginal canal (or the vagina) will be sufficiently widened or
dilated to allow the child to pass through into the world. A moment’s
reflection will at once make clear, that in a strong muscular person,
the resistance to the necessary dilatation will become correspondingly
great, because the muscles are so strong and tense. I have attended
some women where the muscles under the excitement of labor pains felt
as tense and hard, as though they were made of strong india rubber.
It is apparent that the muscular resistance that is offered by these
strong, tense muscles, clearly obstructs and delays the passage or
birth of the child and it makes the strongest labor pains of no avail.
And experience teaches, that the progress of labor is slow and the
delivery generally prolonged until the pains and physical suffering of
many hours, exhaust and relax the muscular resistance so that the child
is allowed to pass. If the above truths were generally understood and
generally recognized they might be guarded against by a proper dietetic
regulation, and thus an infinite amount of suffering could be avoided.
Painless childbirth is only relative, and in the absolute meaning of
the term it is not true, and for this reason, that severe contractions
of the womb are always painful, and extreme tension of tissues and
muscles such as the passage of the child will occasion in its passage
through the soft parts is also more or less painful and there is no
natural childbirth possible without both these factors being present.
Painless childbirth in its absolute sense, as a scientific fact, is not
true, but to assure a comparatively painless childbirth in accordance
with scientific facts which are capable of demonstration is not only
reasonable but absolutely true.
The term “food” is understood to be all those substances, solid and
liquid, which are used for the process of nutrition. For our present
purpose foods may be divided into three classes: _carbo-hydrates_,
_albuminoids_, and _phosphates_.
The carbo-hydrates furnish fat and warmth, as an example we have
starch, sugar, and fats. Persons who are fed principally upon this
class become warm and fat, but will lack muscle and nerve.
The albuminoids are also termed nitrogenous substances, and constitute
the muscle making material. They are derived both from animal and
vegetable sources, and in their most concentrated form we find them
in eggs, milk or cheese, and in meats also in certain meals; wheat,
for instance, contains fourteen per cent of nitrate or muscle-making
material.
Phosphates are generally taken into the system as phosphate of lime
contained in certain foods we eat, as fish, lobster, beef, Southern
corn, peas and beans, barley, sweet potatoes and oats.
It is obvious from what was said of painful and prolonged childbirth,
that the pregnant woman should avoid as much as possible nitrogenous
or muscle-making food; she must starve her muscular system as much as
it is possible for her to do, and the result will be that her muscles
will become soft and relaxable and that means a comparatively easy or
painless childbirth. In Europe, the peasantry who eat meat sparingly or
very seldom, have comparatively little pain, because vegetables enter
largely into their daily diet; the same is true in Asiatic countries
where the staple is rice, the throes of labor are very light. The
squaws of our Indian tribes are remarkable for the little pain they
suffer in childbirth and for the shortness of its duration, and the
recuperation is also a speedy one, for an Indian woman will travel or
be about in a few days after her confinement with her pappoose on her
back.
I would recommend to the pregnant woman to live as much as it is
possible for her to do on a fruit and vegetable diet. Her meals must
be taken at regular intervals, otherwise derangement of the stomach is
sure to follow. Excess in eating even the plainest kind of food must be
studiously avoided, and all food must be eaten slowly and thoroughly
masticated. Wheaten bread or rice and milk diluted with water should
form the main diet. Thoroughly cooked garden vegetables and fresh, ripe
fruit like apples, grapes, peaches, plums, etc., should be used in
summer, and some of the same fruits canned in winter, or dried fruits
slowly simmered until they are soft; it is always better to soak dried
fruit for several hours or overnight before it is put over to boil.
CHAPTER XXVIII.
WHILE IN CHILDBED.
BY childbed is usually meant the period of delivery, but I mean to
include the lying-in period, from the moment the mother has the first
signs of her approaching delivery, to the time when she is supposed to
have fully recovered and is able to be out of her bed and about.
If the suggestions that were thrown out in a former chapter are
complied with, there will be little reason for uneasiness for the
prospective mother, but it will be conducive to her welfare if she be
buoyant in spirit and hopeful of the best possible result.
The nurse should be a quiet, orderly woman, and neither too young or
too old; she should have had experience in nursing during confinements
and taking care of newborn babies; with all this she should not be set
in her ways, but should be accommodating and active, so that she will
carry out conscientiously the instructions of the attending physician.
The choice of a physician should not be delayed until the last moment,
but it should be made several months before the expectation of
delivery, and a woman should never engage a doctor for her confinement,
unless she knows that he has had practical experience in at least ten
cases of confinement, for some of our leading medical colleges and all
of the poor ones, graduate hundreds of doctors each year who never
attended a single case of confinement, and some have, even, never
seen one; yet the newly fledged doctors are turned loose upon the
unsophisticated communities to attend women in the most trying period
of their lives, and at a time when both the experience and science of
her physician should be her sheet anchor of hope. A physician who is
not always sober, of good moral character, and cleanly in his habits
and appearance, should never be allowed in the lying-in chamber, nor
one who is prating of the many severe confinements he has attended,
or who boastingly speaks of the number of times it was necessary for
him to use instruments, for it is quite likely, that the many severe
confinements of which he spoke, were either fictitious or due to
his ignorance of the subject, and the frequency with which he used
instruments was owing to a lack of patience on his part or to a desire
to be meddlesome and make himself officious. There are a great many
medical gentlemen who are not charlatans in disguise, and these should
be singled out. The pregnant female should have herself thoroughly
washed and bathed just before confinement, and the vagina should be
thoroughly rinsed out with half a gallon of warm water in which a
tablespoonful of pulverized borax has been dissolved; this precaution
will wash out any infectious germs that may cause inflammation.
The bed in which the confinement is to take place should be
scrupulously clean, and in order to insure this, it should be made a
rule that the bedstead be taken apart, and taken out-of-doors where it
is thoroughly washed and afterwards exposed to the purifying influence
of the sun and air. The mattress must also be taken out for a similar
dusting and cleaning, and kept for a time exposed to sun and air. The
confinement chamber should go through the same renovating ordeal;
the carpet of this particular chamber should be taken up, the floor
thoroughly scrubbed and the walls and ceiling washed off and whitened.
It will be better if a few clean mats or rugs can be substituted,
and the old carpet not relaid until after the confinement, when the
woman is up and around again. These precautions will guard against
the possibility of infection and the dangers of childbed fever, and
the many different phases of inflammation which are the result of
carelessness in the details of cleanliness. Of course, the nurse and
attending physician must be equally anxious of their own personal
cleanliness. If he or she leave any of the infectious diseases, like
scarlet fever, measles, typhoid fever, erysipelas and puerperal
fever, either of them is quite sure to communicate the contagion to
the innocently ignorant lying-in woman, and entail upon her endless
suffering and death. In France and Germany, stringent precautions for
nurse and physician against the dangers of infections are mandatory
under the laws, but in free America such legal injunctions would be
considered as curtailing our liberty; in the meantime, innocent lives
are sacrificed, through lack of systematized regulations, at the cost
of liberty degenerating into license.
On the day of confinement the bed is held in readiness for the
occasion, by spreading over the mattress a large piece of oiled cloth,
or what is preferable, rubber cloth; this must reach up high enough
so as to afford proper protection and lap over the side of mattress
and bedstead. Beside the bed an extra mat should be laid, to catch any
fluid that may run down the rubber cloth on the floor.
The preliminary signs of labor pains that make themselves felt by the
pregnant female, are of considerable interest to her and I believe,
that if she will familiarize herself with their character she will
have less anxiety and more confidence in a happy termination of her
condition. For some days, and occasionally for two or three weeks prior
to the commencement of actual labor, a sense of uneasiness about the
uterus will be felt by the female; this uneasiness will be observed
several times during the day and night. When the patient complains of
this local disturbance, she may feel, by placing her hands over the
region of the womb, that the organ becomes hard for the time being,
and as soon as the sense of uneasiness passes away, the womb becomes
soft again. These symptoms are called the “independent contractions
of the uterus” and in the first pregnancy they are felt earlier than
afterwards. This is simply a muscular irritability of the womb and is
not accompanied by “bearing down” which is the true characteristic
of labor. These preliminary skirmishes must not be mistaken for
the commencement of labor, otherwise great mischief may be done by
harassing the case into a premature delivery which might sacrifice the
child. The pregnant female will often become very anxious when she
first experiences these independent pains and she may imagine that
something is wrong; for this apprehension there is no reason, because
experience has taught that the greater this local disturbance before
the beginning of labor, the more favorable the progress of labor will
be when true labor pains set in.
“The righting of the organ” will be observed for some days previous
to the confinement, by a change of the position of the pregnant womb.
The womb places itself, as it were, in readiness for the expulsion of
the child, which is shortly to begin. This is done by the body of the
uterus inclining forwards and sinking downwards, and correspondingly
relieving from pressure the organs of the chest; this makes breathing
easier, and in proportion as the body of the womb comes down, so will
the lower portion of the organ descend, and this may give rise to
irritation of the bladder and frequent desire to pass water; sometimes
the passage of urine may be entirely obstructed, so that the water must
be drawn off by means of a catheter. Some women become very nervous
just before the commencement of labor; this is generally due to fear
or anxiety, for which there is no reason, and agreeable companionship
will generally dispel all evil forebodings and restore her to
self-confidence.
Labor pains are divided into _true_ and _false_, and this distinction
is entirely based upon their different sources. True labor pains are
due to the contractions of the muscles of the uterus, and at the
beginning they are slight. They commence in the back and run on down
to the thighs; one feature about them is that they are intermittent,
that is, that they are not continuous; there is always an interval,
especially at the beginning of labor, in which there is no pain at all.
When labor sets in, the pains are grinding or cutting, but as soon as
the mouth of the uterus is fairly opened or dilated, the character of
the pain changes to a bearing down or forcing out nature. If the hand
is applied over the region of the womb, during the presence of a pain,
the organ can be felt hardened and swollen; this subsides with the
pain, and in the interval, the organ relaxes. This is a wise provision
of nature, for it gives the woman an opportunity to recover and regain
fresh strength for each succeeding effort. False labor pain has no
connection with the process of child-bearing, but is only an incidental
complication. It may be caused by gas in the intestines, indigestion,
diarrhea, constipation, disease of the kidney, neuralgia, or rheumatism
of the muscles of the abdomen or bowels, and by the passage of
gallstones; where the false pains have been traced to their origin they
can be properly dealt with.
A muco-sanguineous discharge from the vagina is another sign that labor
has begun, but it will sometimes happen that it is absent, and this
constitutes a _dry labor_. The mucous discharge which is thus observed,
subserves a very important object in lubricating the parts and relaxing
the neck of the womb and the vagina. There is often a slight tinge of
blood, due, perhaps, to a rupture of small blood vessels in the mouth
of the womb; this is called a show, which some women have for several
days before labor commences.
“Stages of labor” are arbitrary divisions, so as to simplify the
explanation of the entire process of labor from the time the womb
begins to act, up to the last act of parturition, which is the
expulsion of the afterbirth, and these have usually been divided into
three stages. The first stage is the dilation or opening of the mouth
of the womb, including also the breaking of the membraneous sac which
holds the fluid in which the child floats, so as to protect it from
pressure that the walls of the uterus would be continually exercising,
which would prevent its proper development. In this stage the woman
should not exert herself by bearing down; this will only waste her
strength which she should preserve for the second stage, when the mouth
of the womb has opened and the progress of the child into the world
has commenced; during this stage, the female should make an attempt
to relieve her bladder, and if she has had no stool for several hours
before, it will be a good thing to use an enema of warm water, and
empty the bowels.
The second stage of labor begins when the bag of water has broken
and the waters escape; the contractions of the womb increase now in
violence and become decidedly of a bearing down character. At this
period the patient should be furnished with something that she may
grasp with her hands; a sheet attached to the post of the bed is the
best for this purpose, and with her feet steadily braced, holding her
breath she bears down whenever a pain comes on; bearing down between
pains, only exhausts the patient and does no good. During this stage of
labor, the pain in the patient’s back will sometimes become intense,
she exclaims: Oh, dear, doctor, my poor back feels like breaking! what
shall I do? The greatest relief that can be given at this time is to
support the back with the flat surface of the hand, or by folding
a towel and placing it under the back, the two ends being held by
assistants.
As the birth of the child progresses and it approaches the vulva, the
patient will feel an urgent inclination to go to stool; upon this she
must not insist, for at this advanced period of labor she may injure
herself and child. The desire is caused by the pressure of the child’s
head against the rectum; any fecal matter that is thus pressed out
should be at once removed by the nurse.
The third stage of labor consists in the expulsion of the placenta or
afterbirth.
There is a natural detachment of the placenta and a natural expulsion,
but one must have the patience to wait. What presumption of the
officious doctor or midwife to suppose that nature was so derelict as
to require some meddlesome assistant, immediately after the birth of
the child, to drag or pull on the placenta: no, more than that, carry
the hand up into the cavity of the womb and detach the placenta with
the fingers and bring it down and out. When I first started out to
practice I was foolish enough to believe and do the same thing, and
afterwards I congratulated myself how wonderfully skilled I was, but
now I am convinced that this procedure was due to ignorance of the laws
of nature. The truth of the matter is, that the sooner and the more one
pulls and feels on the placenta, the more irritable the womb becomes,
and the more will the uterus contract, as though it protested against
interference.
I have had it happen, and others must have had the same experience,
that the womb closes and contracts firmly in ten to twenty minutes
after delivery, the afterbirth becoming tightly inclosed so that one
not experienced would be frightened into the belief, Oh! here the
placenta has grown to the womb. This is a delusion which may lead to
an interference that may entail dangerous consequences to the mother.
The condition is simply this, that as the afterbirth was not completely
detached at the birth of the child, the uterus contracted immediately
upon and around the retained placenta, and for two physiological
reasons: (1) to accomplish the very object which was imagined was
not accomplished, namely, by contracting, the uterus naturally peels
itself off from the placental attachment, and (2) were it not for this
immediate contraction of the uterus after the expulsion of the child,
the mother would likely _flood_ from the uterine vessels of the partly
detached placenta. Of late years I never experienced a single case in
which the placenta did not detach itself, and if I had known twenty
years ago as I do now, I never would have had one.
After the delivery of the child, the woman should be made as
comfortable as possible for the time being, and by the time the child
is washed and dressed, the placenta will generally present itself in
the vulva. If the afterbirth has not come away at once there is no need
to become alarmed. I have waited for six to eight hours for that event
to take place, and if there is delay over an hour, two teaspoonfuls of
fluid extract of ergot will so excite contractions of the womb that its
contents will be expelled.
Whether the afterbirth comes away immediately after the birth of the
child, or is delayed, it must not interfere with putting the mother
in a warm, dry, comfortable condition. Everything that is damp from
perspiration or wet from the waters, both dress and bed linen must
be removed and replaced with warmed, dry, clean linen; this insures
against taking cold. To me it looks like a crime against science and
nature to allow a woman to remain in the wet and soiled bed after her
confinement for twelve or more hours, and the doctor or nurse who
permits this, is ignorant and negligent of his duties.
After the placenta is removed, the binder or bandage is applied; this
is simply a piece of unbleached muslin about eighteen inches wide and
long enough to reach one and a half times around the body; it should
be brought down to cover the hips and then fastened with strong safety
pins. The object of the binder is to give support to the flabby and
relaxed abdominal muscles, which is a great comfort and aid to restore
the muscles to their former shape.
How a woman should lie after confinement is of much greater importance
than how she should lie during childbirth; in fact it does not matter
much how she lies during labor so long as she feels comfortable,
but after confinement and during her convalescence, her position in
bed has an important bearing on her recovery; to avoid repetition I
refer the reader to pages 73 and 250 of this work. Vaginal douches
of hot water, of a temperature of 104 degrees F. serve a very useful
purpose in washing out the secretions that will naturally accumulate
in the vagina, and after a short time undergo septic decomposition;
these rinsings also assist nature to repair and heal the tissues. The
quantity of fluid that should be used at once is half a gallon of water
in which a tablespoonful of powdered borax has been dissolved. Great
care should be exercised by the nurse, lest the bed and linen of the
patient get wet, and through this she become liable to take cold. The
second day after the delivery is about the right time to begin using
the douche, and about this time the mother should also get a mild
laxative, either of castor oil or of Femina laxative syrup, which is
very palatable and suitable for the occasion.
The last throes of labor which usher the child into the world
constitute the climax of the parturient effort and as there is little
or no interval between the pains, the pains at this period have been
appropriately termed _double_ labor pains. There is more or less
excitement and apprehension on the part of the lying-in female and the
experienced practitioner or nurse will concentrate his effort to calm
and encourage the sufferer in the last minutes of her travail.
It is best to wait a few minutes after the child is born before tying
the cord, so as to give the circulation time to equalize itself;
especially is this desirable when the cord was wound around the child’s
neck or when it is otherwise compressed. The cord is tied about an inch
above the navel, and half an inch higher the cord is cut with a pair
of sharp scissors. In the meantime, the nurse, if properly instructed,
will have in readiness on the side of the bed a warm flannel or blanket
which is to receive the little stranger. There is a proper way to
pick up a newborn babe, so that it will not roll or slip from the
hands, which I have known to happen. The little baby must be taken
hold off with the same gentle firmness as an older child. To prevent
any accident, place the posterior surface of the child’s neck in the
space bounded by the thumb and index finger of one hand, and with the
other hand gently seize the thighs and in this manner place it into the
blanket, to be conveyed to a warm place of safety,—the newborn child
must be kept warm, for its very life may depend upon it. After the
mother has had her temporary wants satisfied, the nurse prepares for
the _first toilet_ of the child.
The care of the baby is differently understood by different persons,
and as a result of this difference of opinion I have observed a
great many unfortunate consequences. There is no reason why the care
of the baby should be resigned to custom and habit for both are
often extremely hazardous to the life of the child, and this I will
illustrate in the course of my remarks.
How often are newly born infants taken into a cold room in which, from
the arrangement of the doors, a draft sweeps through whenever a person
goes out or comes in? How the child is laid bare in readiness for the
ordeal of a thorough cleaning! The child is generally first rubbed
with oil and afterwards put into a bath tub or some other vessel of
sufficient capacity to drown several babies at once. It is now treated
to a soaping process, after which, by means of a cloth indifferently
selected, the child is scrubbed with an ambition which would have been
laudable if applied to the nurse’s own person, but why this little
innocent should be the object of such abuse has been a standing wonder
to me from the time I witnessed the first outrage. By the time the
nurse gets through bathing the child, it is shivering and blue from
cold. I had not been practicing medicine very long before I became
appalled by this barbarous procedure, nor had I practiced very long
before I was called upon to sign a number of death certificates of
infants who contracted colds that resulted in bronchitis, pneumonia and
congestion of the lungs, which caused their death.
There is no sense in this dousing and soaping of a newborn child, and
aside from its danger by undue exposure, it is absolutely useless. But
habit is often so thoroughly intrenched that the good judgment which
persons exercise in most of their duties may become entirely suspended,
when this force of habit has established a custom that is well-nigh
universal.
My method of directing the first toilet of the baby is without the
possible dangers to which I have referred, for it has for its object
not only to clean the child, but to dress it as quickly as possible
and again wrap it in flannel. Warmth is the life of the newborn babe;
it does not require much food, if any, the first twenty-four or
forty-eight hours of its life, but it requires to be kept warm. The
room in which the child is to be cleansed must be warm and free from
draft, and if there is a fire in the chamber where the mother is, the
toilet of the child had better be made here under her eyes and those of
the physician. The nurse or person delegated to dress the baby provides
herself with a vase or bowl of warm water and a saucerful of warm olive
oil or vaseline and a few soft cloths. She then seats herself in a low
chair, and by means of a small piece of flannel she applies the oil
all over the baby’s body, rubbing in an extra quantity in the armpits,
groins and other places where the cheesy substance is thickest. When
the oil has softened the sebaceous material, take a soft muslin cloth,
provided for the purpose, and beginning on the head the oil is wiped
off again; where there are blood stains left, wash these off with a
soft flannel cloth; at the same time the eyes are to be bathed and
the mouth washed out. I have not mentioned the use of soap, for the
reason that it is not at all necessary and very often injurious. The
oil removes all the caseous matter and what oil remains is rather an
advantage than otherwise; it preserves the warmth of the child and
protects its skin. If the soap comes in contact with the eyes of the
infant it often becomes a fruitful source of that annoying and often
dangerous disease of the eyes that is technically termed _purulent
ophthalmia_.
Never apply oil or any other greasy substance to the cord before it
comes off, for this will prevent its drying and delay its falling off.
When the cord has come off, you simply keep the navel clean by washing
it daily with a little warm borax water and afterwards apply a small
compress on which has been smeared a little zinc ointment. Always see
to it that the baby is lying dry and use dusting powder freely; the
_precipitated chalk_ is the best and cheapest infant powder that can
be used. The child that is nursed on its mother’s breasts has little
to fear from overfeeding, yet it should not be allowed to hang on the
nipple too long or sleep with the nipple in its mouth. Nurse the child
every two hours during the day and awaken it if it should sleep to give
it its nourishment, but at night allow it to sleep as long as it wants
to; this will cultivate regular habits in the child and it will thrive
much better. If the baby cries and is restless between times do not
imagine that it is always hungry, but rather colicky, for which there
is nothing better than the old German domestic remedy, _fennel seed
tea_; of this give the baby all it will drink every day and until it is
a year old.
Sore nipples are a great annoyance to a mother and often very obstinate
to treatment. The skin covering the nipple is made exceedingly tender
by the sucking of the child’s mouth and in a few days it cracks and
becomes fissured. Sometimes, the pain that the mother endures whenever
the infant nurses is excruciating, for every time the child is put
to the breasts the cracks open anew. The most fruitful cause of this
condition is to allow the child to hold the nipple in its mouth when it
does not nurse or perhaps to allow it to retain the nipple in its mouth
while it sleeps.
This practice must be at once discontinued, and the child must be at
once removed from the breast as soon as it is satisfied. The nipples
should be washed with borax water, and then a salve should be made by
mixing the yellow of one egg with half an ounce of Peruvian balsam.
This is to be applied by means of a camel’s hair brush to the sore
nipple every time after the child is through nursing. Should the nipple
be too sensitive and the suction of the child too painful, then a
breast pump had better be used for a few days and the child not applied
until the teat has sufficiently improved.
Abscess of the breast constitutes a distressing complication of the
puerperal condition, inflicting upon the patient intense suffering,
and very often leading to a long delay in recovery. It may be due to
cold, and in one case it developed from this cause two months before
confinement, but this is an exception. Sore nipples are a fruitful
cause, for the soreness of nursing makes the mother reluctant to have
the child draw all the milk out, hence, the breast cakes and hardens
with the above result. It also is due to neglect in not having the
nipple properly drawn out; or to a foolish custom, derived from remote
ancestry not to allow the infant to be put to the breast for two or
three days after its birth. In this way the milk ducts become greatly
distended, inflammation sets in, which, if not properly arrested will
terminate in an abscess. If gentle friction of camphorated oil and
hot, moist compresses or poultices do not enable the child to draw
out the secretion, a young pup should be obtained, for he draws with
a gentleness and activity which surpasses the most perfect machine.
The patient must drink sparingly of fluids and properly support the
breasts by means of handkerchiefs placed under them and made to cross
the shoulders, and the bowels should be thoroughly opened. Should an
abscess form it should be opened by a free incision, and the poultice
discontinued, but instead a wad of absorbent cotton should be applied
and the breast tightly bandaged with the handkerchief.
CHAPTER XXIX.
DISEASES PECULIAR TO CHILDREN.
THE diseases of children that I propose to inquire into, are not
those of so serious a nature as to require the skill of a physician,
but rather those trivial ailments which are common among children of
tender age and which neither good care nor healthy surroundings seem
to be able to ward off. And for this reason, mothers and nurses should
familiarize themselves with these ailments and their appropriate
treatment, for trivial as they may seem to begin with, if permitted to
go on uncontrolled, they often lead to more serious and perhaps fatal
consequences.
A coated tongue in children is not always a sign of digestive
disturbance, for most nurslings have a white coated tongue in the
first three or four weeks of their lives. With the ancients, and even
up to within a recent period, the tongue was considered the _mirror
of the stomach_; this was a delusion because nothing definite or of
great importance can be deciphered in any case from the appearance of
the tongue alone, but this superstition became so deeply rooted in the
minds of the public, that even now a medical examination is considered
incomplete unless the physician says _put your tongue out_, for the
purpose of a physical inspection.
When the child loses its appetite and the stomach and bowels become
deranged, the tongue generally becomes coated. Children who are overfed
and in whom the food is not digested, may have a thick fur over the
tongue, but as a rule only on the back of the tongue there is a whitish
coat. In diseases of the mouth that are purely local, the tongue is
sometimes coated, quite independently of any disease of the stomach,
as for instance in thrush, in catarrhal inflammation of the mouth,
diphtheria, burns and other injuries.
(_a_) Catarrh of the mouth is an inflammation of the mucous membrane
and is recognized by redness and increased secretion. It is most
intense on the tongue, which presents the appearance as though it
were coated with raspberry syrup. Sometimes the redness is most on
the inside of the cheeks and soft palate, while the tongue is covered
with soft fur. The inflammation of the mucous membrane of the mouth,
extends in aggravated cases to the throat and nasal passages and along
the Eustachian tube into the ear. There is many a baby suffering, no
one knows from what, when it has an earache due to this cause. When the
catarrh has existed for some time, clear, minute water-vesicles rise
upon the tongue, gums and mucous membrane of the lips and cheeks. These
burst and leave behind them small, flat ulcers, which in the first few
days run together and present large, flat, ulcerated surfaces. The
children become feverish and refuse to eat and drink for days, partly
because to do so, pains them and partly from a loss of appetite.
The most common cause is the eruption of the teeth. Mothers of
experience know that when the baby drools, it is teething, and if she
examines a little closer she will discover the catarrhal condition
described. Another cause is the old-fashioned sugar teat with its
souring contents; so is the nursing food, when either too hot or too
cold, and in older children irregular or improper food has the same
effect, for instance, sour ripe fruit eaten in excess.
The treatment for catarrh of the mouth is simple and successful if
directed to the removal of the causes that we have enumerated. The
mouth should be cleansed every few hours with a little borax water, and
the febrile symptoms generally subside with a dose of mild laxative.
(_b_) Putrid sore mouth is an aggravated stage of the above affection;
it begins on the borders of the gums as inflamed patches coated with
a thin layer of yellow mucus. The slightest touch of the ulcerated
places causes bleeding, and the affection can be recognized at quite
a distance from the mouth by the sense of smell. The disease is
contagious and may be imparted from one child to another. Carious teeth
are the predisposing agents; mercury or _calomel_ in repeated and large
doses produces a similar effect. A very simple and efficient remedy for
this affection is a saturated solution of chlorate of potassa, in the
proportion of a teaspoonful to a teacupful of boiling water; with this
solution wash the mouth out every two hours, and allow a little to be
swallowed at the same time; children under one year of age can swallow
ten drops; under two years, twenty drops; under three, thirty drops,
and larger ones can take a teaspoonful.
(_c_) Thrush, sprue, or soor is another type of sore mouth that falls
to the lot of some children. It resembles catarrh of the mouth, but
must be considered a different disease, inasmuch that it is proven to
be due to a fungus growth. The disease begins with a change of color
from the natural bright red, to a livid, dark red color; the entire
mucous membrane of the mouth is uniformly discolored; the discoloration
never occurs in spots, and the surface presents the appearance as if
a thick coat of raspberry syrup had been smeared upon it. The mucous
membrane becomes dry and sticky and the secretion of the mouth is acid.
On inspecting the mouth the fungi can be seen, at first as small white
points if only existing a few hours, but their growth is very rapid,
and they soon form large white patches, which may run together and
cover the entire mouth. The treatment is directed towards removing the
cause in the first place; if the child has been using the sugar teat
that must be discontinued, and even a milk diet should be suspended
for a few days, on account of its containing sugar and cheesy matter,
and instead the child should be fed with a little thickening of arrow
root or wheaten flour. The mouth must be kept sweet and clean with
a solution of borax applied with a small camel’s hair brush; if the
disease is obstinate, dissolve the borax in creosote water obtained
from a druggist, and apply this every hour or two as above.
(_d_) Parotitis, or mumps, is an inflammation of the parotid or
salivary gland. The disease shows itself as a swelling between the
angle of the lower jaw and the ear. Several days before the swelling
and pain begin, the children feel tired, ill-humored, feverish, lose
their appetite, lounge around or voluntarily take to bed. Nervous
children show brain symptoms; they complain of headache, are delirious
and have convulsions. After two or three days they begin to feel
pain behind the jaw, and when they open the mouth, masticate, or on
slight pressure, the pain becomes aggravated. The swelling over the
corresponding cheek extends to the lower eyelid and back to the neck.
The skin over the swelling becomes inflamed and red. In males the
swelling may suddenly move from the neck to the testes, while in the
female it may strike on the mammæ.
The course of mumps is usually favorable, but there is a possibility
of an abscess forming, and this may break directly outward, or burrow
backwards and burst into the ear, perforating the ear drum, causing
lifelong deafness. I have had one case in which the disease went to
the brain; the little boy, a child of seven, died. The patient who
has mumps must be kept warm; over the swelling apply hot poultices
for three or four days, and besides wrap the entire head and neck in
flannel. If the swelling is painful, and the child in robust health,
a few leeches applied to the swelling will relieve the pain and have
a good effect on the cause of the disease. Belladonna ointment is a
valuable remedy for older children, but with babies it must be used
with extreme care. The diet must be bland and light; bread and milk,
or gruel, is the most appropriate. Give a little paregoric at night to
soothe the restlessness, and open the bowels with the Femina laxative
syrup.
(_e_) Tonsilitis or quinsy sore throat is often mistaken for the mumps,
but to the experienced practitioner or nurse there is no resemblance,
and to mistake one for the other is almost impossible. In tonsilitis
the cheek never swells, the swelled tonsils being felt only behind the
jaw and quite below the ear. Tonsilitis occurs oftener than mumps, and
unlike the latter affection, when the patient has had one attack of
quinsy he is likely to have a recurrence whenever he gets a fresh cold.
The disease begins with difficult deglutition, pain, heat and dryness
in the throat, and always more or less fever, from which some children
become quite delirious. The affected tonsils become as large as pigeon
eggs, and can be readily felt beneath the angle of the lower jaw. The
swollen tonsils are red and dotted with yellowish spots, which is due
to the suppuration of the follicles of which the gland is composed. If
both swell at the same time so that they touch each other, symptoms of
suffocation may ensue. The writer suffered from tonsilitis when he was
a student, and the pain was indeed excruciating for a time. The pain is
sometimes greater in swallowing fluids than solids. In examining the
mouth a little skill is required. Some children are so well trained
that they will respond at once, and then by means of a spoon handle
the tongue is depressed, and the tonsils come into view. Others again
have their own sweet will about these things, and simply will not
voluntarily open their mouths. Then it takes two persons to manage them
in the following manner: while one person holds the child in his lap,
its back and head braced against his chest and the hands held down, the
other person slides the handle of a teaspoon along the tongue until he
touches the soft palate; this makes the child gag, and at that moment
the tonsils are brought plainly into view.
The treatment for tonsilitis should be prompt and active; that is,
when the disease is recognized, something should be done at once to
relieve it. If the bowels are constipated give a laxative at once, and
over the painful tonsils apply a flaxseed poultice, keeping the neck
and head wrapped up well at the same time. For the fever give a dose
of _antifebrine_ in the forenoon and at bedtime; for a child one year
old, one grain for a dose; at the age of three or four, give two grains
at once, and at eight to twelve years, three grains can be given.
Chlorate of potassa is the best remedy for a gargle, and for internal
use also. Make a solution of chlorate of potassa by dissolving one
teaspoonful in a teacupful of hot water, and when cooled off, have the
child gargle every hour or two, and swallow a half to a teaspoonful of
the solution at the same time.
(_f_) Diphtheria of the throat is eminently an epidemic disease and of
a highly contagious and infectious nature. Of late years, the disease
occurs in every season of the year, and independently of any epidemic
or contagious influence, but it is presumed that the contagion or
spores are cultivated in improper sanitary conditions arising from
defective sewerage and filthy accumulations. The disease invariably
begins with fever, a marked increase of the pulse, increase of the
temperature of the skin, and general depression. There is first a
difficulty of swallowing, a snuffling voice and stiffness in the neck;
the first two signs are due to the swelling and diphtheritic coating
of the tonsils, palate and nasal passages, while the last symptom
is due to a swelling of the lymphatic glands of the neck which is
never absent in genuine diphtheria. If the throat is examined in the
early stage, the white membrane is first seen in the tonsils and as
the disease progresses it spreads to the palate, the pharynx and the
nasal passages. The color of the membrane also changes; after several
days it passes into a yellowish-white or grayish-white tint. It has
another peculiar feature that distinguishes this membrane from the
exudation of ordinary tonsilitis, which the practical eye at once
detects; the membrane of diphtheria makes the impression of having
eaten into the tonsil or as though it was pressed into the tissue by
the finger. And that is really so too, because as a scientific fact it
is no membrane at all, but a death or slough of the mucous membrane
which may extend down into the tissue beneath the membrane. To treat
diphtheria successfully is simple enough but it requires great skill
and experience, and I will outline what I consider the proper thing to
do and which in my hands saved those lives that were intrusted to my
care.
The treatment resolves itself into perfect cleanliness or disinfection,
stimulating nourishment and internal medication.
Everything must be kept clean around the patient, and a vessel must
be provided, containing a little chloride of lime into which he spits
or hawks the phlegm from his throat. The membrane or slough in the
throat or nose must be thoroughly disinfected and the only evidence
that this has been successfully accomplished is when all offensive
odor has disappeared. For this purpose as a local application I employ
the following preparation: Solution of subsulphate of iron (Monsel’s
solution) 3 drams, glycerine 5 drams; mix and pour ten to twenty
drops into a saucer and by means of a camel’s hair brush apply to the
diphtheritic membrane until the character and odor of it is destroyed;
this application repeat every four hours. Should the nasal passages
be also affected mix a teaspoonful of the preparation to a teacupful
of warm water and by means of a syringe wash the nasal passages out
several times a day. Give the patient internal medicine to disinfect
the stomach and for its alterative action on the blood: for this
purpose use tincture of iron 4 drams, simple syrup, add to make 4
ounces. To a child seven to ten years old give a teaspoonful, ten or
fifteen minutes each time, after the brushing. Between the times of
brushing and giving the medicine, that is two hours afterwards, give
the nourishment and stimulant; this consists of milk punch. A child
seven to ten years old should take no less than a tablespoonful of
whisky, with or without a little sugar, in a half to a teacupful of
milk beaten thoroughly together with an egg beater; this is to be
taken for a meal and drank at once, and repeated every four hours. No
other food or nourishment must be given for a number of days, and if
the child is thirsty between times allow it to drink sweetened water
and whisky. Sometimes the glands of the neck and the tonsils swell and
become very painful; for this the Belladonna ointment applied with
gentle friction night and morning and the neck enveloped in cotton
batting are certain to give relief. The efficiency of this treatment
depends upon the intelligence and faithfulness with which it is used.
(_g_) Croup is a term derived from the German Kropf the crop or craw
of the bird; this disease is known by a great many different names,
but on account of its shortness, _croup_ has received the preference.
The disease has to do with an affection of the organ of the voice, the
_larynx_, which is the upper part of the air passage, and situated
between the trachea and base of the tongue at the upper and front
part of the neck where it forms a projection in the middle line which
is prominent above and called the pomum Adami or Adam’s apple. The
larynx contains the vocal cords, running from before backwards on both
sides; these form the narrow fissure or chink, the _rima glottidis_,
through which we breathe. Like all other air passages this too is
lined with mucous membrane. The symptoms that foreshadow croup are not
particularly significant, for they simply indicate that the child has
a cold. The children have a cough, they sneeze, and their appetite is
capricious for a few days; they are not as lively as usual and are more
or less feverish. In a certain proportion of cases there is nothing
noticeable before the croup develops, for the children may go to bed
perfectly well and sleep calmly the first few hours of the night,
when suddenly they are awakened with a barking cough, which greatly
frightens young children and they begin to cry. The cough may repeat
itself at short intervals, the voice become hoarse and husky and lower
and lower, so that in the morning a well marked croup is developed. The
voice finally disappears so completely that it is not heard above a
whisper, and the greatest pain and harassing symptoms of suffocation
do not enable the child to utter a loud sound. The respiration becomes
labored in proportion to the swelling of the vocal cords and other
obstructions to the passage of air through the larynx. Croup has
vagaries that cannot be foretold. One child may have symptoms of so
threatening a nature that one believes it will suffocate at any moment,
yet, with a few simple remedies, the symptoms will gradually lessen and
it recovers in a few days, while another may be suffering comparatively
little and from appearances one would imagine that there is little or
no danger, but at once it will change and grow worse so rapidly that
it will die in a few hours. For this simple reason no case of croup
should be carelessly or lightly considered. When a child has croup it
should be put at once into a warm room; a big fire should be kept up,
and the child given hot drinks or a cupful of hot tea so as to make it
sweat. The front part of the neck should be rubbed with equal parts of
turpentine and sweet oil until it feels warm and the skin reddens. If
the child has eaten a good supper, a teaspoonful of syrup of ipecac
should be given every half hour until it vomits; otherwise vomiting
should be omitted. The following mixture always gives relief and with
other precautions is all that is usually required.
Take: Bicarbonate of potassa 2 drams
Water 1 ounce
Hive syrup,
Paregoric, of each ½ ounce
Mix and give half to one teaspoonful every two hours until relieved;
then every four to six hours.
What we have considered thus far is also called spasmodic, catarrhal or
_false_ croup, to distinguish it from another variety that is described
under the name of _membranous_ or diphtheritic croup.
This form of croup as its name indicates is characterized by a membrane
which forms upon the surface of the inflamed mucous membrane of the
larynx as an exudation, and sometimes the croupous membrane extends
down into the windpipe or trachea.
This variety of croup begins just like the simple or catarrhal form
only as the disease progresses the symptoms gradually grow worse, and
remain persistent. It is fortunately a very rare disease and almost
always fatal when it does occur. An ordinary or catarrhal croup may,
when neglected, run into the membranous form and for that reason
children who are croupous, no matter how light it may appear, should
be carefully nursed until the symptoms have passed off. The treatment
for membranous croup has been on the whole very unsatisfactory; the
membrane which forms in the larynx and windpipe is the cause of
suffocating the child, and the question how to remove this has never as
yet been answered. Of course a great many remedies have been suggested
and used but at times all have disappointed. The successful case of
membranous croup that I treated many years ago was cured by giving the
little patient inhalations of lime water with a steam atomizer and
besides giving whisky and milk as nourishment; how much of the success
in this case was due to the child’s vigorous constitution and how much
to the treatment will always remain a mystery. In the commencement, the
same treatment that was recommended for false croup is advisable; later
on the skill of a good physician is required.
(_h_) Bronchitis or catarrh of the bronchial tubes is generally the
cause of the ordinary cough due to exposure or taking cold. Its danger
depends upon the severity of the bronchial inflammation and upon the
age of the patient; the younger the child the more dangerous the
disease. In older children or adults there is no connection between
a bronchitis and a pneumonia, but in infants or children under two
years of age who are suffering from bronchitis the tendency toward a
complication with pneumonia is ever present; in fact, in children of
this age, pneumonia usually begins in that way.
Cough is the most prominent symptom and it is always present from the
commencement of the affection, and apprehensive of this the parents
seek medical assistance. The expectoration in young children is
generally swallowed after each paroxysm of cough, hence the nature of
it can rarely be seen. In the first part of the night the cough is
always more severe than during the day, and the paroxysms may last from
half to one minute, recurring several times in the hour. Some children
are less disturbed in their sleep than others, for they sleep on,
notwithstanding the cough, while others always awaken, become annoyed
from the disturbance and cry. These interruptions in their night’s rest
reduce them in strength and flesh. Children who cough more when laid on
one or the other side than when they lie on their back and who distort
their face when coughing or, when old enough, complain of pain during
or after coughing have something more than a simple bronchitis; they
have a complication of pleurisy or a pneumonia. There is always fever
and this may run very high, so that the child becomes delirious; even
before the fever becomes very pronounced or the cough very annoying,
their little hands and faces feel hot to the touch, indicating that
they are not well.
Infants require good nursing when they are suffering from bronchitis,
and it is not good to let them lie on their backs all of the time; when
they have a coughing spell take them up quickly and lay them across the
knees, with their faces downwards; this gives the mucus a chance to run
out of the bronchial tubes and mouth which is better than swallowing
it. The most important feature in the treatment of bronchitis is a warm
room of even temperature night and day. If the temperature is allowed
to go down during the night and the child inhales cold air into the
lungs it will often bring on a relapse or aggravate the disease. When
children have a cough and cold they must be kept warm in order to get
well; this is no time for trying to harden them. A thermometer should
be in every house and certainly in every bedchamber, so that the
temperature of a room may be gauged to a certainty. In ordinary cases
the temperature should not fall below seventy degrees Fahrenheit, and
when the child coughs very much and the bronchitis is very bad it is
best to keep the temperature of the room around eighty degrees night
and day for several days, and as the patient improves, it is advisable
to gradually drop to seventy.
The application of oil and spirits of turpentine is advisable in all
cases of cold in the chest; it does good and one can hardly explain
how and why. For the cough an infant can take with great advantage
three or four drops of syrup of ipecac together with the same amount
of paregoric, every four hours; older children take larger doses in
proportion. When scrofula or tuberculosis is at the bottom of the
bronchitis, a reliable preparation of cod liver oil emulsion should
also be administered.
(_i_) Pneumonia is the technical term for inflammation of the lungs
or _lung fever_. It consists of an inflammation, involving the air
cells and smallest air tubules of the lungs; in other words, it is an
inflammation of the substance or tissues of the lungs.
It is altogether a more serious affection than bronchitis, and in very
small children exceedingly dangerous. The inflammation may affect
either a small circumscribed portion of the lung, _lobular_ pneumonia,
or it may compromise an entire lobe or all the lobes of the lung, and
is then called _lobar_ pneumonia. Pneumonia is dangerous in proportion
to the extent of lung tissue involved and the symptoms become
correspondingly aggravated. The disease occurs extremely often in
children, but it is altogether different from that which occurs in the
adult. In children it is of a bronchial nature, that is, the ordinary
bronchial catarrh has a tendency to extend to the very small bronchial
tubes (capillary bronchitis), thence into the air cells of the lungs.
In this variety of pneumonia the lungs do not become inflamed in their
entirety, but here and there patches of lung tissue become the seat of
lobular pneumonia. In the nursling, catarrhal pneumonia is an extremely
frequent affection and I believe that it is principally due to the
carelessness and promiscuous bathing of infants to which I have already
referred. In foundling hospitals this disease destroys a great many
children, and the chief cause has been attributed to their lying both
night and day in a horizontal posture.
It has been statistically proven that many more children suffer from
the disease in winter than in summer, and further, that in those parts
of the lung that are inflamed the bronchial tubes which lead to them
are also found to be inflamed. This relation of catarrhal pneumonia
to bronchitis may be accounted for by the play of a mechanical force
and thus illustrates the relation of cause and effect. The secretion
of bronchitis not being expectorated, gravitates into the region in
which the inflamed bronchial tubes terminate, namely, the air cells of
the lungs, and by irritating and blocking or filling the air cells, a
catarrhal pneumonia is developed.
The symptoms of pneumonia in children under two years of age are those
of the catarrhal or lobular type; after they have passed through their
first dentition they become subject to lobar pneumonia which differs in
no particular from the disease which occurs in grown persons. Practice
and experience make the discovery of catarrhal pneumonia possible in
little children as soon as they are under observation for a little
while. The most prominent sign is the rapidity of the respiration,
which rises to sixty and eighty per minute instead of forty-four, the
average normal respiration for the first year of infantile life.
The disease begins with a cough and more or less fever, and as it is
always preceded with bronchitis, the symptoms that were enumerated when
speaking of the latter disease are equally applicable to this one.
Later on, when the transition of bronchial catarrh into pneumonia takes
place, all the symptoms become at once aggravated. The breathing, for
instance, becomes labored and increases and the nostrils dilate with
each inspiration. The mouth is open, and its corners are drawn downward
and outward, depicting distress and suffering, while the eyes roll
anxiously about or become glassy and staring.
The treatment of pneumonia in its early stages would be the treatment
of bronchitis, since every pneumonia in young children is preceded by a
bronchial catarrh. The uniform temperature is of the first importance.
The same remedy that was suggested for the cough in bronchitis is also
here serviceable.
A systematic course of nourishment must form a part of every successful
treatment for pneumonia; and as an old medical friend once told me in a
consultation “_if the child is kept alive long enough with nourishment
it is bound to get well_.” In critical cases it is surprising the
large amount of whisky a little infant consumes with avidity; its
eyes begging and watchingly following the teaspoon from the cup to
its mouth. I attended my own child once when only three months old
and although there seemed no hope, for its tiny finger tips were blue
and its lips livid from deficient aeration, yet it eagerly took its
teaspoonful of whisky toddy every fifteen minutes through the longest
part of the night, and towards morning it took a change for the better
and its life was saved. I also believe that these babies must be kept
in a constant sweat; this relieves the congestion of the lungs. The
nourishment must be given at regular intervals of several hours just as
you would give medicine, for indeed it is a medicine at this time.
Another valuable agent to which I attribute a number of recoveries
is the application of a moist girdle suggested by Professor Alfred
Vogel, of the University of Dorpat, Russia. In his work on “Diseases
of Children” he says: “A diaper, or large white pocket handkerchief is
folded up like a cravat; the bandage thus obtained should be three or
four fingers wide, and the whole length of the handkerchief. This is
now dipped in warm water, and wrung out so that the cloth does not
drip, and then applied like a girdle around the chest of the child.
A second cloth, double the size of the first, is folded up in the
same manner like it, but which must be six to eight fingers broad,
and then applied dry and warm over the first. It is very advisable
to interpose a piece of gutta percha or oil silk between the dry and
the wet girdle by which on the one hand, the moistness of the first
cloth is preserved longer, while on the other, the second does not
become wet. If the water with which the fomentations are made is not
too cold, the child will tolerate them very well and in a short time,
a slight retardation in frequency and improvement of the respiration
are indicated by less motion of the nostrils. These warm compresses
should be continued for from four to six days, and it is not at all
necessary, during the entire time, to remove the bandage; the oil silk
is raised up a little, and a few teaspoonfuls of water are poured upon
the girdle or it is moistened with a sponge. The principal thing is not
to allow a cooling of the skin by evaporation to take place. To secure
this object, the dry cloth should properly overlap the moist one on all
sides and as it is impossible to prevent the upper cloth from becoming
wet, it should be changed several times during the day. I certainly
have applied this girdle many hundreds of times, and have very often
seen rapid improvement ensue; nevertheless, it cannot be denied that
the half of these children perish notwithstanding. If cold compresses
are applied the children cry of fright in consequence, and the symptoms
become worse until the cold water has become warm.” The application of
blisters, cupping or leeching should not be tolerated.
CHAPTER XXX.
DISEASES PECULIAR TO CHILDREN—CONTINUED.
(_a_) INDIGESTION in very young children is generally accompanied
with diarrhœa, because that portion of the child’s food which is not
thrown up or digested passes along the intestinal canal and acting as
an irritant causes diarrhœa. An indigestion of only a short period of
duration excites a catarrhal inflammation of the mucous membrane of the
stomach, and this may be so slight that even a change or correction in
the diet may be all that is required to relieve it. Children who are
suffering from indigestion have stomach ache; this may be continuous
or come on half an hour or an hour after nursing. The pain is due to
the irritation caused by the nutriment or to the fermentation of the
food and the consequent accumulation of gas within the stomach. The
stomach becomes distended and sensitive to pressure. When the catarrh
is severe the nutriment that the child takes into the stomach is
immediately rejected or it may vomit glairy or greenish mucus from an
empty stomach. At first the nutrition of the child may not be greatly
interfered with, for some of the food is retained and digested in the
small intestines, but in the course of time these too become irritated
and then diarrhœa complicates the case and the child falls off and
becomes rapidly emaciated. Children who are nourished from their
mother’s breasts rarely suffer from indigestion, but those who are
fed on artificial foods become victims of stomach and bowel troubles.
And for this reason it is natural to suppose that the chief reliance
for a successful treatment is to regulate and study the diet of the
sufferer; the chapter that is especially devoted to this subject should
be consulted for further information.
(_b_) Diarrhœa is a derangement of the stools in which they loose their
semi-solid, pap-like consistence and become watery liquid alone, or
watery liquid in which indigested particles of food and fecal matter
remain suspended. The quantity of alvine matter that is evacuated
greatly exceeds that which passes in the normal state. The stools have
an alkaline or acrid nature which irritates and often inflames the anus
and the surrounding integument. “The normal form of the infantile feces
in the first year of life is the pappy; the color is yellow like that
of the yolk of egg; the smell is feebly acid, never putrid, and only in
children who are fed upon a meat diet as repulsively pungent as in the
adult; in later years they are no longer distinguished from the adult.”
The passages of diarrhœa may be simply softer, but yellowish and
increased in quantity, or they may be bright yellow and so watery as to
squeeze out from the anus as from a syringe and soak through diapers
and bedclothes, or the stools may be green, or bilious, and slimy.
When children teethe they often have a diarrhœa for several days; this
intestinal derangement has no connection with improper feeding, yet it
requires to be watched lest it become serious and uncontrollable. There
is still another kind of diarrhœa which is foamy and contains large
quantities of mucus and little or no coloring matter. For the different
varieties one and the same remedy will answer, and that which I here
submit has never disappointed my expectation:—
Take: Subnitrate of Bismuth 1 dram
Powdered Kino 16 grains
Rubbed thoroughly with Glycerine 1 dram
Paregoric. 2 drams
Chalk Mixture, sufficient to make 2 ounces
Shake the mixture thoroughly before using, and the dose can be
regulated between ten drops for an infant to a teaspoonful for a child
three or four years old.
(_c_) Dysentery or Flux is an inflammation of the mucous membrane of
the large intestine, or colon, extending down to the rectum. Children
under one year of age are not as liable to this affection as those who
are older, and it is during their first dentition that the affection
shows itself. In hot summer months, at the season of unripe fruits,
the disease often becomes epidemic. The loss of strength and flesh is
very rapid, and when children do not perish during the first few days
of their sickness, they may succumb later when the disease has assumed
a chronic form. Dysentery is extremely liable to become complicated
with pneumonia, anæmia, pyæmia, perforations and strictures of the
intestines, jaundice and abscess of the liver, and in proportion that
these complications become developed life becomes seriously threatened.
The symptoms of dysentery are striking and can hardly be mistaken for
anything else. There is always pain over the abdomen, but on touching
the abdomen near the navel and over the course of the colon the pain is
greater than elsewhere.
Tenesmus is a characteristic symptom of dysentery. This is a straining
sensation as if the bowels wanted to move, yet notwithstanding the
violent bearing down, only a little mucus often streaked with pus or
blood is discharged. The straining causes the lower folds of the rectum
to protrude, and this portion of the bowel presents a livid red color;
the sufferer is tormented a great deal by this fruitless bearing down,
and the bowels should be anointed with pure zinc ointment and returned.
The stools of the child are characteristic of this disease. Every
passage contains glairy mucus formed into lumps resembling granules of
boiled starch, streaked with blood and associated with a creamy looking
substance which is purulent matter. If the disease has progressed to
the formation of ulcers the evacuations become grayish red or assume a
dirty ashen color, and the odor is putrescent. Portions of the mucous
membrane slough off and large quantities of pus are discharged from the
ulcerating surfaces so that the stools present sometimes nothing but
purulent and bloody matter.
The treatment for this disease must be prompt and directed to the
point; reliance must not be placed upon one single remedy, but a
combination of expedients must be resorted to.
The greatest annoyance and source of pain is the straining and
tenesmus, and to relieve this steps must at once be taken. There is
hardly any use to give injections for this purpose for the irritable
condition of the rectum makes it impossible for the child to retain
them long enough to do any good. Use suppositories instead, and if need
be, retain them by holding a soft compress of cloth over the anus, for
ten to fifteen minutes until they are dissolved. For example, to a
child one year old I employ the following suppository:—
Take: Laudanum 1 drop
Cocaine 1/30 grain
Bismuth Subnitrate 10 grains
Cocoa Butter 10 grains
Make into one long suppository and roll in powdered bismuth, dip it
first into oil or vaseline and insert into the rectum every three or
four hours until the soreness and straining have subsided. If the child
is not very sensitive nor very ill an injection of a teaspoonful of
boiled liquid starch to which a few drops of laudanum have been added,
may be used instead and as often as may be necessary. Cold drinks
aggravate the pains, therefore give everything warm.
Cow’s milk should be dispensed with in artificially fed children,
and broths substituted to which a portion of a fresh egg is added,
previously thoroughly beaten with an egg beater; in very young
children the yolk alone should be used. A little whisky is always
good for this class of patients, either in their broth, or given as
a toddy in teaspoonful doses for the children are generally always
thirsty and feverish. When children lose their appetites and refuse
nourishment they must be coaxed and even forced to take food at regular
intervals, otherwise they cannot rally and will perish from inanition.
The medicine that I recommended for diarrhœa is also very useful for
dysentery.
(_d_) Colic is the result of an abnormal accumulation of gas,
_flatulency_, in the small intestine. There is always more or less
gas in both stomach and bowels, but usually this passes off and there
is no pain felt from it. It is when the quantity increases so as to
distend the bowels that the walls of the intestines become the seat
of pain. The pain comes on in paroxysms, or fits at short intervals,
and increasing in violence. Children suffering from colic have the
abdomen swollen or bloated, giving rise to that condition termed
meteorismus or tympanites. Those who are under one year old are the
most liable to colicky pains, for it is during this period of life that
digestive disturbances are the most frequent, and these constitute the
chief cause. Whenever the vermicular motion of the intestines becomes
lessened or suspended, the gas is not expelled from the anus, and the
accumulation causes the characteristic pains under consideration. In
perfectly healthy digestion there is always more or less gas developed,
and even then there may be colicky pains. The same pains originate
with every diarrhœa that is due to improper food or feeding, and in
dysentery too they are generally present. Infants who nurse at their
mother’s breasts are less liable, but not altogether exempt, for
mothers’ milk is very sensitive to impressions of purely physical
exertions, or to emotions of fear or fright, thus her milk may become
unhealthy for her child; or through her own digestion, suffering from
temporary or permanent derangement, her milk may transmit a similar
condition to her child; the mother may have eaten green fruit, or too
much of a variety, or it may be too highly seasoned, or too fatty. Many
mothers and nurses look upon the colic cry as a hunger cry, and hasten
to feed the little one, and sometimes a few teaspoonfuls of milk or
broth will relieve the cry for a few minutes, then the pain returns
severer than ever, and the baby cries louder than ever. I have seen
very nervous children thrown into convulsions from severe colicky pains.
My rule has been for years to nurse infants for the first two months
not oftener than once in two hours; after that until they are six
months old, every three hours, and from six to twelve months every
four hours; between times the babies cry, of course, not because they
are hungry, but because they have either pain or are thirsty. The old
German household remedy for this is _fennel seed tea_; there is nothing
as useful; it expels the gas and it quenches the thirst from which
colicky children suffer, at least while they have the colic. This tea
should be given regularly between times, and until they are twelve or
fifteen months old; it is soothing, and what is of equal importance, it
prevents overfeeding, which is the bane of artificially-fed children.
The latter, bottle-fed babies, are all more or less colicky, and for
these the fennel seed tea, between bottle time is indeed a balm. If
the fennel seed tea does not relieve the child at once, or if the pain
seems severe, then add a few drops of paregoric to the fennel seed tea,
and give an injection of German chamomile tea, rubbing the bowels at
the same time with a mixture of turpentine and sweet oil, and I believe
that every case will be relieved. Permanent relief must be sought in
ferreting out the cause and removing it. This may be due to improper
food, or feeding, to indigestible contents in the stomach or bowels,
and indeed, very often to constipation. When the stomach is overloaded,
a dose of syrup of ipecac may give relief, and if due to constipation,
the Femina laxative syrup is the most appropriate remedy.
(_e_) Convulsions, or spasms in children have long been well known to
the laity, and from their frequent occurrence they make an important
class of children’s diseases. If there is one thing more frightful to
behold than another, to the young and inexperienced mother, it is to
see her baby’s eyes unsteadily rolling, or turned up so as to show
only the white of the eyeballs, or may be the eyes steadily fixed in
a stare while the child becomes completely unconscious. A painful
smile may play over its face, or an expression of fear or anger may
distort the facial expression, while the muscles of the face twitch
convulsively. The jaws are sometimes set, then again there is gnashing
of the teeth, alternating with relaxation of muscles and ligaments.
The child cannot swallow, and fluids poured into the mouth flow out
again. The other muscles of the body also participate in the spasmodic
contractions; those of the back contract and relax, and those of the
extremities are involved in lively twitchings, or perform acts of
thrashing, striking or twisting. The breathing becomes very irregular,
and from the spasms of the muscles of the larynx or throat it may
become entirely suspended, and if the spasm does not subside in two or
three minutes the child may die. The skin becomes livid or congested
and loses its sensibility so that blisters or irritants make no painful
impression. Sometimes the child bleeds from the nose or mouth; the
latter is generally due to the tongue having been caught between the
teeth during the paroxysm. Frothy saliva wells up from the mouth and
the urine and stools are involuntarily discharged.
All convulsive attacks have not every symptom above enumerated, some of
them are usually absent and an attack may be quite mild, and last only
a few moments; if convulsions last longer they are not only dangerous,
but indicate serious disease, either of the brain or in which the brain
or spinal cord is seriously complicated.
The period of the child’s life at which convulsions are most frequent
is from the time they are born up to the completion of the first
dentition. Nervous children who had convulsions while they were
teething are susceptible to violent attacks at the commencement of
various diseases or during the developmental stage of the eruptive
fevers. Perhaps the most frequent cause of convulsions in children is
the eruption of teeth. The irritation which a growing tooth causes in
the gums also irritates its nerve and this irritability is reflected
on the brain, and this causes the spasm. An overloaded stomach, worms
and digestive disturbances that accompany teething irritate the bowels
and from this too convulsions ensue. The treatment for convulsions
naturally resolves itself into first giving instant relief during the
paroxysm, and secondly, finding out the cause of the attack. The latter
is not always easy at first sight, and as the cause may be serious
a competent physician should be sent for. But instructions that are
serviceable while the convulsion is on are of the greatest importance
to mother and child. The old and familiar remedy of giving the child a
hot bath as soon as possible is certainly the best thing that can be
done. The child should be undressed as quickly as possible so as to
relieve it from all constriction and so that nothing can interfere with
the respiration and circulation.
A towel wrung out of cold water should be placed over the child’s head
and its body immersed in hot water that is not so hot as to scald; the
hands on which the child is supported while in the water must be well
able to stand the heat. When the spasm has subsided, the child should
be transferred to a previously warmed woolen blanket in which it is to
be wrapped with its head softly elevated. If the bowels are constipated
an enema of warm water and a little castile soap should be administered.
(_f_) Worms of different species infest the human organism; they get
into the system from the outside world, with the food we eat and drink.
Their abiding place seems to be the mucous membrane of the intestinal
canal with the exception of the _trichinæ_ which penetrate the mucous
membrane and make their way to the different muscles throughout the
body; the voluntary muscles seem to be their permanent dwelling place.
These parasites are peculiar to the meat of the hog and as very young
children do not eat this meat, they are so far totally exempt from
them.
Tapeworms are rarely found in children under one year of age; it is
when they get older and especially when they eat hog’s meat, for this
too is the home of the embryo tapeworm, that they become infected.
The roundworm, however, is peculiar to childhood. It is a yellowish
or whitish worm resembling the earthworm, from one to twelve inches
in length. The body is round, tapering toward each extremity. This
worm inhabits the small intestine, but by acts of vomiting they are
frequently ejected from the mouth or they may find their way into other
cavities. On the Pacific slope these worms are not as frequently met
with as on the other side of the Rockies. It is propagated by _ova_ and
taken into the system by means of drinking water containing them. The
number varies greatly in different cases; sometimes there are only a
few and again there may be dozens or hundreds coiled together so as to
form balls or masses. They are most common between the ages of three
and ten years. I do not believe that they ever exist in early infancy.
The symptoms denoting the presence of these parasites are on the whole
obscure and depend somewhat on the temperament of the individual.
A nervous child may be thrown into fits or convulsions from them.
My first case of these worms in a child seven years old was rather
exceptional and remarkable. The child was suddenly taken with a severe
attack of spasmodic croup, for which I prescribed remedies without much
relief. After the second day the child passed five large roundworms,
the croup subsided, and while I claimed no credit that my remedies did
not cure the croup it was generally conceded that they killed the worms.
The usual symptoms are colic pains, impaired appetite, diarrhœa,
itching of the nose, swollen abdomen, puffy features, offensive odor of
breath, dreaming sleep and grinding the teeth during sleep or twitching
of the muscles.
The expulsion of the parasite is generally effected with simple
remedies. Five to ten drops of spirits of turpentine in half to one
tablespoonful of castor oil is a reliable remedy. The oil of wormseed
is another convenient remedy in the same dose on a lump of sugar or
mixed with oil; a cupful of tansy tea early three or four mornings
on an empty stomach serves a useful purpose; pinkroot and senna
administered as a tea has also a well-deserved popularity.
The thread, pin, spring or mawworm inhabits the large intestine
and chiefly the rectum. It is a thin yellowish-white parasite from
one-twelfth to one-third inch in length; the female has a straight,
awl-like, pointed tail, the male has a strongly curved tail. It rarely,
if ever, enters the small intestines. The worms occur chiefly in young
children, but there is no period of life that is exempt from them. They
cause pain and an itching sensation at the anus. This is particularly
troublesome when the children lie in warm beds. The sexual organs are
apt to become excited from the irritation and the habit of masturbation
be thus formed. In girls the worms may travel into the vagina and
leucorrhœa in children is often accounted for in this way; around the
anus there may be pimply redness.
From the loss of appetite and sleep the general health of the child
may become impaired; but the only possible evidence of the presence
of worms is to examine the stools. If worms of the above description
cannot be seen, yet the symptoms make their existence suspected, a dose
of some of the remedies above suggested should be given and afterwards
the stools again examined. Some children have a peculiar predisposition
to pinworms, and although you seem to give them relief for the time
being, in a short time afterwards the same symptoms return and the
worms are as numerous as ever. In these cases a course of continual
treatment becomes necessary to eradicate the morbid habit; for this
course I recommend:
Take: Powdered wormseed,
Powdered chocolate,
Milk of sulphur, of each equal parts.
Mix and give half to one teaspoonful every night at bedtime.
(_g_) Constipation is the bane of artificially reared children and if
the sagacity of mother or nurse does not correct the evil it often
causes serious complications. Sometimes those who are nursed on the
breast suffer from constipation, especially when the mothers or wet
nurses are troubled with similar derangements. Children under one year
of age should have two evacuations, and those from one to three years
should have at least one passage a day; when this does not occur the
feces become solid and constipation is the result. In most febrile
affections constipation is caused by a loss of moisture through the
skin and an increased urinary secretion. Certain foods constipate,
especially the starchy or farinaceous variety, as soups containing
corn starch, rice, sago, etc., and in older children certain dishes
consisting of peas, beans, and wheaten bread. A great many medicines
are constipating, for instance, most cough mixtures, for they contain
opium in some form, also preparations of iron, lead, alum, bismuth,
chalk, and vegetable remedies that contain astringents or tannin.
It must be laid down as a RULE never to be violated, that every child
must have at least one passage a day from the day it is born, and it is
the imperative duty of mother or nurse to see that it is accomplished.
The infant of only a few days or weeks old may require only a few drops
of olive oil, but if that delays in its effect it may become necessary
to give relief at once, and for this purpose we have in a small warm
water enema a most decided and effectual remedy. Soapsuds should never
be used, except in very urgent cases, for I have known a diarrhoea to
ensue from the irritation it caused which was very hard to control.
If the feces are not very hard a soap suppository may be used with
good advantage, and in the following manner: Take a piece of soap and
pare it to a point the thickness of a lead pencil and about an inch
long, moisten this and introduce carefully into the rectum; if the
straining bring only the soap away it may be well to use the water
enema afterward. If the constipation continues to be habitual a slight
modification of the diet becomes necessary; starchy foods must not be
given as often, and thinner than formerly; the milk too should be more
diluted; broth or beef tea substituted once or twice each day will
often have a good effect. When children are old enough to eat mixed
food the diet can often be so regulated as to materially contribute
towards opening the bowels. The children should be encouraged to drink
a great deal of water; from the lack of that alone some children become
constipated. Graham bread and boiled German prunes are especially to
be recommended; so are ripe raw fruits, grapes, strawberries, apples,
pears, etc. Children require fresh air and outdoor exercise to be well
and robust; they run and jump more when in the open air, all of which
gives tone and strength to the general system. If diet and outdoor
exercise alone does not remedy the evil, then the Femina laxative syrup
should be administered; it is efficient in its action, and pleasant to
take, and unlike most laxative or aperient remedies, there is no danger
of forming a habit of using purgatives.
(_h_) Whooping cough is the name of an affection deriving its
significance from a characteristic which is peculiar to this cough. It
commences like an ordinary bronchitis such as is the result of taking
cold; there is the usual hoarseness, tickling in the throat, dry cough,
sneezing, running from the nose; the eyes are red and watery, and
there is more or less fever. Sometimes the cough is ordinary, but at
other times it has a sharp metallic clang from the beginning. Owing
to certain marked periods in the course of the affection it has been
found convenient to divide it into three stages which may usually be
distinguished, although in a certain proportion of cases the first
stage (comprising some of the symptoms that have been enumerated above)
may be submerged into the second or whooping stage. The first stage
may last from four to five days to as many weeks. The second stage is
when the peculiar sound or whoop begins; it consists of a great number
of violent paroxysms, rapidly-recurring spasmodic coughs, until most of
the air in the lungs is expired; there is then a sense of suffocation
and the child becomes bluish red over the entire head and face, from
which the German designation _blue cough_ has originated. During this
spell the face swells and the eyeballs become congested and bulge
from their orbits and the nose often begins to bleed, while the urine
and feces are often involuntarily ejected and the contents of the
stomach thrown up from the violent contraction of the diaphragm. In
a few moments the spell is broken by a protracted, whistling croupy
inspiration, and this constitutes the whoop.
The whooping generally grows worse the first two or three weeks, after
which time in favorable cases the cough gradually becomes milder, but
this is not the rule by any means. I have had it in my own family to
last, in two instances, six months, and in another eight months before
the children had fully recovered.
Laughing or crying, swallowing dry, irritating morsels of food or cold
and impure air will bring on a paroxysm of cough. When several children
are affected together, the coughing of one will make the others cough.
The third stage is when the cough is wearing off and has lost
its severity. The expectoration consists now of a yellowish or
green-colored mucus; in otherwise healthy children this lasts only a
few weeks, but in weakly or scrofulous ones it may last for several
months. This disease is not as yet thoroughly understood. It is an
epidemic, contagious bronchial catarrh, involving the nerves of
respiration and attacks an individual but once. When complications
arise the affection becomes exceedingly dangerous and the most common
of these is pneumonia.
There is no specific cure for whooping cough; it has got to run its
course, which may be either short or long. I have tried every agent
so far known to scientific medicine, and there is none that will give
prompt relief in every instance. Whooping cough being a bronchitis plus
something else, it seems rational that the same precautions that are
observed in a case of bronchitis should be followed here. Children with
this affection must not be exposed to drafts or rough winds lest they
get cold, which might seriously complicate matters. In summer when the
weather is warm, outdoor life is beneficial in hastening recovery. Some
children have the cough so light, that no extra precautions seem to
be necessary; they have no fever, eat, feel and sleep well. But those
who are feverish, who vomit freely, and whose appetite is capricious,
require every attention. Their diet should be especially guarded, so
that all dry, irritating nutriments are prohibited, and so that the
diet consists principally of liquid nourishment. Warm drinks have a
favorable influence on the disease; a plentiful supply of warm milk,
first thoroughly beaten with an egg beater is the most suitable and
convenient. The milk punch is often borne well, and the little whisky
that enters into its composition is a needed stimulant to the sufferer;
broths may be given for a change, and to these the yolk of an egg can
be added with advantage. A great many remedies might be suggested, but
the one which has served my purpose the best, is the following:
Take: Deodorized tincture, of opium ½ dram
Fluid extract, of belladonna 4 drops
Fluid extract, of ipecac. 10 drops
Simple syrup 2 ounces
For a child five years old, give a teaspoonful three or four times a
day; older or younger children in proportion. If the cough is hard
and dry, ten to twenty drops of syrup of ipecac alone should be given
instead of the mixture, and when the cough is loosened, the mixture
can be again administered. When in the course of the affection the
breathing suddenly becomes labored, and the fever increases, it is fair
to presume that the case is complicated with pneumonia.
(_i_) Eruptive fevers, as their name implies, are characterized by an
eruption or exanthema. The most virulent of this class is smallpox. The
eruption of this disease is of the nature of vesicles, or pustules,
while that of measles, scarlatina, and rose rash is dry, and is
properly called a _rash_. Chickenpox, however, has also vesicles and
pustules, and for this reason it is very liable in times of an epidemic
of smallpox to be mistaken for a mild form of the latter disease.
For obvious reasons it is not proper to consider smallpox in this
connection; its gravity and its management require experience, and
further, it generally comes under special quarantine regulations of the
proper constituted authorities.
The eruptive fevers are all divided into three stages, namely: a stage
of invasion or development; a second stage when the eruption appears,
and while it lasts; and a third stage, that of _desquamation_, when the
eruption begins to fade or exfoliate in branny scales.
(_j_) Measles is generally a mild and not serious disease, and only
attacks the individual but once in a lifetime; only through gross
carelessness the disease becomes complicated, and then it may become a
very dangerous affection. It begins with all the symptoms of a common
cold. There is frequent sneezing, and an acrid muco-serous discharge
from the nostrils. The eyes are irritable, reddened and watery, and
there is more or less intolerance of light. The voice becomes hoarse
and there is always a bronchitis present which is characterized by
a dry, harsh cough. The patient is generally feverish, alternating
with chilly sensations or shivering; the appetite is poor or absent
and in some cases there is nausea and vomiting. The children feel
drowsy; they complain of pain in the head and limbs and want to lounge
around. The bowels may be constipated, but diarrhœa supervenes in
a certain proportion of cases. In nervous children convulsions may
occur; bleeding from the nose and false croup are not infrequently met
with in the development of this disease. The duration of the first
stage varies greatly in different individuals, and comprises a period
extending from one to seven days. The eruption begins generally on the
temples and forehead, whence it extends over the head and neck, thence
down the back and over the entire body, occupying in its development
from thirty-six to forty-eight hours. The eruption bears a resemblance
to flea bites at first; it appears as minute red specks which gradually
enlarge and become slightly elevated and arrange themselves in circular
clusters. The portions of the skin that are free from the eruption
retain their white appearance; the face is more or less swollen and the
eyelids puffed. In some patients there is considerable annoyance from
itching in the skin. The cough and bronchitis continue to be prominent
symptoms, and the expectoration, consisting of yellowish sputa becomes
abundant. In some children the fever runs very high in this stage and
they become delirious and restless, but this is only temporary, for it
generally diminishes with the eruption on the third or fourth day.
When the eruption begins to fade the third stage of the affection is
inaugurated, and when there exist no complications, the patient may now
be considered on the way to recovery which takes from four to eight
days longer.
The treatment in measles should consist in good nursing, rather than
in medication. Owing to the inflammation of the membranes of the
eyes, the patient should be kept in a darkened chamber, and the eyes
occasionally bathed with a solution of borax, by dissolving half a
teaspoonful in a tumblerful of water. Good judgment forbids that the
patient should be sweltered, but that he should be kept comfortably
warm and never allowed to cool off suddenly is also very important.
When the eruption is slow to develop a good sweat will often bring it
out; so will undue exposure, to cold drafts and the transportation out
of a warm bed into a cold one or drinking immoderately of cold drinks
either delay the development of the eruption or drive it back, and
from this undoubtedly dangerous complications arise, like pneumonia,
diphtheritic croup, and convulsions. A mouthful of cold water now and
then is harmless, but on the whole the drinks should be quite warm; the
cough and bronchitis alone would require that.
Warm milk thoroughly beaten is the most suitable form of diet; broths
and soups may be given for a change, so can a mixture of equal parts of
weak hot tea and milk. The bowels should be moved with a mild laxative
and if the fever runs very high, ten to fifteen drops of the sweet
spirits of nitre, for a child five years old, in half wineglass of
water every few hours will generally reduce the temperature. For the
itching, the skin should be rubbed with equal parts of glycerine and
warm water. The cough is generally the most troublesome feature, and
the only symptom requiring regular medication; for this a good general
cough mixture will serve every purpose, such as:
Take: Compound mixture of liquorice,
Syrup of wild cherry, of each 2 ounces
Mix and give to a child four years old a teaspoonful every four hours;
older or younger children in proportion.
(_k_) Rose rash, sometimes called false or German measles is a
comparatively trivial affection and of very little importance, for
it never has any serious complications and lasts only twenty-four or
forty-eight hours in the majority of cases. It is often mistaken for
measles, and one attack affords no protection against recurrences. The
eruption appears in small rose-colored spots or patches which are not
elevated. It does not commence on the head, but appears on different
parts of the body. The eruption may be preceded by headache, loss of
appetite, occasionally vomiting, and more or less fever or chilly
sensations.
The affection of the eyes and air passages, especially the bronchitis
which is characteristic of measles, are wanting in rose rash, and when
we hear of children having had measles several times it is reasonable
to presume that it was rose rash instead. This eruption hardly calls
for treatment, but a mild laxative and a regulated diet would fulfill
all requirements.
(_l_) Scarlet fever or scarlatina has received its name from the
color of its eruption. This affection presents itself differently in
different cases. It may be so mild in its attack that it constitutes a
trifling ailment and again it may be so severe that life is seriously
threatened, and destroyed in a few days. This has formed the basis of
dividing scarlatina into three varieties, namely: simple scarlatina,
diphtheritic scarlatina and malignant scarlatina.
The fever, as a rule, is notably higher than in other eruptive fevers.
The attack may begin with a chill, nausea and vomiting and headache.
There is also bleeding from the nose in a certain proportion of cases.
The most constant sign is redness and more or less swelling of the
throat, either with or without a sense of soreness and pain in the
act of swallowing. The stage of development lasts in the average
twenty-four hours, although exceptionally it may appear in a few hours
after the first symptoms of the disease have appeared. The eruption
often begins on the back first, and from there rapidly spreads over the
entire body in twenty-four hours. It greatly differs from the eruption
in measles in not allowing any healthy or white skin to intervene
between the red specks, but the entire skin has a reddish blush.
This has given rise to the expression _boiled lobster_ appearance
in scarlatina, and indeed nothing could illustrate the color of the
skin better than by comparing the one with the other. The eruption
is sometimes accompanied with a great deal of itching and burning
and reaches its fullest development on the third day after its first
appearance; it lasts from four to six days.
The extent and redness of the eruption varies greatly in different
individuals, in some it is very slight and transient while in others
there is not a spot as large as a dime which is not covered. Yet a very
light attack in one patient when communicated to another individual may
develop in that one a most malignant form. One attack secures against a
recurrence.
The throat affection seems to modify the eruption of the skin for in
some instances in which the throat is very bad, the skin eruption is
comparatively slight. There may be simply a little redness over the
tonsils, extending more or less over the soft palate, or on the other
hand, the disease in the throat may become in every respect equal to if
not identical with the worst type of diphtheria. Some writers consider
the sore throat of scarlatina and that of diphtheria identical, and
from a practical point of view there is certainly no difference, and
the very best results are obtained when all severe sore throats of
scarlatina are treated precisely as if they were diphtheria; this has
always been my practice.
The tongue is quite distinctive of the affection; early in the
development of the disease it is generally furred, but later the
coating peels off in patches, and these spots present the appearance of
a ripe _strawberry_; sometimes the entire surface of the tongue looks
as if cayenne pepper or red sand had been sprinkled on it.
The fever generally increases during the eruptive stage, and the skin
becomes very dry and hot. The pulse may run up to 130 to 140 per
minute, while the temperature runs up as high as 106° Fahrenheit; this
state of affairs places the patient in imminent danger, he now may
become restless and even delirious. In a certain proportion of cases
the kidneys become involved and albuminuria is a result, but this
usually passes off with the improvement and recovery of the patient.
In the third stage the cuticle begins to exfoliate in the form of
branny scales. In the absence of serious complications this stage marks
the beginning of convalescence; the fever subsides, the appetite
returns, and the soreness and redness of the throat disappear.
The treatment of this affection always depends upon the nature of the
case. Simple scarlatina requires no medical treatment; the precaution
and intelligence which are comprised in good nursing supply everything
that is required. There is not the same danger of the eruption striking
in with scarlatina as there is with measles, and the patient need not
be kept so warmly covered. When the fever runs very high, sponging the
surface with cool water is very grateful and reduces the temperature.
After the eruption has thoroughly developed, the water for sponging off
may be very cold without the least danger, and this may be repeated
as often as comfort or the high temperature demands. To relieve the
burning and itching of the skin, the entire body should be rubbed
over with glycerine night and morning; this relieves the system and
makes the skin moist and supple. If the throat is only reddened, a
teaspoonful of chlorate of potash dissolved in a cupful of hot water
and when cold used as a gargle and a teaspoonful of the solution
swallowed at the same time every two hours is all that is necessary.
The diphtheritic scarlatina is treated precisely similar to and
according to the instructions laid down for diphtheria in another part
of this work. Move the bowels freely with the Femina laxative syrup.
(_m_) Chickenpox has neither distressing symptoms nor is it significant
as regards danger. It is an eruptive fever which occasionally affects
adults, but for the most part children. The eruption is generally
preceded by a slight fever and nausea, and appears first on the body
and afterwards on the scalp where it is usually more abundant. There
always remains healthy white skin between the vesicles, which at first
contain a transparent liquid, hence called by the Germans waterpox,
which afterward becomes cloudy or opaline. The eruption begins to dry
up from the fifth to the seventh day forming granular crusts that are
sometimes followed by pitting. The disease is contagious and develops
twelve to seventeen days after the exposure. Chickenpox claims no
treatment; its only point of interest is its resemblance to varioloid,
but as a successful vaccination guarantees against the latter, and as
the vesicles of varioloid have a central depression while those of
chickenpox have not, the individuality of the affection is readily
established.
CHAPTER XXXI.
EMERGENCY TREATMENT IN SUDDEN ACCIDENTS.
IF the author reviews his experience of the last twenty years, he
recalls to memory innumerable instances in which the lack of a little
special knowledge, in cases of sudden accidents, did not only incur
useless physical suffering, but cost lives which otherwise might
have been saved. Knowledge of this nature is not intuitive, but must
be acquired by study. He therefore offers for the guidance of the
intelligent reader, common sense advice on the immediate management of
accidents which are liable to occur at almost any moment.
If a child falls any considerable distance to the ground, the system
receives a shock varying from the slightest functional disturbance to
complete insensibility.
In the former case there may probably be only slight pallor of the
countenance, the ideas become confused, there is a disposition to
yawn and a feeling of nausea. Young children have a disposition to
sleep, older ones rub their eyes, stare wildly around and even vomit,
but after a short time they resume their accustomed employment: these
symptoms illustrate a slight concussion of the brain.
When the injury is more serious all the above signs become aggravated
and it may take several hours before the normal condition is restored.
The proper course to pursue in all these accidents is to lay the
patient on a sofa or bed, with his head slightly elevated in a darkened
chamber free from all noise and confusion and let him fall to sleep. In
ordinary cases reaction takes place after a quiet slumber. If however
the patient complains of pains in the head and there is irritability
of temper, the advice of a competent physician becomes necessary.
(_a_) Broken bones or _fractures_ are defined to be a destruction of
the continuity of one or more of the bones of the body.
Fractures are divided into simple and compound; a simple fracture
is one in which the bone alone is broken, and in which the skin or
integument over the seat of the fracture remains perfectly intact.
A compound fracture is one in which the skin and tissues over the
fracture are lacerated or wounded so that the ends of the broken bones
protrude or are exposed to view.
In a case of fracture, no matter of what variety, the first object to
be accomplished is to carefully remove the patient to a place where he
may be in a comfortable position. If the fracture is in the arm or leg
it should be comfortably supported on a pillow so as to relieve the
injured limb from all strain.
In compound fractures, the wound should be carefully covered with a
soft clean compress which is kept thoroughly wetted with clean cold
water until the surgeon arrives.
Sometimes the circumstances make it necessary to remove or transport a
patient; then the injured limb must be properly supported so that it
will remain motionless on the journey. In case the arm is fractured the
above object is readily accomplished by placing it in a sling suspended
from the neck. In the case of the lower extremities this object is
more difficult. The leg should be wrapped in cotton first, or some
other soft clean substance, after which a slat should be placed on the
outside and inside of the limb, the same length as the limb; over and
around these slats strips of muslin or a bandage is wound so as to keep
them in place. This contrivance forms a temporary or improvised splint
until the surgeon takes charge of the case.
(_b_) Wounds are defined as a recent sudden solution of continuity
in the soft parts or flesh of the body. For the sake of convenience
in description and for practical purposes, wounds are divided into
incised, lacerated, contused, punctured, and poisoned wounds.
An incised wound is a clean smooth cut made by a sharp clean-cutting
instrument.
A lacerated wound is one in which the parts have been torn asunder or
in which the instrument was blunt or dull.
A contused wound is one the result of a bruise or blow inflicted with a
blunt object or by a flat surface.
A punctured wound is one in which the flesh is pierced with a
sharp-pointed instrument, like that made with a stiletto or bayonet.
Poisoned wounds are such as have become infected any time after the
receipt of the injury, or which are the result of a bite or sting from
a reptile or insect.
The danger of wounds depends on their extent and depth, and upon the
locality or organ in which the wound is situated. The external wounds,
that is those which admit of inspection, and situated on the head,
trunk or extremities are of most frequent occurrence, and the most
amenable to treatment.
The treatment of wounds has made wonderful progress since the
antiseptic discoveries of the eminent surgeon, Sir Joseph Lister,
and these sound principles have materially influenced almost every
department of the healing art. It was he who first showed how
dust-laden air affected injuriously the exposed tissues of the wounds;
it was he who introduced all the precautions as to cleanliness of
instruments; the disinfection of hands; the change of clothing; and
the purification of sponges and dressings. The magnificent results of
the practice of modern surgery are not owing to the superior skill of
the surgeon of our time, but to the magnificent conception of the idea
of _cleanliness_ from which has grown the entire superstructure of
antiseptic surgery, culminating in the grand triumphs of surgical art.
To the question What to do with recent wounds? The answer now becomes
self-evident; Keep them clean. The best dressing for any clean wound is
its own secretion carefully protected from the outside world by a fold
of clean soft cloth or absorbent cotton, wetted with pure cold water.
This is to be kept in its proper place by means of a bandage, and when
it is desirable to remove the compress, it must first be thoroughly
soaked with water so as not to tear or irritate the wound.
Before Lister’s great antiseptic discovery it was the generally
accepted opinion that suppuration and pus were essential to the healing
of wounds; this was an error and the opposite is now established to be
the truth. Pus prevents or rather delays the wounds from healing, and
suppuration in wounds is a fruitful source of blood poisoning.
If sand, earth, dust or dirt has gotten into or near the wound, it
must be washed off with clean, fresh water, but never employ soiled or
infected clothes for that purpose for these may poison the wound and
do a great deal of mischief. After the wound is clean dress it in the
manner described in a preceding paragraph.
Poisoned wounds are chiefly punctured. The danger of these wounds
lies in the possibility that the poison is absorbed by the lymphatics
and veins, and conveyed to the heart, whence the entire blood becomes
infected. To prevent this a ligature should be tied above the wound, by
means of a strip of muslin or preferably an elastic suspender, so as to
check the free return of the blood by the veins and lymphatics. After
which the poison should be sucked from the wound, or the wound should
be cauterized, with carbolic or nitric acid by means of a sharp-pointed
stick dipped into the acid and then applied to the wound, or _fired_
with a red-hot iron, crochet or knitting needle. The poison of snakes
and tarantulas is neutralized with an alkali; the most efficient seems
to be spirits of ammonia, but a strong solution of washing or even
baking soda should be substituted when ammonia is not at hand. I would
puncture and enlarge the wound of the sting with the point of a sharp
knife or scissors, so that the alkali can come into immediate contact
with the injected venom; the patient must be given frequent drinks of
whisky, brandy or strong wine until a physician arrives to supervise
further treatment.
Wounds inflicted by poisonous insects like the bumblebee, honeybee,
wasp, hornet, yellow jacket and mosquitoes produce wounds which are
instantly followed by a sharp, pungent, itching pain, and in a few
moments after by a pale, circumscribed, inflammatory swelling. Some
persons have a peculiarity in their constitution that the poison
of an insect gives rise to exceedingly alarming symptoms, such as
palpitation, nausea, dizziness, dimness of sight and an indescribable
sense of suffocation. The sting is sometimes left in the skin; for this
the wound should be carefully examined, and when present drawn out. The
most prompt and useful application is water of ammonia, or strong salt
water, or strong soapsuds. Turpentine is also a valuable application.
If the insect has lodged in the throat, large quantities of warm salt
water and mustard must be immediately administered until the patient
has vomited freely, and if there is a sense of suffocation leeches and
afterwards hot poultices should be applied to the neck. If the system
has become poisoned, and some of the distressing symptoms that were
above enumerated are present, the internal use of whisky or brandy is
called for.
Hemorrhage is common to all wounds, and the loss of the blood depends
upon the size and nature of the vessel that is injured.
The bleeding that takes place in ordinary superficial wounds oozes
from minute vessels, the capillaries, and slight pressure temporarily
applied controls it. When an artery is wounded, the blood flows in
intermittent jets, or in a running pulsating stream from the vessel.
The venous blood is dark red and flows in a continuous stream and not
under the same pressure as that coming from the arteries, hence it is
much easier controlled.
The clotted blood with which a wound may be filled, is nature’s means
of arresting the hemorrhage, and it must never be disturbed or washed
off, lest this open the blood vessels again and thereby renew the
bleeding.
The arrest of hemorrhage is accomplished by the application of cold
or ice water, by hot water and by pressure upon the arteries. Persons
fainting from the loss of blood should always be laid with their heads
lower than the body; cold water should be dashed into their faces so as
to restore them to consciousness. Moderate hemorrhage from the smallest
vessels and from the veins generally ceases from slight pressure over
the wounds or by drawing or pressing the edges of the wounds together.
In a very short time the blood coagulates and forms a temporary plug
until the vessels themselves become permanently sealed by a similar
process. The pressure must often be continued for a considerable time
until the object has been attained. A folded clean cloth or compress is
laid over the wound which is the source of the hemorrhage, and this is
retained by means of a properly adjusted bandage. If notwithstanding
the pressure exerted by the bandage or with the hands, the scarlet
blood saturates the cloth and continues to flow, it indicates that a
very large vessel is wounded, and thus life may be seriously threatened
and in proportion to the magnitude of the wounded vessel, a surgeon
should now be summoned to make a further investigation. Hemorrhage from
varicose veins of the legs may be checked by a compress fastened over
the site of the wound by a bandage, but every constriction around the
waist or above the knee by a garter must be loosened. If the patient’s
life is threatened from the bleeding, the limb must be elevated, and
the pressure of the compress increased, or the pressure should be
exerted on the trunk of the bleeding artery above the wound or injury.
(_c_) Burns and scalds are the most commonly fatal injuries which occur
in modern life. The extended use of steam machinery, the universal
employment of coal oil, the general use of the phosphorus and sulphur
matches, and the flowing manner of woman’s dress has materially
increased the liability of this accident. Of all accidents, burns
involve the victim in the most agonizing pain and protracted suffering.
Burns are liable to serious complications; the obstinacy to the healing
of vast ulcerated surfaces, or the lifelong mutilation to which they
condemn the unhappy patient, the rapid draft they make on the patient’s
strength, and the danger of abscess and ulceration of internal vital
organs which eventually destroy life.
These injuries have been classified into three divisions: First degree,
superficial skin irritation. Second degree, cutaneous inflammation.
Third degree, devitalization of the skin or deeper parts, or
carbonization of a member, or the entire body. The first degree is
only a superficial redness, fading without any definite edge into
the natural skin. This may be produced by the sudden and momentary
application of flame over a larger portion of the body, from an
explosion of gas. The local injury is not dangerous, and the epidermis
remains to protect the surface of the true skin until a new layer is
produced, as the injured one peels off. This hardly calls for any other
treatment but one or several applications of sweet oil. In the second
degree, the local injury has penetrated a little deeper, and the sudden
congestion of blood to the surface, raises the epidermis from the cutis
in blisters filled with the serum of its vessels. Here there is a more
serious condition, and indeed dangerous in proportion to the extent of
surface that has become involved. Skirts draped largely with lace, and
those made of cheese cloth, swiss, and other gauzy material are of a
very inflammable nature, and when once ignited blaze into a flame that
is almost sure to consume the material before it can be extinguished,
so that it has been deemed advisable on the German stage, to first
saturate these materials in a solution of sulphate of ammonia to make
them non-inflammable; this does not interfere with ironing, nor with
the texture or color of the fabric. Another source of scalds and burns
is the wash boiler or tub on the floor, with hot or boiling water in
it, so that little children stumble or reach into it. Vessels filled
with hot water or other fluids standing on tables or on stoves within
reach of little children, who innocently pull the vessel down, pouring
its scalding contents over them, is another cause of numerous accidents.
The best course to pursue when skirts or clothing are on fire is to
roll the victim, so as to smother the flames; but the patient herself
has rarely enough presence of mind to do this. She will run for help,
thus fanning the flames, the very worst thing she can do. Take the
nearest blanket or quilt, or if that is not at hand, take an overcoat
or wrap; wrap this around the burning person and throw her to the
floor and roll her until the flames are smothered. Then get some cold
water and pour it on the smoldering clothes until they are thoroughly
saturated, for the hot charred clothing burns into the flesh. In
scalding from hot water or steam the clothing should be cooled off in
the same manner. Cold water must be poured over the hot and steaming
clothes from head to foot, and thus the further action of the heat is
suddenly checked. The patient should now be carefully removed to a warm
room and laid in a blanket, on the table or floor. If he complains of
thirst give a cupful of warm tea or a warm whisky toddy.
Visitors and strangers should now be requested to leave the room and
the clothing should be removed from the body with the greatest care.
The scissors or a sharp knife should be used to cut away the garments,
so as to avoid all possible straining and dragging on the patient. The
blisters must not be torn, and where they are very tense they can be
pricked with a sharp needle, so as to allow the escape of the serum.
The epidermis forms the best protection for the cutis, and where the
skin is stuck to the linen do not tear this off, but allow it to remain
and cut with a sharp scissors around it. The application of cold water
generally increases the suffering, but sweet oil, lard oil, vaseline,
castor and china nut oil will answer for the emergency or until a more
suitable dressing can be obtained, after which the surface should
be covered with cotton batting to exclude the air. A very useful
application is a mixture of equal parts of lime water and sweet oil
or linseed oil. Carbolized sweet oil is another useful dressing and
superior to lime water liniment; it is made in proportion of half an
ounce of carbolic acid to one pint of sweet oil; either of the above
preparations can be poured over the burned surface and then it should
be covered with cotton batting, or small pieces of soft linen cloth can
be dipped and saturated in the oil and then applied over the burns.
The advice of a physician should be sought in view of the dangerous
complications that may occur from extensive burns.
(_d_) Frostbite is the result of exposure to cold, and in certain
regions during the winter months a considerable number are liable to
this accident. But extreme cold weather is not alone responsible for
frostbite; very often this accident occurs in moderately cold weather,
for instance, if persons exhausted from hunger or fatigued from long
travels or stupefied by alcoholic drink lay themselves down and fall
asleep, and a cold wind blows over them which withdraws the bodily
heat, the same effects are accomplished on the system.
The first effect of dry, cold air is a sense of numbness and weight,
with a peculiar prickling or tingling, and a rush of blood to the
surface, giving the skin a lively reddish appearance. If the cold is
maintained for any length of time the blood leaves the surface, which
becomes now of a pale and whitish aspect, forming a striking contrast
to the previous redness. When the cold is suddenly applied and very
intense, the skin exhibits a mottled appearance, which is due to the
presence of congealed blood in the subcutaneous veins.
Moist cold has a similar effect on the living tissues to dry cold. If
the hand is immersed in iced water the blood rushes immediately to the
surface, so that the color of the skin increases, which is followed by
a marked degree of numbness, and an unpleasant burning and tingling
sensation. A reaction comes on in a short time, the blood quits the
surface, and the skin becomes bleached and contracts, the tissues
underneath also shrink and become painful. There is no difference in
the effect of either moist or dry cold, only that the former is more
penetrating and its effects are sooner apparent. Those parts of the
body that are more directly exposed and in which the circulation is
not much protected by fatty tissue, suffer the most from the effects
of cold; after exposure for an unusual length of time the toes, feet,
heels, fingers, hands, nose, and ears, together with the lips and
cheeks are for this reason oftener affected than other parts of the
body. Persons whose constitutions are broken down by intemperance,
starvation and other privations which lower the power of resistance are
more susceptible to this accident.
The first effect of cold in the general system is bracing and
stimulating; an agreeable glow is felt over the surface of the body and
one feels strengthened and exhilarated. But if the cold temperature
is unusually prolonged this agreeable sensation is changed into one
of pain and drowsiness; the brain becomes inactive as if under the
influence of a powerful opiate or narcotic, and the desire to go to
sleep is so strong that it requires the greatest effort to keep awake.
To yield to this inclination to sleep would result in slumber that
knows no waking, for the blood would now rapidly accumulate in the
internal organs, the breathing would become irregular and spasmodic,
the nervous functions would soon be suspended and death would ensue
from general paralysis. An individual thus exposed, so as to have
become drowsy or unconscious and then suddenly brought into a hot
room is likely to die from congestion of the brain and lungs, or if
he should revive for a short time, the frost-bitten parts will be
stricken with mortification. Professor Samuel D. Gross says: “The
treatment of frostbite requires no little judgment and adroitness to
conduct it to a successful issue. The great indication is to recall
the affected parts gradually to their natural condition by restoring
circulation and sensibility, in the most gentle and cautious manner,
not suddenly, or by severe measures. The first thing to be done is to
immerse them in iced water, or rub them with snow, the friction being
made as carefully and lightly as possible, lest overaction be produced,
as they are necessarily greatly weakened. If no ice or snow is at
hand, the coldest well water that can be procured must be used; and if
immersion is inconvenient, wet cloths are applied, with the precaution
of maintaining the supply of cold and moisture by constant irrigation.
Moderate reaction is aimed at and fostered. All warm applications,
whether dry or moist, are scrupulously refrained from; the patient
must not approach the fire, nor immerse his limbs in hot water, or
even be in a warm room. Attention to these precepts must on no account
be disregarded, as its neglect would be almost certainly followed by
mortification or other disastrous consequences.”
(_e_) Drowning or the submersion of an individual until life is
destroyed by suffocation is not an uncommon accident. “The immediate
cause of death in drowning,” says Dr. Gross, “is suffocation or
insufficiency of air. Respiration being thus arrested, the blood is
unaerated and consequently unfitted for life, although the circulation
may go on for a short time after breathing has completely ceased.”
The Navarino sponge divers whose occupation has accustomed them to live
under water the extreme limit, average only seventy-six seconds, while
the Ceylon pearl divers seldom remain under water with impunity more
than two-thirds of that time.
Dr. Gross says: “The period at which a person after submersion may be
resuscitated varies very much in different cases and under different
circumstances. In some cases, for reasons not always explicable,
recovery is found to be impossible at the end of one minute. The
chances are never good after submersion of twice this length of time,
especially when the water and the air are both uncommonly cold.
“The treatment of apnœa from drowning must be prompt and decided. Every
moment of time is most precious. The body being removed from the water
to a dry place, is immediately stripped, wiped, and covered with a
blanket, especially in cold weather. The mouth, nostrils and throat are
cleared of mucus, froth, and any other substances likely to interfere
with the admission of air to the lungs; the tongue is to be pulled
out at the corner of the mouth, and prevented from falling back upon
the glottis; ammonia is rapidly passed to and fro under the nose; and
the body is stretched out at full length with the face downwards, the
forehead resting upon one arm, for the purpose of allowing any water
that may be in the stomach and air passages to escape by the mouth and
nose. If these means do not speedily revive the patient, artificial
respiration is instituted. For this purpose, the body being placed
upon its back, with the head slightly elevated, the arms, grasped just
above the elbows, are carried outwards and upwards from the chest
almost perpendicularly, and retained in this position for about two
seconds, the object of the procedure being designed to promote the
introduction of air into the lungs as in natural breathing. They are
then lowered and brought closely to the sides of the chest, where they
are held for the same length of time, to expel the air, the effect
being aided by pressure applied to the inferior and lateral portions
of the chest. These alternate movements of elevation and depression
from twelve to fourteen times a minute, and are performed with all
possible gentleness. As soon as signs of life are observed, dry warmth
should be applied to the extremities, the region of the heart, loins,
and abdomen, a little brandy and water being administered, or if
deglutition be impracticable, thrown into the rectum.”
(_f_) Poisons and their antidotes form an important subject for our
consideration, because many of the poisons are among the most useful
remedies. The daily accounts in the public press of serious and
fatal mistakes in the administration of medicines, are always due to
carelessness and very often to criminal negligence.
No package or bottle should be kept about the house without its proper
label.
Those that contain poisonous drugs or chemical preparations should be
plainly marked POISON, besides the name of their contents.
Vials or packages containing poisonous drugs or chemicals must not be
kept on the same shelf and near those medicines that are comparatively
harmless.
Always look at the label twice; once before the contents are poured
out, and a second time, before the dose is swallowed. Never take
medicine in the dark, in the belief that you are certain of the right
vial and locality; many a sad accident has occurred from this venture.
Sulphuric, nitric, and muriatic acid cause great heat and a sensation
of burning pain from the mouth down to the stomach. Acids are
neutralized by alkalies, hence one teaspoonful of washing soda or two
teaspoonfuls of bicarbonate of soda dissolved in a pint of water should
be drunk as soon as possible: chalk or powdered magnesia mixed with
water will also answer the purpose.
Oxalic acid is frequently mistaken for Epsom salts; lime water,
chalk or magnesia mixed with water and taken in large quantities are
antidotes: then administer emetics, which act more quickly if the
stomach is filled with fluids; sometimes the finger run down the throat
will excite quick and sufficient vomiting.
Creosote and carbolic acid benumb the stomach so that emetics usually
will not act, and large quantities of sweet oil or castor oil should
be first drunk; I prefer the former because from one to two pints
of it can be taken; after which lime water or a solution of Glauber
salt (sulphate of sodium) should be taken; the latter is especially
recommended as neutralizing carbolic acid. When circumstances make it
possible the stomach pump or india rubber siphon tube should be at once
employed.
Alkalies, for example, caustic potassa, soda, lye, strong solution of
ammonia, earths and lime are neutralized by drinking vinegar or lemon
or lime juice; afterwards milk in water and flaxseed tea.
Arsenic: Give the white of eggs, lime water or chalk and water;
tablespoonful doses of carbonate of iron, mixed with water, or calcined
magnesia in the same manner, then evacuate the stomach with an ipecac
emetic.
Corrosive sublimate: Give white of eggs, or wheat flour mixed with
water; afterwards give an emetic.
Alcohol: First cleanse out the stomach with an emetic, then dash cold
water on the head and give frequent doses of aromatic spirits of
ammonia in water.
Charcoal or coal gas poisoning: Remove the patient into the open air,
dash cold water on the head and body and stimulate by passing ammonia
to and fro under the nostrils, at the same time rubbing the chest
briskly.
Lead: White lead and sugar of lead should first be treated with alum
emetic, afterwards a cathartic of castor oil or Epsom salt.
Nitrate of silver (lunar caustic): Give a strong solution of common
salt, and then emetics.
Prussic acid or cyanide of potassium. For this no certain antidote
exists, and it destroys life so suddenly as scarcely to allow of
use if we had one. When there is time chlorine in solution has been
recommended, also water of ammonia and cold affusions.
Opium, laudanum and morphine require the same antidote. If the patient
can swallow an emetic should be given; twenty grains of sulphate of
zinc and a teaspoonful of powdered ipecac mixed in a draught of water
should be given every twenty or thirty minutes until vomiting is
insured. A mixture of half teaspoonful of mustard and a tablespoonful
of salt dissolved in a pint or quart of warm water is another efficient
emetic in these cases. If swallowing is impossible the stomach pump
must be used. When the stomach is cleansed out give strong coffee and
acid drinks, dash cold water on the head and keep the patient walking.
Belladonna and black henbane: Give emetics, and afterwards a dose of
paregoric, and a hot whisky toddy, or a cupful of strong tea.
Nux Vomica and strychnine have no reliable chemical antidote; emetics
should first be given, or the stomach washed out with a siphon tube or
stomach pump. Chloroform must be employed to control the spasms, then
alcoholic stimulants should be freely administered.
Aconite, digitalis, hemlock, lobelia, cantharides, poisonous mushrooms
or toadstools, etc., have no certain antidotes. Emetics should be
immediately given when any of them are known to have been taken. Animal
charcoal is recommended to absorb and render harmless organic poisons
in the stomach; teaspoonful doses mixed with water should be given
repeatedly, and for those drugs least depressing in their action castor
oil is also recommended.
When a prompt emetic is urgently demanded and no drugs of any kind are
at hand, large quantities of tepid water should be drunk, say half
gallon to a gallon; this distends the stomach mechanically, and by
titillating the throat prompt and effective vomiting may be excited;
this may be repeated as often as necessary and the stomach thoroughly
washed out.
CHAPTER XXXII.
SOMETHING ABOUT DIET.
IT has been truthfully said that “many persons dig their graves with
their teeth,” but, that improper feeding causes many a grave to be dug
is also true.
So never feel sorry or disappointed when the family physician makes a
professional visit, and fails to write a prescription, but instead,
gives you instruction in the art of feeding and nursing the patient.
Food and stimulants support the strength of the system until the
struggle between health and disease or between life and death is
overcome, and thus cure the patient by not allowing him to starve.
There is a large group of diseases for which there are no acknowledged
remedies, and in which a properly selected and regulated diet forms the
mainstay of successful treatment. This should be combined with healthy,
clean rooms, proper ventilation, and other hygienic means which may
suggest themselves to the intelligent practitioner.
The patient’s fancy for this or that article of diet is no index, as a
rule, of what is best suited for him; invalid appetites and cravings
are abnormal; they are like that of the chlorotic girl who eats chalk
and slate pencils, instead of wholesome food and some preparation of
iron.
An aversion to food is also no criterion of the patient’s need for
nourishment, for the sense of taste is generally blunted or perverted.
The desire for food is lost in all diseases of a catarrhal nature of
the mouth or stomach, and in those that are characterized by high
temperature. In typhoid fever and diseases of a typhoid nature this is
always the case.
With children this aversion to food is greater and more general than
with adults; and it must be made a rule that their refusal to take
nourishment must not be extended beyond several days, otherwise they
fail so rapidly in conjunction with the disease as to perish from
exhaustion.
The repugnance to food arises from abnormal conditions that are
generally localized in the mouth and especially in the parts of the
tongue which are supplied by the nerves of taste; these nerves are
the lingual branch of the trifacial and the glasso-pharyngeal. But
notwithstanding that the food is almost tasteless, when it gets into
the stomach it is retained and properly digested and the patient feels
better for having taken it. An appetite can be thus cultivated, and
after a few days of coaxing or perhaps of forcible feeding, which in
children who are failing rapidly becomes necessary in order to save
them, the taste and desire for nourishment become natural or restored.
Quite often patients beg and plead not to be given food; but in wasting
diseases it should be insisted that some at least should be taken
(always liquid of course), and when they are sufficiently rational they
will always afterward admit that the nourishment did them good.
Liquid food or nourishment and no other is suitable for a sick
person; an invalid can drink food when it would be impossible for him
to swallow solid material. I have often seen the whim of patients
who craved meat indulged; they got a juicy porterhouse steak with
the understanding that it was to be thoroughly masticated before
swallowing. As a rule, the patient is disappointed with his own bill
of fare, and after trying one or two mouthfuls orders the meat taken
away with the remark that it is as dry as a chip. But this same person
will drink a milk punch, a thin gruel with the yellow or all of an
egg beaten into it, with some degree of relish; salt should always be
added and indeed, as much as the taste will permit, but sugar should
be used as sparingly as possible. Salt is what is needed above all
other seasoning; the system requires the chlorides for they are wasted
in fevers, but even in health, the chlorides are very essential and
salt is the best one we have; salt is the source of the hydrochloric
acid in the stomach and one of the most important factors in albuminous
digestion.
The saliva is not secreted in sufficient quantity in fever to allow
insalivation of food, or to moisten the solid morsel sufficiently to
permit its being swallowed without a choking sensation as it glides
into the stomach. A person prostrated by disease has not the strength
to masticate solid food and that is another reason why liquid food is
to be given.
The famous physiologist, Dr. E. Brown-Séquard, is the author of a
method for feeding the sick peculiarly his own, namely, that of
administering small quantities of food at short intervals. He would
give a glassful of milk punch in tablespoonful doses, repeating every
ten or fifteen minutes; this method is advised for the treatment and
cure of dyspepsia, anæmia, chlorosis, nervous diseases and even organic
diseases of the stomach. No particular kind of food was selected for
this treatment; butter, milk, cheese, and meats, bread and potatoes
were alike to be given in small quantities and at short intervals. One
or two mouthfuls even to be eaten at a time, and then repeated in ten
or fifteen minutes, until thirty to forty ounces are consumed daily.
This system never became a recognized expedient, it is wrong in theory,
and certainly in practice; while it may be applicable in isolated
cases, they would be so very few that this method of feeding forms the
exception and not the rule.
Cases are frequently met with, especially in infants and older children
whose digestion has been completely ruined by being fed too often.
These cases are not really overfed, because the entire amount in
the twenty-four hours, does not exceed the requisite quantity; but
giving the food in driblets and at short intervals, causes lactic
fermentation, or in plain English, the food sours on the stomach and
does not digest, as it would do if a proper time were interposed
between each feeding. As soon as the patients are fed at regular and
longer intervals, say, from two to four hours, the indigestion corrects
itself. During the interval, between the time set for feeding, the
children will naturally cry; this is interpreted by the mother or nurse
as a sign of hunger, but nothing is oftener further from the truth. The
child cries generally for one of three reasons: one of these may be
that it wants to be taken up, and dandled or rocked, to which previous
indulgences have accustomed it; or it may have pain in the stomach and
bowels as a natural result of indigestion or flatulence; or the child
may cry from thirst or a sensation of dryness in the mouth and throat;
in any event, additional food would only prove injurious. There is no
objection against giving nurslings cold water between their meals when
they are thirsty or feverish, but warm aromatic tea is so very much
superior that I consider it one of the essentials of the nursery. I
mean fennel seed tea, of which a sufficient quantity should be prepared
every morning to last twenty-four hours; this should be strained and
sweetened, then set aside for further use. When the child is restless,
between meals, some of the tea should be warmed, and given from the
nursing bottle until it is satisfied, for the tea soothes the pain,
quenches the thirst and dispels the flatus.
There are also physiological reasons for these longer intervals
between nursing; they allow the stomach sufficient time to dispose of
its contents before another mess is given to disturb the digestion
of former food, which is as yet incomplete. There is another immense
advantage in having the length of time between two meals from two
to four hours; it allows time for medication and other necessary
management of the sick, for sponging off with cold water in fevers, and
many other things which are necessary for the patient’s comfort and
convalescence, and which can only be carried out between the times the
nourishment is given. A memorandum should be kept in the sick room and
the time and hour noted when everything becomes due in proper order;
this avoids confusion and lessens labor.
Digestion is the solution of the food in the stomach for purposes
of nutrition. Nitrogenous materials, egg, meat, muscle are digested
principally in the stomach, but not entirely so, because the particles
of albuminous food which pass from the stomach into the upper portion
of the small intestine come into contact with the pancreatic fluid,
which is the digestive agent for fats and starches, but which possesses
also powerful digestive properties for nitrogenous or albuminous
substances and even in a greater degree than the gastric juice of the
stomach, which has a strong acid reaction, while the pancreatic juice
has an alkali reaction; here is a very interesting illustration how
similar digestive processes are accomplished under opposite chemical
conditions. The intelligent reader must not fail to observe, from
what has been said, that there are two distinctly different digestive
processes, namely one going on in the stomach and another equally as
important taking place in the small intestines.
Pepsin is the active principle of the gastric juice, held in solution
in a clear colorless liquid, principally water; it has a sour taste
and a peculiar characteristic sour smell. The length of time required
by the gastric fluid to dissolve the food depends greatly upon the
minuteness of the division of the solid substances to be acted upon, as
well as upon the quantity and quality of the peptic fluid.
The pepsin changes the physical properties of nitrogenous substances
so as to make them soluble in water in any proportion and when the
albuminoids have acquired this property they are termed peptones;
peptones are simply nitrogenous food which has been modified to fit it
for absorption and nutrition of the body.
In the tissues of the body there are continual changes going on, termed
in technical language tissue metamorphosis; the waste products that are
thus formed constitute a group of highly nitrogenized substances, which
in a healthy condition of the system are eliminated by the kidneys.
These nitrogenized products are urea, urate of soda and uric acid;
the accumulation of any of these substances in the blood gives rise
to disease; the former is the cause of uræmia and uræmic convulsions,
and the latter have been detected in the blood and exudations in cases
of gouty and rheumatic disease. The characteristic gouty deposit is
urate of soda, due to an excess of nitrogenous elements of the blood.
An excess of uric acid constitutes a disease which is first recognized
by a reddish crystalline sediment in the urine; the term _lithiasis_
has been employed to denote this peculiarity. These lithates are always
to be found in the urine of high livers and are due to an excessive
consumption of nitrogenous food. The great English authority, Dr.
Murchison, looks upon the excessive production of uric acid, or lithic
acid, as it is sometimes called, as due to one of two causes and
sometimes to both, namely to the excessive consumption of nitrogenous
food, or to an inability of the liver to perform its duty, which among
other things is to dispose of the nitrogenous waste products. From
this point of view lithates or brick dust deposits in the urine are
no sign that the kidneys are deranged, but quite the reverse may be
true when the kidneys are overburdened in eliminating this excessive
waste, for they are performing extra duty, which excess in living or a
sluggish liver imposes upon them, and this may excite inflammation in
the tissues of the kidneys and develop into what is known as Bright’s
disease.
This very interesting exposition of the deposit of lithates or gravel
in the urine will naturally suggest that when the urine is overloaded
with these nitrogenous products nitrogenous food like eggs, cheese,
beef, etc., should not be eaten for awhile, and that a vegetable diet
should be principally relied upon, thus giving the liver a vacation;
the diet should be supplemented with plenty of clean fresh water, and
no liquors of any sort should be taken by those whose liver is affected.
Starch, sugar and fat are composed of carbon, hydrogen and oxygen;
starches and sugars are termed carbo-hydrates; because the hydrogen
and oxygen is always present in them in equal atomic weights so as to
represent water; while in the fats the oxygen is considerably less.
This is exemplified by comparing the chemical equivalents of starch and
cane sugar with those of fats:
Starch C_{12}H_{10}O_{10} Oleine C_{94}H_{87}O_{15}
Cane sugar C_{12}H_{11}O_{11} Margarine C_{76}H_{75}O_{12}
When starch is boiled with diluted nitric, sulphuric or muriatic acid
for thirty-six to forty hours, it becomes colorless and thin like
water, and is converted into a species of sugar. A similar process
takes place when starch is taken as food, the diastase of the saliva,
and the pancreatic and intestinal juices change starch into _glucose_,
in which form it is ready for nutrition.
Cane and other sugars introduced into the system as ingredients of
fruits and vegetables are not absorbed as such, but undergo a process
of digestion which converts them into grape sugar or glucose; after
that they are suitable for nutrition and absorption into the blood, but
not before.
The digestion of starches and sugars has been incidentally referred
to as not taking place in the stomach but in the upper portion of the
small intestine, through the agency of the pancreatic juice which has
the peculiar property of converting farinaceous and saccharine matters
into grape sugar. But this transformation into grape sugar is not
the final product of digestion. In the normal process of intestinal
absorption the grape sugar is taken up by the portal capillary vessels
and carried to the liver, where under the influence of this organ it
is changed into liver sugar or glycogen, and it is as glycogen that it
again enters the circulation, to disappear in the lungs. But if the
liver from disease or other causes fails to perform this task, the
glucose passes through the organ unaltered, and as such again enters
the circulation where it acts as an irritant and finally is eliminated
by the kidneys in the urine giving rise to the affection known as
diabetes.
We have learned that there is a stomachic digestion and an intestinal
digestion, the former principally for meats, or that class which are
now called nitrogenous foods, while the latter is confined generally
to starches and fats. This physiological fact suggested the idea of
feeding dyspeptics only on such food as is not acted upon in the
stomach, but passes beyond that cavity to become digested in the
small intestines, giving the stomach a rest as it were so that it
may recuperate and gain strength while the system is being fed by
farinaceous aliments. While a superficial glance justified such a
procedure, a moment’s reflection proves it to be a delusion, and
for this reason, that there will be an unavoidable irritation of
the stomach which the journey of the farinaceous material occasions
in its passage through the stomach, and the insufficient nutritive
value of a simple non-nitrogenous diet causes a rapid loss of tissue
and bodily strength; hence this course proved itself impracticable
and was abandoned. Then again the experiment was tried of putting a
certain class of dyspeptics on a purely meat diet; this had one fault
common with the former plan; it was also too one-sided, and the system
suffered for want of fat and starch, and secondly peptones were not
always formed in the stomach from a deficiency of the gastric juice or
an impairment of its quality, so that this method was also abandoned.
Fats belong to the starches and sugars as heat producers; they are
insoluble in water, and by boiling them in caustic alkali they are
decomposed into soap and glycerine. In the cavity of the stomach fats
remain unaltered; the heat of the stomach may melt or liquefy them,
but in no other way are they changed. They are also digested, like the
starches, in the small intestine by the action of the pancreatic juice
which possesses the remarkable property when brought in contact with
fatty or oily matter at the temperature of the body of emulsifying
it, and of converting the fats into a milky, white, opaque looking
fluid, by a minute subdivision of the oily particles. This emulsion of
the fatty and other substances of the food is termed chyle, and as
such, the fatty substances are ready for absorption by the absorbents
of the intestinal tract. Experience teaches that a deficiency of fat
causes scrofulous diseases, and this class of patients have generally a
repugnance for fat; this is another illustration of the unreliability
of patients to choose their own food. Professor John H. Bennet first
pointed out the usefulness of cod liver oil in consumption and other
scrofulous diseases, and directed attention to the value of fat in the
nutrition of the body.
Dr. Ferguson made extensive observations on the little children of the
factory operatives of Lancashire, Eng. The children were principally
fed on tea or water and bread, little or no fat, bacon, butter or
cream, and they grew up into puny and stunted men and women, while
those who had a bread and milk diet grew into hardier and finer human
specimens.
Fat is also an essential food for the brain and general nervous system;
the lean are the nervous patients and not the fat and sleek, hence
fatty food is considered an important diet for this class of diseases.
The brain and nerve fat is called “lecithin” and a little phosphorus
enters into its composition. Chronic obstinate neuralgia has often been
cured by the administration of cod liver oil.
Milk is the only single article of diet which possesses in itself
all the properties to supply the wants of the system, and it may be
profitable to give this subject more than passing notice. It is the
natural and most wholesome food for the infant when it can suck it from
its mother’s breast; instinctively the newborn rolls its little head
hither and thither in search for this fountain of infantile life and
however great the skill of the chemist in approaching the composition
of mother’s milk, he can never produce an equally good substitute. Milk
contains all the principles which are necessary for human food, the
nitrogenous, the oleaginous and the saccharine, and these are blended
in such proportion that milk is adapted for the complete nourishment
of the young and old. In no other single substance supplied by
nature does a similar combination exist; it contains the material
for the consolidation of bone and for the formation of the red blood
corpuscles, by carrying in solution the phosphates of lime, magnesia
and iron; in this respect an analysis of milk shows a remarkable
similarity to blood. The proportions of the different constituents of
milk are liable to great variations and are greatly influenced by the
nature of the food.
Dr. Playfair of London, who has made some interesting researches
regarding the milk of the cow, has demonstrated that the amount of
butter depends in part upon the quantity of oily matter in the food
and in part on the amount of exercise which the animal takes; and upon
the warmth of the atmosphere in which it is kept. Exercise and cold
weather eliminate the oily matter or butter, in the form of carbonic
acid and water, while rest and warmth diminish this drain by favoring
its passage into milk. On the other hand, the proportion of the cheesy
matter is increased by exercise.
In Switzerland, where the cattle pasture in very exposed situations and
where, from the rolling of the country, they are obliged to use a great
deal of muscular exertion the quantity of butter yielded by the cows
is very small, while the cheese is in unusually large proportions; but
the same cattle when stall fed give a large quantity of butter and very
little cheese.
The character of the food will decide the nature and healthfulness of
the milk. The best food for milch cows is bran or middlings mixed with
well-seasoned and sweet-cut hay, and this mixture thoroughly scalded
and saturated with boiling water; a little flaxseed oil cake, should be
added occasionally, for it enriches the milk and keeps the cattle in
good condition; during the day the cows should be in the open air; they
should not be irritated by dogs, or made to run or trot; these things
will affect the milk injuriously. To feed cows on kitchen garbage or
swill of any sort will taint the milk so that the offensive odors of
the swill can be readily detected, especially after the milk has stood
awhile; such milk is particularly dangerous to infants and should at
once be discontinued. Distillery slops are often fed to cattle in
large cities; these are not only productive of poisonous milk but
also injure the cattle so that they become salivated and lose their
teeth after a few years of this diet. Brewers’ grains are not open to
the same objection as whisky slops; a certain proportion of brewers’
grains added to the cut food increases the flow of milk. In all large
towns there are families who keep one or two cows and who sell the milk
as a means of making a livelihood: as a rule these cattle are fed on
swill, and not upon the best quality of food, and although this milk is
recommended as being pure and one cow’s milk, it is as a rule not good,
for the stalls and the food do not come up to the requirements for
wholesome milk.
I have always found a healthier and purer milk from the dairies run on
a large scale, and outside of the centers of population. The cattle
look healthier, have better food, good pasturage and pure country air,
and if the milk is properly chilled or cooled off before it is poured
into the wagon cans, country dairy milk is to be greatly preferred
over city milk. The animal heat should have left the milk before it is
put into cans for transportation, for it is the animal heat in tightly
closed vessels which causes the chemical changes that encourage the
development of organic milk poisons or so-called _ptomaines_.
Milk promiscuously mixed from a group of apparently healthy cows is
preferable to that of one cow, and for several reasons; the honesty
of dairymen is doubtful, for they will not take the extra trouble to
keep the milk of one cow apart when the cows are being milked; again
tuberculosis or consumption in all its stages is a common disease among
cattle, and quite often a milch cow has tuberculosis when she seems
healthy. If a child should subsist on the milk from a tuberculous cow,
serious consequences would undoubtedly ensue, but if this milk had
been mixed with that of thirty or forty healthy cows, the danger of
infection would be correspondingly lessened.
Cow’s milk should average 12 per cent. of cream; if it contain less
than 8 per cent., it is probable that the milk is watered or that it
was skimmed. A cream gauge is a cylindrical glass vessel about one
and a half inches in diameter and eight inches high, with a capacity
of 12 fluid ounces. This tubular measure is graduated so as to make
it possible to read off from the top downwards 1, 2, 3, etc., parts
or drams of cream which gradually rises to the surface. This glass is
filled with the suspected specimen of milk up to the highest mark and
set aside for 24 hours, at an ordinary temperature; at the expiration
of that time the quantity of cream which rose to the surface of the
milk is read off, and in this manner it is easy to see the proportion
of cream to the entire bulk of milk tested. Above it was stated that 12
per cent. is an average for good milk, and 14 per cent. is extra good,
while 8 per cent. is the lowest that is permissible. If the percentage
falls below 8 per cent. it is a sign that the milk has been skimmed,
and if the density or specific gravity is below 27 degrees, then it is
to be presumed that the milk has also been watered, for sometimes the
milk is both skimmed and watered.
The density or specific gravity of milk gives an approximate idea of
the quantity of solid matter a given specimen submitted for examination
contains, as compared with pure water. The lactometer or galactometer
is a kind of hydrometer, but specially graduated to readily read off
the density which pure milk should have. Pure milk at a temperature
of 55 to 60 degrees should have a specific gravity varying between 27
and 33 degrees and if the sample falls below 27 degrees, it is to be
presumed that water has been added. The density of diluted milk is
sometimes maintained by boiled starch water; this can be detected by
adding a few drops of tincture of iodine, which changes the starch into
a beautiful violet blue, also giving the adulterated milk a similar
tint.
It must always be remembered that while milk presents itself in a
liquid form it becomes a semi-solid in the stomach in the ordinary
process of digestion; this change is accomplished by the action of
the gastric ferment, curdling the milk. Milk is not a diluent for
solid foods and it should never be drank as a substitute for water
when other solid food has been eaten. The practice of eating a
regular meal of meat and vegetables and drinking milk at the same
time invariably overloads the stomach, and if it does not injure the
digestion immediately it is sure to do so in time; it also furnishes
an oversupply of nitrogenous food, developing an excess of lithates or
uric acid, and this burdens the liver and kidneys. If a person is fond
of milk it is most excellent as a principal article of diet at a meal,
and indeed nothing is better than a bowl of well-prepared mush or a
few slices of bread with a pint of fresh milk for either breakfast or
supper.
Boiled milk has considerable healing and binding virtues; it may be
thickened with a teaspoonful of wheat flour to the pint, and taken
quite warm; as a household remedy, it is one of the most valuable in
ordinary cases of diarrhœa, but no other food should be taken until the
cure is effected.
The milk cure is a well-established and recognized expedient for
the relief and cure of a certain class of patients, and as the
success of the regimen depends upon an intelligent employment of the
fluid, it becomes necessary to enter somewhat into the detail of its
administration.
The milk-shake, that is milk shaken in a tumbler or beaten with an
eggbeater for several minutes is frequently borne by persons who cannot
digest milk which has not been so treated; then again, a teaspoonful
of mush or gruel added to a tumblerful of milk and thoroughly beaten,
divides the curd mechanically when it forms in the stomach, and so
makes the milk much more soluble by the gastric juice.
Milk should never be drank cold, but at a temperature of about 100°
F., which is about as warm as it comes from the cow, for cold delays
the curdling and hence the digestion of the milk, and gives it time
to develop acid or lactic fermentation in the stomach, and this may
cause indigestion; a pinch of salt should be added to milk, it assists
in its digestion. There must be certain periods at which to take milk,
allowing a definite interval for the milk to digest; taking milk in
mouthfuls, for instance as a drink instead of water is wrong, for this
will ferment and occasion indigestion. The proper length to intervene
between each meal of milk is four hours; breakfast 8 o’clock, dinner
at 12 o’clock, lunch at 4 and supper at 8 o’clock; if the patient is
considerably exhausted, the time between 8 o’clock in the evening and
the same hour in the morning may be too long, and if the patient is
awake, a meal should be given at midnight.
The quantity of milk which may be taken for one meal is of great
importance, for there is the same danger of taking too much of this
food as of any other. The average quantity to begin with must not
exceed half a pint, and when the appetite is capricious one-fourth of a
pint is sufficient. It is now fully established that a grown person can
be fairly well nourished for quite a while on one quart of milk in the
twenty-four hours.
It is also of considerable importance to the patient that he does not
gulp the milk as this would cause it to curd into a large cohesive mass
of casein, which would be slowly dissolved or acted upon by the gastric
juice, and might give rise to distress from indigestion. If, on the
other hand, the patient sips the milk slowly, or eats it with a spoon,
the curds will be small and flaky particles which even a weak stomach
may digest. There are quite a number of persons who like milk, yet
whose stomachs do not take to it, and for these a milk cure might be
just the thing. It requires often a great deal of ingenuity to devise
a plan whereby the obstacle may be overcome. The first step should
be to shorten the interval between each meal and lessen the quantity
correspondingly; thus to give the patient the milk every hour would
imply that he was to take only one-fourth as much at a time as if he
took it every four hours. Perhaps the milk would digest more easily if
it were first beaten and slightly seasoned with a pinch of salt, or if
a little strained gruel were added to mechanically divide the curd. A
soda cracker, toasted bread, or the rind of thoroughly baked wheaten
bread is an excellent substitute for dividing the cheesy substance of
the milk when it gets into the stomach. They should not be soaked or
dipped into the milk and eaten together, but eaten dry and thoroughly
masticated until the saliva has reduced the bread to a soft pulp, after
which a spoonful of milk should be taken and the bread stuff washed
down. The saliva serves another useful purpose besides moistening the
bread as it changes the starchy substance into sugar.
In other cases the milk sours on the stomach, and then some antacid
or alkali, like lime water or bicarbonate of soda should be added
for several days or until the disposition to lactic fermentation has
subsided. If notwithstanding every precaution, waterbrash, heartburn,
or a heavy oppressed pain in the stomach occurs, or if sourish, slimy
secretions are vomited, the milk cure must be abandoned for something
else.
Diarrhœal diseases of infants who are fed on cow’s milk are caused,
in many instances, by germs or spores that get into the milk from
lack of proper cleanliness and from the unavoidable exposure of the
fluid to the atmosphere of stables and dairy rooms where the milk is
handled before transportation to consumers. To obviate the danger of
feeding nurslings with infected milk, and to destroy the vitality of
germs which find access to the milk, methods have been devised for
_sterilizing_ the milk. This process was first proposed in 1886 by
Professor Soxhlet, and has ever since gained favor with the profession;
it consists of exposing the milk to a temperature of live steam or
boiling water for about forty-five minutes. In New York City there are
two reliable firms which sterilize milk at the dairy in the country and
ship it to the city.
In all the methods of sterilization the milk is placed in six or
eight-ounce bottles and set on a tray or shelf, which stands above the
water at the bottom of a vessel, the cover then applied and the water
made to boil forty-five minutes; a perforated stopper is inserted into
each flask, admitting of the escape of air and gases at the beginning
of the heating process. The stopper may consist of cork with a glass
tube in the center, or cotton, or of rubber with a channel a part of
the distance on one side. If necessary the family can improvise their
own apparatus; an inverted tin pan will serve the purpose of a tray
to support the nursing bottles, and this placed in the bottom of an
ordinary tin vessel with a cover completes the contrivance. The milk
is to be prepared as it is to be administered, that is, the proper
quantity of water, a little sugar, and the point of a penknifeful of
bicarbonate of soda added, and distributed among as many eight-ounce
flasks or nursing bottles as the child is fed during the twenty-four
hours; thus if fed every four hours the milk should be distributed
among six flasks, and if fed every three hours, it would require eight
flasks. When the milk has been sterilized, it keeps sweet for an
indefinite period at ordinary temperature; the bottle is to be well
shaken to mix the cream before the cork is removed and the nipple
applied.
When an apparatus or a sufficient number of flasks cannot be readily
obtained I have the milk boiled in a fruit jar after the manner of
making beef tea, as follows: A quart preserve jar is filled with milk,
obtained not later than four to six hours after milking, the cover is
lightly put on, to allow the escape of air and gases, and then the
jar is put into a vessel, on the bottom of which an inverted pan has
been placed so that the preserve jar does not rest on the bottom of
the vessel where the heat would crack it; the vessel is then to be
filled a third with water, and this boiled for an hour, after which
the jar is carefully closed, as in preserving fruit, until wanted for
use. The milk should be kept in a cool and clean place, and only as
much measured out each time as is required for one mess, after which
immediately close the jar. The water that is to be used for diluting
the milk must have been thoroughly boiled; it is always better to
prepare and dilute the milk before sterilizing it for very young
infants, but when they are a year or more old, the boiling water may be
added at each meal.
The casein, which is the curd or coagulable part of milk, differs
greatly in its physical property in the milk of the cow from that in
human milk. Mother’s milk curds in _soft flaky coagula_ which are
readily dissolved in the infant’s stomach, while cow’s milk curds in
a semi-solid conglomerate coagulum which the cavity of the child’s
stomach is often unable to tolerate nor the gastric juice to penetrate
and dissolve. It is this heavy curd which forms the main objectionable
feature of cow’s milk as a substitute for that of the mother. This can
be greatly modified by first thoroughly beating or churning the cow’s
milk with an egg beater, and afterwards scalding it as above described;
the milk treated in this manner curds light and flaky. But it must not
be presumed that the physical characteristic of casein is the only
peculiarity of cow’s milk in comparison with mother’s milk, for this is
not so; it also differs in quantity, that is, mother’s milk has less of
casein, a fact which may be better understood by the following chemical
analysis of both:
Human milk. Cow’s milk.
Water 87.09 87.00
Casein and albumen 2.48 3.72
Fat 3.90 3.66
Sugar of milk 6.04 4.92
Phosphatic salts 0.49 0.70
—————— ——————
100.00 100.00
There are some children who are unable to digest cow’s milk in any
form, either from a peculiarity of constitution, or from a derangement
of the digestive apparatus; the milk, no matter how prepared, passes
through them curdled, in lumps and undigested; to continue feeding
infants on milk, notwithstanding this symptom would in all probability
sacrifice the life of the child. If curds persist in the stools milk
is to be withheld for a time, and crushed wheat, barley gruel or other
diluents should be given alone or in combination with the thoroughly
beaten white of egg. This treatment must be continued for several days
and in some cases for several weeks.
Whey prepared from sweet and pure milk has often been borne by delicate
and suffering infants, when nothing else could be retained. An
examination into the chemical composition of whey reveals astonishing
nutritive virtue, which it holds in solution; the following table shows
the proportional constituents in one hundred parts:
Water 93.31
Nitrogenous matter 0.82
Fat or butter 0.24
Sugar of milk 4.98
Fixed salt 0.65
When the whey is the product of soured milk, 0.33 or more of lactic
acid is to be added to this analysis, and the same amount deducted
from the sugar of milk. Essence of pepsin will curd lukewarm milk, not
warmer than can be agreeably borne by the mouth; a temperature higher
than one hundred and fifteen degrees Fahrenheit destroys the curdling
principle of the pepsin. The quantity of essence of pepsin to be used
to the pint of milk depends on the strength of the preparation; usually
a teaspoonful or two is added and stirred just enough to mix; let it
stand till firmly curded, then beat up with a fork until the curd is
finely divided; now strain and the whey is ready for use; it should
be sweetened a little; sugar of milk, if pure, would be the best,
otherwise white cane sugar may be used. A newborn babe will require a
tablespoonful to begin with, every two hours, always slightly warmed.
It is particularly essential to keep everything clean, especially the
tube and nipple; these are to be brushed and cleaned after each meal,
and then laid on a clean dry plate for future use; the nursing bottle
too must be rinsed and drained. The prevalent custom of keeping the
tube, nipple and bottle in water after they are washed is a bad one,
for to have them sweet and pure they should be allowed to dry out
between times.
Condensed milk is often a valuable substitute for fresh cow’s milk; its
utility, is probably due to the employment of heat in its manufacture,
which destroys the germs or spores that find their way into all milk,
and to the scalding of the casein which modifies its physical character
so that it no longer curds into large lumps when in the stomach, but
into smaller flakes. There are different brands in the market, and even
the best of them may be too old and shop worn; they then become thick
and dark in which condition they are no longer fit for infants’ food.
The Eagle and Anglo-Swiss are among the best varieties; others contain
too much sugar, while some are adulterated with starch or flour. A
heaping teaspoonful of condensed milk to a teacupful of warm water,
previously boiled, is the average strength, although better results
are obtained when a thin gruel of corn starch or arrowroot is employed
instead of plain water; when the child grows older cracked or rolled
oats or graham flour may be substituted for the arrowroot. The gruel
is prepared in the following manner: take half a teacupful of oatmeal
or graham flour, saturate first with cold water, then stir slowly into
three pints of boiling water; add a pinch of salt and boil over a slow
fire for three-quarters of an hour, stirring constantly so that it will
not scorch on the bottom; then strain, and if it has boiled down to
less than a quart of gruel, add a sufficient quantity of boiling water
through the strainer to make it measure a quart.
The gruel is to be prepared fresh every morning, and the above quantity
will last about twenty-four hours. It should be kept in a porcelain
or glass pitcher covered with a napkin, and set aside in a clean cool
place. At regular mealtimes take out the required quantity, warm in a
little agate saucepan, kept only for this purpose, and when warmed add
the condensed milk, stirring until it is dissolved. This makes a fine
cream-like food, agreeable to take and very nourishing if well borne by
the stomach. The stools may become too loose at times from the oat or
wheaten gruel, then this gruel should at once be changed for that of
corn starch or arrowroot until the bowels are regulated again, and when
that is done it may be advisable to return to the oatmeal or cracked
wheat. The exercise of a little judgment and close observation in
feeding a child will contribute greatly to its well-being; any diarrhœa
or disturbance of the digestion must at once receive prompt attention
and this can often be accomplished by change of food; to allow
these disorders to run for any length of time is to invite serious
consequences.
Adults or grown persons have also their share of stomach troubles; as
a rule they eat too much, too fast and do not masticate their food
sufficiently. It is not so much what a person eats, but how he eats,
not so much quality as quantity.
After an exclusive dietary of milk dyspeptics should gradually return
to a mixed diet, that is a regular dinner once a day; but eat slowly
and masticate thoroughly; thus one eats rarely if ever too much. When
the food is bolted, it makes little or no impression on the nerves of
taste, nor does it appease the sense of hunger, and the only indication
of satiety is a feeling of fullness.
As to the time of taking one’s dinner that depends altogether on the
occupation and habits of the individual. In dyspeptics in whom the
digestion is slow and the circulation sluggish the principal meal or
dinner should be eaten at noon; this gives opportunity to move about,
stimulating the circulation, hence increasing the absorption to its
highest point. If a man eats his dinner in the evening and afterwards
goes out into society or attends amusements the late dinner is not
objectionable. But if a person is worn and tired out at supper and
then eats a hearty meal, and lounges around the room the remainder
of the evening, reading the newspaper or otherwise inactive, he is
quite likely to feel distress from what he ate, and sure to experience
occasional bilious spells; nightmare disturbs his sleep and he awakes
in the morning unrefreshed, languid and dull. It is better for such
persons to eat their dinner at noon, and retire early on a very light
supper.
Beef tea became very popular at one time as a nourishment for the
sick, and there can be no doubt that many patients who were stricken
down with different acute diseases slipped into their graves, because
beef tea was relied upon with a belief that it was a sufficient
nourishment. Observation and careful researches on the subject have
proved conclusively that the nutritive value of beef tea as ordinarily
prepared, that is chopped beef put into a bottle and boiled in a
water bath for three or four hours, has been greatly exaggerated. The
process of boiling the beef has no other effect than that of drawing
out the watery substance of the meat. The phosphatic salts that are
contained in the meat are also extracted with the serum which holds
them in solution. The natural albuminoids (musculine) which constitute
the real nutritive element of beef are congealed and surrounded by the
fibrous tissue—that part which snarls up and renders the beef gristly
and tough. Yet as a nutritive stimulant, beef tea possesses at times
considerable value; it is an excellent vehicle sometimes, for instance
an egg thoroughly beaten and added to a cupful of warm beef tea is a
desirable form of liquid food for invalids.
Eggs constitute a highly nitrogenized food and their nutritive value
is even greater than that of stall-fed beef. The subjoined tables of
chemical analysis give the definite quantity of each constituent that
is contained in one hundred parts of egg and beef:
STALL-FED BEEF. EGG. LEAN BEEF.
Phosphatic salt 0.5 1.0 1.5
Albuminoids 10.5 15.0 17.5
Fat 45.0 12.0 6.0
Water 44.0 72.0 75.0
————— ————— —————
100.0 100.0 100.0
If we compare the analysis of egg with that of milk, a remarkable
similarity will be observed, save one exception, namely the
carbo-hydrate sugar of milk is lacking in egg, and in order that eggs
have the same property of nourishing the body as milk, this element
may be readily supplied by eating a little bread. The writer is
familiar with the history of a case in which a patient was kept on an
exclusively egg diet for five months, and during this time he increased
his weight thirty-eight pounds; he consumed eight eggs and twelve
ounces of bread a day.
We hear considerable unfavorable comment in regard to hard-boiled eggs,
and indeed for good and sufficient reason, but the indigestibility
of the hard-boiled egg is not due to any change in the nature of the
albumen because it is boiled; the cause is entirely mechanical. The
reason is that a hard-boiled egg is not sufficiently divided by the
ordinary process of mastication to allow the gastric juice to attack
it from all sides; if it were finely pulverized either by the teeth or
otherwise it would be as readily digested as a soft-boiled or raw egg.
A raw fresh egg that is thoroughly beaten with an egg beater is
the most readily digested food that there is. The author has known
dyspeptics who could not digest any other kind, and by adding a pinch
of salt and half to one tablespoonful of whisky after it is thoroughly
beaten, it is certainly one of the most valuable foods for a certain
class of stomach troubles that can be recommended. Patients whose
digestion is very weak should begin with one egg every four hours
until four eggs are taken during the day; when the strength increases,
two may be taken for breakfast, and one for each meal the rest of the
day; after the lapse of a few days another may be added to the second
meal, and so the number gradually increased until eight are consumed;
prudence would not go beyond this number lest an excess of nitrogenous
matter overtax the liver and kidneys to eliminate it from the system
and this result in other complications.
Dyspeptics, more than others, must avoid overtaxing the digestive
organs, and while the stomach is sensitive and for a long time
afterwards, they must avoid solid food.
The quantity of bread must also be jealously guarded; while the stomach
is very sensitive and weak it had better be entirely suspended and when
resumed no more than three ounces should be eaten at each meal to begin
with. For those dyspeptics whose stomachs possess average digestive
power, and who require a nourishing and readily digestible meal, the
writer would recommend for breakfast a milk gruel to which a raw egg
has been added: he directs that four tablespoonfuls of oatmeal mush
be mixed with three-quarters of a pint of warm milk and this worked
through a tin strainer by means of a potato masher; to the milk gruel
so obtained and again moderately warmed, a raw fresh egg is added,
which has been previously beaten to a foam, and then the whole mess is
again beaten together, seasoned with salt and served in a bowl.
Medicines should play a very minor part in the treatment of dyspepsia;
the artificial pepsin preparations are all overrated and their supposed
efficacy is due to a careful and regulated diet rather than to the
virtue of the pepsin. If the bowels are costive and if the stomach is
sour and feels oppressed, prescription No. II will materially relieve
these symptoms.
A person who is suffering from indigestion must above all things
learn to discipline himself; when that has been once accomplished the
task of carrying out an appropriate diet will become an easy one, and
restoration to health and strength will be the reward.
INDEX.
ABORTION. The practice on the increase, and not due to a single cause,
113, 114, 115, 116.
is it ever justifiable? 111.
meaning of the term, 110.
criminal, 101.
Catholic Church is decisive on, 112.
Abrupt termination of pregnancy constitutes a disease, 117.
Abscess in peritonitis, 278.
in perimetritis, 278.
of the breast, 340.
Abuses of surgery, 19.
“A bad getting up,” 204.
A husband should not cease to be a gentleman, 94.
A little reflection, 250.
Academicians’ view of fetal life, 102.
Acton, Dr. “A warning against sexual dangers,” 92.
After the delivery, 334.
Amenorrhœa, 132, 133.
Anatomy of the female organs, 119.
Anteflection of the womb, 242.
Anteversion of the womb, 240.
Antidotes to poisons, 389, 390, 391.
Antiseptic precautions, 75.
Apostoli, Georges, Dr., 298, 301.
Arnold, Prof., on cancer, 218.
BABY, barbarous practice of bathing, 337.
care of the, 337.
first toilet of the, 338.
Bacteria, 286.
“Bad getting up,” 144.
Bandaging after delivery, 250.
Bartholow, Prof., 296.
Battery, 294, 295.
Beef tea, 412.
Bennet, John H., 400.
Bennett, Dr., 196, 197.
Berkeley, Bishop, 47.
Bladder, catarrh of, 163.
catarrh, and other diseases, 157.
chronic catarrh of, 164.
hemorrhage of, 168.
inflammation of, 158, 159.
in pregnancy, 308.
irritability of, 252.
nervous irritability of, 166.
paralysis of, 167.
ulceration of, 163.
Braid, Dr. (discoverer of hypnotism), 54.
Brain, fat an essential food for the, 400.
Braine, Dr. Woodhouse, 51.
Breast, or mammæ, of the pregnant woman, 318.
abscess of, 340.
Bright’s disease, 397.
Broken bones, 378.
Bronchitis, 350.
Brown-Séquard, 394.
Burns and scalds, 382.
classification of, 383.
useful application for, 385.
CAMPBELL, DR. HENRY F., 254.
Cancer, Prof. Arnold on diagnosis of, 218.
Carbolic acid, poisoning from, 389.
Carbonic-acid poisoning in chlorosis, 135.
Carpenter, Prof. W. B., 48.
Castration, 274.
Catarrh of the womb, 219.
cause of, 213.
symptoms of, 215.
vaginal and uterine, 177.
Catarrhal inflammation of the womb, 209.
of the mouth, 342.
Cellulitis, pelvic, 285.
in childbed, 288.
Cervical endometritis, 211.
Charcot, Dr. Experiments in hypnotism, 54.
on “Impersonal Sleep,” 54.
Chickenpox, 375.
Childbed fever, my first case, 74.
Children are common objects of love, 96.
will of, 53.
diseases of, 356.
Chlorosis, iron in, 137.
Chronic inflammation of the womb, 104.
causes of, 105.
Clothing to avoid taking cold, 190.
Coated tongue, 341.
Cohnheim, Prof., his theory of inflammation, 147.
Coition and conception widely different processes, 106.
Coitus, injury of interruption or incomplete, 96.
Cold, injurious effects of taking, 184, 185.
Colic of infants, 360.
Conception, independent of the sexual act, 107.
Conjugal onanism, Dr. Devay, 96.
Constipation, 366.
causes of, 366.
in pregnancy, 319, 320.
treatment of, 367.
Continence, 95.
Convulsions in children, 361.
Corset waist, 191.
Cow, exercise of, 401.
Cows’ milk, 403.
cream of, 403.
density of, 403.
Croup, 348.
false, 349.
membranous, 349.
Cutler, Dr. Ephraim, 298.
Cystitis, acute, 161.
chronic, 162.
DALTON, PROF., on menstruation, 130.
Dame Nature, 41.
Danger of overheating, 189.
Darwinian theory applicable to the overcrowded professions, 17.
Days of doctrines and rules, 17.
Delusions as to the curative value of drugs, 36.
Depraved associates pave the way to feticide, 114.
Descartes, 48.
Diarrhœa, 357.
prescription for, 357.
in pregnancy, 320.
Diet, 392.
morbid fancy for, 392.
for pregnant women, 324.
Digestion, 396.
of fats and starches, 399.
Diphtheria, 346.
Disease is as much a vital process as health, 37.
Diseases of children, 341.
that are conjured up in the minds of susceptible persons, 25.
Disinfection of the lying-in woman in Germany, 289.
Dispersing electrode, 299.
Divided skirts, 194.
Dobell, Dr. Horace, 189.
Drowning, 387.
treatment for, 388.
Drug diseases of Hahnemann, 43.
Drugs are physical agents, 44.
Düvelius, Dr., 212.
Dysmenorrhœa, 138.
prescription for, 142.
inflexion, 244.
Dyspepsia, or indigestion, 137, 138.
Dyspeptics, 411, 414.
EGGS, 412, 413.
Elastic garters, 193.
Electricity in diseases of women,297.
as a remedy, 294.
in catarrhal inflammation, 302.
in subinvolution, 303.
medical, 296.
without puncture, 200.
Electrodes and poles, 295.
Electro-puncture, 298.
Emergency treatment in sudden accidents, 377.
Endometritis, 209.
acute and chronic, 210.
Engelman, Dr., 299.
English law on “quickening,” 104.
Epileptic fits cured by a “Christian Scientist,” 57.
Equestrian tights, 195.
Erosions often mistaken for cancer, 218.
Eruptive fevers, 370.
Evans, Dr., 47.
Exclusiveness that has characterized the professions, 16.
Exercise, must be interesting, 63.
in the open air, 62.
Expectation or attention influences the bodily functions, 50.
FAITH cures disease, 55.
Falling of the womb, or prolapsus, 231.
Fallopian tubes, 124.
Fats, digestion of, 399.
Feeding, intervals between, 395.
Ferguson, Dr., 400.
Feticide, 101.
Fire, clothing on, 384.
Flexion of the uterus, 139.
Flexions and versions due to abortions, 117.
Floor of the pelvis, 228.
Flux, 358.
Fly-blister, causing inflammation of the urethra, 152.
Food, repugnance to, 393.
liquid for invalids, 393.
Fractures, 378.
Fright causes and cures disease, 58.
Frostbite, 385.
treatment for, 387.
Functional diseases, 56.
GALVANOMETER, 300.
General causes of uterine and pelvic diseases, 61.
Germ theory of disease, 77.
German measles, 372.
Germans, river-bathing of, 77.
Germicidal properties of drugs, 176.
Girls should be independent to choose their choice, 66.
Gonorrhœal infection, statistics of, 276.
Goodells, Prof., on “abuses of uterine treatment,” 22.
on uterine symptoms, 140.
Graafian follicles, 263.
Green sickness, 133, 134.
Growth of the uterus from the moment of conception, 72.
HEMORRHAGE of the womb, 143, 144.
of wounds, 381.
arrest of, 382.
Hemorrhoids, causing inflammation of urethra, 152, 322.
in irritability of bladder, 166.
Heroic treatment, 42.
Hippocrates’s view of fetal life, 102.
Histology of inflammation, 145.
How a woman should lie after confinement, 335.
Human ovum, size of, 264.
Hygiene of gynecology, 78, 79.
Hygienic measures, 182, 183.
Hypnotism, 52.
Hysteria, amenable to mind cure, 56.
ICE-BAGS, 291.
Imagination is the realm of the soul, 49.
Impersonal sleep of Dr. Charcot, 54.
Improprieties of dress, 68, 69, 70.
Imprudence during menstruation, 71.
In the realm of thought there is no monopoly, 15.
Indigestion, 356.
Infants fed on cows’ milk, 406.
overfeeding of, 394.
Infection, 287.
gonorrhœal, 81.
innocent, 81.
Inflammation, 145.
of the womb, 196.
chronic, 203.
Interpolar regions, 297.
Intra-abdominal pressure, 233.
Involution, 73.
Iron pills in chlorosis, 137.
KNEE-CHEST posture, 254.
in relaxed vagina, 180.
in falling of the womb, 236.
LAITY, object of educating the, 18.
Landois, Prof., on the curative force in the lower animals, 39.
Laws on abortion, 104, 105.
Leucorrhœa, 80, 176.
Little girls, muco-purulent secretion of the vagina, 152.
Lochial discharge, 84.
Lung fever, 352.
Lying on the back after confinement, 73.
MALTHUS, law of, 99.
Man, instinctive desire of, 89.
Mania for cutting operations, 21.
Marital excesses, and prevention of conception, 87.
Marital excesses the mainspring of disease, 91.
Married women exposed to infectious contamination, 80.
Martin, Dr., of Chicago, 300.
Massey, Dr. G. Batton, 297.
Measles, 370, 371.
Measurements of the healthy uterus, 71.
Mechanical age, 19.
Menopause and puberty, 129.
Menorrhagia and metrorrhagia, 143, 144.
Menstrual disorders, 131.
Menstruation and menstrual disorders, 126.
Menstruation, average period of, 128.
precocious, 132.
source from which the blood comes, 128.
Menstruation suspended during pregnancy, 129.
Menstruation, climate and temperament, 127.
Menstruation, diversity in ages, 126.
Mental photography in the hypnotic state, 54.
Mesmerism, 52.
Metritis, 196.
acute, 198.
causes of, 199.
chronic, 203.
cold applications in, 201.
treatment for, 200, 207, 208.
Metrorrhagia, 143.
Milk, 400.
analysis of, 408.
arrowroot with, 410.
boiled, 404.
condensed, 410.
gruel for, 410.
diarrhœal diseases from, 406.
from the country, 402.
promiscuously mixed, 402.
quantity to be taken, 405.
sterilizing the, 406.
shake, 404.
Milk-leg, 290.
Mill, John Stuart, 99.
Milliampère, 300.
Moral restraint, 90.
More thought required to make good mothers than to file briefs or
write prescriptions, 68.
Morning-sickness, 300.
Morphine habit _vice_ asthma, 60.
Mouth, catarrh of the, 342.
putrid sore, 342.
Mucous membrane, 182.
Mumps, 344.
Murchison, Dr., 397.
Mystic union of the soul with the body, 102.
NAVEL, care of the, 338, 339.
Nerve strain, 140, 141, 152.
Nervous and congestive dysmenorrhœa, 140.
Nervous system in chlorosis, 135.
Nervousness, due to excessive mental application, 63.
Negative pole, 301.
Nine years of my professional life, 15.
Noeggerath, Dr., on gonorrhœal infection, 276.
OBJECT of educating the laity, 18.
Ovaries, 124.
acute inflammation, 266, 267.
chronic inflammation, 270.
cysts or tumors of, 264.
diseases of, 263.
displacement of, 266.
incomplete or rudimentary, 266.
supernumerary, 265.
Ova, number discharged at the menstrual period, 131.
Ovaritis, 266, 267.
treatment of, 269, 272.
PAIN in the abdominal walls, 321.
Painful sensations from imaginary causes, 48.
Painless childbirth, 325.
Palpitation of the heart, 321.
Parametritis, 285.
Parotitis, 344.
Pelvis, true, 120.
false, 119.
floor of the, 228.
Perimetritis and peritonitis, 275.
Perineum, 121.
Period of fruitfulness, 264.
Peritonitis and perimetritis, 275.
Peritonitis, treatment of, 282, 283.
criminal abortion the cause, 281.
Piles, 322.
Playfair, Dr., 401.
Pneumonia, 352.
treatment for, 354.
Poisons, 388, 389, 390, 391.
Precocious talents should not be forced, 64.
Pregnancy, breasts become enlarged in, 308.
bladder trouble in, 321.
constipation in, 319, 320.
capricious appetite in, 307.
deposit of coloring matter, 308.
duration of, 305.
diet in, 324.
extrauterine, 305.
false, 306.
menstruation during, 306.
nausea and vomiting, 319.
salivation of the mouth, 307, 319.
simulating, 314.
symptoms of, 305, 306.
unnatural, 305.
Pregnant woman, precautions to, 316.
clean linen for the, 318.
proper clothing for, 315.
Preliminary signs of labor, 330.
Preparation of homœpathic dilutions, 44.
Prolapsus, or falling of the womb, 231.
Protophytes, 286.
Psychical exaggeration, 140.
Ptomaines are developed from uncleanliness, 83.
Puberty and menopause, 129.
Puerperal or childbed fever, 77, 78, 290.
Pulsation of the fetal heart, 311.
Putrefactive germs, 286.
Putrid or septic poison, 287.
Pyosalpinx, 285.
QUICKENING, 103, 104, 310.
Quinsy, 344.
REPARATIVE energy of nature, 38.
Reparative process after confinement, 233.
Retroflexion in pregnancy, 256.
treatment of, 252.
Retroflexion of the womb, 247.
Retroflexion, replacement of, 254, 255.
Retroversion of the womb, 246.
Round ligaments of the womb, 248.
Rose-rash, 372.
Rumbold, Dr. Thos. F., 184.
SALPINGITIS, 259.
treatment for, 260, 261.
Sawyer, Dr. Herbert C., 58.
Scalds, 382.
Scarlet fever, 373, 374, 375.
Schelling, William Joseph, 47.
Scrofulous diseases, 400.
Serous membrane, 277, 278.
Sexual desire, Prof. Carpenter on, 89, 90.
Sexual instinct not unholy and depraved, 109.
Signs and symptoms of pregnancy, 305.
Signs of chronic inflammation of the womb, 207.
Skin, or integument, 182.
Somnambulism, 52.
Soor, 343.
Sore nipples, 339.
Soxhlet, Prof., 406.
Spasms in children, 361.
Spermatozoa, 89, 100.
measurements of, 105.
Spruce, 343.
Stages of labor, 332.
Sterility in flexion, 244.
in ovaritis, 272.
due to abortion, 118.
Sterilization of milk, 407.
Stoics’ view of fetal life, 102.
Stricture of the neck of the womb, 139.
Stupidity of the masses, 23.
Subinvolution of the womb, 73.
Sugar, digestion of, 398.
Superfluous garments, 70.
Sympathy will cause disease, 58.
Syringe, proper selection of a, 181.
TEMPERATURE for living-rooms, 189.
Terror causes or cures disease, 58.
The bed for confinement, 329, 330.
The choice of a physician, 328.
The care of the baby, 337.
The nurse, 328.
The righting of the organ, 331.
Thermæ, 76.
Thrush, 341.
Tonsilitis, 344.
Too much mischievous doctoring, 24.
Tubal dropsy, 259.
Tuke, Dr. Daniel H., 50.
Tying the cord, 336.
UNCLEANLINESS a cause of disease, 76.
Union suits, 194.
Urethra, 121.
gonorrhœal infection of, 152.
in pregnancy, 155.
in the newly married, 156.
inflammation of, 150.
irritation of, 150.
neuralgia of, 155.
Urethritis and neuralgia of the urethra, 150.
caused by eruptive fevers, 152.
Urethritis in pregnancy, 153.
papillated growths and mucous polypoids, 153.
Urinary fistula, 170, 171.
Uterus, 123.
anteflexion, 242.
anteversion, 240.
changes after confinement, 72.
measurements after confinement, 72.
natural position and support, 226, 227.
prolapsus, or falling of the, 236.
retroflexion, 247.
retroversion, 246.
treatment for prolapsus, 236.
versions and flexions, 240.
VAGINA, 122.
catarrh of, 175.
catarrh in children, 177, 178.
acute and chronic inflammation of the, 172.
gonorrhœal infection of, 174.
knee-chest posture in catarrh of the, 180.
relaxed, mistaken for falling of the womb, 179, 180.
Vaginal douches after confinement, 335.
Vaginal injections, directions for their use, 85, 86.
Versions and flexions due to abortions, 117.
Virchow, Prof., theory of inflammation, 146.
WARMING a dwelling, 186.
Weapon ointment, 41.
What is mind-cure? 46.
What is termed mind-cure is not mind-cure, 40.
When the soul becomes associated with the body, 107.
When to begin to train mothers, 65.
Whey, 409.
While in childbed, 328.
Whites, 176.
Whom to teach, 15.
Whooping-cough, 367, 368, 369.
Why crowd our girls into the profession? 67.
Winter cough, 189.
Wives who become delicate and nervous, 93.
Womb, 123.
tear or laceration of, 84.
Women’s rights vice women’s wrongs, 68.
Women, after getting up from confinement, 74.
Worms, 363, 364, 365.
Wounds, 378.
contused, 379.
incised, 379.
lacerated, 379.
poisoned, 380, 381.
punctured, 379.
ZIEGLER, Prof., on infection, 286.
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